I’m going to send out the next edition of the Trauma MedEd newsletter early next week. In this one, I’ll be presenting and discussing some of the “Laws of Trauma” that I’ve observed over the years. I think you’ll find them interesting and amusing.
As always, this issue will go to all of my subscribers first. If you are not yet one of them, click this link to sign up and/or download back issues.
Unfortunately, non-subscribers will have to wait until I release the issue on this blog, about 10 days later. So sign up now!
The last two posts, I went on a rant about taking hypotensive patients to CT. The bottom line is that this is a generally bad idea, even if bad papers say it’s okay. However, we all know that there are no absolutes, especially in trauma.
So yes, there are two cases where one could justify taking a hypotensive patient to CT scan. Here they are:
- You believe that your patient has a catastrophic brain injury which is responsible for the hypotension. You would like CT confirmation so you can begin to withdraw support and terminate any other interventions.
- Your patient has sustained a cervical spinal cord injury and has neurogenic shock. You have started fluid resuscitation and are considering a pressor to normalize blood pressure, but would like to continue your diagnostic routine.
But before you can even consider leaving your resuscitation room, you must ensure that there is no other source of hypotension. This means getting chest and pelvic xrays to look for hemothorax or fractures. It means getting a good FAST exam to make sure there is no significant hemoperitoneum. It also means making sure that any fractures are properly splinted and there is no uncontrolled external bleeding.
You can only go to CT scan once all of these other potential bleeding sources have been ruled out. If in doubt, you must proceed to OR to either stop the bleeding or prove that it does not exist.
Are there any other reasons to take one of these patients to CT that you can think of? If so, leave comments or tweet!