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First Line Intervention

Introduction to First Line Intervention

Motor vehicle accidents are one of the most common avoidable causes of health burden and concerns globally (Anjuman et al., 2020). Even with a paramount of road safety laws and regulations, Australia recorded 1145 fatal road accidents in 2018 (Mackie, 2018). Individuals can suffer from major injuries and life-threatening scenarios in these situations and are therefore immediately rushed to the emergency care ward for prime assistance (Chang et al., 2017). It is critical to provide immediate and accurate care to these individuals as their bodies have already had an impact of the accident and lack of adequate care within the requisite time can further worsen the health and lead to threatening consequences (Chang et al., 2017). This document will be focused on a particular case scenario of a car collision. Based on the assessment details provided in the case scenario, the pathophysiology and the observed signs in both the causalities will be assessed. Further, the assessment and management approach for both the causalities will be taken into consideration. This paper will also discuss the nursing research and methods applied for the well-being of both the casualties.

Case Summary

Two female drivers aged 25 and 75 collided with each other with a driving speed of 50 kmph and 65 kmph respectively. It has been approximately thirty minutes as per estimation since the accident and helps received by the patients. Both casualties were wearing seatbelts and the airbags of the vehicles were released to have minimized the damage. Multiple injuries have been reported in both the individuals and further assessment is required for treatment and recovery to ensure wellbeing.

Pathophysiology, Signs and Symptoms

Casualty one (25 years)

The casualty one has suffered from major injuries on the face with the glass and is therefore not being able to open her left eye. Major injury and tissue rupture of the eye by glass piercing has affected the patient resulting in inflammation, pain, and swelling along with wound that is hindering the opening of the eye muscles (Cikulin & Kulinski, 2017). Further, bruising is also observed in the left side of the chest of the patient with pain and difficulty in breathing. The vitals of the patient indicates that her oxygen saturation levels have fallen below 95%, and are at 93%. The increased respiratory rate of the patient is also indicative of the difficulty in breathing and poor oxygen availability in the body of the patient (Higgs et al., 2018). Due to a likely rib injury in the patient, the patient is facing problems in breathing and struggling to breathe and compensate for the required oxygen levels.

Chest auscultation of the patient also indicates that the patient has reduced air in the left lung and thus provides the direct primary evidence for the cause of limited oxygen saturation levels and high respiratory rate of the patient at 32 breaths per minute (Dreyfus et al., 2016). Swelling has also been reported in the mid-left thigh of the patient with severe pain indicative of internal injury. The blood pressure of the patient is beyond the normal range of 120/80mmHg and is at 85/53mm/Hg (Peixoto et al., 2018). This can be associated with blood loss that must have persisted before the patient received help. The heart rate of the patient is high with 135 beats per minute and signals that the body is trying to compensate for the lost blood and low blood pressure (Dreyfus et al., 2016). The patient is aware, alert, and conscious indicating absence of stroke or concussion (Wang et al., 2018).

Casualty two (75 years)

Casualty two has also suffered from major injuries and wounds. The patient is also found to be wearing a medical band for epilepsy. The patient is currently alert but is disoriented concerning time and place. There is the presence of a superficial wound on the left side of the forehead of the wound with blood ooze and requires further assessment for internal impacts (Peixoto et al., 2018). The right foot of the patient is trapped under the pedals and possesses visible deformities. The patient has also complained of pain. The right foot is observed to be bleeding, this indicates a high possibility of bone fracture (Wang et al., 2018). There are no signs of arterial bleeding recorded in the patient. There is also an observed deformity in the left wrist with a visible wound. The heart rate of the patient is high at 110 beats per minute and can be associated with the extreme distress and trauma of the accident (Rudisill et al., 2016b). The oxygen saturation levels of the patient are at 94%. The blood pressure of the patient is 110/65 mmHg with a respiratory rate of 28 breaths per minute indicative of extreme stress and pain with evidence for blood loss (Ruslin et al., 2019).

Assessment and Management

Assessment, management, and treatment of motor vehicle accidents require critical focus. The clinicians that cater to motor vehicle accidents are trained for trauma support care. An initial evaluation of the physical injuries is performed to identify the threatening injuries and provide the primary adequate support. In the given case scenario, both the patients must be assessed for the primary trauma to assess the impact of the accident with both visible and internal injuries. Assessment and management of these conditions are crucial as traumatic injuries can range from small lesions to life-threatening impacts. The following assessment and management considerations should be followed for the patients

Casualty One (25 years)

