Monday, February 11, 2013

Nemo


I hope everyone is safe, warm, and healthy. The picture above is from the recent snowstorm in the Northeast, shown under GNU Free Documentation License, from Wikipedia.

Say a patient is pulled out of the vehicle above. She is brought to the emergency department, minimally responsive with a core temperature of 30 degrees. Her hematocrit is 36 (reference range 35.4-44.4). Her finger stick glucose is elevated to 200, and she is given insulin. From the extraction, she has some cuts and abrasions that continue to bleed. Despite a normal PT, PTT, and INR, you consider giving her clotting factors.

Challenge: Are you worried about the hematocrit? Tell me about the insulin. And would you give her some FFP?

2 comments:

Anonymous said...

Is it cold-induced platelet dysfunction? the glucose measurement is high due to elevated stress hormones such as glucagon..
no FFP as the problem might be due to platelets function, so vitamin K or platelet transfusion maybe?

Craig Chen said...

good ideas - temperature causes dysregulation of so many homeostatic mechanisms. this is what I thought:
-
Nemo

Hematocrit increases 2% for each 1 degree drop in temperature, so a low normal hematocrit is concerning. Insulin does not work below 30 degrees Celcius. And coagulation labs are typically normal in a cold patient because the lab runs them at 37 degrees. Warming the patient will correct the bleeding; coagulation factors will not help.

Source: UpToDate.