Problem
A 73-year-old male arrives in the ER with a gunshot wound (GSW) to the chest. He is being brought in by the local police. You have prepared the room ahead of time by raising the temperature of the room. You check to make sure there is blood in the refrigerator and your blood infusion machine is turned on. Patient is moaning in pain, bp is 80/40, lung sound normal, wound on right side of lower chest wall and exit wound on left side. Pt not able to answer questions at this time. Pt was incontinent of his bowels and had large loose bowels on the bed. 2 units of blood were initially ordered by physician. 120 mg of Ketamine given, 1 gram of Calcium (Ca) given and patient given endotracheal intubation.? A foley catheter was ordered. Labs and x-ray ordered. Gunshot wound missed the lungs but hit the upper intestines and OR is on standby for when patient is stable for surgery.
1) As an ER nurse, why would the room temperature be increased? How is this in relation to trauma Triad?
2) Explain Trauma Triad and how it increases chances of life.
3) Why would you worry about hypothermia and clotting?
4) How does Trauma triad and relationship with respiratory and metabolic acidosis?
5) Is it respiratory acidosis or alkalosis for acute bleeding. Explain the pathology in that answer. Why would you have to worry about metabolic acidosis?
6) What is MTP? Ratio?
7) What blood would you give?
8) Why do you heat up the FFP? Why is blood (PRBC) , Fresh Frozen plasma (FFP) and platelets given separately?
9) Why is Ketamine given instead of other opiods?
10) Why would you give calcium to a trauma patient?
11) Why is patient intubated?
12) Why was there an order for foley catheter?
13) For crimes, what is protocol for personal belongings, clothes and why should you not cut on side of entry wound?