STRAC Case Presentation S. Hinan Ahmed, MD UTHSCSA Division of Cardiology

Presentation 51 y/o man brought to UH by EMS after sustaining GSW to his bilateral thighs and buttock (06:32). Trauma alert called. EMS noted he was hypotensive with massive blood loss, altered mental status and combativeness. Due to his altered mentation, he was intubated. 4 units of pRBCs administered and aggressively bolused with IV fluids.

Trauma Surgery (07:16-08:45) His right groin was explored and bleeding was identified from the branches of the profunda femoris artery which were ligated as well as the superficial femoral vein which was repaired. His left groin was explored without significant bleeding source identified. His gluteal wounds were investigated, rigid proctoscopy was performed excluding injury. Anesthesia identified ST abnormalities on his ECG

Code Heart Cardiology contacted by Trauma surgery regarding STEMI. Exam: Sedated/intubated in the SICU Neck: No JVD or bruits Heart: reg S1, S2; no R/G/M Lungs: CTAB on vent Abd: NABS, soft, NT, ND Ext: right groin wound vac in place, left incision below femoral head, right radial arterial line; 2+ pulses

Discussion Cardiology and Trauma surgery had a discussion regarding the safety of anticoagulation and antiplatelet therapy: it was deemed that the benefit>risk for coronary reperfusion and he was brought to the cath lab. Patient brought to cardiac catheterization laboratory (12:28)

Cardiac Cath #1

Cardiac Cath #2

Cardiac Cath #3