Trauma Nursing: Case Study, Mechanism of Injury, Pathophysiology, Management

Running head: TRAUMA NURSING
Trauma Nursing
Name of the student
Name of the university
Author’s name

TRAUMA NURSING1
Table of Contents
Case Study.......................................................................................................................................2
Mechanism of Injury........................................................................................................................4
Pathophysiology..............................................................................................................................5
Management....................................................................................................................................7
Subarachnoid hemorrhage (SAH)............................................................................................7
Subdural hematoma.................................................................................................................7
Anterior dislocation of the ankle joint.....................................................................................8
Instability in the ankle syndesmosis........................................................................................8
Futuristic Considerations.................................................................................................................9
Conclusion.....................................................................................................................................10
Reference.......................................................................................................................................11

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Case Study
Steve Smith is a 27-year-old male, and he was admitted to the emergency department in
an unconscious condition as he had a severe head injury and an open fracture in the right leg due
to a motorcycle accident. After the crash, he was left untreated for 45 minutes, and after that,
pedestrians kept him to the emergency department of the local hospital. After assessing the
patient, it was revealed that the patient had a GCS (Glascow Coma Scale) of 3T along with with
4mm bilaterally fixed pupils. The nursing personnel reported that the patient negatively
responded to the corneal assessment. The CT (Computed tomography) assessment of the patient
showed that the person had already developed a subarachnoid haemorrhage with left frontal and
temporal subdural damage. The nurses also reported that the patient had developed right-sided
hemi-paralysis, facial dropping.
Moreover, the CT scan showed that there is a left frontal/temporal and parietal hematoma
along with mass effect and a 5.38-mm left to right midline shift was also observed in the CT
imaging due to cerebral oedema. In the right temporal bone of the patient, there was a non-
displaced comminuted fracture. When the injury of the open fracture of the right leg was
assessed, it was demonstrated as Gustilo IIIA which is the fractures that consist of high-energy
fractures as shown by the severe bone injury (segmental or highly comminuted fractures) often
contaminated soft-tissue wounds. The nurses helped Smith clean his wounds, lavage of the
damage, removing tissue lesions, and assisted in fixing the trans-articular external leg bones at
the ankle joint in regarding deliver treatment for the injury.
The vital sign assessment of the patient stated that the person was a bradycardic and
hypertension was also reported by his family members. The recorded blood pressure of the

TRAUMA NURSING3
patient was 150/ 100 mm Hg at the time of admission, and after 1 hour of the admission, the
blood pressure suddenly elevated, and the nurses recorded that the blood pressure was almost
180/ 110 mm Hg. The intracranial pressure of the patient was recorded as 13 mmHg.
Temperature Heart
rate
Respiration
rate Blood pressure SpO2
38.8°C 110 bpm 20/per minute 150/100 mmHg (Initial)
180/ 110 mm HG (After 1 hour) 90% (room air)
For controlling the heart rate of the patient, the nursing personnel pushed atropine and
nicardipine after getting approval from the doctors, and along with this, a central venous catheter
and an arterial line catheter were placed for delivering the fluid and other medicines. For treating
the brain herniation symptom of the patients, endotracheal incubation, Mannitol IV, hypertonic
solution of 23% sodium chloride was administered to Mr Smith. After the administration of the
medications mentioned above, no improvement of the patient was reported, and doctors decided
to perform a surgery of Smith. After the surgery, an external ventricular drain was placed, and
the patient was examined to measure the postoperative ICP, and the ICP was noted as 4-5 mm
Hg. The GCS of the patient was recorded as 5T and pupils of the patient were reported to be
active bilaterally. On the second postoperative day, the patient had improvement regarding the
midline shift, and on the 3rd postoperative day, the nurses reported about shivering, fever and
hypertension.
On the contrary, the GCS was improved, and it was recorded as 8T. On that day, the
patient reported about homonymous hemianopia and aphasia. Next day, the oxygen saturation of