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

2. 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= , RR= 15 Receiving oxygen 100% NRB Video: 2b

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

4. 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

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

6. 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

7. 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

8. Video 2

9. 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

10. This patient does not meet Level One Criteria.
True
False

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

12. What is wrong with this CXR?

13. 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

14. 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”

15. Video 3A

16. 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

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

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

19. 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

20. 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

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

22. 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

23. 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

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

25. Video 4