I have experienced a patient, a case of RTA, who came in shock with lower than 60 bp. Patient with non reacting dilated pupil was explored, immediately had splenectomy and recovered fully. Now recently i was called for help in another hospital, again for case of RTA, with femure fracture, extradural hematoma and shock due to haemoperitoneum and fixed dilated pupil. Patient was 5 hours in ER, in the shock and had received 5 litres of i/v fluids and 3 units of PRBC.
On questioning to surgeon, who supposed to attend the patient, "What are you waiting for? Why patient did not get explored ?" He told me that, anesthetist is reluctant to give anaesthesia, as patient is having fixed dilated pupil and thinks patient is brain dead. As far as i know you cant declare any patient brain dead in ER, as long as he is in shock, he has received sedatives, relaxants. As this patient was already…
