Shock Quiz 2

Name

27 y/o male motorcyclist struck by a car that ran a red light. He did not have a helmet on when found, it was approximately 14 feet from the patient. His speed was 45 mph, the other car was said to be going 65 mph. The patient was found 5 feet from the point of impact and his bike. Upon your arrival the patient was unconscious and responsive to painful stimuli by groaning. His airway had a copious amount of blood. His respirations are 42 and shallow with noticeable retractions. He has absent radial pulses, a carotid pulse of 142 bpm, and no gross external hemorrhage noted, although a great deal of road rash is present. The patient's skin is pale, cold, and moist, his BP is 78/48, and his CRT is 3.5 seconds. His head-to-toe reveals pupils fixed and dilated, possible mandible dislocation, large laceration with matted blood on his left occipital region, a left anterior flail segment is barely noticeable because of the shallow respirations, diminished breath sounds on the left side, the abdomen is distended and rigid in all four quadrants, the patient groans when the pelvis is palpated and crepitus is noted, the left leg is noticeably shortened and externally rotated with no distal CMS found on either lower extremity, the back reveals a large area of flank and posterior bruising on the left side, upper extremities have negative distal pulses but patient responds to stimuli by groaning. Patient's SpO2 is 87% on room air. (10 points)

Field diagnosis? (10 points)

Treatment? (5 points)

Field diagnosis? (10 points)

Treatment? (5 points)

35 y/o female confusion and abdominal pain. You are greeted at the door by her husband who said she has just had a miscarriage and has had abdominal pain for two days but has seen her OB and been told that this is normal. You find her CAOx4 on the couch. She is pale, with tear stained face, and cool to the touch. Her airway is patent, respirations are 28 and produce equal chest rise, radial pulses are 118 and regular. The BP is 118/70 and the abdomen is tender and slightly distended. Her husband tells you she has complained of thirst but has not had anything to drink because she is also nauseous. Her FSBS is 88 mg/dL. The remainder of your secondary assessment is unremarkable. (10 points)

Field diagnosis? (10 points)

Treatment? (5 points)

88 y/o female who fell down the cellar stairs yesterday and was found by her daughter who called 911. Her daughter tells you she found her mother at the bottom of the stairs and she was cold and anxious. Airway was patent, respirations were 38 and producing slight chest rise. Radial pulse of 128, thready, and slightly irregular, no apparent external bleeding, BP of 82/58 and CRT is delayed. The patient appeared dehydrated, with poor skin turgor and dry mucous membranes. She is CAO with slight confusion, very anxious, and states that her hip and her stomach hurt and that she couldn't get up. Your head-to-toe reveals some facial abrasions, a split lip that is not bleeding, a large hematoma on her forehead above her right eye, her pupils are PERRL, abrasion to the lateral aspects of both arms, lung sounds have rales at both bases, abdomen is rigid and tender, pelvis is tender, both knees are bruised and swollen, her right ankle is deformed, tender, and swollen, she has barely palpable distal pulses in all four extremities, her SpO2 is 87% on room air, and her FSBS is 62 mg/dL. (10 points)

Field diagnosis? (10 points)

Treatment? (5 points)