It is 0730 hours on a coolish spring morning. You are dispatched to a report of a man in a boarding house (supported accommodation) known for frequent disturbances who is unconscious. Upon arrival, an approximately 45-year-old male is found with multiple stab wounds to the chest, back and arms who is lying prone in a pool of blood outside wearing blood soaked singlet and underpants. He is noted on primary assessment be drowsy, confused, pale and cool to touch.

No danger – victim states the person who stabbed him (unknown) has fled the scene. No weapon near patient.

Your primary assessment finds the following:

AVPU Opens eyes to voice

RR 32 (shallow)

Auscultation Equal air entry with no adventitious sounds

Trachea Midline

Effort Increased

SpO2 92%

Blood Loss Estimated blood loss is 1500mls – no spurting

Pulse No radial pulse, brachial = 132 regular, weak thready

Skin Cool, pale, diaphoretic

ECG Sinus tachycardia rate of 132

BP 70/45mmHg

Central capillary refill 4 seconds

GCS Eye opening to voice, confused verbal response and obeying motor commands

BGL 4.2mmol/L

Pupils Equal and reacting to light

Temperature 35.5°C

Pain 4/10 Exposure

Exposure of patient shows 20 stab wounds (lacerations approximately 3-5cm deep and lengths varying from 5cm-10cm) to chest, back and arms with estimated time of injury 2300 hours night before (8.5 hours ago). No other injuries found.

Other Information:

• You estimate the patients’ weight is 67kg
• No drug paraphernalia present
• PHx: Alcohol abuse (has been sober for 1 month)
• Medication: none
• Allergies: states none known
• You are 20 minutes from your state trauma centre.

1. Outline your management and preliminary diagnosis for this patient and provide rationales (backed by current evidence) for your interventions.

2. What body systems must be addressed to ensure they are functioning properly?

3. 4 hours ago this patient had a blood pressure of 110/65 (all other signs the same)- explain why this patient was then normotensive.

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