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Jamaica Amurao, Kenny Dadacay and Josh Perez
Sean is a 21-year-old male who was admitted to the emergency department after being involved in a motor vehicle accident with his sister Anna. Anna was pronounced dead on scene and Sean suffered mild loss of consciousness. Upon arrival to the emergency department, Sean was confused and complained of left upper quadrant pain, which radiated to his left arm. During physical examination, Sean’s vital signs were: BP 123/85 mmHg, HR 95 beats/min., RR 22 breaths/min, Temp, 98.6°F, and an Oxygen Saturation of 97%. Sean’s orders included strict spinal immobilization protocols, EKG, IV fluid bolus, morphine and zofran, ultrasound (FAST), and a CT scan. After the CT scan, Sean lost consciousness and vital signs significantly changed from baseline. Sean’s vital signs were: BP 93/56 mmHg, HR 132 beats/ min, RR 34 breaths/min. Temp, 95.6°F, and an Oxygen Saturation of 89%. The trauma team performed resuscitation interventions and then the patient was transferred to the operating room to treat the cause of bleeding. Sean was hemodynamically stabilized and transferred to the intensive care unit for further monitoring.
Questions:
- which patient characteristics indicate altered hemodynamic stability and why?
- based on the signs/symptoms what organ might’ve been affected that led to the bleeding and why?
- What is the role of case management in this scenario?
