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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
 
BMJ Case Rep. 2010; 2010: bcr0420102872.
Published online Oct 6, 2010. doi:  10.1136/bcr.04.2010.2872
PMCID: PMC3027800
Unusual presentation of more common disease/injury
Paradoxical bradycardia in a patient with haemorrhagic shock secondary to blunt abdominal trauma
Muhammad Sagheer Rana,1 Usman Khalid,2 and Simon Law3
1Department of Acute Medicine, Milton Keynes NHS Trust, Milton Keynes, UK
2Department of General Surgery, Milton Keynes NHS Trust, Milton Keynes, UK
3Department of Anaesthetics, Milton Keynes NHS Trust, Milton Keynes, UK
Correspondence to Muhammad Sagheer Rana, muhammad.rana/at/doctors.org.uk
Abstract
A 47-year-old woman, with no previous medical problems, presented to the Accident and Emergency department with left shoulder pain following a fall onto her left side from a horse. Physical examination was unremarkable and she was discharged with simple analgesia. However, 2 h later, she re-presented with worsening left shoulder pain, dizziness and mild epigastric discomfort. A new examination revealed blood pressure of 100/60 mm Hg, which dropped to 95/65 mm Hg on standing, a Glasgow Coma Scale score of 15 and pulse of 62 beats/min. She was resuscitated with 2 litres of Hartmann's fluid. A focused assessment with sonography for trauma (FAST) scan of her abdomen was negative. Then, 1 h later she experienced generalised abdominal pain and developed postural hypotension. However she remained bradycardic (heart rate 45–60 beats/min). Repeat examination revealed peritonitis. A further FAST scan showed free fluid in the left hypochondrium. A CT scan demonstrated a complex tear of the spleen, for which she underwent an emergency total splenectomy. Her postoperative recovery was uncomplicated.
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