authored by Clark J. Albert, M.D. ,used with permission

Anesthesia Case #1
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?