Hypotension in ICU

 

A 48 yo man had been intubated and ventilated in ICU for 12 hours following a traumatic brain injury and abdominal injuries. A R central venous catheter was inserted via the subclavian route.

6 hours later the patient was noted to have a systolic BP of 70/40. (Down from around 110/65).

Abdominal examination at this time was unremarkable.

500 mls of colloid were given leading to a rise in BP to 120/75.

 

30 minutes later the BP was 60/40. This was corrected to 90/60 with 1 L of N/Saline and two doses of metaraminol 0.5 mg.

The Hb was found to be 8 g/dl.

 

A CXR showed a white out on the R side with a haemothorax.

A R ICC was inserted which drained 1½ L of blood.

The patient was taken to the OT. After lengthy exploration a severed R internal mammary artery was discovered and ligated.

The patient’s post operative course was uneventful.

 

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