85 years old male is BIBA after mechanical fall onto his left side in drive way about 45 min ago. He has obvious swelling and bruise of left shoulder, left leg externally rotated on initial review. No history of head trauma. His vitals on arrival are HR 76, BP 102 systolic. Temp 35.6. RR 18, sats 98 RA. His GCS is 15 but complaining of lot of pain in shoulder and hip. ECG sinus rhythm. His Past medical history includes atrial fibrillation, He is on apixaban and spiranolactone and compliant with his medications. His primary survey on arrival is okay. Log roll has not been done yet.
His Hb on arrival is 115. 30 min later his BP drops to 77/54, and HB has dropped to 91 on repeat VBG. His xrays so far have confirmed left proximal humerus fracture and left proximal femoral shaft fracture. He is given 500 ml fluid bolus awaiting response.
Questions:
- What are the clinical concerns in this patient based on above case history and examination and blood results?
- How will you further investigate this patient. ?
- How will you manage this patient?