1. What happening to CF
Patient was stabbed on left chest 5th ICS MCL, diminished breath sounds LLL field, there is blood coming out, patient also
... [Show More] present the sign of abdominal muscle guarding.
2. What is your impression?
Pneumothorax & Hemothorax secondary to stab wound at 5th ICS MCL
-Beceause decease in tactile fremits and decrease breath sound in LLL
3. How will you manage patient initially?
-initial manage by occlusive dressing secured on 3 sides to prevent tension pneumothorax
-Request chest X-Ray for confirmatory diagnosis
-Then place chest tube, to evacuate the air out
-Give antibiotic prophylaxis (2nd GEN Cefoxitin) and tetanus toxoid
4What is ATLS
-ATLS is “The Advance Life Support”
-This refers to the primary survey as assessment of ABCDE
. A: Airway and C-spine control-> Place the patient on neck collar
. B: Breathing-> Evaluate BS-> Decrease BS may indicate a pneumothorax
. C: Circulation-> Check any sign of shock (Low BP<90mmHg, HR>100bpm, UOP<0.5ml/ kg/hr)
. D: Disability prevention-> Apply splint
. E: Exposure-> Make sure there are no others injury
5.What will be your admitting order? Why?
Date and time : Febuary 11, 2018 :
Name : C.F Age : 26
Admit: to general surgery ward, under the service of Dr. ..................
Secure consent to care
Problem: stab wound at 5th left ICS MCL
Admitting diagnosis: Pneumothorax & Hemothorax secondary to stab wound at 5th ICS MCL
Vital signs: BP-120/80 mmHg , HR-110/min , RR-30/min , T-36.3 C
Frequency (per routine); q4° when awake / q4° / q2° × 3 then q4° Allergies: no food and drug allergies
Condition: guarded, serious
Activity : CBR w/ TP (complete bed rest w/ toilet privilege)
Diet : place patient on NPO
IV: D5LR 30 gtts/min
Medication:
- give tetanus IgG
- Meperidine (Demerol), 25-100 mg IV q4-6hr as need for pain
- Ranitidine
-Antibiotics
Laboratory: ECG, CBC, platelet, blood typing and cross match, bleeding time, U/A, serum creatinine and BUN ,
secure 2 bags of Imaging: chest x-ray AP view
Special instruction: prepare for CTT insertion , inform anesthesiologist insert NGT F 18
Nursing: monitor I/O, urine output >0.5 cc/kg/hr for 3 consecutive
Notify MD if: watch out for hypotension (SBP< 90 or >160 mmHg ,) ,Temp 39 C and dyspnea Signature: Dr................... [Show Less]