A 15-year-old male presents as a walk-in to a large urban Pediatric Trauma Center Emergency Department (ED) after a 14-day hospital admission for three gunshot wounds to the gluteal area. During his initial hospital stay, he received urgent surgical intervention and a massive transfusion protocol for transection of his inferior vena cava (IVC).
Three days after discharge from the hospital, the patient’s mother brought the patient to the ED, concerned that he was “ill-appearing” and had developed a fever, abdominal pain, vomiting, and black tarry stools. Initial triage vital signs: HR 140, BP 108/58, RR 36, Temp 101.2.
Shortly after arrival, his vital signs decreased to a systolic BP in the 70s and continued to be tachycardic in the 140s. He clinically presented with signs and symptoms of shock, including a shock index of 2.0. Knowing his recent past medical history with the addition of fever and black tarry stools, rapid treatment and correction of decompensated shock was a priority effort.
The patient was administered two units of Low Titer O Negative Whole Blood (LTO-WB) and 1 unit of Packed Red Blood Cells (PRBCs) via the LifeFlow PLUS Blood & Fluid Infuser and QinFlow Warrior blood warmer. The LifeFlow and QinFlow allowed for rapid administration of 1300mL warmed blood products in under 6 minutes.
His post-resuscitation vital signs in the ED improved to HR 113, BP 110/70, and RR 18. His shock index decreased to 1.0. His initial Hgb 3.9 and Hct 12.4 improved to Hbg 7.3 and Hct 21.5. The patient was admitted to the ICU for 24 hours for additional blood products and close monitoring. He was then transferred to the Step-Down Unit and discharged home.
During his hospital stay, he was ultimately diagnosed with a GI Bleed likely related to the anticoagulation medications for his IVC repair. Additionally, he was discovered to have a urinoma that caused an underlying septic shock.
He presented to the ED as a clinically complex case due to his GI Bleed and urosepsis. Treatment and correction of decompensated shock require rapid blood product or fluid administration. The LifeFlow PLUS and QinFlow Warrior aided the staff in quickly and efficiently correcting his decompensated shock state. As a result, the patient was able to make a full recovery and was discharged home.