Question

1. A patient presents to the critical care unit with a gunshot wound to the left lower anterior chest from a 0.45-caliber semiautomatic weapon. What additional prehospital information would be helpful? Considering the mechanism of injury and location of the entrance wound, describe the potential patterns of injury. What are the immediate management priorities? 2. After operative repair, this patient is admitted to the critical care unit. Describe the assessment and intervention priorities during the first postoperative hour. 3. Why is it necessary to administer platelets and fresh frozen plasma along with packed red blood cells in the patient who requires a massive blood transfusion (>10 units)? 4. What are the management priorities for a patient with a traumatic brain injury?

Answer 1

1. ANS: Penetrating trauma refers to an injury that occurs when an object pierces the skin and enters a tissue of the body, and creating wound. The penetrating object comes back out the way it entered, or may remain in the tissues, or pass through the tissues and exit from another area.

Pre-hospital information such as level of consciousness, blood pressure, pulse and heart rate, and respiratory rate of patient would be helpful. Considering penetrating trauma, pattern of injury is found to be medium velocity injury. The priority interventions at this time are evaluation of airway patency and adequate ventilation, providing optimal oxygenation, reestablishing an effective circulatory volume, and a stabilizing hemodynamic status.

2. ANS: Provides during first postoperative hour are initial assessment of airway, breathing, circulation, rhythm, pulse, vital sign, level consciousness, and pupil reactivity. Priorities of interventions are continuous monitoring of airway, breathing and circulation, stabilizing hemodynamic status, providing optimal oxygenation, and reestablishing an effective circulatory volume.

3. ANS: The blood in the body is made up of several components. White blood cells or leukocytes, which fight infection red blood cells, which carry oxygen; and platelets, which assist in the formation of blood clots. The straw-colored liquid pad of the blood is called plasma. Red blood cell transfusions are used to improve oxygen delivery to tissues. It s based on the patients clinical condition.

Fresh frozen plasma infusion s used for reversal of anticoagulant effects. Platelet transfusion is used to prevent hemorrhage in patients with thrombcocytopenia or platelet function defects. That s why both are given with red blood cell transfusion.