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You are working a night shift in the emergency department (ED) when the security staff yells...

You are working a night shift in the emergency department (ED) when the security staff yells for help at the ED entrance. As you grab a pair of gloves and race to the entrance you find a young adult white male lying on the pavement of the drive, unconscious and bleeding from his torso. He does not respond to verbal or painful stimuli but he has respirations of approximately 14 breaths/min and a weak and thready pulse of 120bpm. Two more staff members appear with a stretcher and a backboard and as the team log rolls the patient onto the backboard you see tears in his shirt where the bleeding is coming from. The patient is taken into the emergency department into a trauma bay where trauma assessments and interventions are employed. Upon examination you find that the patient has a blue discoloration with an abrasion to the left forehead above the left eye. It measures 5cm x 3cm. Swelling and a 3cm x 1cm abrasion is noted to the bridge of the nose with epistaxis. Three torso wounds are noted that line up with the tears in the shirt. He is bleeding heavily from the largest…it appears with smooth edges and appears deep. A constant ooze of blood is flowing. It is found on the right lateral chest mid axillary line at the 4th rib 3cm x 2cm x 5cm deep. A 3cm x 2cm x 2cm wound is found at the mid clavicular line, 2nd rib above nipple on the right side. A linear cut is noted lateral to the right nipple 4cm x 2cm x 1/2cm deep. Bleeding is controlled by provider and a metal fragment pulled from the wound. A large amount of dried blood covers the patient’s torso. The palm of the right hand has two linear cuts that are parallel and 4cm x 2cm and 4 1/2cm x 2cm. The patient is taken to surgery and planned to transfer to the ICU. No information has accompanied this patient other than another ED patient stating that as they were walking in they saw a dark car open the passenger door and the patient fell out.

1. During the life-saving interventions on the patient such as IV insertion, intubation, central line placement, or chest tube insertion what forensic considerations can the nurse take to preserve evidence? Consider the location of injuries.

2. Provide head-to-toe documentation in narrative form.

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Answer #1

1)Some of the forensic consideration a nurse can take to preserve evidence are

  • Proper documentation
  • Proper handover of the metal fragments to the forensic department
  • Not disclosing the patient status or condition to strangers or unknown person without proper identification
  • Upon considering the location of injury it seems that the victim has been forcefully attacked with sharp items,injury on his hand reveals he has tried to ensave him by restricting

2)Head to toe documentation

  • Head: cyanosed abrasion on forehead (left side above eye) (meaduring5cm×3cm)
  • Nose:Epistaxis, abrasion at bridge of nose(measuring 3cm×1cm)
  • Chest:Rt lateral mid axillary midline at 4th rib (3cm×2cm×5cm)
  • Mid clavicular line: 2nd rib above nipple of the chest ,right, (3cm×2cm×2cm)
  • Right nipple:lateral side (4cm×2cm×1/2cm)
  • Right hand:linear cut on palm (4cm×2cm,4 1/2cm×2cm)
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