Chapter 25, Problem 1CCS

Mr. Heyden, a somewhat stocky 72-year-old man, is brought in to the emergency room (ER). The paramedics report that his left arm and the left side of his body trunk were pinned beneath some wreckage in a bus accident, and that when he was freed, his left hypogastric and lumbar areas appeared to be compressed and his left arm was blanched and without sensation. On admission, Mr. Heyden is alert, slightly cyanotic, and complaining of pain in his left side; he loses consciousness shortly thereafter. His vital signs are taken, blood is drawn for laboratory tests, and Mr. Heyden is catheterized and immediately scheduled for a CT scan of his left abdominal region.

Analyze the information that was subsequently recorded on Mr. Heyden’s chart:

Vital signs: Temperature 39°C (102°F); BP 90/50 mm Hg and falling; heart rate 116 beats/min and thready; 30 respirations/min

Given the values above and his attendant cyanosis, what would you guess is Mr. Heyden’s immediate problem? Explain your reasoning.