Initial bradycardia in hypotensive (hemorrhagic) patients in a prehospital setting – does it have a prognostic value?

A 47-year-old woman, with no previous medical problems, presented to the Accident and Emergency department with left shoulder pain following a fall onto her left side from a horse. Physical examination was unremarkable and she was discharged with simple analgesia. However, 2 h later, she re-presented with worsening left shoulder pain, dizziness and mild epigastric discomfort. A new examination revealed blood pressure of 100/60 mm Hg, which dropped to 95/65 mm Hg on standing, a Glasgow Coma Scale score of 15 and pulse of 62 beats/min. She was resuscitated with 2 litres of Hartmann's fluid. A focused assessment with sonography for trauma (FAST) scan of her abdomen was negative. Then, 1 h later she experienced generalised abdominal pain and developed postural hypotension. However she remained bradycardic (heart rate 45-60 beats/min). Repeat examination revealed peritonitis. A further FAST scan showed free fluid in the left hypochondrium. A CT scan demonstrated a complex tear of the spleen, for which she underwent an emergency total splenectomy. Her postoperative recovery was uncomplicated.

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Initial bradycardia in hypotensive (hemorrhagic) patients in a prehospital setting – does it have a prognostic value?

Abstract: ABSTRACT

Cited by 2 publications

References 19 publications

A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting

A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting

Paradoxical bradycardia in a patient with haemorrhagic shock secondary to blunt abdominal trauma

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