Spin Levels—ICU answer...more

First things first.

This guy is trying to die, so you have to save his life first. What do you do when someone is trying to die? ABC's. Always. Train yourself to say ABCs whenever you are in a life-threatening emergency. If you do this alone, you will buy enough time for someone else to come in and help you out.

OK. He's breathing OK, but is very hypotensive and shocky. So you get some normal saline or lactated ringers or something and start pouring it in. Get his volume replaced. While sticking him for the IV, draw off some labs, a CBC and some chemistries at least.

Well now, you've given him about a liter and his pressure is up to 90. That's a start. Now take a big deep breath and think of what is going on with this guy. Keep the IV fluids going while you think.

Hmmm. T12 fracture. No lights go on.

Hmmm, repeated. Boring epigastric pain going thru to the back...vomiting...hypotension. Sounds like a chronic alcoholic with pancreatitis you saw a while ago.

Pancreatitis. Why? Aaah, the pancreas sits in the retroperitoneum, just anterior to T12. It can be injured in trauma, a traumatic pancreatitis. Send an amylase and a lipase along with those chems and get an NG tube down him. Probably also drop in a CVP because he may need massive volume replacement.

So you responded to the immediate emergency, stabilized the patient, and then thought through the problem in greater detail. Congratulations. You may now indulge yourself with 30 minutes of sleep before morning rounds. Don't forget to check the CBC.