A 82-year-old man underwent Prostatectomy. At 11:30 a.m., the operation was finished, breathing was 18 times / min, pulse was 72 bpm, and blood pressure 105 / 68mmHg. Then the patient was sent to intensive care unit for observation. At 13:30 a.m., heart rate was 116 bpm, and blood pressure was 94 / 52mmHg. At 14 o'clock, the patient was comatose, heart rate was 95 bmp, blood pressure was 61 / 37mmHg, pulse was weak, and limbs were cold and wet. Abdominal exploration was performed and hematoma founded
The following questions arise:
-What's wrong with the patient? What might be the cause?
-How is the patient’s blood pressure being maintained at 13:30? What evidence is contained to indicate the physiological mechanisms involved?
Dear Fatemeh Meschi,
I can try to answer some parts of your question.
1.The Cause of hematoma may be intra abdominal bleeding resulting from injury to the vascular wall occuring during surgery.
2.The cause for increase heart rate and decrease blood pressure and eventually to shock was hemorrhage (resulting in the hematoma) from intra abdominal vessels.
3.During hemorrhagic shock there are compensatory mechanisms to maintain BP, particularly by its vasoconstriction.
Chaudhury Meshkat Ahmed
The heart rate keep increasing in about 2 hours but why it's decreased when the patient comatose ?
Thank you for your time
Dear Fatemeh Meschi,
Tachycardia is the rule in hemorrhagic shock, as a compensatory mechanisms. Do initialy there was increase heart rate. But as more bleeding occured it compressed the abdominal viscera. There can be decrease heart rate during shock, when it occurs with intra abdominal bleeding. The mechanism is: pertonial blood triggers parasympathetic activity, as abdominal viscera contains vagal receptors predominately over sympathetic receptors.
Ref:BMJ 2004:328:45
http//doi.org/10.1136/bmj.328.7437.451
Dear Fatemeh Meschi,
Bradycardia may be present in patients with haemorrhagic sbock, when the patients is athlete, on B Blocker and as has been mentioned during the intra abdominal bleeding (in 30%of cases).
Ref: Tintin alli, Judith E. 2010. Emergency Medicine :A comprehensive study guide ( emergency medicine (Tintin alli)) New York :Mac Grew _Hill companies :pp174_175.
It's seems that Unusual complication happened to Patients during Prostatectomy in whom hemodynamic parameters was normal previously as well as during operation . Unusual complication might be the Bladder perforation along with open up of more prostatic venous sinuses. Bladder perforation can lead to Intraabdominal collection of blood resuted in the fall of BP, Increased HR and altered Consciousness. Definitive treatment includes emergency exploratory Laparotomy and repair of underlying cause along with Fluid Resuscitation Blood Transfusion and Inotropic support if required.
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