When You Can't See the Bleeding

​BY MARIA AHMAD, & AHMED RAZIUDDIN, MD​A 50-year-old woman presented to the ED at 10 a.m. one day complaining of severe left upper quadrant and left flank pain since 2 a.m. the night before. The pain was associated with nausea and four episodes of vomiting, and she described it as nonradiating, sharp, and stabbing. The patient was in obvious distress and diaphoretic. She confirmed that she had never had surgery and was not taking any medications. Her first set of vital signs included an oral temperature of 97.4°F; blood pressure of 105/92 mm Hg; pulse of 106 bpm; respiratory rate of 28 bpm; mean arterial pressure of 96; SpO2 at 97%, a and 10/10 pain.While awaiting lab results, the patient started complaining of worsening pain in the same location but a bit more generalized. She became hypoxic, stopped breathing, and became pulseless. The patient was then intubated with a 6.5-size endotracheal tube. CPR was initiated with several rounds of epinephrine and bicarbonates. At the end of the third round of CPR, she had no pulse, no heart tones, and no spontaneous respirations.The only abnormality on her labs was a platelet count of 13,000, indicating thrombocytopenia. CT scans were negative for any bleeds, but they did show the perinephric fluid on the left side slightly greater than normal, suggesting possible inflammation. (See image.)Spontaneous bilateral adrenal hemorrhage (SBAH) is a rare condition that results in adrenal crisis, shock, coma, and death. Unfortunately,...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research