CASE STUDY 1 Essay Example

Case Study

Question 1

• A – Ensure the airway is clear confirming cervical and spine protection.

• B –confirm that breathing is present and regular ensuring efficient ventilation. Commence oxygen therapy 15 litres per minute in cases of smoke inhalation.

• C –ensure the circulation and presence of cardiac activity. Initiate intravenous fluids.

• D –rule out disability via performing the neurologic assessment.

• E –confirm the environment is warm. Remove all clothing and jewelry on the burnt surface.

Following a burn or burns, it is important to commence some medication on the patient. Firstly, analgesics for pain relief like morphine 0.1 milligrams per kg body weight in titrated bonuses. Secondly, prophylactic antibiotics are administered in consideration of altered neutrophils activity, an imbalance in the cytokines production and an increase in lymphocites dysfunction. Topical antibiotics are a preference such as silver sulfadiazine. Thirdly, the patient requires benzodiazepines to allay anxiety following the burn injuries.

The calculation of the total body surface burnt is estimated via the rule of nines or the palm formulas. Following the history of the burnt surface on the victim, the rule of nines is more accurate in the calculation of the burnt surface area. The rule of nines estimates burns on the chest to be 9%, burns on the abdomen to be 9% and on the forearm to be 4.5%. The total burnt surface area equals to 22.5% of the total body surface area.

Intravenous fluids like Hartmann’s solution or normal saline administration is crucial within the first 24 hours. The calculation is via the Parkland formula that includes:

4mls * body weight in kilograms * total body surface area in percentage

4 * 80*22.5

7200 milliliters

50% of the total fluid is administered within the first 8 hours while the remaining 50 % over 16 hours.

1^st 8 hours = 7200/2

=3600 milliliters

Next 16 hours = 3600 milliliters

Irrigate the burnt surface with tap water for 20 minutes. Avoid ice water to prevent vasoconstriction. Ensure the patient remains warm. Evaluate the extent and depth of the burns. Commence fluid resuscitation following calculation according to the Parkland formula. Provide emotional support to allay anxiety.

The 5potential problems the patient is at risk of developing include: infection, inflammation, wound edema and blisters. Others include burn impetigo due to loss of epithelium. Cellulitis occurs when the injured skin around the wound gets infected.

Question 2

Ensure the airway is patent. Confirm that the victim is breathing and well ventilated by counting the respiration rate. Confirm the presence of a cardiac activity and circulation by counting the heart rate. Conduct a neurologic exam to rule out disability via the Glasgow coma scale. Ensure the environment is warm.

• Narcotics like morphine

• Opiods like tramadol

• NSAID like piroxicam

The most significant action following a hemorrhage is stopping the bleeding. The action may be achieved by applying pressure to the bleeding part or application of a tourniquet to cut off circulation from that part. Secondly, ensure the patient is swiftly transported to a hospital set up. Continue with resuscitation to maintain the peripheral pulse and mental status.

The patient is presenting with stage 2 hypovolaemic shock.

• Gently clean the amputation part with crystalloid solution.

• Wrap the body part in the crystalline soaked gauze in a tight sealed plastic wrap.

• Label the sealed wrap and put in crushed ice.

• Avoid using dry ice or freezing the part.

• Carry the part along the patient to a hospital set up.

The patient is at risk of experiencing phantom pain. Secondly, the patient may develop an infection in the wound. Thirdly, he may suffer autonomic dysfunction where the other limb is affected due to the sympathetic nervous system alteration. Fourthly, he is at risk of experiencing muscle weakness and instability on the affected side. The fifth risk is osteomyelitis as a result of a sinus infection.

The golden period is the span of time following a traumatic injury that a victim can survive before initiating treatment. It relates to the patient in that he/she is experiencing uncontrolled bleeding and is at risk of going into hemorrhagic shock if the bleeding remains active.