J.A., a 19-year-old, unrestrained driver, was involved in a motor vehicle incident on I-90. He arrived in the Emergency Department in full spinal immobilization and a hard-cervical collar. His Glasgow Coma Scale was 15 (normal). His blood pressure is 94/60, pulse 128, respirations 30. His respirations are shallow and chest excursion is paradoxical. The left side of J.A.’s chest moves inward during inspiration and outward during expiration. Breath sounds are diminished throughout the chest. Crepitus is found on palpation. J.A. complains of dyspnea and chest pain and demands to remove his cervical collar. 1. What is the most likely cause of J.A.’s paradoxical respirations? 2. What general assessment and diagnostic procedures should be performed immediately? 3. What is the concerns related to the cervical collar removal?
GENERAL ASSESSMENT AND DIAGNOSTIC PROCEDURES :
DIAGNOSTIC PROCEDURE:
1. X-RAY - should be done immediately in order to see for any thoracic fracture specifically.
2. CT scan should be done in order to check for internal bleeding and injury.
3. MRI
GENERAL ASSESSMENT:
1. Vitals signs should be checked
2. Assess neurological condition.
3. Assess pain scale score and its intensity.
4. Assess for internal bleeding.
CONCERNS RELATED TO CERVICAL COLLAR REMOVAL :
We should be very careful while removing the cervical collar as mishandling it can lead an injury near the cervical region which can also lead to cervical injury.
J.A., a 19-year-old, unrestrained driver, was involved in a motor vehicle incident on I-90. He arrived...
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