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D-Danger- In the given case scenario the patient was riding her bicycle on a considerably high speed when she accidently got stuck by sudden opening of a car’s gate. She was not wearing helmet as well. Riding without wearing a helmet, can be quite fatal for the person, even when commuting at a slower pace. The patient in the give case scenario was at a high speed of 40km/hour, when she hit the gate of the car. The danger in such given scenario magnifies by multiple folds. Without the protective gear, the damage can be more than anticipated and can also lead to traumatic brain injury to the person, leading to severe impairments and even death in worst case scenario (Wu, 2018). If the person doesn’t suffer from grave consequences, there are still long-term medical implications from the injury caused to the brain in such scenarios.
R-Response- The patient in the give case scenario was having a GCS of 14 at the site of injury. However, on arrival to the emergency department she was unconscious. A GCS reflecting a score of 14 can be considered under the category of the patient having minor brain injury (Ogami, 2017). However, upon arrival the patient was opening her eye to verbal command and was in a drowsy state as well. The GCS for the patient, by the time she arrived at the hospital must have dropped considerably low, falling in the category of severe brain injury or severe traumatic brain injury. Although a painful stimulus was not applied to her limbs but they were observed to be having a normal response, presuming no motor loss.
A-Airway- The patient was not found to have anything stuck in her air passage. However, her respiratory rate was found to be considerably shallow. The patient was maintained on 5 liters of oxygen supply with the help of Hudson mask. As the patient had normal saturation rate, she was managed with the help of oxygenation through the means of Hudson mask (Yan, 2018). There were no open wounds to be found in the patient. Apart from this the patient is not having hypoxia or any abnormal breath sounds on auscultation. The patient’s neck is also supported with a spinal collar in situ, to avoid any further damage (Ballester, 2019).
B- Breathing- The patient had a shallow respiratory rate, but she had normal oxygen saturation reading. The shallow respiration can also be due to her drowsy status (Liang, 2020). The patient was however maintained on 5 liters of supplement oxygen, she should be ventilated as the respiratory rate and other vital parameters might alter drastically with her deteriorating state of clinical presentation. In the given scenario the vitals can be monitored after ventilating the patient, as a precautionary measure.
C- Circulation- The patient is having a high heart rate reading of 110 bpm. The body temperature of the patient is found to be normal. The blood pressure reading of the patient is however, found to be considerably low, noted as 89/60mmHg. The patient is in hypotension. Traumatic brain injury patients are shown to reflect on the signs of hypotension (Spaite, 2017). Post-traumatic injury the blood circulation is hampered due to injury at multiple sites. This can be directly reflected in low blood pressure readings, due to inadequate blood circulation to the vessels of the body (Spaite, 2017).
D- Disability- The patient is in a drowsy state but she is opening her eye in response to the command given to her. The arms and legs are also reflecting a normal pattern of movement. The patient can be presumed to have a GCS score of 9-10. The patient however, had a GCS reading of 14 at the injury site. Due to progressive impact of the injury and medications given to her she must have attained a reduced level of consciousness. The pupil size also appears to be in normal range. The blood glucose level in the given case scenario stands at a reading of 5.2mmol, which can be indicated to be in a normal range (Burns, 2018). So, there are no potential disabilities observed in the patient at present.
E- Exposure- The patient was safely evacuated from the injury site. She was placed in a spinal immobilizer. Her coagulation parameters were all within normal range and these were no additional injuries observed in the patient on examination.
The patient is a 27-year-old professional athlete, who met with an accident while cycling. She was not wearing a helmet at the time of incidence and was driving her bike at a speed of 40km/hour when suddenly a person sitting in a car parked on her way, opened his gate. The patient smashed into the car and was thrown about 15meters away. Volunteer ambulance was called. The patient had a GCS score of 14 at the time of the incidence and was rushed to the emergency department for further management. The patient was given supplement oxygen at 5lts and was placed in a spinal support for further management. Lab tests and scanning examinations were carried out for the patient. The patient arrived at the hospital in a drowsy state, with eye opening response to verbal command. There are no details available on the patient’s past medical or surgical history. The incidence landed the patient in a drowsy state, but with no physical harm visible to the naked eye. The incident happened in late evening hours.
The patient is having high heart rate and low respiratory rate as well as blood pressure. There are no external wounds noted in the patient. The pupils are of normal size. There is asymmetry in the breathing pattern observed in the chest area. The limbs are responding normally in terms of movement. The patient is in a drowsy state and is not in a state to provide her details (Wurster, 2017).
The patient has been provided with supplement oxygenation through the means of Hudson mask. Various blood tests have been carried out for the patient, reflecting all parameters within the normal range. The arterial blood gas analysis of the patient was also done. It revealed the patient is having respiratory acidosis. Patient also underwent CT-scan for brain (Goyal, 2020), which showed results as a depressed focal right temporal skull fracture and the whole clinical presentation reflecting towards a moderate head injury.
Following nursing priorities can be catered to in this case scenario:
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