Geelong Hospital????

[Bakes]

Having just read the GFC site about Tom andhis treatment;

Lonergan has been in an induced coma since complications arose early on Sunday morning after it was initially felt he would not need surgery.

"About 3am on Sunday morning his blood pressure was dropping and a quick decision was made to take him to theatre and it was found he had lost about three litres of blood,' Bradshaw said, adding the human body held around five litres of blood.


Seems a little wierd that it takes 3 litres before "experts" pick up that there is a problem. You would have thought that tests could have found this out long before 3/5 of the bodies blood have oozed out.

opinions?

[Whispers]

Geelong medical staff should be questioned over the procedure of taking Lonegan off the ground. I recall he jogged off, which is appalling considering Lonegan was down for around 45 seconds... disappointing..

[Ricardo]

Geelong medical staff should be questioned over the procedure of taking Lonegan off the ground. I recall he jogged off, which is appalling considering Lonegan was down for around 45 seconds... disappointing..

I was amazed he could even walk off let alone jog off......hopefully he gets well soon and nothing more serious happens :(

[S "Thinks He's Daicos" J]

Having just read the GFC site about Tom andhis treatment;



Seems a little wierd that it takes 3 litres before "experts" pick up that there is a problem. You would have thought that tests could have found this out long before 3/5 of the bodies blood have oozed out.

opinions?
When they say he lost 3 litres of blood, it doesn't mean it came out of his body, and was dripping all over the floor.

[VikingCat]

From my limited understanding of medicine, internal bleeding is not always easy to pick up. One of the most common indicators of whether someone is bleeding internally is through blood in the stool, and obviously that might not happen for quite some time. Blood pressure and oxygen levels are the general ways to monitor internal blood loss, but you will only see a drop in blood pressure once the patient has lost 25 to 30 per cent of their blood.

Tom would have been unlikely to realise how severe his injury was when he got up off the ground - the laceration would only just start to bleed. So while he would doubtless have been in pain, he might have felt able to get himself off the ground to ensure he could go back on if he felt okay later - an option unavailable if he was stretchered. And for someone with something to prove, the option to go back on would be important.

I am by no means a doctor or a nurse or anything close, but this is the understanding I've been given by my medical relatives.

[YOTC]

Having just read the GFC site about Tom andhis treatment;



Seems a little wierd that it takes 3 litres before "experts" pick up that there is a problem. You would have thought that tests could have found this out long before 3/5 of the bodies blood have oozed out.

opinions?
Oh dear

I suggest you go back and do what you do best, because these doctors saved his life...

He would have died if we had left you in charge.......blood doesn't have to come out of the skin for you to be bleeding...

[thegerman]

Bleeding would appear as swelling, but due to that loss he would almost certainly be losing his functions, i.e. passing out.

He had an injury when he was young, 16 or so which was in the same area, same kidney in fact. So that didn't help the situation.

[LifeSpan-Void]

blood loss from a ruptured kidney would be bleeding into the peritoneal cavity, so externally visible swelling wouldn't have been apparent. The FIRST sign of blood loss is a drop in blood pressure with a simulataneous increase in heart rate, as the heart tries to compensate for the loss of volume with an increase in output. A CT scan would have confirmed an internal bleed, but under the circumstances that may have taken too long. Blood in the faeces (melaena) is not associated with internal bleeding unless that bleeding is from the intestines themselves.

[thehoff]

blood loss from a ruptured kidney would be bleeding into the peritoneal cavity, so externally visible swelling wouldn't have been apparent. The FIRST sign of blood loss is a drop in blood pressure with a simulataneous increase in heart rate, as the heart tries to compensate for the loss of volume with an increase in output. A CT scan would have confirmed an internal bleed, but under the circumstances that may have taken too long. Blood in the faeces (melaena) is not associated with internal bleeding unless that bleeding is from the intestines themselves.

Doc Larkin, is that you?

