Chapter 25, Problem 4CCS

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:

Urinalysis: Some granular casts (particulate cell debris) are noted, and the urine is brownish-red in color; other values are normal, but urine output is very low. An order is given to force fluids.

(a) What might account for the low volume of urine output? (Name at least two possibilities.) (b) What might explain the casts and abnormal color of his urine? Can you see any possible relationship between his crush injury and these findings?

The next day, Mr. Heyden is awake and alert. He says that he now has feeling in his arm, but he still complains of pain. However, the pain site appears to have moved from the left upper quadrant to his lumbar region. His urine output is still low. He is scheduled once again for a CT scan, this time of his lumbar region. The order to force fluids is renewed and some additional and more specific blood tests are ordered. We will visit Mr. Heyden again shortly, but in the meantime think Think about what these new findings may indicate.