Things that make you go hmmm.

[SANDMEDIC]

:roll:

Yeah thats what I meant.

The term "if you don't use it, you lose it" comes to mind.

but ask me about URI or sinusitis, I'm on it.

Yeah in the days of when I was flying we used a Swan frequently.

For RA/CVP RV PAP and PCWP.

I think it's time to go through the CCEMT-P/ FP-C once I'm outta here, to get back on track.

this scenario definately opens some eyes on what I have lost in a year and a half.

Thanks for pointing that out Chbare.

Where do you work that you do all the high speed patient care? Sounds like a good gig.

[tniuqs]

The oxylog 2000 isnt bad kit, the venturi can save a lot of O2 on long flights, and it actually increases inspiratory flows (but numerous documented failures out of OZ from failed exhalation blocks on the 1000) with PIP of only 21 .... I would either get Vts up trying to keep them under 40 cmh2o to correct PH and/ or add some bicarb, about Bicarb 3 amps in d5w ~ 200 to 300 mils per hour but he will not tolerate Ph of 7.30 for too long, shocking kidneys.

Try another sedation regiment ... as Profol is metabolised by the liver and this fella took a to the liver, maybe its causing the hypotension.

Maybe some uncrossmatched blood too as Hgb is just 11.

What do you think is going on? Is it even directly related to the trauma?

Yes absolutely related to the trauma, looking back your asking for a working dx? Can't really hang my hat on it, but if the urine is a tad on the red brown color (vin color) then I would be swayed towards a working Dx of Rhabdomyolysis.

cheers

[chbare]

Could something else be causing the acidosis and myoglobinuria? While this is all related to the trauma (if he was never hit by an IED, he would most likely not be in this position), could something else be causing these problems. His H&H is a bit on the low side; however, lets say it has stabilized and there are no indications of ongoing hemorrhage or coagulopathy. This is a tricky one.

Take care,

chbare.

EDIT: SANDMEDIC, most of what I do in the sandbox is typical primary care stuff with an occasional medical evacuation and commercial escort evac thrown in for variety. I still hold a part time position at an ER and with a flight service in the states where I plan to work while on leave.

[ERDoc]

How long has this guy been on a Propfol drip for?

[p3medic]

I guess the propofol could be a problem, especially at higher doses. The OP mentioned he required a large amount of sedation. In any event, some volume expansion is in order, would be nice to have a CVP as a guide, but given the elevated CK, creatinine and myoglobinuria and urine output of 10ml/hr, we need to get those kidneys working again. Also concerned about hyperkalemia, the 12ld didn't suggest it, and we don't have labs to guide therapy on that either.

[chbare]

Diprivan for at least 48 hours. What are we thinking?

Take care,

chbare.

[towheadedmule]

rhabdomyolysis?

ABG, CK, UA and outputs lean this way, along with the trauma

R

[ERDoc]

rhabdomyolysis?

ABG, CK, UA and outputs lean this way, along with the trauma

R

What in the ABG points to rhabdo?

[chbare]

rhabdomyolysis?

ABG, CK, UA and outputs lean this way, along with the trauma

R

Agreed, rhabdo is a problem.

Look at all the problems we have:

1) History of catecholamine use

2) High doses of diprivan

3) Most likely some inflammation from trauma and surgery

4) Renal failure and rhabdo

5) Metabolic acidosis

Can we make any connections between all of these concepts?

Take care,

chbare.

[ERDoc]

Agreed, rhabdo is a problem.

Look at all the problems we have:

1) History of catecholamine use

2) High doses of diprivan

3) Most likely some inflammation from trauma and surgery

4) Renal failure and rhabdo

5) Metabolic acidosis

Can we make any connections between all of these concepts?

Take care,

chbare.

Yes we can.