The primary concern that must be immediately catered to is to provide oxygen support and ventilation to the patient to prevent hypoxia (Dreyfus et al., 2016). The patient has declining oxygen saturation levels with poor auscultation of air ventilation in her right lung. The patient must also be screened for internal bleeding and fractures and treated immediately to prevent further complications and exacerbation of the current medical condition (Peixoto et al., 2018). Supplementary oxygen support to the patient will provide access to oxygen and help in the regularization of patient vitals and thereby prevent tissue and organ damage that may occur in hypoxic conditions (Wang et al., 2018). Pain assessment of the patient must be done to ensure the scale to provide suitable analgesic treatment to the patient (Dreyfus et al., 2016). Intravenous administration can be considered based on patient response and recovery of the vitals. Capillary refill assessment should be done periodically along with a close watch on the vitals to observe improvements (Peixoto et al., 2018). A Glasgow Coma Scale assessment should also be done after the initial stabilization of the patient to assess the impact of trauma and provide aid as needed (Ruslin et al., 2019).

Casualty Two (75 years)

The patient has suffered from major injuries and requires essential assessment. The patient is alert but is disoriented about time and place and thus needs immediate care. The wounds of the patient must be managed and the screening should be done for internal bleeding. The patient must also be screened through the Glasgow Coma Scale assessment to screen the damage and assess the impact of trauma. The patient must also be screened through imaging techniques as she has also faced injury on the head and is already suffering from epilepsy. Deformation in the legs and the wrist of the patient must be screened and treated (Wang et al., 2018). The patient should also be administered analgesic for pain management (Dreyfus et al., 2016). Once the patient is stabilized, further assessment for the overall health of the patient must be delivered. Since the patient is epileptic, more critical care towards head injuries and trauma of the accident should be assessed (Patel et al., 2019). Epilepsy is caused by the shift of balance between the GABA and glutamate neurotransmission in the body that affects the motor and neurological functioning of an individual subjecting them to higher incidences of seizures (Patel et al., 2019).

Nursing Care and Methods

Road traffic and collisions can cause several injuries and significant trauma. Therefore, the patients require immediate critical care from emergency nurses for the assessment of impact and overall wellbeing of the individuals. The nursing responsibility to care for patients in road collisions follows multiple steps. The first step that is followed for care method is to provide pre-hospital care and emergency services to the affected individual. The patient is then transported to a hospital care facility (Dreyfus et al., 2016). Primary survey of health and well being is ensured through advanced trauma life support care (ATLS) (Dreyfus et al., 2016). Based on this assessment, if the patient requires specialized care, transfer to a specialized trauma centre and is subjected to secondary or tertiary surveys. The nursing responsibility and care methods in prehospital trauma care include providing situation-dependent assessment and care with prime focus on stabilization of the patient health (Peixoto et al., 2018). The primary survey of health is conducted using the ABCDE approach (Ruslin et al., 2019).

In the given case scenario, the primary assessment did not follow this approach. Using the ABCDE approach, assessment of airway systems is done and signs of respiratory distress are identified. A cervical spine injury is assumed for blunt trauma patient until the final assessment. Ventilation and intubation are performed for stabilization of the patient. Breathing assessment is done to assess the oxygen saturation levels and to auscultations are performed to screen the chest for injuries. Assessment of circulation is done through palpation of central and peripheral pulses. Focuses assessment and sonography for trauma (FAST) is performed for patients (Ruslin et al., 2019). Blood loss assessment must be regulated as bleeding in the accident can accelerate to external hemorrhage, thoracic bleeding, femur fractures, see shock etc. Disability assessment should be done using the Glasgow coma scale and sensation of the patient must be assessed. Exposure should also be assessed through screening for signs of occult injury. Palpation should be done to assess the vertebral tenderness and rectal tones (Rudisill et al., 2016a).

The nursing research is a key component of the conduct of professional behaviour as per the code of conduct established by the Nursing and Midwifery Board of Australia (Cowin et al., 2019). The primary diagnostics that should be performed include portable X-rays, FAST assessment, CT scans, and preliminary lab tests. X-rays are required for a primary survey to screen the injuries and bone damage in the accident (Rudisill et al., 2016a). In the given case scenario, deformities in chest, wrist, and feet have been observed in the casualties and with severe chest, thigh, and leg pain. X-rays can be used in this scenario. FAST assessment is primarily done for hemodynamically unstable patients. CT scans are performed to assess the impact of the injury on the body and are performed for hemodynamically stable patients (Rudisill et al., 2016a). High energy accidents like motor vehicle collisions often use pan scans for the entire body. Once the patient is stabilized and is under clinical observation multiple laboratory tests are also conducted to ensure well being of the patient. These tests include CBC analysis (Dreyfus et al., 2016). Basic chemistry analysis. Urinalysis to assess kidney injuries, microscopic hematuria is also assessed as it is common in trauma in the adults. Secondary analysis and survey are conducted by a collection of patient history and physical examinations, a tertiary survey must be conducted after twenty-four hours of the impact and observe the changes of the interventions applied (Peixoto et al., 2018).

