Case Study 11 PDF

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Case Study #11 Andrew, a 22-year-old male, was involved in a head-on collision. He was not wearing his seatbelt at the time of the accident. When emergency crews reached the scene of the accident they found Andrew wedged against the steering wheel. Following a difficult extraction from his vehicle, Andrew is exhibiting the following symptoms: - Semiconscious - Dyspnea - Inward movement of the left anterior portion of his thorax during inhalation - Pain in his left thorax and upper left abdomen - Pale and cyanotic mucous membranes and cyanotic areas around his upper lip and nail beds - BP 83/51 - CBC HgB 10.1, HcT 30% - Blood chemistry abnormalities Arterial PO2 65mmHg, Arterial PCO2 55mmHg, Arterial pH 7.27 - Urinalysis: pH 4.0 1. What is the most likely cause of Andrew’s symptoms? - Andrews symptoms are likely caused by a pneumothorax from the blunt trauma. The hypoventilation also effects Andrew. 2. Flail chest is a condition which occurs when one section of the ribcage moves inward while the rest of the thoracic wall moves outward during inhalation. What might be the cause of this condition? -The flail chest is a result of the blunt trauma from Andrew hitting his steering wheel. 3. How might this condition affect the breathing process? - This would affect the breathing process by causing SOB. 4. Why does Andrew have cyanotic mucous membranes? - Andrew has cyanotic mucous membranes because of insufficient maintenance of oxygen demands. 5. What kind of acid/base imbalance has Andrew developed? -Respiratory Acidosis. 6. Explain how this acid/base imbalance developed? -This acid/base imbalance developed because of internal bleeding and decreased respirations. 7. Is there evidence of homeostatic compensation occurring which will attempt to restore normal blood pH? If yes, what? - Yes because the urine pH is acidic which means the body is trying to compensate for the acidosis

8. Before Andrew was removed from his demolished vehicle, his BP was 110/70. After he was extracted from his crushed car, his BP was 83/51. What is the explanation of this sudden change in BP? - The way Andrew was positioned in the car was causing pressure on his internal bleeding sites. Once released from this position the blood was able to flow more freely. 9. Andrew was given an isotonic solution IV to help treat his condition. How will this help him? - The isotonic solution will raise his BP by causing an increase in the extracellular fluid. 10. Several days prior to his accident, Andrew had a normal CBC at this doctor’s office. What is the explanation for his abnormal CBC values now? - Andrew’s CBC values are abnormal now because he experienced blunt force trauma and most likely has internal bleeding....