trauma to the neck in an automobile accident

Esme12, ASN, BSN, RN · May 13, 2014

We are happy to help...is this for school?

HelloKitty17 · May 15, 2014

It's for my nclex-pn review. I came across this question and the rationale didn't really explain much to me.

The nurse is caring for the client admitted after trauma to the neck in an automobile accident. The client suddenly becomes unresponsive and pale. With B/P of 60 systolic. The initial nurse's action should be:

a. Place the client in trendelenburg position

b. Increase the infusion of normal saline

c. administer atropine IM

d. obtain crash cart

correct answer is B.

nursemeanie · May 15, 2014

What do you think is the important info in this scenario?

akulahawkRN, ADN, RN, EMT-P · May 15, 2014

It's for my nclex-pn review. I came across this question and the rationale didn't really explain much to me.
The nurse is caring for the client admitted after trauma to the neck in an automobile accident. The client suddenly becomes unresponsive and pale. With B/P of 60 systolic. The initial nurse's action should be:
a. Place the client in trendelenburg position
b. Increase the infusion of normal saline
c. administer atropine IM
d. obtain crash cart
correct answer is B.

Go through each of those answers and tell us why each one is right or wrong. Forget that the "answer" is B.

libran1984, ASN, RN · May 15, 2014

The SBP is low, the easiest and fastest thing to do is just allow the already infusing fluids to flow in by gravity. That's a corrective action that is a flip of the thumb. Much easier than running to get the crash cart (which would then be my next move)

HelloKitty17 · May 21, 2014

I think A is wrong because it will not be good to put pressure towards his head at this time.

for B i didn't know what the purpose was for it. C i didnt think it was necessary because there are no information that indicates the need for the medication.. (although that was the answer i originally picked) hehe.. and D. i didn't think they really needed that at that moment.

HelloKitty17 · May 21, 2014

Thank you for that info. it was very helpful

akulahawkRN, ADN, RN, EMT-P · May 21, 2014

The systolic BP is low because the patient is running low of fluid in the vascular space. Putting the patient in Trendenenberg will temporarily help the BP but the effect doesn't last long. It's not a corrective action. Atropine work by blocking the action of the vagus nerve on the heart. In effect, it's like taking the foot off the brake. If everything else is working right, the heart's already accelerating and therefore isn't being slowed down so you don't need the Atropine. Getting the crash cart is not a bad idea, but what will you do with it? It sets up further corrective actions down the road, but not immediately and that also means you're leaving the bedside to get it. Increasing the circulating fluid (blood would probably be MUCH better) is immediately corrective for the low BP problem. You do that by increasing the infusion rate. That's option B. That buys time to get things going to bring the right resources to the patient.

HelloKitty17 · May 22, 2014

The systolic BP is low because the patient is running low of fluid in the vascular space. Putting the patient in Trendenenberg will temporarily help the BP but the effect doesn't last long. It's not a corrective action. Atropine work by blocking the action of the vagus nerve on the heart. In effect, it's like taking the foot off the brake. If everything else is working right, the heart's already accelerating and therefore isn't being slowed down so you don't need the Atropine. Getting the crash cart is not a bad idea, but what will you do with it? It sets up further corrective actions down the road, but not immediately and that also means you're leaving the bedside to get it. Increasing the circulating fluid (blood would probably be MUCH better) is immediately corrective for the low BP problem. You do that by increasing the infusion rate. That's option B. That buys time to get things going to bring the right resources to the patient.

This is very helpful... thank you so muchh

notmanydaysoff · May 23, 2014

My first thought after reading this was that the pt was going into hypovolemic shock due to decreased blood flow and poor perfusion. For the initial action, the path of least resistance, like a PP said, would be a flick of the thumb to increase fluids.

When studying for nclex a coupla yrs ago, I looked hard and fast at the wording in the Saunder's 3500 bonus CD questions. Statements that include words like "initial action," will give you an idea of the correct answer w/o having to fully understand the scenario. Rule out the obviously wrong answers and pick between what is left, choosing the safest for the patient answer. Good luck!