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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How To Treat Pelvic And Rib Fracture?

Had a patient with p wave inversion and 1mm depression in t waves only in septal leads. Any thoughts? 65yo female Presented unresponsive, needed airway managment and ventilation, rr shallow and uneffective, hypotensive 90/60, varying bglu, small pupils, not pinpoint. 4 mg narcan given, 12.5g d50 given bglu initially 121, then 20 min later bglu was 20, then after d50 back up to 200, no response, no improvement. She is sp 2 weeks fall down a flight of steps with pelvic fracture and rib fracture and no significant pmh.
Thu, 3 Jul 2014
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Internal Medicine Specialist,  's  Response
Have you checked her for pulmonary embolism and collapsed lung? Either of these could result from the injuries she had received earlier, particularly if she'd been immobile. Changes in the EKG would also result. The concern now is not to treat the pelvic and rib fractures, but to diagnose and treat the acute life-threatening problems. Has she had a blood gas? Chest xray? Cardiac enzymes? I would be obtaining these while giving the supportive treatment needed. Could she have had a stroke? The EKG can also be affected with stroke. My first thought would be PE but I would be checking for other cardiopulmonary problems as well.
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How To Treat Pelvic And Rib Fracture?

Have you checked her for pulmonary embolism and collapsed lung? Either of these could result from the injuries she had received earlier, particularly if she d been immobile. Changes in the EKG would also result. The concern now is not to treat the pelvic and rib fractures, but to diagnose and treat the acute life-threatening problems. Has she had a blood gas? Chest xray? Cardiac enzymes? I would be obtaining these while giving the supportive treatment needed. Could she have had a stroke? The EKG can also be affected with stroke. My first thought would be PE but I would be checking for other cardiopulmonary problems as well.