Trauma and Bleeding Chief Complaint: 31 year-old Afrian American male injured whilerok-climbing History of Present Ilness: This 31-year-old male was rock-climbing with two friends at a national park 14 miles away from the nearest hospital when he suddenly lost his footing and slid 18 feet to the ground. Both friends who witnessed the fall said that he slid against sharp rock all of the way down, landing almost in a standing-up position, finally slumping to the ground. They also said that his head was not jarred during the slide. The man was alert and oriented when his friends reached him, and could move all four extremities quite easily. He had multiple scrapes over his anterior torso and a larg gash over his right anterior upper thigh (near the groin) which was bleeding profusely. makeshift tourniquet slowed the bleeding. The party was able to rad io to the park rangers station for help. The ranger, in turn, contacted the “med-evac” unit at the city hospital. The helicopter located and evacuated each arm in-fligh the man. A large-bore IV was placed in t, and normal saline fluid was administered intravenously. The patient became increasingly disoriented during the flight, reaching the emergency room a 40 minutes after the fall. Past Medical History: According to the man’s friends, the patient was in good health prior to the accident, with no history of allergies, anemia, bleeding disorders, or diabetes mellitus. Family History: Family history was not attainable. The patient’s family lived in another state and could not be contacted. Physical Examination: The patient was lethargic but responsive to shouting and sternal pinch. He had multiple abrasions over his chin, neck, anterior thorax, and abdomen. A six-inch-long, half-inch deep laceration was noted in the right inguinal region, extending into the right, upper thigh. The tourniquet placed in this area was soaked with blood. Height 6′ 2″, weight 205 lbs. Vital signs were as follows: HR 112 (supine) and 128 (sitting), BP 108/ 60 (supine) and 92 /52 (sitting), RR 32, rectal temp 99.4°F. Skin was cold and clammy, and nail beds, palms, and mucous membranes were pale. Carotid, radial, left femoral, and dorsalis pedis pulses were al weak and thready. Cranial nerves, to the extent that they could be tested, were intact bilaterally. Pupils were equal, regular, and reactive to light. External jugular venous collapse point was not visible in either the sitting or recumbent position. Heart sounds were regular, tachycardic, with no murmur, Ss or S4 sounds. Lungs were clear to percussion and auscultation. Abdominal guarding was noted, attributable to multiple lacerations; no masses were felt. Blood was drawn, typed, and crossed. A urethral catheter was placed to monitor urinary output, and another catheter was placed into the right subclavian vein and threaded into the superior vena cava to monitor central venous pressure. A cardiovascular surgeon was consulted for repair of the lacerated right femoral artery.
Laboratory studies of the venous blood revealed the following: Blood Type A+ Diferwhite biood cell (WBC) count-7,400 WBCs /mm(normal 4,000 to 11,000) Differential WBC count revealed 59% neutrophils Hematocrit-46% Hemoglobin -15.0 gm/di Sodium (Na-138 mEq/L Potassium (K) = 5.1 mEq / L Chloride (C)- 104 mEq/L BUN 27 mg / d Creatinine 1.9 mg /dl Glucose 165 mg /d SGPT 41 IU / L SGOT 48 IU/L normal-55-70%) normal 42-54%) (normal 14-18 gm /d) (normal 136-145 mEq/L) normal-3.5-5.1 mEq/) normal-96-106 mEq / L) normal 6-23 mg / d) (normal = 07-15mg/dl) normal-70-160 mg /dl) (normal 0-33 I0/L) Knormal 041 IU/L) Laboratory studies of the arterial blood revealed the following: Blood pH -7.28 pCO2 31 mm Hg p02-78 mm Hg Hemoglobin-O2-saturation-88% (normal = 94-100%) HCO3] 14 mEq / L (normal 7.35-7.45) (normal = 40 mm Hg) (normal= 90-100 mmHg) (normal 22-26 mEq/L Urinary output in first 60 minutes in ER was 20 ml (color was dark yellow). Urine specific gravity1.029 (normal -1.003-1.030). Central venous pressure ranged from 1 to 3 cm H20 throughout the cardiac cycle (normal range 5.5 to 13 cm H20) ECG revealed normal sinus rhythm with slight ST-depression in most leads. As soon as whole blood became available, 2 units were rapidly transfused into this patient.
9. If the hematocrit was in the normal range, why was the patient given 2 units of whole blood? 10. If this patient were stabilized, how would his hematocrit change over the next 24 hours? 11. Why was whole blood (rather than packed RBCs) given to this patient? 12. Physicians attending to this patient debated ordering an abdominal CT scan, but decided ultimately against it. Why might they have ordered one?
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https://nursingpaperspros.com/wp-content/uploads/2020/05/logo-nursing--300x60.png00Hectorhttps://nursingpaperspros.com/wp-content/uploads/2020/05/logo-nursing--300x60.pngHector2020-06-07 19:19:172020-06-07 19:19:17Physicians attending to this patient debated ordering an abdominal CT scan, but decided ultimately against it. Why might they have ordered one?
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