Paradoxical bradycardia in a patient with haemorrhagic shock secondary to blunt abdominal trauma.
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.
Department of Acute Medicine, Milton Keynes NHS Trust, Milton Keynes, UK. muhammad.rana@doctors.org.uk
Muhammad Sagheer
MS
Rana
Usman
U
Khalid
Simon
S
Law
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000058:Accidental Falls; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008875:Middle Aged; D018570:Risk Assessment; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000628:therapy; D013156:Splenectomy / Q000379:methods; D013161:Splenic Rupture / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000601:surgery