Tom Medical History Case Study
- Country :
Australia
Tom 80-year-old High-speed MVA (100km/h) he was driving his wife with him in the car Multiple bloods strained vomits with paramedics Amnesic post-event (after an accident) Vitals on ED arrival/ RR20, HR101, Bp150/58, O2 98% with 4 L/ nasal prong GSC 15 Primary/secondary surveys Had primary survey his airway is patent C collar ( cervical neck injury) , warm. sturur result from mechanism of injury, blood in both his nose Breathing spontaneous Trachea was midlineAuscultation, fine wheezes left and right which reduce air and entry basally.
Circulation, he was worm, sound shill GCS 14(slightly confused)
Secondary survey
Head: he has blood in both nose
Neck: deep copyright pace of neck
Set belt signs
Chest: no abnormality detected
Abdo: no distention pain in power patient
Pelvic: obvious seat belt operation
Rt arm deformity
No deformity or injury in legs
T1 log roll
PMHx- IHD, hypercholesterolaemia, HTN, Previous prostate Ca.
Lives with wife, No EPOA (actively declined) Unknown medication
INVESTIGATION
CXR, clean, No abnormity detected
PXR, Open book pelvic
Undisplaced Iliac wing #
Displaced R iliac wing #
INVESTIGATION
CXR, clean, No abnormity detected
PXR, Open book pelvic
Undisplaced Iliac wing #
Displaced R iliac wing #
CTB, no haemorrhage
CT C- spine /C5, C6 # vertebral body
CT chest no abnormality detected
CT abdo . max entry extend and contusion
CT pelvis just confirm Injury
Open book pelvic #
2-Undisplaced Liliac wing #
3-Displaced R illac wing #
4-C5 C6 vertbral body # Osteophyte, (CT spine)
5- Radius/Ulnar #
Questions
- What some patient care plan for this case
- How nurse manage pain
- What some nursing education for this case
IVY 93-year-old passenger ( her daughter was driving his car) 60 km/hr head-on collision On arrival to ED RR 32, HR95, Bp 90/ 65, spo2 82% RA, T35,5 GCS14 Pas medical history: HTN, Hyperthyroidism., L TKR, sigmoid Adenocarcinoma, cataracts, osteoporosis Lives alone , in depended with iADLS Primary survey / secondary survey Patent Airway Spontaneously breathing Midline trachea Decreased air on right side chest while prozing.
Circulation: hypotensive, heart sound dull soft non-tender
Disability: GCS 14 pupil equal reactive she was confused
Secondary survey Rise chest the pain
Thoracic pain on hand swelling
Right knee pain
Intervention
eFAST
CXR, PXR, plain film R humorous , Knee, ankle
Fluid resus one unit -PRBC ( remember this lady hand swelling with fracture) role of intraosseous
ECG
Injuries
Right flail chest segment ribs 2-9
Left 2 nd rib#
Significant right pulmonary contusions
Small hemopericardium
Small left pneumothorax
C2 – C5 spinous process # s
T1, T11#s
L1, L3#s
Displaced left 1st- 5th metacarpal #s
Right 2nd – 5th metacarpal #s
Right patella #
Think about interm body destem
She got Significant thoracic spinal injury both hand and her right leg
Treated in ED then moved to ward
Becomes drowsy – MEWS 3(hypotension, tachypnoea febrile)
Respirtory source likely – RAP
Becomes confused- displays inappropriate behaviour
Was diagnosed with E Delirium
Issue to consider
Complexity of care ( multiple body systems simultaneously injured)
Thoracic injury
Respiratory assessment
Optimising oxygenation – HFNP
Allied health roles
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Optimisation of oxygenation, how and why escalation oxygen from NP- to NRB- to HFNP- to NIV- to ETT
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Pelvic binder(what role , haemorrhage control , pain , relief fracture stabilization)
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How assess pain ( pain scales )( Wong baker,Mild /mod servers
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What pain techniques ( RLAT, PCA,SR opioids)
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Role of Intraosseous IVaccess
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How we deal with spinal immobilisation (c-collar/MiamiJ)
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Role of documentation
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Role professional care
