Shocked
Gastrointestinal System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S16_F1.jpg"}},{"insert":"\n\n"},{"insert":"It\u0027s been a slow day at the ER. You hate slow days. They make you feel stiff and lethargic.\r\n\r\nYou watch the hands of the clock drag on like an invisible weight were pulling them back.\r\n\r\nJust two minutes to the end of this dreary shift. You feel restless.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S16_F2.jpg"}},{"insert":"\n\n"},{"insert":"Suddenly, an ambulance siren blares in the distance and you spring up from your seat, at once energized as you hear the familiar sound of the vehicle rounding the corner.\r\n\r\nYou dash to the ER, greeted by the sight of a young man on oxygen with his right leg in a splint, lacerations all over his face and chest. He appears to be conscious.\r\n\r\nThe paramedic rattles off a quick review.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S16_F3.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Mr. Simmons, 32 years old, fell off the roof of his house 15 minutes ago,\u0022 the paramedic says, then gestures to a woman standing nearby, \u0022This is his wife, she was with him at the time, they were decorating for Hallowe\u0027en\u0022\r\n\r\n\u0022Hello Mr. Simmons, I\u0027m the doctor in charge. Can you speak?\u0022, you ask.\n\n\u0022I hurt a lot... doctor... especially my leg... and belly,\u0022 he replies slowly and effortfully, visibly in pain.\r\n\r\n\u0022Is he going to be okay?\u0022 asks Mrs. Simmons, agitated with worry.\r\n\r\n\u0022He\u0027s in good hands ma\u0027am, we\u0027re going to do everything we can,\u0022 you reply, gesturing for one of your team members to show her to a seat in the waiting room.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S16_F4.jpg"}},{"insert":"\n\n"},{"insert":"You begin to quickly assess Mr. Simmons, inspecting his airway to rule out a visible obstruction.\r\n \r\nHis chest wall expands adequately, his lungs resonant to percussion and clear on auscultation.\r\n \r\nHis skin looks slightly pale; his peripheral pulses are rapid. A quick neurologic evaluation reveals a GCS of 14.\n\nHis blood pressure is 80\/50 mmHg, with a pulse of 120 bpm and a respiratory rate of 25 cycles per minute.\r\n\r\nYou\u0027re surprised to find him in class III shock. Since there are no signs of external hemorrhage, you immediately suspect he may be bleeding out internally.\n"}]}
4
{"ops":[{"insert":"What will you do now?\n"}]}
1. Emergency exploratory laparotomy
2. Focused assessment with sonography in trauma (FAST)
3. Non-contrast CT of the abdomen
8
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7
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6
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5
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