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A Road Accident Casestudy
Ryan should be in triage 2. This is because of the fact that patients in this cadre are critically ill and therefore demand medical attention within 10 minutes or else their situation will degenerate into more complicated forms. In most cases, these patients are normally brought to medical facilities by emergency ambulances.
In Ryan’s case, he is complaining of chest pains and has become notably shorter of breath and distressed on route. From these observations among others, it can be suspected that Ryan may be having a right sided haemothorax.
Also, Ryan should be in this triage because of the mere fact that he got retrieved from the accident scene by the Emergency Ambulance team half an hour after the accident had occurred and from this, he could be deep pain hence necessitating the need for immediate medical; attention without fail.
Haemothorax can degenerate into a situation where the accumulation of blood will start to exert pressure on mediastinum and trachea. This will strain the volume of blood that the ventricles of the heart are able to fill. Subsequently, this will further affect the trachea deviating to the unaffected part. This is what explains why Ryan should be in triage 2 where he is guaranteed medical attention at most within 10 minutes.
Priorities for care for Ryan
From the information given about Ryan’s situation, the first priority will be containing the chest pain, stabilizing breathing ability and nursing any injury sustained in the accident both seen and unseen.
The chest pain and breathing inabilities could be a result of haemothorax which is right sided. Because of the dire dangers of these condition posses to the patient, immediate and decisive measures are needed that they can be limited and thus saving the already threatened life of the patient.
First, it will be very prudent to remove the part that that causes bleeding and drain any blood and air that is in the thoracic cavity and the chest area. This is accomplished through the process of inserting a thoracostomytube into the chest cavity and thus resulting in the expansion of the lungs thus preventing further bleeding.
While executing the above process, the danger of blood clogging in the tube is eminent.Therefore, to achieve effective and intended results for Ryan, better and effective drainage tubes are a necessity when draining the blood and air that might be in the chest cavity.
As earlier stated, the priority for Ryan’s treatment is to get him stable, stop any internal bleeding and drain blood and air from the bleeding and drain blood and air from the pleural cavity and also examine his entire body to establish whether there could be other hidden injuries that can pose a danger to hi healing process or at worse even his life.
A chest tube shall be inserted through the wall of the chest and made to drain the blood which is a result of draining and also air that could be in this cavity.
In situations where haemothorax may be complex and established that a tube alone can not mitigate the oozing blood,thorascomy or surgery option may be explored. This will be administered with the sole intention of controlling and deterring the bleeding that could potentially worsen the situation. Therefore, for him to regain the lost blood that is highly needed for his recovery, proper diet especially on green vegetables and any other food that is rich in minerals is a must.
From the description of the whole accident that Ryan got involved in, it was a grisly scenariothat must have left him in a shock. Therefore, Ryan also needs some professional counseling that will accompany other therapies so that he can regain his usual self. Though the time that the counseling can be done may be in contention, but it is a necessity for him to receive it and the earlier this therapy can be administered to him the quicker
Another priority of care for Ryan shall be, identifying the genesis of the haemothorax and free treating it. In Ryan’s case of accident, a tube is what is needed though surgical operation can be explored in situations of further complications.
Ryan’s quick recovery can also be a top priority for the nurses attending to him. This can be achieved through a careful and systematic approach that can hasten his healing process without necessarily compromising its quality.
From the observation, Ryan has also sustained bruises especially the one that could have been caused by a safety belt. Such bruises if left unattended could also be a source of discomfort to Ryan who is also reeling from chest pain, breathing problems and even shock form the accident. Therefore, an emergency way of dressing such bruises can also be another priority Ryan also complains of nausea. This could be that when the TV flow. IV flow is higher chances are very high that the patient will vomit. Therefore in Ryan’s case it could be better if the IV flow can be adjusted so that he doesn’t vomit. This will further weaken him.
If an operation has been carried on Ryan or the point at which the drainage tube was inserted must be dressed. The dressing should be conducted to prevent any infection to the wound. The material chosen for such dressing should be of quality so as to promote faster healing
Also, another priority for Ryan will be the dressing on the wound that ought to be changed when: the wound is not dry and intact. This situation can be attributed to; symptoms ofinfection or any other worrying tendency like, example redness of the wound, swelling or discharges or no evidence for routine wound dressing after every three to seven days.
It must also be emphasized that dressing of wound should be done carefully and in the right way to avoid further complications from the wound which can affecthis recovery path can be
Finally, the health priorities for a patient like Ryan can be many. However, compromises have to be made so as to ensure that the primary priorities for such patients are first addressed before other issues are dealt with. All these measures will be aimed at promoting his healing process while at the same time deterring the possibility of further complications from his conditions.
Pathophysiological events and nursing consideration
Hamathorax is contained first by removing the part that causes bleeding and draining any blood that might be in the thoracic cavity. Through the process of tube thoracostomy, blood in the cavity is drained. This is done through the insertion of a chest tube thus subsequently, affecting the lung to expand hence stopping the bleeding.
To prevent chest clogging or occlusion which potentially can lead to further complications like crippling effective drainage of the space in the pleural cavity, better performing chest tubes are a must.
Large diameter tubes or more than one tube are normally used with an intention of limiting clogging potentials and should clogging be detected, the patient always must transferred to a theatre with an intention of opening up the chest through a surgical process in order to get rid of pleural cavity clot.
In an event that the clot persists in the chest tube that is being used to drain the blood and any air from the chest cavity, or in the pleural cavity, Thrombolytic agents are applied to break this up. Though this can be an effective way of dealing with blood clogging, it does pose a risk in that it can result in increased bleeding as a result of the thrombolytic agent that makes blood less thick thus causing over bleeding
In circumstances as listed below surgical operations shall be explored so as to reverse the trend of blood being less thick. These circumstances are;
First, if there is continued bleeding from the chest, a condition that can be explained a 150-200 ML/h for two to 4 hours
Secondly, if back to back blood transfusion is needed so that to maintain the haemodynamic stability in the body.
When draining blood and air from patients with a coagulopathy, great care and attention must be paid.
This caliber of patients includes those patients who are normally administered with anticoagulation therapies whenever need arises.
At this stage, it must be noted that needle aspiration are not applied in an event where clotting deficiencies are prevalent. Instead, tube thorascomy is applied with a capability of visualizing and managing any bleeding from the chest wall. Out of necessity for patients who are in need of extended anticoagulant medication, such treatment mode can be re-continued after 8-12 hours after the thoracostomy has been done.
With the completion of tube thorascomy process, repeated chest radiographs should follow immediately. This will aid in the observation of the chest tube position hence assisting in observing how the exercise of evacuating the haemothoraxfrom the chest cavity has been done. It may show other intrathoracic pathology that had been obstructed by the haemothorax.
Normally, a chest tube is placed to a water seal when the lung has been fully expanded through radiography. The drainage of fluid is usually less than 50ml within 4 hours and in these circumstances, residual air leak is limited.
There could be circumstances where a chest tube ought to be clamped. After the realization that air or liquid collection is absent through conducting follow up observation by use of radiography, the tube is removed. Also it is important that radiography is done after the removal of the tube to be certain of the absence complications should drainage be incomplete as shown by radiograph studies after the removal of thorascomy chest tube, a second tube should be done through the use of video-assisted surgery. (V.A.T) and a further operation conducted to completely drain the pleural cavity.
Research has shown that 70-78% of patients with traumatic haemothorax usually get successful treatment through the use of theroscomy chest tube and therefore such patients demand no further therapies apart from one to three follow up chest radiographs within a span of 2-5 weeks to be certain of absence of intrathoracic collections that can degenerate to further complications.
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