Questions and Answers
What is your initial action for a 37-year-old man in profound respiratory distress?
Which assessments would be included for Mr. Rodriguez? (Select as many as applicable)
What recommendation would you now make to the physician?
Which assessments would you include in your re-evaluation of the patient's condition? (Select as many as applicable)
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Based on your findings, which recommendation would you now make to the physician?
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Study Notes
Patient Overview
- Patient: Mr. Rodriguez, 37 years old, 5'9" (175 cm), 170 lb (77 kg), rescued from a burning barn.
- Emergency department assignment at a 420 bed medical center; shift from 7:00 AM to 7:00 PM.
Initial Assessment Findings
- Patient exhibits tachypnea, tachycardia, and profound respiratory distress with audible wheezes.
- Immediate action involves administering oxygen with a non-rebreather mask at 15 L/min.
Key Assessment Components
- Sensorium: Conscious, alert, and oriented.
- Respiratory pattern: 45 breaths/min with intercostal retractions, use of accessory muscles, and high-pitched inspiratory sounds.
- Chest movement: Notable bilateral movement.
- Posture: High Fowler position indicating distress.
- Heart rate: 140 beats/min.
- Skin color: Cherry-red appearance of lips and eyelids.
- General appearance: Anxious demeanor along with first-degree burns on the face and neck.
Recommendations for Management
- Physician instructed to perform endotracheal intubation to secure the airway.
- After 30 minutes, reevaluation made, with multiple assessments including:
- Complete blood count (RBC 4.9 mill/cu mm, Hb 14.9 g, Hct 45%, WBC 5,800/cu mm).
- Arterial blood gas: pH 7.51, PaCO2 30 torr, PaO2 400 torr, HCO3 28 mEq/L.
- Vital signs: Temperature 37.5°C (99.5°F), pulse 110/min, respirations 27/min, BP 130/88 mmHg.
- Hemoximetry results: O2 Hb 70%, COHb 30%.
Follow-Up Assessments
- Diagnostic chest percussion revealed resonant sounds bilaterally.
- Chest auscultation showed bilateral vesicular sounds and a few inspiratory crackles.
- Capillary refill test indicated normal perfusion (color returns within seconds).
- Tracheal position remained midline, with sensorium steady (conscious and oriented).
- Breathing pattern stable, showing bilateral chest expansion without retractions.
Final Recommendations
- Based on findings, maintaining current therapy was recommended, continuing to monitor the patient's respiratory status and overall condition.
Simulation Conclusion
- End of simulation process; key elements detailed for patient assessment and management in emergency scenarios.
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Description
Test your knowledge with these flashcards focusing on emergency department procedures and patient assessment in critical situations. Designed for staff therapists, these cards will help reinforce important concepts in trauma care and patient management.
