• Leila Costa Volpon, Evora Paulo Roberto Barbosa PRB Department of Surgery, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil., Gisele Douradinho Teixeira, Maurício Godinho, Sandro Scarpelini, Fabio Carmona, and Carlotti Ana Paula de Carvalho Panzeri APCP Department of Pediatrics, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil..
• Department of Pediatrics, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil.
• J Emerg Med. 2018 Oct 1; 55 (4): 553-558.

BackgroundMethylene blue (MB) has been advocated for the treatment of shock refractory to standard measures. MB is proposed to increase blood pressure in shock by interfering with guanylate cyclase and nitric oxide synthase (NOS) activity. Several studies have evaluated the vasoconstrictive and positive inotropic effects of MB in septic shock patients. However, there is a paucity of studies involving trauma patients.Case ReportA 4-year-old boy was hit by a truck while riding his bicycle and was treated with fluid resuscitation at the emergency department and then taken to the operating room for damage-control surgery. He had liver, diaphragm, rectal, and thoracic injuries. At the pediatric intensive care unit (PICU), he remained hypotensive despite volume, dopamine, epinephrine, and norepinephrine infusion. A dose of 0.5 mg/kg of i.v. MB was administered. During the next 2 h after MB administration, we were able to wean him off norepinephrine, and doses of epinephrine and dopamine were reduced. Ultimately, he was discharged from the PICU 13 days later in good condition. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trauma patients who have experienced bleeding and survived the initial insult are still at risk of dying from continuing systemic hypoperfusion and the resultant multiple organ dysfunctions. Use of a low dose of MB as an adjuvant to treat shock might improve survival of these patients.Copyright © 2018 Elsevier Inc. All rights reserved.

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