Question

In Habersham County, Tom was feeling slightly nervous as he exited the staff lounge

and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff , wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

After his lunch break, Tom didn’t have long to wait before the paramedics burst in through the swinging double-doors of the ambulance bay wheeling in a young man on a gurney. Edward, a veteran EMT, recited the vital signs to Tom and Dr. Greene as they helped push the gurney into the trauma room, “A 18-year-old male, GSW to the right abdomen, heart rate 92, respiratory rate 22, blood pressure 95/65 no loss of consciousness.” A gunshot wound! Tom knew that gunshot wounds were sometimes the most difficult traumas to handle.

Once inside the trauma room, Dr. Greene began his initial assessment of the patient while Tom got busy organizing the things he knew would be needed. He attached a pulse-ox monitor to the patient’s index finger so Dr. Greene could keep an eye on the O2 levels in the patient’s blood and he inserted a Foley catheter so the patient’s urine output could be monitored.

After finishing his initial duties, Tom heard Dr. Greene saying, “It looks like the bullet missed the liver and kidney, but it may have severed an artery. That’s probably why his BP is a bit low. Tom, grab a liter of saline and start a fast IV drip … we need to increase his blood volume.” Tom grabbed one of the fluid-filled bags from the nearby shelf, attached a 12-gauge IV needle to the plastic tubing, and gently slipped the needle into

the patient’s antecubital vein. He then hung the plastic bag on the IV stand and let the fluid quickly start to flow down the tubing and into the patient’s vein.

The reaction was quick and violent. The patient’s heart rate began to skyrocket and Tom heard Dr. Greene shouting, “His O2 saturation is falling! Pulse is quickening! What is going on with this guy?!” Tom stood frozen in place by the fear. He heard Dr. Greene continuing, “Flatline! We’ve lost a pulse … Tom, get the crash cart, we need to shock this guy to get his heart going again!” Tom broke free from his initial shock and did as Dr. Greene had ordered. He then started CPR as Dr. Greene readied the cardiac defibrillator to shock the patient. They continued to alternate between CPR and defibrillation for almost an hour, but to no avail. As Dr. Greene announced the time of death, Tom felt a sickening feeling in the pit of his stomach. He couldn’t believe that he had lost his first trauma patient!

Then Tom noticed that the fluid in the Foley catheter bag was bright red. “Dr. Greene, there’s hemoglobin in the Foley bag,” he said. “How could that be?” responded Dr.

Questions

1)      After Tom made his error, is there anything that could have been done to save the patient’s life?

2) The solute concentration in blood is equivalent to 0.9% NaCl.

Several drops of blood were added to three different solutions: 0.09% NaCl, 0.9% NaCl and 9% NaCl. What would happen to the cells dipped in three different solutions?

Answer 1

For question 1

From what they say your questions i can see what this is about. For the first answer, the only thing Tom could have done to save his life would have been to remove the solution that he put in. If he gave him distilled water (or some other hypotonic solution as injetctable water), this creates hypotonic conditions that cause the cells to explode. In theory to give the patient a hypertonic solution until the amount of solutes is corrected in the patient (who returns to isotonic conditions) could save his life, but in reality it is much more difficult.

For question 2

In hypotonic solutions (0.09%) the cells swell and depending on whether or not they can withstand the osmotic stress they end up breaking, the amount of solutes inside the cell is higher so the water tends to enter the cell to try "solubilize" that excess of soultos.
In isotonic (0.9%) conditions there is no apparent water movement there is the same amount of solutes both inside and outside the cell.
In hypertonic (9%) conditions the water of the cells leaves to try to "solubilize" the excess of solutes that exist in the external environment.
This I exemplify better with the following drawing: