I have long had some disagreements with the way assessment is traditionally taught. I don't believe that it is automatic that if you know the normal you can recognise the abnormal. Sometimes assessment, particularly in the hospital setting is about evaluation of an evolving abnormality.
So here is the game I will post a scenario about a patient and ask everyone to try to picture this patient from their point of view. The next step will be up to you - over the next 12-24 hours what will we expect to see. How can we assess if the patient is getting better or worse?
So there is no real "Wrong" in this game only some answers that are more right than others so no blame and no shame! You might post an answer about the improvements you might expect and you would be equally as correct as the person who posts about a rare and life-threatening complication. As I said as there will be many "Right" answers no one will be flamed for not getting it right.
Feel free to post even if you are unsure or ask a question at any time.
Paul Monery is a 46 year old man who has just been admitted following a single vehicle accident involving a high speed collision. He was wearing a seat belt and has sustained 2 rib fractures. He has a significant amount of pain from the rib fractures. The medical staff tell you that they are concerned that he might develop some pulmonary contusion. Since he has been a heavy smoker for more than 30 years there is some concern about underlying lung function. He has a pca but because he is only a small man you are concerned that the dosage might be set a bit high.
As you can see a lot of factors impacting on the respiratory system for this patient so what would you assess for. Assume that on admission all vital signs are within normal limits for this patient and that his sao2 is 97% on 2 lpm via nasal prongs.
