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History/Information:
This 55-year-old woman was admitted to the Emergency Department (ED) after being struck by a motor
vehicle, while crossing a busy downtown intersection. On arrival to the ED, the patient was alert and
oriented times three, receiving 100% oxygen per non-rebreather mask and vital signs were BP 80/56, HR
130, RR 28-32, and SpO2 88%. Her cardiac rhythm was Sinus Tachycardia. She had one peripheral 20ga
IV catheter with 1000mL 0.9%% NS infusing wide open. The paramedics stated eyewitnesses reported
the woman had landed on the windshield of the car after being thrown into the air by the impact. On
admission to the ED, the patient was electively intubated and oxygenated on on 100% oxygen. She was
typed and cross matched for four units of packed red blood cells (PRBC). In addition, multiple x-rays and
CT scans were obtained. These studies revealed no head trauma or cerebral bleed. However, the extensive
studies did reveal bilateral pulmonary contusions, kidney contusions, a perforated bowel and a left open
humerus fracture. Despite multiple transfusions and fl uid resuscitation, the patient was unable to sustain
a systolic blood pressure greater than 90mm Hg. The patient was transferred to the Operating Room for
an emergent exploratory laparotomy and repair of her humerus fracture. After surgery, the patient was
transferred to the Surgical Intensive Care Unit. She is receiving mechanical ventilation. She has a right
nasogastric tube to low wall suction draining a small amount of pink tinged drainage. She has a urinary
catheter with bloody urine. Despite frequent blood transfusions, the patient remains hemodynamically
unstable. A left femoral arterial line and pulmonary artery catheter were inserted for more accurate
hemodynamic and blood pressuring monitoring. The patient has advanced directives on the chart.
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