bradycardia in the traumatic setting

[Timothy J Coats (SURG) 7728]

One explanation in addition to those given: This may be a 
completely normal (or even slightly fast) pulse for a fit young man. 

I can remember (in my youth!) getting very worried about a marathon 
runner with a pulse rate of 40. He had come to the ER because of 
shin splints and was most bemused to be dragged into a cardiac 
bay, monitored, ECG'd and bled by a worried looking me. 
Fortunately wiser heads became involved before I put a pacemaker 
in!

Tim.

> 
>      INCIDENT:  20 year old male, restrained front passenger of a  car vs. 
> tree front impact mvc. High rate of speed estimated at >60 mph. major vehicle 
> damage, steering wheel bent, windshield fractured, passenger pin in due >20in 
> passenger compartment intrusion.  pt denies loss of consciousness.   
>      Patient has several large lacerations to the right temporal scalp, nose, 
> lips
> and some  right sided chest tenderness. clear breath sounds to auscultation, 
> bilaterally. pt CAOx4 GCS 15.
> 
> V/S     98/70 BP  
>           58 HR
>           16 shallow RR  no complaint of dyspnea
>           99% pulse oximetry on RA
> 




Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.