Mr. L, a 17-year-old male, was involved in a motor vehicle crash. He was wearing a seat belt but was traveling at a high speed when he lost control of the car and crashed into a tree. He was awake at the scene, but his level of consciousness quickly declined during transport to the trauma center by emergency medical services (EMS). The prehospital team was unable to intubate him during transport, and the patient’s airway was maintained with bag-mask device ventilation using a fraction of inspired oxygen (FiO2) of 1.00 (100%). Two large-bore intravenous catheters were placed, and normal saline was infused at 250 mL/hr. Three liters of fluid were administered before arrival in the emergency department. Mr. L. does not have a significant medical history or any drug allergies. Initial vital signs were temperature, 36.6° C; blood pressure, 92/62 mm Hg; heart rate and rhythm, 136 beats/minute with sinus tachycardia; respiratory rate, 36 breaths/minute with assisted manual ventilation; and oxygen saturation, 95%. He is nonresponsive to verbal commands, and his pupils are 2 mm and reactive to light. He has a 6-cm scalp laceration, a right closed femur fracture, four broken ribs, and suspected closed head injury. Initial laboratory results were:
Aggressive fluid resuscitation continues as he is transported to radiology for computed tomography to evaluate his head, chest, and abdomen for injuries. EMS contacted his parents, who are both in the waiting room of the emergency department.
Questions
1. What are the possible injuries based on the mechanism of injury?
2. What is the priority intervention at this time based on his vital signs?
3. What is your interpretation of the laboratory results? What interventions do you anticipate based on these results?
4. What are possible reasons for his unresponsiveness?
5. What additional diagnostic studies or interventions do you anticipate the patient needs after the computed tomography scan?
6. What additional nursing interventions do you anticipate in the emergent evaluation and treatment of this patient?
7. What are the needs of the family?