What is your general impression of this patient?

CHAPTER 12 CASE STUDY

You and your partner respond to a motor vehicle crash involving two cars. En route, you follow standard precautions in preparation for your arrival at the scene, where you find a 25-year-old man. Law enforcement informs you that the other car left the scene. The patient was restrained and is sitting outside the car. He is pale. You observe the car for damage. The air bag has deployed and the steering wheel has some damage.

On the basis of your scene size-up, what may potentially be wrong with the patient?
What is your general impression of this patient?
You approach the patient and introduce yourself. He appears visibly upset but he lets you take his vital signs. His vital signs are a pulse of 115 beats/min, respirations of 26 breaths/min, and a blood pressure of 110/75 mm Hg. He has a laceration on his knee where it hit the dashboard.

What are the next steps in assessing this patient?
Is there a significant mechanism of injury?
You place a bandage on his laceration as he explains what happened. You also ask questions to obtain a SAMPLE history. The patient says that he recently had strep throat. As you are talking, you take another set of vital signs. His pulse is 118 beats/min, respirations are 28 breaths/min, and blood pressure is 108/70 mm Hg. His skin is clammy.

What are your concerns for this patient?
What is the significance of his recent illness?
You and your partner immobilize the patient on a long backboard. The patient seems anxious; he states that he does not feel well and needs to get to the hospital immediately. He is loaded into the ambulance, and your partner reassesses his vital signs. Your partner reports that the vital signs are a pulse of 122 beats/min, respirations of 30 breaths/min, and a blood pressure of 106/68 mm Hg. Your partner places a blanket over the patient and administers high-flow oxygen.

What do his vital sign changes indicate?
Summary questions:

List the approximate systolic BP values for each palpable pulse location:
Radial: ___________________

Carotid: __________________

Femoral: _________________

The mechanism of injury (MOI) in this scenario is significant. Although the patient was restrained, airbag deployment and damage to the steering wheel indicate that there was force involved. What specific organs/structures would be susceptible to injury from this MOI?
How is the patient’s recent history of strep throat significant when evaluating the level and possible progression of shock?
Is the patient in compensated or decompensated shock? How do you know?
Without a specific scenario, how would you describe the general presentation of a patient in profound shock? Use medical terminology.