Question

Bobby Sue was brought to the ER where she was assessed for trauma. Physicians were worried about a myocardial contusion or other myocardial damage, and ran an EKG. Below is an image of a 6 second strip. They checked her systemic blood pH (7.11; low), blood oxygenation (86%, low), and body temperature (95.8 oF). The broken knees were wrapped, but surgery was put off until her metabolic condition was stabilized. After all, bones can be fixed later—cells are more difficult to replace. This is termed “Damage Control” in trauma: stabilize the patient, schedule major surgeries to repair massive injuries once the patient is stable. In exsanguinating hemorrhage, patients die from coagulopathy, hypothermia, and metabolic acidosis. The metabolic failure is often the terminal condition, and therefore must be dealt with immediately.

The ER physician diagnosed myocardial contusion. A first year Medical student knew that this could cause A-fib, and could lead to blood clotting and stroke. He suggested that they give her heparin. In unison, the ER trauma team yelled “NO!”.

 Given her pH and body temperature what is her blood clotting status?

 How does heparin work to prevent blood clots?

 Why would you not give heparin to Bobby Sue?

Answer 1

1-subject have low pH (acidosis)and temperature-platelete function are impaired in low pH so the coagulation will not take place.person will bleed for more time

2-how heparin works-it is an anticoagulant produced in the body.by itself it has no anticoagulant property.but when it combine with antithrombin 3,the effectiveness of antithrombin 3 for removing thrombin increases largely and thus it act as anticoagulant.the complex of heparin antithrombin 3 removes several other activated coagulation factors in addition to thrombin increases effectiveness.they are factors 9,10,11,12.

3-the persons blood clotting is already in low status due to decreased pH.giving heparin further decrease coagulation by it's anticoagulant activity.the person will bleed profusely from injuries and can be lead to death