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265 CB CASE STUDY (SURGERY) BASED ON PROFESSOR’S LECTURE ANSWERED PERFECTLY!!
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265 CB CASE STUDY (SURGERY) BASED ON PROFESSOR’S LECTURE ANSWERED PERFECTLY!!
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265 CB CASE STUDY (SURGERY) BASED ON PROFESSOR’SLECTURE ANSWERED PERFECTLY!!
At 9 PM, George White, 22 years old, was robbed and stabbed twice with a knife
on his way home from work. A bystander activated the Emergency Medical
Service (EMS) system by calling 911.EMS personnel arrived on the scene and
found George tightly holding his abdomen and refusing to let go. They noted a
knife protruding from George's right upper quadrant (RUQ), and a large amount of
bleeding. George was immediately placed in the ambulance to be brought to the
Emergency Department (ED).
At 9:30 PM, George arrives in the Emergency Department (ED). Two peripheral
IVs with large gauge catheters are infusing 0.9% sodium chloride.You work in
both the ED and the Surgical Intensive Care Unit (SICU). This evening you are
working in the ED, and assigned to care for George.
Upon arrival in the Emergency Department(ED), George is moaning. He is holding
his abdomen, and is fearful of letting go.You immediately note eviscerated in
Answers :Evaluate and insure adequate airway and breathing
Assessing for adequate airway and breathing takes priority with George. A patent
airway is needed for adequate respiration and tissue oxygenation and function.
Adequate airway and breathing are necessary for survival. Respiratory rate,
rhythm, and quality should be assessed and breath sounds should be auscultated as
soon as possible.
George is able to talk and take breaths without difficulty. He is breathing rapidly at
28 irregular, deep breaths per minute. With auscultation, breath sounds are found to
be present and clear bilaterally.George's airway and breathing are evaluated as
adequate.
After evaluating George's airway and breathing, which assessment is most
important?
,Answers :Circulation
After assessing George's airway and breathing, cardiovascular status and
circulation are evaluated. Adequate circulation is required for survival. After
insuring adequate airway and breathing, circulation is evaluated so that any
problems can be identified and corrected. Rapid assessment of circulation involves
assessment of pulse, skin color, and level of consciousness. These, along with
blood pressure, reflect cardiac output, tissue perfusion, and volume status.
George's apical pulse rate is 110 beats per minute. Pulse is strong and regular.
George's BP is low at 94/64, and reflects volume depletion secondary to blood
loss.George's skin is pale and cool. Pale, cool skin occurs with a low circulating
fluid volume, and in George's situation, is due to blood loss. It is a result of
peripheral vasoconstriction, a compensatory effort to maintain perfusion of vital
organs (brain, heart, lungs, kidneys).
A quick neurological assessment identifies George as alert and responsive,
indicating adequate cerebral tissue perfusion and function.Manual pressure on
George's stab wounds is continued, to minimize bleeding.George is kept covered to
protect him from hypothermia.
Oxygen, administered in transport, is continued at 8 liters per minute by means of a
non-rebreather mask. Oxygen saturation monitoring by pulse oximetry (SpO2) is
initiated. George's current SpO2 is 98%. Arterial blood g
Answers :A quick neurological assessment identifies George as alert and
responsive, indicating adequate cerebral tissue perfusion and function.Manual
pressure on George's stab wounds is continued, to minimize bleeding.George is
kept covered to protect him from hypothermia.
George has eviscerated intestines. EMS personnel have already provided
immediate related care. Which immediate intervention is indicated when a person
has eviscerated intestines?
Answers :The eviscerated intestines should be covered with moist sterile gauze
, Sterile saline-soaked gauze provides a moist protective barrier for exposed
intestines. This moist application helps to prevent tissue damage or bowel necrosis
that could result from dryness.
George is frightened about the knife that continues to protrude from his RUQ. He
is afraid to have it touched, but also wants you to remove it, because it hurts.
You explain to George that the knife will be removed during surgery. It cannot be
removed now because:
Answers :removing the knife now could cause further damage and bleeding
Removing the knife in the Emergency Department (ED) could result in additional
tissue damage. An impaled object may tamponade (place pressure on) an injured
blood vessel, and prevent hemorrhage. Removing the knife in an uncontrolled
setting outside the Operating Room (OR) could result in massive bleeding.
Stat lab work has been drawn, and includes type and crossmatch for six units of
packed red blood cells. Fully crossmatched ABO/Rh compatible blood is usually
available in 30-40 minutes.When blood replacement is needed before fully
crossmatched blood is available, ABO compatible blood, usually available within
10 minutes, is administered. For immediate use, uncrossmatched O-negative blood
(universal donor blood) is usually available in Emergency Departments.
In evaluating George, you consider which organs might be traumatized. Based on
the location of the two stab wounds (LUQ and RUQ), what organs might be
injured?
Answers :Liver
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