Harry's Trauma Care by Kimmy Medrano

The Injury

kimmyisraelsen — 2024-02-06 17:42:52 UTC

Nurses Initial Response

kimmyisraelsen — 2024-02-06 22:04:12 UTC

Paramedic Response:

zacharyostendorf — 2024-02-16 21:21:03 UTC

First and foremost, we're going to ensure our own scene safety. We don't want to fall for other home alone traps and create an incident within an incident. We don't want more patients.

When we arrive in the kitchen, we're going to maintain manual c-spine until we can apply a c-collar. We want to learn how oriented the patient is and find out long he was unconscious. Patients' airway is going to be suctioned to remove teeth and blood. We're going to put the patient on oxygen as long as he remains conscious and can maintain his own airway. We will get a full set of vitals including end tidal CO2 and a 4 lead, vitals will be reassessed every 5 minutes enroute.

We want to do a head-to-toe trauma assessment. Especially looking for any injury to the back of the head. We also want to start an IV for pain management, starting with 50 mcs of fentanyl. Head trauma patients can also be confused and combative so we will consider IV versed.

Because of the unequal pupil size were going to consider this a high priority transport and load and go as quickly as reasonable. We're going to call the closest trauma I center on route to activate their team.

Nurses Response to Paramedics:

kimmyisraelsen — 2024-02-19 20:58:10 UTC

Thank you for the notification!

-What supplies, equipment, and/or personnel would you want ready in the trauma bay on arrival?

-Is there any additional information that would be useful to know regarding the patient's status?

Trauma Sheet

kimmyisraelsen — 2024-04-01 02:37:57 UTC

Page Summary

kimmyisraelsen — 2024-04-01 02:40:04 UTC

Laboratory Results

katelynhitt — 2024-04-04 21:28:43 UTC

Laboratory Results

allisondean128 — 2024-04-05 05:23:58 UTC

Respiratory Response to Paramedics

rebekahwinger — 2024-04-05 17:42:30 UTC

Was end-tidal CO2 maintained between 35-45 mmHg? What was the values through out the 5 minute reassessments?

Rebekah Winger RT

Respiratory response to Nursing:

rebekahwinger — 2024-04-05 17:43:48 UTC

Per trauma sheet update, patient is awaiting surgery for lumbar fracture. Following surgical intervention, and patient waking up from anesthesia inform the respiratory department. We will provide incentive spirometry to prevent pneumonia using lung expansion therapy.

Rebekah Winger RT

Laboratory results

christinaglenzel — 2024-04-06 16:07:36 UTC

Nurses to Radiology

kimmyisraelsen — 2024-04-07 02:35:55 UTC

How can I help you get images accurately and quickly? Also, What factors can affect the accuracy of your images?

Laboratory Results

sanhou33 — 2024-04-07 11:37:31 UTC

Nursing response to Respiratory:

chelseaflitton — 2024-04-08 14:57:07 UTC

Excellent! We will remind patient to use the incentive spirometer to prevent pneumonia. Are there any other airway or breathing complications that could develop later for this patient?

Nursing response to Laboratory

chelseaflitton — 2024-04-08 15:04:23 UTC

Thank you for the report. What factors can impact the accuracy of toxicology reports? Are false positives common and what can cause them?

Respiratory response to nursing:

jaydentaylor1_8 — 2024-04-08 19:40:00 UTC

Thanks for helping us remind the patient to do their incentive spirometry! The patient may have difficulty coughing and clearing out the secretions in their lungs after surgery due to pain in their head. We will want to make sure we keep on top of their pain medications to keep it under control. Can nursing help us with that?

Jayden Taylor RT

Respiratory Evaluation of Lab ABG results:

jaydentaylor1_8 — 2024-04-08 20:28:11 UTC

The Ph, PO2, HCO3-, and PCO2 seem to be within acceptable parameters. So it looks like the patients respiratory drive is doing well with regard to these numbers. We will still make sure to assess the patient periodically and make sure their breathing patterns are normal. If any nursing staff notice any abnormal breathing issues please let respiratory know so we can come check on the patient.

Jayden Taylor RT

Laboratory Response to Nursing

katelynhitt — 2024-04-08 23:28:35 UTC

Depending on the analyte being tested, false-positives are not necessarily uncommon as certain products, foods, and drugs can interfere with the test results.

Drugs that could result in a false-positive fentanyl test include risperidone, trazodone, and labetalol.

A false-positive ETOH could be caused by certain cough medications such as Nyquil, fermented food and drinks, and mouthwash.

Nurses to Laboratory.

jadenbnelson — 2024-04-09 02:40:46 UTC

Thanks for the lab results! How can we as nurses maintain the integrity of the samples that we are sending you? Also how long does it usually take for labs to result such as chemistry and a CBC?

Nurse response to respiratory.

jadenbnelson — 2024-04-09 02:52:18 UTC

Yes we can help keep on top of the patients pain through both pain medication and controlling the patients environment by keeping the environment quiet.

Respiratory response to nursing:

2024-04-09 05:46:37 UTC

I wanted to add a little more to this, yes while taking their pain medications they will do better another thing that also also help the patient have better numbers on IS is the coaching, we coach them when we do that but I think nursing could keep on encouraging the patients and also asking them questions about how their IS is going.

Victor Contreras RT

Respiratory response to nursing:

2024-04-09 05:57:43 UTC

One of my fellow RT classmates answered this but I have more insight on this, some things that could develop later if they IS is not done is that the alveoli can collapse and that can complicate the patient’s respiratory drive, so yes I agree we need to stay on top of IS and by we I mean respiratory and nursing having good communication!

Victor Contreras RT

Laboratory response to nurses

christinaglenzel — 2024-04-09 13:38:13 UTC

Whole blood samples are typically good for around 72 hours refrigerated, so I would say that is the preferred method. They can be held at room temperature for around 24 hours. The sooner the lab can get the sample, is always better.

STAT CBC results can take anywhere from 1-2 hours. STAT Chemistry results can take around the same time. I would always suggest requesting orders to be STAT if testing is needed quicker.

Nurses to Radiology

madelynboyle1 — 2024-04-13 04:32:06 UTC

What images do you predict to be ordered? Are there any special precautions on your end that we need to be aware of?

Nurses to Respiratory

hazinbennett — 2024-04-13 20:35:32 UTC

What are some specific signs we can continue to monitor the patient for in regards to watching for further respiratory distress?