The Pathophysiological Process of Victim - Assignment Example

Case Study Name: College: Course name/number: Professor’s name: Assignment number: Date: Case Study 1 1 Discuss the pathophysiological process associated with the patients presenting signs (i.e. why are the abnormal signs outside of ‘normal’ ranges). The gross pathophysiological process of victim is indicative of massive trauma and shock that is manifested in the viciousness of the shark attack that indicates that the victim may have attempted to fend off the shark as indicated by the heightened heart rate of 132, which is above the normal range of 60 to 100 beats per minute. The shark may have bitten the leg of the girl as the girl attempted to pull away causing the shark’s teeth to lacerate the flesh of the thigh deeply as indicated by the extent of tissue damage and even baring of the femur. In addition, the girl must have been repeatedly bumped by the shark, leading to a concussion, as indicated by her being barely conscious. Luckily, the lifesavers may have moved in fast and scared off the shark because only one wound is visible, meaning that the girl probably had one encounter with the shark. This presented massive blood loss, thus causing blood pressure (70/45 mmHg) to fall below normal, which is between 120/80 and 140/90 mmHg. The absence of spurting of blood is indicative of the lowered blood pressure. From the microbiological perspective, the pathophysiological process presents the likelihood of the onset of sepsis of the wound considering that shark teeth and seawater have a plethora of harmful bacteria, which can lead to rapid progression of myositis or cellulitis. 2 What is your preliminary diagnosis for this patient and why? Initial preliminary diagnosis indicates that the patient is in hypovolemic shock and traumatic shock because she is barely conscious due to massive loss of blood after the harrowing experience with the shark. The shock is also a sign of a concussion due to being hit and shaken violently by the shark. This is manifested as low blood pressure, being barely conscious and heightened heartbeat rate as a sign of palpitations. In addition, the patient may be suffering from hypothermia considering the lowered body temperature. This may be due to extended exposure to cold water. The victim has massive tissue damage on the right thigh involving muscle and tendon damage that presents high chances of getting infected and developing sepsis (Lentz et al., 2010). The disfigurement of the legs may be another source of traumatic shock as the girl tries to come to terms with the realities of her new image. In addition, from this damage, it is likely that the wound contains shark teeth debris, arterial laceration and even avulsion fracture of the femur, which is causing the patient massive pain, heightened perspiration (diaphoretic) and septic shock. 3 Outline your treatment (management) for this patient and provide rationales backed by contemporary evidence for your interventions. The first management would be to cover the patient with a blanket in a bid to keep her warm. Often, a victim of a shark attack is subjected to cold temperatures for being inside water for an extended period. Such covering may help prevent the onset of hypothermia considering that the patient’s body temperature is low by 2 degrees, at 35.5 OC (Caldicott, Mahajani & Kuhn, 2001). Since the patient is conscious because she is able to respond to voice and light, and is able to obey motor commands, resuscitation is not necessary. In addition, supplementary oxygen supplied is not required because the patient exhibits normal levels of blood oxygen saturation level (SpO2) of 92 %, which is above 90 %. However, due to much bleeding, the patient could be gradually falling into unconsciousness and thus all efforts should be made to maintain her consciousness. This is important because it informs on where pain is being felt, which can assist in deciding on the treatment approach. However, since the patient is obviously in hypovolemic shock, an isotonic crystalline solution should be administered intravenously to rehydrate the patient and raise the blood pressure as well. In addition, strong antibiotics such as tetracycline, cefuroxime or ciprofloxacin, should be administered locally and intravenously to the patient immediately to minimize or eradicate the onset of infection and manage septic shock. Indeed, shark bites can be lead to serious infections because the shark’s teeth are populated with numerous bacteria. Therefore, in order to ensure that no infection onsets, a shortgun approach for antibiotic administration is advisable because it employs antibiotics that are able to contain a broad spectrum of bacteria (Fleshler, 2013). The antibiotics administered should be efficacious against Aeromonas and Vibrio spp., which are known to be hardy and halophilic (Fleshler, 2003). After administration of antibiotics, the laceration should be carefully examined to determine whether femoral arteries are intact or not, whether there are any teeth debris lodged in the wound as well as the extent of the damage and whether the femur is fractured or not while controlling the bleeding through covering the wound with some pressure. In addition, arteriography should be undertaken to determine the extent of the injuries on the vascular system (Scharf, 2002). The wound should be cleaned, disinfected and sutured as soon as possible. Finally, the patient should be rushed to the nearest hospital once she has been stabilized so that the wound can be debrided and suturing performed. While at the hospital, after administration of intravenous fluids, an x-ray of the leg should be taken and inspected for breakage, after it has been copiously irrigated, debrided and disinfected. This should be followed by suturing and casting the femur. Case Study 2 4 Discuss the pathophysiological process associated with the patients presenting signs (i.e. why are the abnormal signs outside of ‘normal’ ranges). The stab at the T6 with a narrow and sharp object injured the spinal cord of the inmate. This spinal cord injury is responsible for presenting the development of paraplegia on the lower body of the victim as indicated by weakness and numbness in the left side of the abdomen and legs, and manifested by the inability to walk. The fact that the alert, voice, pain and unresponsiveness (AVPU) assessment indicated alertness, which is indicative of consciousness, with no breathing problem, little pain (1/10) and lucidness, the patient is in neurogenic shock. Indeed, neurogenic shock due to spinal injury is indicated by the low blood pressure, which is 80/40 mmHg rather that 120/80 mmHg, lowered body temperature (35.5 OC rather than 37 OC). In addition, sepsis could develop at the stab location, particularly if the weapon employed was dirty and rusty. 