First one with correct answer with justification win.

 

[size=20px]A sixteen-year old intoxicated driver was thrown from her vehicle after it hit a tree at high speed. She presented to the trauma bay with a distended abdomen and hemorrhagic shock unresponsive to resuscitation. She is taken to the operating room where she is found to have bleeding liver and spleen lacerations controlled with packing. She received seven units of packed red blood cells, five units of fresh frozen plasma and a twelve-pack of platelets. She has an expanding pelvic hematoma that broke through the retroperitoneum. Her temperature is 35.8° C. Her International Normalized Ratio (INR) is 4 and her activated prothrombin time is greater than 100.

 

The next best step in management of this trauma patient requiring massive transfusion is

 

A pack the abdomen and pelvis.

 

B emergent angioembolization.

 

C ligating bilateral internal iliac veins.

 

D ligating bilateral external iliac arteries.

 

E administering a factor VII continuous drip.[/size]

E

A

(Untitled)

 

B

Correct :)

correct answer:

 

A pack the abdomen and pelvis.

 

 

The patient being discussed has severe injuries and has required massive blood transfusion. She is cold and coagulopathic. In this instance doing damage control laparotomy - packing all quadrants to control hemorrhage, achieving control of intestinal spillage and temporary abdominal closure - allows the caregivers to catch up with the hypothermia, blood loss, coagulopathy, acidosis and electrolyte abnormalities (e.g. hypocalcemia) typically associated with this scenario.