Bobby Sue was brought to the ER where she was assessed fortrauma. Physicians were worried about a myocardial contusion orother myocardial damage, and ran an EKG. Below is an image of a 6second strip. They checked her systemic blood pH (7.11; low), bloodoxygenation (86%, low), and body temperature (95.8 oF). The brokenknees were wrapped, but surgery was put off until her metaboliccondition was stabilized. After all, bones can be fixed later—cellsare more difficult to replace. This is termed “Damage Control” intrauma: stabilize the patient, schedule major surgeries to repairmassive injuries once the patient is stable. In exsanguinatinghemorrhage, patients die from coagulopathy, hypothermia, andmetabolic acidosis. The metabolic failure is often the terminalcondition, and therefore must be dealt with immediately.

The ER physician diagnosed myocardial contusion. A first yearMedical student knew that this could cause A-fib, and could lead toblood clotting and stroke. He suggested that they give her heparin.In unison, the ER trauma team yelled “NO!”.

ï‚· Given her pH and body temperature what is her blood clottingstatus?

ï‚· How does heparin work to prevent blood clots?

ï‚· Why would you not give heparin to Bobby Sue?