CLINICAL CASES FOR THE EXAM 6 Trauma PROBLEM 28 A 19 year old man is brought into the emergency department following a motorcycle accident in which he was thrown 20 feet. Vital signs on admission to the emergency room are blood pressure 90/60, pulse 140, respirations 24 and noisy. He is unconscious, has a bruise over his forehead, there is fresh blood flowing from a laceration in his right groin, and his left leg is twisted in a deformed angle. Study Questions: 1. What is the priority of steps for the initial evaluation and resuscitation of this patient? 2. What are the methods of securing control of the airway, particularly with facial and head trauma. 3. Which type of intravenous fluid should be administered initially in this patient and in what quantities? What would be the indications for giving blood transfusions? 4. What type(s) of shock could be present? How are the different types differentiated? Which is most likely? PROBLEM 29 A 26 year old man sustained a stab wound to the left chest just below the mid-clavicle. His blood pressure is 70/50. He is cyanotic. His neck veins are markedly distended, and there is minimal external bleeding. Study Questions: 1. What life-threatening injuries might account for this patients condition? 2. How would one differentiate among the injuries listed in 1? 3. How should each of these possible injuries be managed emergently? 4. If an intercostal drainage tube yielded blood from the pleural cavity, what guidelines would indicate the need for a thoracotomy? PROBLEM 30 A 45 year old woman who was wearing a lap seat belt is involved in a head-on automobile collision. She is awake and complains of abdominal pain. She is slightly pale and has a blood pressure of 110/80. There is a bruise across her upper abdomen, with slight guarding and moderate tenderness to palpation. Study Questions: 1. What are the two diagnostic tests that would be most often used to assess this patient for significant intra-abdominal injury? 2. Describe how the above tests are performed and discuss the criteria that would indicate that a laparotomy should be performed. PROBLEM 31 A 16 year old boy falls from a tree and lands on his head. He is found unconscious at the scene with vital signs of blood pressure 120/80, pulse 90, and spontaneous respirations at 16. In the emergency room his vital signs are the same, but he is mumbling incoherently and there is an enlarging hematoma on his forehead. He does not respond to verbal stimuli. He opens his eyes to painful stimuli and has a flexion response in both upper extremities. There are no other apparent injuries on physical examination, and there are no focal neurological signs. Study Questions: 1. Describe how one would protect the cervical spine during the performance of resuscitation. How would one rule out a cervical spine injury? 2. What is the Glasgow Coma Scale? What is this patients score? 3. How would one maximize perfusion of the brain and minimize cerebral edema during the initial assessment and stabilization of this patient? How can one best assess this patient for intracranial injury which would require surgical intervention? Burns
Posted on: Tue, 25 Nov 2014 11:50:52 +0000
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