Coda Change Massive Haemorrhage
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Sep 12, 2020 A shocking case of a polytrauma patient challenges the resuscitation team when a CT scan reveals no active bleeding despite severe shock. They delve into alternative causes of hypotension, like traumatic brain injuries and cardiac contusions. The discussion highlights the importance of thorough clinical assessments over reliance on imaging. Non-traumatic conditions and iatrogenic issues also come into play, emphasizing the need for a meticulous approach in trauma care.
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CT Shows No Bleeding Despite Shock
- The CT scan returned with no active bleeding yet the patient remained profoundly hypotensive despite multiple units of blood.
- The team were surprised and paused as blood bank asked whether to send the next pack and the haemoglobin measured 168.
Don't Let CT Define The Diagnosis
- Our default assumption in hypotensive blunt trauma is major hemorrhage needing surgery or angioembolisation.
- But some physiological derangements after trauma won't show as anatomical injuries on CT and demand a broader differential.
Brain Injury Can Mimic Ongoing Shock
- Traumatic brain injury can present with hypertension and tachycardia and may be missed if assumed bleeding.
- Hypoxic arrests from impact brain apnea or airway obstruction can produce secondary brain injury and hemodynamic instability despite a normal initial scan.