Pima Medical Institute Assignment 4
RES270
Student Name: Student Grade: /100
Case Instructions: Please review the case carefully. Analyze the data and respond in 250 words what is
happening with this patient. History
A 22-year-old male with a long history of alcohol abuse is in an MVA. Upon arrival at the trauma bay, both upper and lower front teeth were broken to gum lines, paradoxical movement over the left anterior chest with bruising.
Vitals on initial assessment: HR 120bpm, BP 165/92 mmHg, RR 26/min, SpO2 59%, and rectal temp 97.2*F. ABG via iSTAT 7.17/82/27/37/64% on NRBM.
Summary
The ABG indicates an acute respiratory acidosis with a severe hypoxemia. His P/F ratio indicates a severe shunt as well as respiratory failure. Given he has paradoxical chest movement, he likely has flail chest and needs a thoracentesis or chest tube placement. I would recommend an ultrasound prior to the procedure to confirm this. A chest CT and chest
X-ray should take place to assess any fluid or air in the chest cavity, and to rule out flail chest
or rib fractures. This should also be done to ensure that the patient did not aspirate, as his teeth were broken. While the patient has a low Spo2, high systolic BP, high HR, and high RR, all of this will likely be addressed by the thoracentesis. If the patient’s vitals and labs continue to be in the critical range, I would suggest rapid sequence intubation and mechanical ventilation. The patient has a severe shunt and if it persists, his hypoxemia can only be addressed by positive pressure. The patient should also be given a drug screening and
