A 22-year-old man is involved in a high-speed, head-on automobile collision. He arrives in the ER in coma, with fixed, dilated puprls. He has multiple obvious fractures in both upper extremities and in the right lower leg. His blood pressure is 70 over 50, with a barely perceptible pulse rate of 140. where is he bleeding?
(19) Trauma - abC- circulation/ shock NOT bleeding in the head! recognize he is in SHOCK & there isn't enough room in the brain for a intracranial bleed to cause shock, therefore he much be bleeding somewhere else We have pointed out that shock in the trauma setting is caused by bleeding (the most common source), pericardial tamponade, or tension pneumothorax. This case fits right in, but the presence of obvious head injury might lead you into a trap: the question will offer you several kinds of intracranial bleeding (acute epidural hematoma, acute subdural hematoma, intracerebral bleed- ing, subarachnoid hemorrhage, etc.) as the answer. They are not. Intracranial bleeding can indeed kill you, but not by blood loss. There isn't enough room in the head to accommodate the amount of blood needed to go into shock (roughly a liter and a half in the average size adult). Thus, you need to look for another source (we will elaborate in the section on abdominal trauma).