CASE STUDY: FLUID, ELECTROLYTE AND ACID-BASE BALANCE

 Mr. Heyden, a somewhat stocky 72-year old man, is brought in to the emergency room. The paramedics report that his left arm and the left side of his body trunk were pinned beneath some wreckage, and that when he was freed, his left hypogastric and lumbar areas appeared to be compressed and his left arm were blanched and without sensation. On admissions, Mr. Hayden is alert, slightly cyanotic, and complaining of pain in his left side; he loses consciousness shortly thereafter. His vital signs are taken, blood is drawn for laboratory tests, and Mr. Heyden is catheterized and immediately scheduled for a CT scan of his left abdominal region. **PLEASE REWRITE IN YOUR OWN HANDS** Analyze the information that was subsequently recorded on Mr. Heyden’s chart: **Vital signs: Temp. 39 C. ( 102 F. ) ; BP 90/50 mmHg and falling; Heart rate 116 beats per min. and thread; 30 respirations/min. 1. Given the values above and his attendant cyanosis, what would you guess is Mr. Heyden’s immediate problem? Explain your reasoning. PLEASE ANSWER IN ESSAY FORM ( 3 -5 SENTENCES). **CT scan reveals a ruptured spleen and a large hematoma in the upper left abdominal quadrant. Splenic repair surgery is scheduled but unsuccessful; the spleen is removed.PLEASE ANSWER IN ESSAY FORM ( 3 -5 SENTENCES). 2. Rupture of the spleen results in massive hemorrhage. Explain this observation. Which organs (if any) will compensate for the removal of Mr. Heyden’s spleen? PLEASE ANSWER IN ESSAY FORM ( 3 -5 SENTENCES). ** Hematology: Most blood tests yield normal results. However, renin, aldosterone, and ADH levels were elevated. 3. Explain the cause and consequence of each of the hematology findings. PLEASE ANSWER IN ESSAY FORM ( 3 -5 SENTENCES). **Urinalysis: some granular casts (particulate cell debris) are noted, and the urine is brownish-red in color; other values are normal, but urine output is very low. An order is given to force fluids. 4. a) What might account for the low volume of urine output? (Name at least two possibilities). PLEASE ANSWER IN ESSAY FORM ( 3 -5 SENTENCES). b) What might explain the casts and abnormal color of his urine? Can you see any possible relationship between his crush injury and these findings? PLEASE ANSWER IN ESSAY FORM ( 3 -5 SENTENCES).