Question

You suspect that your trauma patient may be experiencing the adverse effects of a crush injury after being entrapped under a fallen building for several hours before rescue. He is found to be wheezing with shortness of breath and hypotension with no obvious sign of chest wall/lung injury or blood loss.

What is the most likely cause of these findings in a crush injury patient?

A. Histamine release

B. Atelectasis from the compressive forces

C. Aortic dissection

D. Thrombin formation

Answer 1

The wheezing, shortness of breath, and hypotension in a crush injury patient with no obvious chest wall/lung injury or blood loss is most likely caused by histamine release, leading to an anaphylactic-like reaction.

Step-by-step explanation:

The most likely cause of wheezing, shortness of breath, and hypotension in a trauma patient who has a crush injury with no obvious chest wall/lung injury or blood loss is histamine release. This can occur during severe crush injuries when there is a massive release of cell contents into the circulation, potentially leading to anaphylactic-like reactions. The release of histamines causes vasodilation, increased vascular permeability, and contraction of bronchial smooth muscles, which results in hypotension and respiratory distress. While options like aortic dissection, atelectasis, and thrombin formation could also cause similar symptoms, the presentation here points more towards the systemic effects of histamine, which are prominent in anaphylaxis or anaphylactic-like reactions. These conditions can be life-threatening, often requiring immediate use of epinephrine to counter the effects of the histamine release on both blood pressure and airway constriction.