Question

An adult pedestrian was struck on the right side by sport utility vehicle traveling at 40 mph the patient is awake and alert and the right leg is shortened following the initial resuscitation with fluids the patient remains hypotensive which would the priority intervention?

Answer 1

The priority intervention for a hypotensive pedestrian after vehicle impact is urgent medical evaluation to identify and stop internal bleeding; surgical procedures, blood transfusions with type O negative blood, and fluids may be necessary.

Step-by-step explanation:

An adult pedestrian hit on the right side by a vehicle and remaining hypotensive despite initial resuscitation is likely suffering from hypovolemic shock, possibly due to internal bleeding. The priority intervention in such a case, especially when a shortened leg indicates potential serious injury, would be urgent medical evaluation to identify the source of bleeding and to stop it. Possible interventions include surgical procedures, blood transfusions, and additional fluid replacement. If the patient is too unstable to determine their blood type, type O negative blood would be used for transfusions, as it is the universal donor type and can be received by patients of any blood group without the risk of immunological reactions.

Answer 2

The priority intervention for a hypotensive pedestrian struck by a vehicle is to control internal bleeding and consider blood transfusion with O negative blood in case of severe hemorrhage. It is crucial to provide intravenous fluids or blood products and potentially use medications to improve blood pressure and hemodynamic stability.

Step-by-step explanation:

Following a motor vehicle accident where a pedestrian has been struck and remains hypotensive despite initial resuscitation with fluids, the priority intervention would be to address the possibility of internal bleeding. This situation points to hypovolemic shock, which is often caused by hemorrhage. The patient's shortened leg indicates a likely fracture, which could be associated with significant blood loss. With persistent hypotension, control of bleeding is critical, and a surgical evaluation for potential sources of hemorrhage is required. Furthermore, blood transfusion may be necessary to restore adequate circulation volume and improve blood pressure.

For patients in critical conditions following traumatic injuries, where there is no time to determine their blood type, O negative blood is often transfused because it is considered the universal donor type and is less likely to cause adverse reactions. In shock management, it is essential to stop the source of bleeding and provide sufficient intravenous fluids or blood products to restore hemodynamic stability.

It's important to continue monitoring the patient's vital signs, urine output, and mental status to assess their response to treatment. Medications like dopamine, epinephrine, and norepinephrine may be used to support blood pressure if fluid resuscitation alone is insufficient. Immediate attention to airway, breathing, circulation, disability, and exposure (ABCDE) is crucial in the acute management of trauma patients.