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Old 10-20-2011
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Vascular Discolored and Swollen Cath Site

A 45-year-old man undergoes a cardiac catheterization. Three hours ago he complained of light-headedness. His blood pressure is noted to be 85/60 mm Hg and his pulse is 110/min. He denies chest pain or shortness of breath. He had the catheterization for evaluation of chest pain and had a stent placed in the left anterior descending artery. He is now on heparin, metoprolol, and aspirin. His heart is tachycardic. Lungs are clear. His left groin at the site of the catheter insertion looks discolored and swollen. His hematocrit is 40%. Which of the following is the most appropriate immediate management?
A. Administer intravenous fluid
B. Apply pressure to groin
C. Obtain an echocardiogram
D. Obtain a vascular surgery consult
E. Transfuse blood
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Old 10-20-2011
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  • no ideaaaaaaaaaaa
may b A. Administer intravenous fluid
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Old 10-21-2011
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E. Transfuse blood
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Old 10-21-2011
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D: Consult Vascular surgeon
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Old 10-21-2011
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B. Apply pressure to groin?
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Old 10-21-2011
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A. Administer intravenous fluid
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Old 10-21-2011
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The correct answer is B. This patient most likely has an aneurysm in the femoral artery or a puncture and is losing blood rapidly into the groin. His hematocrit at 40% is inaccurate because this does not reflect the acute blood loss. The source of the blood loss needs to be stopped immediately. This requires direct pressure at the hematoma site for at least 20 minutes.

Once the groin is accessed in this manner, other resuscitative steps can be initiated, including fluid bolus (choice A).

The patient probably does not have sudden heart failure of left ventricular dysfunction. An echocardiogram at this time would lose precious time (choice C).

He may require vascular surgery if the direct pressure and fluid bolus does not help (choice D).

The patient may require blood transfusions urgently if the above steps are ineffective (choice E).
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