Case 4
A 56-year-old man presents to the emergency department following an assault by multiple assailants.
He is intoxicated and aggressive towards staff. He is uncooperative and shouting that he is in pain but cannot provide further information.
Abdominal palpation is normal. You notice bruising to his head, face, lower chest, flank and anterior abdominal wall.
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Question 1 of 3
1. Question
What should be your immediate concern regarding possible injuries to this patient?
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Question 2 of 3
2. Question
The patient receives analgesia and becomes more compliant. His heart rate is 120 bpm and his blood pressure is 88/60 mmHg. He is GCS 13 (E3, M6, V4). He has stigmata of liver disease.
Select the three immediate bedside tests that will be most useful.
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Question 3 of 3
3. Question
The patient's BM is 2.7 which demonstrates that it is dangerous to assume that confusion, reduced GCS or aggression are due to alcohol alone. You correct this and he improves to GCS 14 (E4, M6, V4). His breath alcohol is 2.4. Urinalysis shows large blood. A chest x-ray has no air under the diaphragm.
After one litre of normal saline he remains hypotensive at 90/60. A FAST scan shows free fluid but you know from his old notes that he has moderate ascites.
What should you do next? (Select all that apply)
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