Examkin

Question

Difficulty: MediumInitial Stabilization and Triage

A 68-year-old male with a history of hypertension and heavy tobacco use collapses during a family gathering and is rapidly transported to the acute care bay. He is lethargic, moaning in pain, and complains of sudden, excruciating pain tearing through his abdomen and lower back. Initial assessment reveals a pale, diaphoretic patient with cool extremities and delayed capillary refill.

Vital signs:
- Temperature: 36.2°C (97.2°F)
- Heart rate: 132/min
- Blood pressure: 65/40 mmHg
- Respirations: 22/min
- Oxygen saturation: 94% on room air

Physical examination is notable for a distended abdomen with a prominent, pulsatile mass palpated just above the umbilicus. Bedside focused assessment with sonography for trauma (FAST) demonstrates free intra-abdominal fluid.

Based on the clinical presentation, which of the following simultaneous initial management steps are most urgently indicated? (Select exactly two options)

  1. Establishment of two large-bore peripheral intravenous linesAnswer
  2. B
    Immediate transport for computed tomography angiography of the abdomen and pelvis
  3. Activation of the massive transfusion protocol with uncrossmatched bloodAnswer
  4. D
    Initiation of a continuous norepinephrine infusion
  5. E
    Administration of intravenous ketorolac for analgesia

Answer

The correct simultaneous steps are the establishment of two large-bore peripheral intravenous lines and the activation of the massive transfusion protocol with uncrossmatched blood.
Establishing two large-bore peripheral intravenous lines and activating the massive transfusion protocol with uncrossmatched blood are the correct and most urgent simultaneous steps. In profound hemorrhagic shock, securing rapid peripheral access is critical because short, large-diameter catheters provide the fastest flow rates for volume resuscitation. Furthermore, replacing lost intravascular volume with uncrossmatched, oxygen-carrying blood products prevents the lethal triad of trauma (coagulopathy, hypothermia, acidosis) and bridges the patient to immediate, definitive surgical repair.

Step-by-Step Solution

1
Identify the primary clinical syndrome from the patient's presentation.
The patient exhibits the classic triad of a ruptured abdominal aortic aneurysm: severe abdominal/back pain, profound hypotension, and a pulsatile abdominal mass.
Recognizing the underlying catastrophic vascular emergency dictates the urgency and direction of care.
2
Determine the physiologic state requiring immediate intervention.
The severe hypotension (65/40 mmHg), tachycardia (132/min), and positive FAST exam confirm decompensated hemorrhagic shock.
Classifying the type of shock determines the correct initial stabilization pathway (volume vs. pressors vs. inotropes).
3
Select the most appropriate simultaneous stabilization orders.
Prioritize securing rapid vascular access with bilateral large-bore peripheral IVs and immediately initiating uncrossmatched blood products.
In hemorrhagic shock, oxygen-carrying capacity and coagulation factors must be replaced immediately to prevent irreversible end-organ damage prior to surgical repair.

Key Concept

The initial stabilization of decompensated hemorrhagic shock secondary to a ruptured abdominal aortic aneurysm prioritizes immediate peripheral vascular access and rapid blood product resuscitation, deferring definitive imaging in unstable patients.
Estimated Time:1m 0s
Rate this question

Topics

Initial Stabilization and Triage

More questions from this topic