05-19-2008, 08:23 PM
This female patient recieved after blunt trauma is in hemorrhagic shock. She has a scalp laceration which does not explain the large volume of blood loss (about 1500ml or 20 to 30% is required to cause hypotensive shock). Additionally her BP is not improving on rapid intravenous infusion of crystalloids, suggesting possibility of internal bleeding.
Chest x-ray, x-ray of pelvis and x-ray of extremities being normal, the likely site of bleeding is therefore intra-abdominal. There is mild distension of the abdomen but no tenderness. In absence of signs of intra-peritoneal irritation, exploratory laparotomy should not be the first intervention, it may however be ultimately required.
A diagnostic peritoneal lavage (or better a portable USG, if it was a choice) is required to confirm the diagnosis in this case of silent abdomen.
Chest x-ray, x-ray of pelvis and x-ray of extremities being normal, the likely site of bleeding is therefore intra-abdominal. There is mild distension of the abdomen but no tenderness. In absence of signs of intra-peritoneal irritation, exploratory laparotomy should not be the first intervention, it may however be ultimately required.
A diagnostic peritoneal lavage (or better a portable USG, if it was a choice) is required to confirm the diagnosis in this case of silent abdomen.