Conclusion on First Line Intervention

This paper provides a critical assessment of the nursing response with respect to a case study of the motor vehicle collision. The document provides a primary analysis of the case scenario and identifies the assessment procedure and anomalies reported in the patient. Based on the case scenario, the paper also evaluates the suitable assessment criteria for the primary assessment of trauma due to motor vehicle collision impact on both the patients. The clinical modalities of both the patients are assessed individually. Further, this document also relates the signs and symptoms noted in the assessment with the pathophysiology and clinical manifestation of the condition in the patients. The nursing methodology for motor vehicle collision accidents has been assessed. The nursing responsibilities and the method of care to be provided to the patients to ensure their wellbeing have also been included in this document.

References for First Line Intervention

Anjuman, T., Hasanat-E-Rabbi, S., Siddiqui, C. K. A., & Hoque, M. M. (2020, December). Road traffic accident: A leading cause of the global burden of public health injuries and fatalities. The Lancet, 390(10100), 1151-1210. https://me.buet.ac.bd/icme/icme2007/Proceedings/PDF/ICME07-AM-30.pdf

Chang, Z., Quinn, P. D., Hur, K., Gibbons, R. D., Sjölander, A., Larsson, H., & D'Onofrio, B. M. (2017). Association between medication use for attention-deficit/hyperactivity disorder and the risk of motor vehicle crashes. JAMA Psychiatry, 74(6), 597-603. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2626505

Cikulin-Kulinski, K. (2017). Physical Therapy Clinical Handbook for PTAs. United Kingdom: Jones & Bartlett Learning. https://www.sciencedirect.com/science/article/pii/S026736491830356X

Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019). The relevance of nurses and midwives code of conduct in Australia. International Nursing Review, 66(3), 320-328. https://onlinelibrary.wiley.com/doi/abs/10.1111/inr.12534

Dreyfus, J., Flood, A., Cutler, G., Ortega, H., Kreykes, N., & Kharbanda, A. (2016). Comparison of pediatric motor vehicle collision injury outcomes at level I trauma centers. Journal of Pediatric Surgery, 51(10), 1693-1699. https://www.sciencedirect.com/science/article/pii/S0022346816300161

Higgs, A., McGrath, B. A., Goddard, C., Rangasami, J., Suntharalingam, G., Gale, R., ... & of Anaesthetists, R. C. (2018). Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia, 120(2), 323-352. https://www.sciencedirect.com/science/article/pii/S000709121754060X

Mackie, T. (2018). Proving liability for highly and fully automated vehicle accidents in Australia. Computer Law & Security Review, 34(6), 1314-1332. https://www.sciencedirect.com/science/article/pii/S026736491830356X

Patel, D. C., Tewari, B. P., Chaunsali, L., & Sontheimer, H. (2019). Neuron–glia interactions in the pathophysiology of epilepsy. Nature Reviews Neuroscience, 20(5), 282-297. https://www.nature.com/articles/s41583-019-0126-4

Peixoto, C., Hyland, L., Buchanan, D. M., Langille, E., & Nahas, R. (2018). The polytrauma clinical triad in patients with chronic pain after motor vehicle collision. Journal of Pain Research, 11, 1927. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160266/

Rudisill, T. M., Zhu, M., Davidov, D., Long, D. L., Sambamoorthi, U., Abate, M., & Delagarza, V. (2016)a. Medication use and the risk of motor vehicle collision in West Virginia drivers 65 years of age and older: a case-crossover study. BMC Research Notes, 9(1), 166. https://link.springer.com/article/10.1186/s13104-016-1974-x

Rudisill, T. M., Zhu, M., Kelley, G. A., Pilkerton, C., & Rudisill, B. R. (2016)b. Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review. Accident Analysis & Prevention, 96, 255-270. https://www.sciencedirect.com/science/article/pii/S0001457516302792

Ruslin, M., Brucoli, M., Boffano, P., Benech, A., Dediol, E., Uglešić, V., ... & Stephens, J. (2019). Motor vehicle accidents–related maxillofacial injuries: a multicentre and prospective study. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 128(3), 199-204. https://www.sciencedirect.com/science/article/pii/S2212440318313063

Wang, H., Zhou, Y., Liu, J., Ou, L., Zhao, Y., Han, J., & Xiang, L. (2018). Traumatic fractures as a result of motor vehicle collisions in children and adolescents. International Orthopaedics, 42(3), 625-630. https://link.springer.com/article/10.1007/s00264-018-3777-2

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