A 41-year-old male client is status post VA, motor vehicle (crashed) accident, and was brought to the Emergency Department transported by the ambulance EMS. EMS provides the following report: Arrived on scene to witness 2 vehicle collision. Patient’s car appears to have struck the other car from behind at around 1 pm on October 13, 2020. The patient was found in the driver’s seat without seat belt engaged, and with positive alcohol breath. The patient’s eyes were open and he was responsive to the team. He was mumbling incomprehensible words when questioned and following commands in all four extremities. Visible contusions on front of forehead where it likely strucked the steering wheel. The patient was removed from the vehicle and placed in the ambulance. Initial vitals HR 114, BP 134/90, RR 24, SpO2 88% on room air. Patient was placed on nasal cannula. Patient became less responsive on route to hospital and SpO2 continued to fall, patient was placed on non-rebreather mask and SpO2 stabilized at 94%. Blood glucose 110. Patient only opening eyes to repeated stimulation and intermittently following commands. Arrived at the Emergency department for continuity of care. Emergency Room In the hospital, he was attached to cardiac monitoring with continuous pulse oximetry and a full set of vital signs is taken. 12-lead electrocardiogram and lab work are quickly obtained. Then, nurses performs their head-to-toe assessment of the patient, including a full neurologic examination. Physical Exam is performed with the following pertinent findings: Head: Hematoma on forehead without laceration; no drainage noted Neck: Unable to state pain, no grimace to palpation; no overt signs of trauma Cardiac: Irregular rhythm with no extra heart sounds; 1+ pulses, brisk capillary refill Pulmonary/Thorax: Fine crackles at bilateral bases; increased work of breathing GI: soft, non-tender, not distended abdomen; active bowel sounds throughout GU: no signs of trauma; no discharge or lesion present Integumentary: Scattered ecchymosis on limbs and trunk; no open wounds Neurologic: Eyes open to noxious stimuli, no verbal response, withdraws to pain in upper extremities and flexes to pain in lower extremities CN: Pupils equal and brisk, corneal reflex and VOR intact, grimace to pain equal bilaterally, gag intact Motor: withdraws to pain in upper/lower extremities Sensory: Responds to painful stimuli in all four extremities Cerebellar: Patient unable to cooperate with exam Reflexes: normal reflexes in all four extremities Due to the patient’s decreased level of consciousness, the patient is unable to participate in some aspects of the exam, so it is modified to still obtain as much information as possible. Subjective history is limited at this time due to the patient’s mental status. When family arrives, they state he was a former half pack per day smoker who quit 5 years ago. He was an occasional alcohol drinker but without use of recreational drugs. No previous hospitalization for 2 years and not on any medications. No known food and drug allergy. Vitals Signs The patient is on non- rebreather mask and the vital parameters are: Temperature- 37.7 degree centigrade Heart rate - 128 beats/ minute Respiratory rate - 25 breaths/ minute Blood pressure - 100/60 mmHg And saturation - 92% The initial survey reveals a patent airway with no evidence of current obstruction. Breathing is tachypneic and regular, with accessory muscle use indicating increased effort. Circulation characterized by tachycardia and mild hypotension. There are 1+ distal pulses bilaterally, and the skin is warm and dry. At the ER, an ECG reveals sinus tachycardia of 129, which resolves without any prior medical management. Sinus at 98 beats per minute. Identify the life-threatening injuries of the patient using the ABC prioritization. Why?
A 41-year-old male client is status post VA, motor vehicle (crashed) accident, and was brought to the Emergency Department transported by the ambulance EMS.
EMS provides the following report:
Arrived on scene to witness 2 vehicle collision. Patient’s car appears to have struck the other car from behind at around 1 pm on October 13, 2020. The patient was found in the driver’s seat without seat belt engaged, and with positive alcohol breath. The patient’s eyes were open and he was responsive to the team. He was mumbling incomprehensible words when questioned and following commands in all four extremities. Visible contusions on front of forehead where it likely strucked the steering wheel. The patient was removed from the vehicle and placed in the ambulance. Initial vitals HR 114, BP 134/90, RR 24, SpO2 88% on room air. Patient was placed on nasal cannula. Patient became less responsive on route to hospital and SpO2 continued to fall, patient was placed on non-rebreather mask and SpO2 stabilized at 94%. Blood glucose 110. Patient only opening eyes to repeated stimulation and intermittently following commands. Arrived at the Emergency department for continuity of care.
Emergency Room
In the hospital, he was attached to cardiac monitoring with continuous pulse oximetry and a full set of vital signs is taken. 12-lead electrocardiogram and lab work are quickly obtained. Then, nurses performs their head-to-toe assessment of the patient, including a full neurologic examination.
Physical Exam is performed with the following pertinent findings:
- Head: Hematoma on forehead without laceration; no drainage noted
- Neck: Unable to state pain, no grimace to palpation; no overt signs of trauma
- Cardiac: Irregular rhythm with no extra heart sounds; 1+ pulses, brisk capillary refill
- Pulmonary/Thorax: Fine crackles at bilateral bases; increased work of breathing
- GI: soft, non-tender, not distended abdomen; active bowel sounds throughout
- GU: no signs of trauma; no discharge or lesion present
- Integumentary: Scattered ecchymosis on limbs and trunk; no open wounds
- Neurologic: Eyes open to noxious stimuli, no verbal response, withdraws to pain in upper extremities and flexes to pain in lower extremities
- CN: Pupils equal and brisk, corneal reflex and VOR intact, grimace to pain equal bilaterally, gag intact
- Motor: withdraws to pain in upper/lower extremities
- Sensory: Responds to painful stimuli in all four extremities
- Cerebellar: Patient unable to cooperate with exam
- Reflexes: normal reflexes in all four extremities
Due to the patient’s decreased level of consciousness, the patient is unable to participate in some aspects of the exam, so it is modified to still obtain as much information as possible. Subjective history is limited at this time due to the patient’s mental status. When family arrives, they state he was a former half pack per day smoker who quit 5 years ago. He was an occasional alcohol drinker but without use of recreational drugs. No previous hospitalization for 2 years and not on any medications. No known food and drug allergy.
Vitals Signs
The patient is on non- rebreather mask and the vital parameters are:
Temperature- 37.7 degree centigrade
Heart rate - 128 beats/ minute
Respiratory rate - 25 breaths/ minute
Blood pressure - 100/60 mmHg
And saturation - 92%
The initial survey reveals a patent airway with no evidence of current obstruction. Breathing is tachypneic and regular, with accessory muscle use indicating increased effort. Circulation characterized by tachycardia and mild hypotension. There are 1+ distal pulses bilaterally, and the skin is warm and dry. At the ER, an ECG reveals sinus tachycardia of 129, which resolves without any prior medical management. Sinus at 98 beats per minute.
Identify the life-threatening injuries of the patient using the ABC prioritization. Why?
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