Clinical Review Lesson of the week

Splenic trauma complicating cardiopulmonary resuscitation

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7284.480 (Published 24 February 2001) Cite this as: BMJ 2001;322:480
  1. A Fitchet, specialist registrar in cardiology ([email protected])a,
  2. R Neal, specialist registrar in elderly medicineb,
  3. P Bannister, consultant physicianc
  1. a Manchester Heart Centre, Manchester Royal Infirmary, Manchester M13 9WL
  2. b Blackburn Royal Infirmary, Bolton Road, Blackburn BB2 3LR
  3. c Department of Medicine, Manchester Royal Infirmary
  1. Correspondence to: A Fitchet
  • Accepted 17 July 2000

Cardiopulmonary resuscitation can result in trauma to abdominal organs. We report two cases of splenic rupture causing life threatening haemorrhage.

Unexplained hypotension after cardiopulmonary resuscitation might be due to intra-abdominal trauma and concealed haemorrhage

Case reports

Case 1—A 64 year old woman who had undergone coronary artery bypass grafting 10 years previously had a cardiorespiratory arrest at a railway station late one night. Cardiopulmonary resuscitation was started immediately by bystanders and continued for 20 minutes until paramedics arrived. Ventricular fibrillation was confirmed, and she was externally defibrillated. On arrival at hospital she was alert and breathing spontaneously but hypotensive with a blood pressure of 80/40 mm Hg and a sinus tachycardia of 100 beats/min. Clinical examination suggested hypovolaemia with lowered central venous pulse pressure, normal heart sounds, and clear breath sounds. Electrocardiography confirmed an acute inferior myocardial infarction. Thrombolysis was not given because of prolonged resuscitation. She clinically improved on challenge with intravenous fluid. The central venous pulse became visible and her blood pressure rose to 120/70 mm Hg. Over the next hour progressive hypotension recurred, once again with clinical evidence of hypovolaemia. Blood pressure was restored with further intravenous fluid. An echocardiogram excluded major pericardial effusion, showing a non-dilated left ventricle with inferior wall akinesia and overall moderate function. At this stage the patient complained of left sided abdominal pain, with tenderness elicited over the left hypochondrium. Chest x ray films taken in the erect position showed no evidence of rib fractures or subdiaphragmatic gas. Ultrasonography showed …

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