It is 0730 hours on a coolish spring morning. You are dispatched to a report of a man in a boarding house (supported accommodation) known for frequent disturbances who is unconscious. Upon arrival, an approximately 45-year-old male is found with multiple stab wounds to the chest, back and arms who is lying prone in a pool of blood outside wearing blood soaked singlet and underpants. He is noted on primary assessment be drowsy, confused, pale and cool to touch.

On further assessment you find the following:

No danger – victim states person who stabbed him (unknown) has left the scene and no weapon near patient

Patient responds to voice (confused)

Respiratory rate = 32 (shallow) – equal air entry with no adventitious sounds on auscultation, trachea mid line, increased effort and SpO2 = 92%,

Pulse = 132 regular, weak, thready, Skin = cool, pale, diaphoretic, ECG = Sinus tachycardia, BP = 70/45, Central capillary refill = 4 seconds

Patient eye opening to voice, confused verbal response and obeying motor commands, BGL = 4.2mmol/L, pupils equal and reacting to light, tympanic temperature = 35.5 degrees Celsius, no drug paraphernalia present, pain = 4/10, patient weight = 67kg (estimate)

Exposure of patient shows 20 stab wounds (lacerations approximately 3-5cm deep and lengths varying from 5cm-10cm) to chest, back and arms with estimated time of injury 2300 hours night before (8.5 hours ago). No other injuries found.

Patient has a past history of alcohol abuse (been sober for 1 month), Currently taking no medication and is not allergic to anything.

 

Outline your management and preliminary diagnosis for this patient and provide rationales (backed by current evidence) for your interventions.

Discuss the pathophysiological process associated with this condition.

What body systems must be addressed to ensure they are functioning properly?

4 hours ago this patient had a blood pressure of 110/65 (all other signs the same)- explain why this patient was then normotensive.

Discuss the concept of permissive hypotension in relation to penetrating injuries and fluid management.

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