Disaster patients

[EMEDPA]

recently had a string of disaster pts:

1.coagulopathic posterior nose bleed with hep C, drunk, who keeps pulling out her nasal packing....

2.hypotensive(60/p) gi bleed presenting with chest pain, initially scanned to r/o dissection, H+H 4/12, intensivist says "too unstable to transfer"....too big to go by helicopter....later acepted elsewhere by ground when H+H after 6 units 5.5/16 and bp 100/p.

 

anyone else seeing disaster folks this weekend?

[rcdavis]

Only way to treat pt #1, short of taking to the OR would seem to be load with ffp and, I would assume platlets as she probably is thrombocytopenia plus coagulopathic.. What did you do?

 

#2 is more interesting.. Did the cp improve with improved hemoglobin? How did you address the GIB. UPPER OR LOWER? I am assuming LGIB. As an upper that severe would have required endoscopic bleeding control and I doubt you could have gotten ahead of the loss with PRBCs.

 

Sometimes, as you we'll know, patients die. #2 sounds like she came close.

 

No disaster for me.. Closest was 6 year old with florid PSGN, edema, hypertension 200/115, 4 plus protein urial.sent to Peds nephro for Dmission and bx for crescent bodies ... (To see if steroids would help). Nothing c.w. Y'all in the wild Wild West

 

Rc

[medic25]

No true disasters, but had a couple last weekend with potential for badness.

 

1) 13yo bicyclist without a helmet, fall from bike.  Unwitnessed LOC, c/o severe headache and one episode of vomiting.  Vomited twice more at CT, where we found an occipital skull fracture and a small subarachnoid bleed.  Shipped by ground to the pedi trauma center.

 

2) 80's female on coumadin c/o fatigue and black, tarry stools.  SBP in the 80's, HCT 30 from 47 the month before.  The hypotension responded to crystalloids; she got two large bore peripheral lines, vitamin K, and a trip to the hospital for an emergent GI consult.  These cases always have a pucker factor when I'm working in the free-standing ED; we don't have a blood bank, so short of a couple of units of uncrossmatched RBC's and PCC there isn't much we can do to help a major GI bleed.

[GetMeOuttaThisMess]

RCD, you're the only soul I've ever run across that had a PSGN, and knew it for what it was.

[EMEDPA]

Only way to treat pt #1, short of taking to the OR would seem to be load with ffp and, I would assume platlets as she probably is thrombocytopenia plus coagulopathic.. What did you do?

 

#2 is more interesting.. Did the cp improve with improved hemoglobin? How did you address the GIB. UPPER OR LOWER? I am assuming LGIB. As an upper that severe would have required endoscopic bleeding control and I doubt you could have gotten ahead of the loss with PRBCs.

 

st

 

Rc

#1 FFP, restraints, and ativan then a transfer for a trip to the o.r.(we don't have platelets at this 10 bed rural e.d.)

#2 upper gi bleed. guy had back pain which was actually referred pain from his duodenal ulcer(not perferd per chest ct done early in work up) which he then treated with...high dose ibuprofen and alcohol...6 units whole blood, 3 L NS(when I though it was a thoracic dissection and his bp was in the toilet), IV protonix, o2 by mask for his sats in the 80s, and transfer when I found a willing accepting intensivist 3 hrs away by ground. CP/SATS/BP did improve with tx.