Case study - Emergency Nursing

A patient approximately 20 years of age without identification presents to the trauma unit on a backboard with a cervical collar in place. The patient was ejected from the drivers side of the car. The patient was oriented x3 at the scene and able to move all extremities. The patient stated that he passed out and regained consciousness quickly. Within 5 minutes the patient became lethargic, had slurred speech and the right pupil was unequal and sluggish. Before becoming comatose the patient had complained of chest pain when he breathed, and there as an imprint of the steering wheel on his chest in the form of a bruise. As he breathed paradoxical chest movements were noted on the right side of the chest. The trachea is deviated to the right side. The trauma team, consisting of the trauma surgeon directing the team, two nurses and a resident, providing care. The initial vital signs were as follows: temperature 100 degrees F; blood pressure, 78/42mmHG; heart rate, 70bpm respiratory rate, 28 breaths/min, uneven rapid breathing with periods of apnea. The pulse oximetry reading is 85% on room air. Two large IV's are established and labs, including arterial blood gases are obtained and sent to the lab for immediate processing. An indwelling urinary catheter is inserted and 300 mL of amber colored urine without sediments is noted. An initial survey is completed to assess for obvious problems and steps are taken to prioritie the need of the patient and provide emergent treatment. ( Learning Objective 2)

a. What are the possible injuries to the patient according to the information presented in the initial presentation and what medical-surgical management is anticipated?

b. What are the priorities for care for this individual based on the information presented?