Blood Case Study: Richard Watkins, 20, fell off his roof while replacing some shingles. Upon arrival at the scene, paramedics make the following observations: •Abdominal pain, right upper quadrant •Cyanotic, cool, and clammy skin •Falling blood pressure, 100/60 mm Hg; rapid pulse, 100 bpm. Paramedics start an IV to rapidly infuse a 0.9% sodium chloride solution (normal saline). They transport him to a small rural hospital where Mr. Watkin’s blood pressure continues to fall and his cyanosis worsens. The local physician begins infusing O negative packed red blood cells (PRBCs) and arranges transport by helicopter to a trauma center. She sends additional PRBC units in the helicopter for transfusion en route. After arrival at the trauma center, the following notes were added to Mr. Watkin’s chart: •Abdomen firm and distended •Blood drawn for typing and cross matching; packed A positive blood infused •Emergency FAST (focused assessment with sonography for trauma) ultrasound is positive for intraperitoneal fluid A positive FAST scan indicates intra-abdominal bleeding. Mr. Watkin’s condition continues to deteriorate, so he is prepared for surgery. The operation reveals a lacerated liver which is repaired. Mr. Watkin’s vital signs stabilize. 1. Mr. Watkin’s was going into shock because of blood loss, so paramedics infused a saline solution. Why would this help? 2. Why was Mr. Watkin’s given PRBCs in addition to normal saline solution? What problem does the infusion of PRBCs address that the saline solution could not? a. PRBCs help restore blood ion composition to normal. b. PRBCs increase blood osmotic pressure, making the infused fluid stay in the vessels rather than move into the cells. c. PRBCs enhance clotting, sealing off the injured vessels. d. PRBCs contain hemoglobin, so they are able to carry oxygen to the tissues. 3. Why was the physician able to use O negative blood before the results of the blood type tests were obtained? 4. Mr. Watkin’s blood type was determined to be A positive. Which of the following types of blood can he receive? a. A positive, A negative, O positive, and O negative b. A positive, O positive, and AB positive c. A positive but not A negative d. Only A positive and O negative 5. What would happen if doctors had infused type B PRBCs into Mr. Watkin’s circulation?
