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Management Strategies for Multiple Trauma: A Case Study

   

Added on  2021-04-16

14 Pages4408 Words381 Views
RUNNING HEAD: MULTIPLE TRAUMAMANAGEMENT OF MULTIPLE TRAUMAStudent nameInstitutional affiliation

MULTIPLE TRAUMA 1The current paper will discuss critically the management strategies of a multiple trauma patient. A case study of a patient involved in a motorcycle accident will be outlined to provide the background for the discussion. The paper will critically detail the late phase management of multiple trauma using evidence-based approaches. It will look at the immediate interventions after a primary survey of a trauma patient. The care management issues including the implications and complications will be examined. Lastly, the impact of the chosen management strategies on patient outcomes.The case study is of a 54-year-old male who sustained multiple trauma secondary to a motorbike accident. There was a possible medical cause to the accident as witnesses saw a change in posture prior to the accident. At the scene, 10 minutes CPR was commenced with a defibrillator used on an unknown rhythm. Intubation was done at the scene after the return of spontaneous circulation. He was hypotensive at 70 mmHg systolic pressure and 750ml crystalloids were given. In the emergency department the following results were obtained, systolic blood pressure of 70mmHg, catheterization lab results were normal, CT scan for trauma series showed multiple injuries including an unstable C2 injury, right vertebral artery dissection, left 2nd to 4th undisplaced rib fractures, left 5th to 6th rib fractures with anterior dislocation, right 4th to 6th undisplaced rib fractures. The brain, abdomen, and pelvis were intact. He has a past medical history of deep venous thrombosis of the lower limb in December 2017 due to an unknown cause and was on rivaroxaban for the treatment of the same. His wife had provided a corroborative history of him having bouts of intermittent chest pain for the past three weeks and odd behavior where he was withdrawn and prone to anger. Past surgical history involved surgeries for C4 to C7 spinal fusion and L4 to L5 laminectomy. His alcohol history is unknown. He, however, does not smoke. The systemic review showed a GCS of 3, spinal collar, normal

MULTIPLE TRAUMA 2tone, heart rate of 80 bpm on adrenaline, mean arterial pressure of 70 mmHg and good pulses. There were deep lacerations to his right hand. Shock secondary to trauma is of note in this patient. Shock is a state of circulatory insufficiency whereby the blood flow hence tissue perfusion is inadequate to meet the metabolic needs of the body leading to life-threatening organ failure (Australian Resuscitation Council [ARC], 2016, p. 1). The type of shock present in the patient is a cardiogenic shock due to impaired pumping capacity of the heart. He had a cardiac arrest requiring cardiopulmonary resuscitation and ionotropic support. He also has a history of coronary disease. The history from his wife which reports him having intermittent chest pains is suggestive of angina. The heart failure would lead to decreased cardiac output, hypoperfusion, hypoxia and to multisystem manifestations of hypoxia. Cell anoxia leads to the release of inflammatory cytokines and the reversion to anaerobic respiration. Anaerobic respiration leads to the production of lactic acid that accumulates leading to an anion gap metabolic acidosis. Hypotension is a hallmark of shock as the circulatory mechanisms are insufficient to maintain a normal cardiac output and since blood pressure is a product of cardiac output and peripheral resistance, it will be reduced. At the scene of the accident, the blood pressure was unreadable, after CPR and return of spontaneous circulation, it was hypotensive at 70 mmHg. At the emergency department despite support with adrenaline, it was at 70 mmHg. Shock progresses through a series of stages namely initial stage, compensatory stage, progressive stage and finally refractory stage.Olgers et al., (2017, p. 69) on encountering a critically ill patient or injured patient, the healthcare provider performs the primary assessment. It helps in detection of life threating condition early. This enables timely resuscitation/treatment. It also gives a resuscitation guide. Primary assessment involves airway, breathing, circulation, disability and exposure assessment

MULTIPLE TRAUMA 3(Rauen & Munro, 2015, p. 48; Clarke & Aiken, 2013, p. 43). In this paper the focus will be on; cardiovascular assessment and disability assessment. On cardiovascular assessment, it showed hypotension, the systolic blood pressure of 70mmHg. This was intervened by giving the patient adrenaline infusion and crystalloids. Adrenaline is ionotropic it increases the heart muscles contractility, heart rate and also causes vasoconstriction which causes an increase in blood pressure (Barrett, Barman & Boitano, 2011, p. 450; Guyton, 2015, p. 100; Hinkle & Cheever 2013, p. 644). The crystalloids increase the blood pressure by increasing preload which causes anincrease in cardiac output (Perel, Roberts & Ker, 2013). The patient has a known history of deep venous thrombosis (DVT). Due to the patient’s immobilization and trauma, it can trigger DVT (Walker & Lamont., 2011, p. 35). On the assessment of D-disability, the patient had fractured cervical spines. An injury to the spine causes paralysis. To avoid further injury, the patient was sedated with fentanyl. This prevents agitation and trials to move that can further damage the spinal cord. The neck was further immobilized using a soft collar. The above assessment qualifies the patient to be admitted to the intensive critical care ICU. The admission plan deduced from the primary assessment include: sedation, use of mechanical prophylaxis for DVT, attain a mean arterial pressure of 70, insert an indwelling catheter, infuse 4% albumin, keep her oxygen saturation levels at more 94% or more, start feeding, use aspirin for the dissection, evaluate the thyroid functions, and X rays of the right hand. This paper will focus on the use of mechanical prophylaxis to prevent DVT and sedation of the patient which aims at reducing the patients’ agitations and in turn prevents further spinal injury. The two interventions will be critiqued. Shehabi et al. (2012, p. 45) conducted a study on early sedation in intensive care in predicting the long-term mortality in those patients that are critically ill and ventilated. The study

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