5 What is your preliminary diagnosis for this patient and justify your decision including pathophysiology? Preliminary diagnosis indicates that the victim is suffering from an injury into the spinal cord that may be causing the numbness in the lower end starting from the hip area to the legs. Indeed, lack of pain and feeling is indicative of injuries on nerves making an individual insensitive or lack sensation. From these indications, the inmate could be developing paraplegia of the lower body, which could be permanent if not addressed promptly. In addition, the patient could be experiencing neurogenic shock due to the trauma on the spinal cord. This is indicated by low blood pressure and lowered body temperature. Indeed, the victim is presenting hypotension considering that he is presenting lowered blood pressure of 80/40 mmHg, which is outside the normal range of between 120/80 and 140/90 mmHg. Further, the inmate may have sustained various internal injuries in his torso and thoracic area considering that the other inmates stamped upon him. The minimal bleeding indicates absence of arterial damage that the victim presented despite obvious pain indications by the victim. 6 Outline your treatment (management) for this patient and provide rationales backed by contemporary evidence for you interventions. The first intervention would be to immobilize the victim to deter movement of the spine, which would aggravate the injury of the spinal cord (Haut et al., 2010). The airway of the victim should be cleared to facilitate breathing. This is done by ensuring that the tongue is not obstructing breathing and the trachea is aligned to the midline as well. The inmate should also be covered with a blanket or any other warm clothing considering that he is experiencing lowered body temperature. Indeed, covering a victim helps stabilize the breathing and heart rate to normality. However, supplementary oxygen supplied is not required because the patient exhibits normal levels of blood oxygen saturation level (SpO2) of 92 %, which is above 90 %.Thereafter, the stab wound should be closely examined for presence of leakage of spinal fluid, which would be indicative of injury to the spinal cord (SCI) (Smith & White, 2014). In this case, since the stab weapon is dislodged from the back, its tip should be inspected for breakage, which would indicate that a piece of the it has remained in the victims back. In addition, the stab wound should be inspected of presence of debris from the stab weapon. Further, the mouth and the anus of the victim should be inspected for signs of blood, whose presence is indicative of internal bleeding due to injury on internal organs such as the liver and kidneys among others. For pain management, painkillers should be administered to the victim while antibiotics and an anti-tetanus jab should be administered to fend off infections and the onset of sepsis and tetanus at the stab wound. In addition, a steroid such as methylprednisolone should be administered as an anti-inflammatory within 8 hours of injury to combat neurogenic shock and prevent the onset of paralysis. An immediate x-ray and computerized tomography CT scan of the spinal cord should be undertaken immediately to ascertain the extent of spinal damage and the presence of the remnants of the stab weapon. According to Smith and White (2014), neurological functions can be restored immediately after the stab weapon is dislodged. Thereafter, the patient should be taken to surgery to remove any stab weapon remnants lodged in the spine, correct any misalignment of the spine, and restore neurological functionality of the spine as well. Finally, the stab injury should be sutured to close it and prevent possible infection. However, a focused abdominal sonography for trauma (FAST) should be undertaken as well to inform on the level of damage or injury on abdominal tissue and organs (Butt, Zacharias & Velmahos, 2009). Presence of such damage, which is likely to cause internal bleeding may require surgical evacuation of blood from the abdominal cavity. References Butt, M. U., Zacharias, N., & Velmahos, G. C. (2009). Penetrating abdominal injuries: management controversies. Scandinavian journal of trauma, resuscitation and emergency medicine, 17(1), 19. Caldicott, D. G., Mahajani, R., & Kuhn, M. (2001). The anatomy of a shark attack: a case report and review of the literature. Injury, 32(6), 445-453. Fleshler, D. (2003). Bacteria in sharks’ mouths almost as scary as teeth. Sun Sentinel. Retrieved March 25, 2017 from http://articles.sun-sentinel.com/2013-02-01/news/fl-shark-bites-20130201_1_shark-bites-shark-fishermen-first-shark. Haut, E. R., Kalish, B. T., Efron, D. T., Haider, A. H., Stevens, K. A., Kieninger, A. N., ... & Chang, D. C. (2010). Spine immobilization in penetrating trauma: more harm than good? Journal of Trauma and Acute Care Surgery, 68(1), 115-121. Lentz, A. K., Burgess, G. H., Perrin, K., Brown, J. A., Mozingo, D. W., & Lottenberg, L. (2010). Mortality and management of 96 shark attacks and development of a shark bite severity scoring system. The American Surgeon, 76(1), 101-106. Scharf, M. J. (2002). Cutaneous injuries and envenomations from fish, sharks and rays. Dermatologic Therapy, 15(1), 47-57. Smith, C., & White, J. B. (2014). Penetrating knife injuries to the spine: Management considerations and literature review. Interdisciplinary Neurosurgery, 1(1), 3-4. Read More