[fusion]

blood loss from a ruptured kidney would be bleeding into the peritoneal cavity, so externally visible swelling wouldn't have been apparent. The FIRST sign of blood loss is a drop in blood pressure with a simulataneous increase in heart rate, as the heart tries to compensate for the loss of volume with an increase in output. A CT scan would have confirmed an internal bleed, but under the circumstances that may have taken too long. Blood in the faeces (melaena) is not associated with internal bleeding unless that bleeding is from the intestines themselves.

Sounds about right. It is even harder to detect the changes of internal bleeding in elite athletes, as their body can compensate for the loss of blood much longer. This is a well known physiological effect, and also occurs in children. By the time they have a change in blood pressure and pulse they can be much sicker than a "normal" individual.

Also blood loss doesn't have to be at the same rate over time. The body obviously has clotting mechanisms to try to stop it. Bleeding can start and stop, and accelerate. Often the first CT scan may not show a lot of blood due to this.

Surgeons also prefer to try to save the kidney, and will only take it out if really necessary. So without us having all the details, it sounds like they did the right thing by admitting him to ICU for continual montoring and observation, and as soon as they detected that he'd crossed the threshold where they felt there was more risk in continuing to observe, they operated.

Furthermore, most patients that are brought in to hospital with trauma will have a saline drip connected - which helps resuscitate the patient. If the rate of blood loss is compensated by the fluid that is being pumped in (and the compensatatory mechanisms of the body work) - then the blood pressure will not change much.

I can understand the line of questioning by the original poster, but it really shows that you have no knowledge in this area.

[smelly cat]

I am a doctor (currently on a rotation at a GP practice next to the Geelong Hospital), and what has happened to Tom is pretty difficult to protect against. Anyone who has open abdo surgery would be having round the clock observations, but the vessels that go to the kidney are a decent size and can lose a lot of blood in a very short space of time.

Contrary to popular belief, a drop in BP in anyone under 50 is a pretty late sign of blood loss, thanks to the body's compensation mechanisms- raised heart rate and vasoconstriction. So it isn't like his BP was 120/80 then all of a sudden 70/35. A fit person can lose up to 1.5 litres beofre the BP drops. Kids are even worse- they can lose over 50% before the BP drops.

As for the CT scan- we call them the 'donuts of death.' Unless the patient can be semi stablised, they hate doing CTs unless they have to because it's always far away from the operating room and if the patient goes down hill you are in deep ****e.

In Tom's case, they would have followed the clinical signs (raised pulse, increased respiratory rate, shut down peripherally and decreased urine output) and done an ultrasound, which would have shown free fluid in the abdomen and then sent him straight back to the operating theatre.

[VikingCat]

Wow! We've got some really educated supporters here!
Thanks for sharing your expertise, guys - I think a lot of people will be interested in what would've actually been happening in the body at that time. I certainly am.

[S "Thinks He's Daicos" J]

Haha SNAP!

[LifeSpan-Void]

As for the CT scan- we call them the 'donuts of death.' Unless the patient can be semi stablised, they hate doing CTs unless they have to because it's always far away from the operating room and if the patient goes down hill you are in deep ****e.

Never a pleasant experience having to call a code when they're on the CT table, tubed to a dodgy drager and ionotrope infusions left right and centre ;)

[fusion]

What i was suggesting was that doctors should of picked up the bleeding (internal bleeding for idiots like SJ and YOTC) through tests earlier.

That sounds logical, but as pointed out in the replies, it just isn't that easy. Saying they "should of" detected the blood loss implies that they had the opportunity to do so, but didn't. The reality is that it is very difficult to do so.

The body can compensate for some time, often without detectable changes, and then suddenly deteriorate.

I think it would have been better for the original question to have been "was it possible to detect the internal bleeding earlier?" - and then you wouldn't have been called an idiot by SJ/YOTC.

[Dale Chapman]

I was amazed he could even walk off let alone jog off......hopefully he gets well soon and nothing more serious happens :(

Same here, good on you Tom :thumbsu: