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45 yrs old male, brought by ambulance while he was working at rail road stations, he has severe sob, tachpnea, drowsey, complain of chest pain. Just by looking at the patient, he had few laceration on his head and chest.
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
EXPLOSION
45 yrs old male, brought by ambulance while he was working at rail road stations, he has severe sob, tachpnea, drowsey, complain of chest pain. Just by looking at the patient, he had few laceration on his head and chest.
ER
IV access
Normal saline, IV, continuous
Pulse oximetry
Oxygen inhalation
Continuous BP monitoring
Continuous cardiac monitoring
Morphine, IV, bolus
Portable CXR
UA
Focused exam,..general, CVS, Resp
ABG stat & hrly
Urgent intervention if needed…..tension pneumothorax -needle followed by Chest tube, Hemothorex -Chest tube drain
CT head, chest, abdomen,pelvis
Blood type and cross match, stat
CBC with diff, stat
BMP, stat
12 lead EKG, stat
Serum amylase, stat
LFTs, stat
Urine analysis, stat
PT/INR,PTT, stat
Blood ethanol, stat
Urine toxicology screen, stat
Interval HO & Complete PE
Advance the clock to get the results
Tetanus injection
IV Antibiotics
Consult trauma team for suture of chest and head
If need to go OT,…NPO, consult Anaesthetist, HBs Ag, HIV, lFT
Admit to ICU /Floor
Order review:
Hb and hematocrit, every 6 hours (Type H&H)
Surgery consult, stat
Blood transfusion if needed
Oximetry every 6 hours
Take brief history and examine focused for every 4-6 hours
Repeat the CXR or CT next day
Ambulation
Compression stocking
Discharge:
Acetaminophen oral and codeine combination (Percocet for pain)
*Follow up visit in one week
5min screen
Patient counseling
No smoking
No alcohol
Seat belts use
Helmet
Chest physiotherapy
Educated safety precaution
Influenza dater later
inform authority or social service ( not sure what is in soft ware)