Shock Solution 9

Clinical Scenario 9

A 22 year old male motorcyclist is involved in a accident. He arrives in the ER intubated and hypotensive. His blood pressure is 82/40, minimal urinary output, heart rate 130, fractured left acetabulum, fractured left femur, flail chest on the right, normal cardiac silhouette, grade 2 liver laceration. His hemoglobin is 9.2g/L, creatinine 1.6, and creatine kinase 1084, MB 15%. ECG: ST segment elevation along anterior leads.

What is the diagnosis, and how would you manage this patient?
 

This patient has undergone extensive chest trauma, with almost certain cardiac contusion. A contused segment of myocardium will behave in a similar manner to infracted tissue with the anticipation that functional recovery will occur. The presence of ST segment elevation may represent actual ischemia due to disruption of a coronary artery. The patient undoubtedly has systolic dysfunction, requires volume loading and inotropic support until an intra-aortic balloon pump has been placed. The patient requires urgent angiography and perhaps surgical intervention.

Dx: cardiogenic shock, pump dysfunction.