The right decision?

[IMGASMD]

Not again

There is a story here…..

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[Beeftenderloin]

Is it empty because of hypovolemia, or a tension pneumothorax? Rescue echo won’t necessarily tell you that.

Bedside US is better than X-ray for diagnosing PTX, and can be done in about 10 seconds by someone who knows what they’re doing (Though I recognize that the latter portion of that statement is probably not common enough for it to be an option for most at the moment).

 

[vector2]

18 year old female involved in a high velocity car crash. Arrives to the OR anxious, in pain but stil talking. We do a basic rapid sequence intubation. She has a deep laceration in her back about 40 cm long which has active bleeding, a lot. Vascular surgeo arrive and controls the bleeding. At this point the pt is on levophed .6mg per kg, has bled 2.5 l, we activated MHP. The bleeding is under control but the pt is not improving, trauma arrives and wants xrays (they did not take them in ER because of the bleeding). Anyway we turn the pt and as we are doing that crashes and arrest, after one cycle we get her back. Trauma still tries to move the pt for the xrays but the same happens. After we get her back again my attending says she is not dying in my OR and tells trauma to stop and we send the pt to ICU. She got treatment there and is stable all afternoon. After that trauma finally has their xrays and the pt got pelvis facture, femur fracture, sacrum, tibia, clavicle etc. Later we have her in the OR again for an external fixator in pelvis and femur. This time the pt is stable all the way trough.

My question here, was my attending right stopping them from taking the xrays in the OR and potentially put the external fixator right there?

While people are going back and forth on the compressions thing....when this lady arrested during the turning for the xrays was it a true arrest or simply pseudo-PEA? What was the EKG rhythm? Was there still pulsatility on the a-line? What was the ETCO2?