B:The patient is a 17 year old hispanic gender fluid person who came into the emergency room last night. The patient has not provided an address or identification documents and has said little to no words. The aunt is answering all the questions for them and does not leave their side. 

A:The patient came in with a fractured right humeral head that is consistent with blunt force trauma. Upon assessing the patient further, it was revealed that they had multiple bruises on their torso that were all in different healing stages. On their neck they had 3 scars from cigarette burns. The patient’s vital signs are a heart rate of 92 bpm, blood pressure 134/84, respiration 18, temperature of 37.5 C, and oxygen saturation is 99% on room air. 

R: Place the patient on 1:1 for close monitoring for signs of self harm and continue to build trust and rapport with the patient. Encourage the patient to open up and talk about the trauma. Keep the patient calm and incorporate trauma informed care.

After noticing the patient has hung herself, the nurse immediately gets the patient down and calls a code team. She assesses the patient airway, breathing, and circulation. The nurse began CPR while the team set up the AED and they shocked the patient which successfully brought her heart rate back. Due to the patient's condition she is being transferred to the ICU for further monitoring, assessment, and intervention.

The patient refused to talk to any staff in the room and avoided eye contact. The patient started to scream when anyone walked too close. The nurse went into the room to speak privately with the patient, reintroducing herself and calmly discussing the care plan. The nurse was transparent with the patient and made sure not to pressure them to speak, and allowed enough time for the patient to respond. Patient kept on looking for items to harm herself with in the room even after initial suicide attempt. She was found looking frantically through cabinets for anything to use while muttering words under her breath. Any items from the room that the patient could use to hang herself, cut herself, or swallow were removed from the room. Nurse reassured the patient that she was in a safe place and stayed with her in the room. 

P: Patient is a 17-year-old gender fluid individual who is suspected to be a victim of human trafficking. Patient has suicidal ideations and has attempted suicide once while in our care. We were able to get a heartbeat back, however she is still unresponsive. Her vital signs were as follows: heart rate of 48 bpm, blood pressure 82/58, respiration 8, temperature of 37.5 C, and oxygen saturation is 83% on room air. The patient came in with a fractured right humeral head that is consistent with blunt force trauma. Upon assessing the patient further, it was revealed that they had multiple bruises on their torso that were all in different healing stages. On their neck they had 3 scars from cigarette burns. Patient became violent when a male staff member attempted to take vital signs.

A: Monitor vital signs periodically for improvement or deterioration. Please keep the patient on 1:1 for suicidal ideations. Have a female staff member attempt vital signs and go slow to avoid re-traumatization. Contact the provider for care of the patient’s right humeral head fracture. Assess pain and provide comfort measures and pain medication as ordered. Obtain a psychiatric evaluation consult and work alongside health care providers to establish a plan of care.

S: If the patient’s suicidal ideations worsen, please provide comfort measures to ensure the patient feels safe. 

S: The patient’s priority intervention is to stabilize their vital signs and monitor for suicide. The patient's safety and pain is also of great importance. You want to attempt vital signs and proceed slowly to avoid re-traumatization. I will contact the provider regarding the humeral fracture and methods for pain management.