{"id":1471,"date":"2020-02-19T11:49:22","date_gmt":"2020-02-19T11:49:22","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=1471"},"modified":"2020-07-21T23:51:32","modified_gmt":"2020-07-21T23:51:32","slug":"parforthecourse","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2020\/02\/19\/parforthecourse\/","title":{"rendered":"Case # 17: Par for the Course"},"content":{"rendered":"
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An 80 year old man presents to a rural emergency room at 3am with abdominal pain. His past medical history is significant for mild hemophilia A. Six hours prior to arrival, he was driving a golf cart when he struck a pole and the steering wheel hit his stomach.<\/p>\n

He initially had no symptoms but began to have abdominal pain while trying to sleep. He also became nauseated and vomited once. He eventually called EMS and was brought to the ER. On arrival, his vitals are as follows. <\/p>\n

Vitals: <\/span>T: 90.7, HR: 108, BP: 74\/48, RR: 28, SpO2 98 on 4L<\/span><\/p>\n

He is alert, oriented and his only complaint is abdominal pain. A FAST exam was done. What do you see? What are your next steps?<\/p>\n

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Answer and Learning Points<\/h3>
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Answer<\/strong><\/p>\n

Although the quality of images is lacking due to the urgency of the situation and the patient's body habitus, the first image (RUQ) does not show obvious free fluid. The following images (suprapubic and LUQ) clearly show free fluid in the abdomen.\u00a0<\/p>\n

An emergent evacuation of the patient to a level 1 Trauma service was requested. Patient was transfused with two units of O blood. Due to his history of hemophilia A, the patient was also given factor VIII to 100% repletion. The patient was taken to the OR at the level 1 trauma center where he was found to have a greater omental bleed and was successfully treated with clot evacuation and laceration repair. He was placed on a factor VIII drip postop.\u00a0<\/p>\n

Learning Points<\/strong><\/p>\n