Joyce, a 27-year-old right-handed patient, was involved in a motor vehicle crash. Joyce was an unrestrained passenger in a car that swerved off the road
... [Show More] and struck a tree. She was ejected from the car and was found unconscious by the emergency medical service personnel.
After being placed on a spinal board and in a Philadelphia collar, Joyce was transported by helicopter to the nearest emergency department trauma center. Joyce was somewhat combative and unresponsive to commands at arrival.
1. As the receiving nurse, what additional information would you want at this point?
Any change when they picked her up. Pupillary reflexes. Resp patterns.
Baseline vitals, type of blood, hgb and hct levels
2. You begin your primary survey. Explain what this means as it related to Joyce.
The Primary Survey is a quick way for you to find out if someone has any injuries or conditions which are life-threatening. If you follow each step methodically, you can identify each life-threatening condition and deal with it in order of priority.
Use the letters DR. ABC to remember the steps: Danger, Response, Airway, Breathing and Circulation.
Joyce’s diagnostic data were as follows:
BP
HR
Respirations
Temperature
Pupils Reactive
Glasgow Coma Scale score
90/40 mm Hg
100 bpm
40 breaths/min
36.7° C (98° F)
Left > right
9
3. What would you do next?
Administer analgesia, sedation, and control of agitation.
May give morphine. High dose barbiturate to help reduce elevated ICP and protect brain against hypoxia. Elevate HOB.
Pulse ox, assess hypovolemia, pregnancy test. tox test. h and h, lactate levels. End tital co2, iv acesess.CT scan, foley.
Initial evaluation of her cervical spine revealed no abnormal findings, and the long spine board and Philadelphia collar were removed. Joyce’s initial computed tomography (CT) scan of the head revealed a left temporal cerebral contusion with a midline shift of brain structures. The CT scan also revealed a left temporal parietal subdural hematoma (SDH). [Show Less]