Abdominal Trauma Case Study- MR. LancasterMr. Lancaster is a 35-year-old client who was involved in a motor vehicle accident. Mr.
Lancaster was wearing a seat belt and driving at a high rate of speed when he lost control of the
car and hit an abutment. He was initially awake at the scene, but his...
Mr. Lancaster is a 35-year-old client who was involved in a motor vehicle accident. Mr.
Lancaster was wearing a seat belt and driving at a high rate of speed when he lost control of the
car and hit an abutment. He was initially awake at the scene, but his level of consciousness
declined while in transport to the hospital. Upon arrival to the emergency department he was
already intubated orally with a # 8.0 endotracheal tube at 22 cm depth at the teeth, had bilateral
18 gauge IVs in his forearms, and had received 2 liters of normal saline due to hypotension.
Mr. Lancaster’s medical history was noncontributory. His family history was negative for heart
disease, diabetes, or cancer. He has a 15-pack-year history of smoking and drinks socially.
Upon arrival at the hospital, Mr. Lancaster was on a backboard with a cervical collar. His vital
signs were the following after fluid resuscitation:
BP 110/80 mm Hg
HR 113 beats/min
Temp 97.0 oF
RR 24
SpO2 95% (on 100% FiO2)
His pupils were 3 cm, equal, and reacted briskly to light. He was able to move all four
extremities spontaneously, but orientation to time, person, and place was difficult to assess
because he had been sedated. The tympanic membranes were clear, and the trachea was midline.
He was tachycardic with normal S1 S2 and no murmurs, rubs, or gallops. Peripheral pulses were
2+ bilaterally in all extremities. Examination of the chest revealed no flailing and no
subcutaneous emphysema. Breath sounds were diminished in the lower lobes bilaterally. His
abdomen was soft and moderately distended with hypoactive bowel sounds. There were no
palpable masses and no hepatosplenomegaly. The pelvis was stable. Genitourinary assessment
revealed no hematuria. Rectal tone was normal, and stool was guaiac negative. Skin had
scattered abrasions throughout.
Initially Mr. Lancaster was taken for a CT scan, which revealed a grade III liver laceration. No
splenic or renal injuries were noted. A CT scan of the head revealed no hematoma. Because of
the client’s unstable condition, his spine could not be fully evaluated. Chest x-ray examination
revealed bilateral pulmonary contusion with bilateral rib fractures.
His initial lab values after fluid resuscitation and arterial blood gases (ABGs) were the following:
Na+ 135 mmol/L
K+ 4.2 mmol/L
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, Cl- 119 mmol/L
CO2 22 mmol/L
BUN 9 mg/dL
Creatinine 1.0 mg/dL
Glucose 170 mg/dL
Ca+ 8.4 mg/dL
Total Protein 4.5 g/dL
Albumin 1.8 g/dL
AST 635 U/L
ALT 507 U/L
ALP 283 IU/L
Bilirubin 0.9 mg/dL
PT 21.0 sec
PTT 41.9 sec
INR 1.7
WBCs 21,700 cells/mcL
RBCs 3.0 million cells/mcL
Hemoglobin 9.6 g/dL
Hematocrit 32%
Platelets 217,000 /mcL
Toxicology Screen Negative (for drugs)
ETOH 171 g/dL
pH 7.1
PaCO2 48 mm Hg
PaO2 80 mm Hg
(on 100% FiO2)
HCO3 16
SO2 91%
Base deficit 14.4
Mr. Lancaster’s problem list upon admission to the trauma center was the following:
1. Blunt abdominal trauma
2. Bilateral pulmonary contusions with bilateral rib fractures
3. Relative hypoxemia with a PaO2 value of 80 on 100% FiO2
4. Metabolic acidosis
5. Hypovolemic shock
Mr. Lancaster was taken directly to the surgical trauma intensive care unit (STICU), where he
was given synchronized intermittent mechanical ventilation (SIMV) with positive end expiratory
pressure (PEEP) and pressure support (PS). A pulmonary artery (PA) catheter, arterial catheter,
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