. Look at the EKG strip. What is her atrial excitation rate per minute? What is her ventricular
excitation rate per minute? Show your math. Relative to rest, is this high, low, or normal?
2. The physicians stabilized her using the standard Trauma procedure. Since her blood pH and oxygenation were low, they were concerned about metabolic issues. Why is she acidemic?
What was the sequence of events that led to this condition?
3. Physicians were also worried about her low blood oxygenation. In a healthy patient, how do low blood oxygen levels affect the local controls that regulate vasodilation/constriction? In Bobby Sue’s case, how does this affect her TPR?

Bobby Sue was ready for her second date. She was a little nervous because the first date went really well, and she was hoping that this might work out. After all, she was a junior at State University, and her mother kept reminding her that it was time to get that Mrs. degree. She was meeting Sam at the local cafe for dinner and then a movie. As Bobby Sue got into her car, she thought about how perfect her outfit was, and that she didnt want to wrinkle her dress with a seatbelt. It would only be about a mile away-no harm, right? Well The sound of crunching was overwhelming as the pick-up truck swerved into her lane-head-on collision. Then there was the smell of burning, and she felt like her legs were bent backwards as her knees were both broken. But the pain on her chest was crushing, She couldnt breathe. Sam saw the whole thing, and was able to keep calm enough to call 9-1-1. Bobby Sues blood made the road slippery when Sam ran over. He wiped out, but got up in time to talk to her and keep her calm while they waited for the ambulance. Luckily the ambulance came quickly, and Bobby Sue was brought to the ER where she was assessed for trauma. (More on this later.) Physicians were worried about a myocardial contusion or other myocardial damage, and ran an EKG. Below is an image of a 6 second strip. They checked her blood pH (7.11 ; low), blood oxygenation (86%, low), and body temperature (95.8 °F). The broken knees were wrapped, but surgery was put off until her metabolic condition was stabilized. After all, bones can be fixed later-cells are more difficult to replace. This is termed Damage Control in trauma: stabilize the patient, schedule major surgeries to repair massive injuries once the patient is stable. In exsanguinating hemorrhage, patients die from coagulopathy, hypothermia, and metabolic acidosis. The metabolic failure is often the terminal condition, and therefore must be dealt with immediately. (More on all of this later in the semester.)
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