Tom Medical History Case Study

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 spontaneousTrachea 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 copyrightpace 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 confirmInjury

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 surveyRise 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

1. Optimisation of oxygenation, how and why escalation oxygen from NP- to NRB- to HFNP- to NIV- to ETT

2. Pelvic binder(what role , haemorrhage control , pain , relief fracture stabilization)

3. How assess pain ( pain scales )( Wong baker,Mild /mod servers

4. What pain techniques ( RLAT, PCA,SR opioids)

5. Role of Intraosseous IVaccess

6. How we deal with spinal immobilisation (c-collar/MiamiJ)

7. Role of documentation

8. Role professional care