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Discussion

case study help

can anyone help me out here, i am new to the case study thing, i need some advice on this one. i am pretty sure i have it figured it out, but i was just looking for others opinons on this one.

marty dickinson is a 35-year-old married father of two. heis driving home from work on the interstate at 65 mph when a car crosses themedian and strikes his vehicle head on. marty, not wearing a seat belt, isthrown forward against the steering wheel. the front of the car is crushed, thesteering wheel traps his torso, and dashboard traps his lower extremities.extrication takes 45 minutes; he is then flown to a level i trauma center. hehas two iv lines in place and is immobilized on a backboard with a cervicalcollar. his knees are flexed. the flight nurses notes that he has severeabdominal pain and is unable to lay with his legs flat. vital signs during theflight are bp 90/60, p 120, r 36, oxygen saturation is 88%. supplemental oxygenis administered at 15 l.m via non-rebreather facemask. other obvious injuriesinclude contusions and edema in both knees. distal pulses in the lowerextremities are present.

focus questions:

1. what should marty's initial physical assessment include?indentify specific problems you are looking for and immediate actions.

2. which diagnostic tests should be obtained immediately andwhy?

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    this is what i have come up with so far, not sure how good it is.

    1. first and foremost of course is determining wheather or not the patients airway was stable, checking for obstruction and the ability to pass air. if the patient was able to this then contacting anesthesia for an emergency intabation would be the next step. 2nd listen for breath sounds, determine how they sound and haow hard the patient is having to breath. a non rebreather mask at 100% oxygen is applied. 3rd assess heart sounds. patient is at risk for hypertension.look for any external hemmorage and apply pressure there if needed. 4th try to determine patients mental and moter status.

    2. Chest x-ray to look for possiable pneumothrax, or pulmonary contussion. CT scan to look for internal bleeding and injuries. type and cross, blood gasses, H&H, urinalyis, cbc.

    Im new at doing these sometimes I know what I want to say, but not sure how to put it. any advice would be greatly appreaciated. I am not looking for easy answers just opinons.

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