Question

Case study, Chapter 72, Emergency Nursing

1. A patient approximately 20 years of age

without identification presents to the trauma unit on a backboard with a cervical collar in place. The patient was ejected from the drivers side of the car. The patient was oriented x3 at the scene and able to move all extremities. The patient stated that he passed out and regained consciousness quickly. Within 5 minutes the patient became lethargic, had slurred speech and the right pupil was unequal and sluggish. Before becoming comatose the patient had complained of chest pain when he breathed, and there as an imprint of the steering wheel on his chest in the form of a bruise. As he breathed paradoxical chest movements were noted on the right side of the chest. The trachea is deviated to the right side. The trauma team, consisting of the trauma surgeon directing the team, two nurses and a resident, providing care. The initial vital signs were as follows: temperature 100 degrees F; blood pressure, 78/42mmHG; heart rate, 70bpm respiratory rate, 28 breaths/min, uneven rapid breathing with periods of apnea. The pulse oximetry reading is 85% on room air. Two large IV's are established and labs, including arterial blood gases, are obtained and sent to the lab for immediate processing. An indwelling urinary catheter is inserted and 300 mL of amber-colored urine without sediments is noted. An initial survey is completed to assess for obvious problems and steps are taken to prioritize the need of the patient and provide emergent treatment. ( Learning Objective 2)

a. What are the possible injuries to the patient according to the information presented in the initial presentation and what medical-surgical management is anticipated?

b. What are the priorities for care for this individual based on the information presented?

Answer 1

a)Clinical scenario states patient has uneven rapid breathing with periods of apnea ,Spo2 value of 85% indicates hypoxia. Tracheal deviation to the right side indicates tension pneumothorax results from increased intrathoracic pressure resulted from a rib fracture as patient chest shows an imprint of steering wheel. Hypoxia and Hypotension results from tension pneumothorax and brain stem injury .

b)Emergency intubation is done to maintain artificial ventilation. Tension pneumothorax secondary to rib fracture can be treated by splinting the area to prevent further collapse of alveoli. Emergency intercostal drainage tubes (ICD) can be done to relive intrathoracic pressure in the thoracic cage.

Open reduction internal fixation is done to repair fractured rib. Osmotic diuretics to treat traumatic brain injury. Emergency craniotomy to treat skull fractures and internal bleeding.