Critical care clinical conundrums

摘要

A 50-year-old postman was admitted to the Accident and Emergency (A&E) department as a trauma call. He had been found unconscious at the side of the road with his mangled bicycle nearby. Passers-by noticed he had been wobbling on his cycle prior to his event, but no one had seen him fall. On admission, he had a Glasgow coma score of 3/15 with pinpoint pupils, profound hypotension and tachycardia. He was intubated and ventilated, and 2 1 of warmed Hartmann's solution were administered rapidly intravenously. During the secondary survey, he was reviewed by the intensive care consultant, who noticed that he was very hot, dehydrated and vasodilated. His tympanic temperature was 41.2°C. As it was one of the hottest days in the hottest summer of many years, a presumptive diagnosis of heat stroke was made. Immediate cooling measures were instituted and the warmed fluid changed to cold colloid. He was noticeably bleeding from all puncture sites and fresh frozen plasma (FFP) was ordered. He was taken quickly to the intensive care unit after a computerized tomography (CT) scan of the brain, which demonstrated no abnormalities.