cause of hypotension

[Mike Smertka]

Hello,
   
  Could I ask the mechanism of injury, with the obvious exclusion of a major bleed i would guess there is some kind of cerebral insult. But there is also the possibility of thing altering the normal symptoms like medication or street drugs. other than genetic defect or drugs can't think of anything that would cause pupil dialation other than head trauma if the patient was not in arrest. 
   
  as a question, can anyone let me know if it is possible to decompensate so quickly from  an intercranial bleed that the brady/hypertension would be transient (a few seconds or a few minutes) prior to arrest. It seems like it would be possible to me.
   
  Mike 

"Dr.Asif Huda Ansari" <asifhansari at yahoo.com> wrote:
  SUB: Cause of hypotension in MVA patient.

Hellow,

i am a Gen.Surg resident and in 2 years of i have seen 2 pts coming to trauma, in shock,25yr male,Unconscious(intubated),BP not recordable,peripheral pulse absent, Pupils B/L dilated and fixed,chest-B/L breath sound +,CVS-audible heart sounds. Abdomen Soft/lax/Bowel sound+
aftr resuusitation with 2 Lit RL and 2 U PRBC, BP came to 110/70,pulse110
CXR no pneumo/hemo
Pelvic xray-no #
USG abdomen- no free fluid
we decide to shift the pt to CT with the above vitals-as the pt is shifted to CT table, pt. arrest , CPR done 40mins 
but pt declared dead.

my question here is, what could be cause of shock if we excluded hemorhage, as there was no bleeding in the chest/abdomen/
pelvic/no long bone fractures.

the only thing was the pupils B/L Dilated and fixed !
now is there any cause in the Head which can cause this?
i mean after excluding Hemorrhagic cause, if we label Neurogenic shock, the pt should be Hypertensive and Bradycardic.
please give your expert opinions.
Thanks

Dr.Asif.H.Ansari;MBBS, MRCS (Std)
King Khalid Hospital
Saudi Arabia


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