Question

Case Study: The Trauma Patient

The patient is a 37-year-old man who was the driver in a high-speed motor vehicle crash. EMS reports that his vehicle was struck on the driver’s side by a truck and the victim had to be extracted using the “jaws of life.” The patient was wearing a seatbelt, and he was unconscious when EMS arrived, but he has intermittently aroused reporting extreme pain in the chest and pelvis area. He arrives secured to a backboard with a C-collar in place. His breathing is uneven and becomes increasingly more labored as he is transferred to the ED stretcher. Vital signs are respirations 35/min; pulse 125/min; and blood pressure 86/40 mm Hg; cardiac monitor shows sinus tachycardia. The resuscitation team includes an ED health care provider, primary nurse, secondary nurse, respiratory therapist, and a UAP.

1. During the primary survey, what is the highest priority intervention?

2. When assessing breathing during the primary survey, what is included in this assessment?

3. Discuss interventions that accompany the ABCDE of the primary survey. Discuss with a classmate several ways that assessment, interventions, and responsibilities could be divided between the primary and secondary nurse. (Use your critical thinking skills and discuss your answer with your instructor.)

4. What duties would be appropriate to delegate to the UAP?

5. What is the purpose of the secondary survey?

6. Why is the mechanism of injury (MOI) important in trauma cases? In the scenario above,speculate about the relationship of the mechanism of injury and the EMS report on the patient’s complaints and injuries.

8. Using the concept of gas exchange, explain why the patient is likely to have a nasogastric tube. Using the concept of tissue perfusion, explain why a Foley catheter would be used for a patient with severe trauma.

Answer 1

1. In first priority should check with adequate aieways(ABDCDE). It involved in clearing the mouth, inserting an oral airway, assisting with intubation, oxygen therapy and assessing continually the patient's respiratory system. Check and monitor the patient's vital signs, administer intravenous fluids appropriately along with medications, insert foley catheters and note urinary output. Simultaneously, the nurse constantly observes the patient's level of consciousness and neurological status. Document all the information correctly.

2. Assessment includes -

• Respiratory Rate(12-20 beats per mts but in this case it is 35/mts),
• Chest wall movement(Normally, a 2-5" of chest expansion can be observed),
• Chest percussion,
• Lung auscultation,
• Pulse oximetry(97%-100%)

3. In ABCDE assessment stands for Airways, Breathing, Circulation, Disability and Exposure.

Airway assessment includes to check voice and breathsound of the patient. If any difficulty found should follow with head tilt and chin lift position, Oxigen and suction.

Breathing assessment includes Respiratory Rate(12-20 beats per mts but in this case it is 35/mts), Chest wall movement(Normally, a 2-5" of chest expansion can be observed), Chest percussion, Lung auscultation, Pulse oximetry(97%-100%) and can be improved patient condition through following treatment seat comfortably , rescue breath, Bag mask ventilation, and Decompress tension.

Circulation assessment includes skin color, sweating, capilory refill time, palpate pulse rate, heart auscultation, BP and ECG monitoring and the patient is facing with low BP and it should treat with as per doctors prescription, and other treatment include stop bleeding, elevate legs, IV access and infuise saline.

Disability assessment includes Level of consciousness( Alert, Voice responsive, pain responsive, unresponsive), Limb movements, Pupilary light reflexes, and Blood glucose. Here the patient face problem with pain and the treat with pain management and other treatment includes clear Airway, Breathing and Circulation problem , recovery position and glucose for hypoglycemia.

Exposure assessed through the expose skin and temperature and treat accordingly.

Primary Nurse should focus on ABCDE and Secondory Nurse should assist Primary Nurse and advice any corrective action required on time.

4. Duties can deligate to UAP can be Check Vital signs of the patient, wound cleanup etc

5. It will helps to take corrective action and determine the patient condition and also helpfull to confirm the nursing Diagnosis.