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Introduction

Mike, a 35 year-old male, is presented to the emergency department with multiple puncture wounds to the right arm and bruising on the face. He arrived at the hospital via emergency medical services after calling 911.

Background

Mike was playing with his dog, a German Shepherd, in front of his hoe one day when all of the sudden, his dog decides to bit his right arm and punch him in the face. He immediately takes off his jacket and notices blood all over his arm and calls 911. calling 911, Mike states that he has been bitten on his arm and punched in the face by his dog. The operator tells Mike that EMS will be there in 10 minutes and to clean the wounds with soap and water and to cover the wounds if possible.

Assessment

On route to the hospital, EMS performs a primary assessment using the ABCDE approach.

• Airway: Patent
• Breathing: tachypneic with labored breath and breath sounds normal
• Circulation: pulses rapid and weak
• Disability (LOC): awake, alert, responds to pain and voice. GCS: 15
• Exposure: Site of wound exposed. Wounds on right arm and bruising on face noted

C-Spine Stabilization is not indicated.

Upon admission to the ED, the secondary assessment was performed. The patient’s vital signs were a BP: 92/54, HR: 120, RR: 22, T 100.7F, O2: 96% on room air, and a pain of 9/10. Performing a full head-to-toe assessment revealed:

• Neurological: Awake, alert and oriented x 4, GCS 15, full PERRLA
• Cardiovascular: Normal s1s2, pulses rapid and weak, cap refill <2 secs
• Respiratory: Tachypneic, labored breathing, normal breath sounds
• GI: Nondistended, soft, non-tender, bowel sounds active
• GU: No complaints of urinary problems
• Integumentary: Multiple right arm puncture wounds. Bruising on face. Site of wound warm and swollen. Skin is cool and pale.
• Musculoskeletal: weakness and pain in right arm
• Psychological: Possible PTSD

The patient’s medical history was gathered using the mnemonic device, AMPLE:

• Allergies: Latex
• Medications: Atorvastatin, metoprolol
• Past medical history: Splenectomy 19 years ago
• Last oral intake: a glass of water
• Event leading to injury: playing with dog. Dog overexcited

Question 1: After reviewing the findings in the secondary assessment, what are some notable concerns to address in the assessment?

Question 2: Based on the secondary assessment, what interventions should the nurse expect to be ordered?

Question 3: After performing these interventions, should the patient be admitted into the hospital or discharged and given a follow up visit? Why?