Case Studies Shelley Atkinson, MSN, ANP-BC, ACNP-BC Trauma Resuscitation Case Studies Shelley Atkinson, MSN, ANP-BC, ACNP-BC

Case Study #1 20 year old male, unrestrained driver, in a motor vehicle that collides into a large tree. +LOC at the scene and unresponsive. Starred windshield. Life flight transported to VUMC. VS: 120/70 mm Hg, HR= 110-115, RR= 15 Receiving oxygen 100% NRB Video: 2b

What is the number one priority during the initial assessment of this trauma patient? Airway Breathing Circulation Disability

What Level One Criteria does the patient meet? GCS < or = 8 Head injury with LOC > 5 min Moderate to severe respiratory distress All the above

The patient’s need for airway protection and ventilation is due to unconsciousness. True False

Which two steps listed below are early steps in the RSI procedure? Pre-oxygenate with 80% oxygen & apply cricoid pressure perform chin lift/jaw thrust to open airway& pre-oxygenate with 100% oxygen C. Administer a paralytic & ventilate

How do I know the ETT is in the correct position? Presence of CO2 in the end tidal CO2 detector only? Equal breath sounds bilaterally and gurgling in the epigastrium C. Presence of CO2, equal bilateral breath sounds and CXR

Video 2 http://vimeo.com/9656036

Case Study #2 20 year old male assaulted. GSW to right chest and left lower extremity. Patient is c/o chest pain, SOB, and left lower extremity pain HR= 110; BP=120; RR = 30; SaO2= 90% on 100 % NRB; No BS on Right Video 3a

This patient does not meet Level One Criteria. True False

What trauma imaging is needed for this patient? CXR only CT of the chest CXR, CT chest/abd/pelvis, Left femur XR Head CT

What is wrong with this CXR?

What do you think is wrong with this patient based on the CXR provided? Labored breathing due to pain Spleen laceration C. Pneumothorax D. Hemothorax

What should be assessed in the secondary survey? Pulses of right leg only Roll the patient for posterior check C. Roll patient over (posterior check) and assess pulses (Fem, DP,PT) D. Secondary survey excluded because the patient states, “I am fine”

Video 3A http://vimeo.com/9656241

Case Study #3 18-20 year old male unrestrained passenger. Car hit a bridge. Driver DOA. Reported by EMS, “Initially awake, not acting right”. Gradually more confused & verbally uncooperative. 2L NS in air craft. BP=110 and decreasing. HR=120. RSI per life flight. Video: Case 4

What signs/symptoms are the patient exhibiting that he needs resuscitation? Decreased mentation Increasing HR and decreasing BP C. Both

The patient has increasing HR =130s BP= 84P What stage of shock is the patient in?

The patient was given 2L of NS during his flight and was unresponsive to this. What is the next step? BP 84P HR=130 Order a 3rd liter of crystalloid Order 2 U PRBCs C. Do nothing D. Give 4 FFP

What trauma imaging is needed at this time What trauma imaging is needed at this time? Secondary survey noted left lower abdominal ecchymosis CXR CT chest/abd/pelvis FAST exam A and B only

A FAST exam (focused assessment sonography)is used to rapidly identify hemorrhage or potential hollow viscous injury True False

FAST study positive for a large amount of fluid in the abd FAST study positive for a large amount of fluid in the abd. What intervention is needed for the patient at this time? Go to the operating room Activate the trauma exsanguination protocol Go immediately to CT scan Both A and B

What is the trauma exsanguination protocol or Massive transfusion protocol? 2 L crystalloid 2 U PRBC 2 L crystalloid and 2 U PRBC 6 U PRBC, 4 U FFP, 1 pack plts

If the patient arrived hemodynamically stable, the patient would have went to the CT scan. This may be what you would find.

Video 4 http://vimeo.com/9656503