Case 144: The Beginning

A 76 year old lady with a history of Hypertension and Diverticular disease collapses while out having her Sunday lunch with her family. An ambulance is called and she is hypotensive complaining of abdominal pains. The Paramedics bring her to A&E resus.

On arrival her Observations: BP 78/30 P 110 R 20 Sats 96% on air.

The resus team have gained IV access and performed an ABG and FAST USS scan of her abdomen. She has intraperitoneal free fluid visible on plain USS and in this context it is assumed she has a ruptured aortic aneurysm. Her Hb on the ABG is reading as 64. The resus team activate the Major Haemorrhage Protocol and fast bleep the vascular team.

You are the on call Haematology Registrar and they ring you asking for advice regarding parameters for transfusion. They tell you they have no blood results available and that these may be slower than usual due to the hospital IT system having an upgrade.

What history may be useful?

What advice would you give them?

Is there any other test that may be available quicker than usual FBC/coagulation screen could be helpful when bleeding?

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