authored by Clark J. Albert, M.D. ,used with permission
|A two and one half year old, 15
kg, white male had undergone an uneventful appendectomy
12 hours ago. Surgical findings were a ruptured appendix
with severe peritonitis. Over the last six hours, the
patient's vital signs have changed. Heart rate has
increased from 90 bpm to 140 bpm. Blood pressure has
remained stable at 110/70. His temperature is 100.1
degrees F. The patient had not voided in spite of an iv
rate of 65 cc per hour overnight. Patient was warm to the
touch with good capillary refill; however, he was thought
to be pale.
The attending physical elected to administer a 15 cc/kg i.v. bolus of a balanced salt solution. No changed in heart rate or urine output was noted. A hematocrit was then drawn which revealed a severe anemia (14%). The operating room was notified that the patient's abdomen would need to be re-explored for bleeding.
What is your assessment of the patient at this stage?