Spine Level—ICU quiz 1

Your patient with a T 12 burst fracture is doing well after being in the hospital for 2 days. Plans are to operate and fuse on day 4-5.

However you are called to his bedside at 0300 (why is it always 0300?) because he "looks sick."

And indeed he does. He is pale, sweaty, with a rapid, thready pulse. His blood pressure is hovering around 70/zip and his heart rate is in the 130s. He complains of a terrible boring pain "like someone sticking a spear into my stomach and out my back." He looks like he is trying to die on you, and in fact, he is. He also just vomited green bile all over your scrubs.

What is going on? What do you do?

Your chief resident is now doing a nasty subdural, and your senior resident is now reintubating a trauma who went bad in the unit. YOYO, babe. Think it through.

Some guidance:

Do first things first
Think, then do.

OK, fun's over. Here is an approach to this all too common situation.