Chapter 17, Problem 1CCS

20-Year-Old-Male with Abdominal Trauma

Richard Watkins, 20, fell off his roof while replacing some shingles. Upon arrival at the scene, paramedics make the following observations:

•Abdominal pain, right upper quadrant

•Cyanotic, cool & clammy skin

•Falling blood pressure, 100/60 mm Hg; rapid pulse, 100 beats/min

Paramedics start an IV to rapidly infuse a 0.9% sodium chloride solution (normal saline). They transport him to a small rural hospital where Mr. Watkins’s blood pressure continues to fall and his cyanosis worsens. The local physician begins infusing O negative packed red blood cells (PRBCs) and arranges transport by helicopter to a trauma center. She sends additional PRBC units in the helicopter for transfusion en route. After arrival at the trauma center, the following notes were added to Mr. Watkins's chart:

•Abdomen firm and distended

•Blood drawn for typing and cross matching: packed A positive blood cells infused

•Emergency FAST (focused assessment with sonography for trauma) ultrasound is positive for intraperitoneal fluid

A positive FAST scan indicates intra-abdominal bleeding. Mr. Watkins's condition continues to deteriorate, so he is prepared for surgery. The operation reveals a lacerated liver, which is repaired. Mr. Watkins’s vital signs stabilize.

1. Mr. Watkins was going into shock because of blood loss, so paramedics infused a saline solution. Why would this help?