Situation: Multi-trauma admission. 13-year-old boy brought in by ambulance after being struck by
a car travelling at approximately 50Km/hr. Just admitted to ICU post-surgery. Intubated and
ventilated remains sedated for comfort and ICP control.
Background: Billy was crossing the road to school this morning and was struck by a car at the
school crossing. Witnessed collision, bystander first aid at the scene. BIBA, trauma team notified.
To OR for general and orthopaedic surgery
Assessment: Injuries and surgery as per below
Injury Group 1
• Fractured Right Tibia & Fibula – internal fixation.
• “Open Book” Pelvic Fracture – external fixation.
Injury Group 2
• Right sided haemopneumothorax – Chest drain inserted and UWSD (inserted in DEM)
• L sided contrecoup subdural haematoma – not for evacuation. ICP monitor in place, no EVD

Notes:
GCS E3M6V GCS E3M6V(t) – Sedated but appears comfortable and seems to understand. ICP monitor reading 16mmHg.
Has fentanyl running at 10mcg/hour for pain. Does not appear to be in pain.
CVS: Pulse 102, BP 114/65. Good Peripheral perfusion Capillary refill <2 secs, normal sinus rhythm. Temp
36.8 deg C.
Resp: Tolerating the ETT well. Ventilator settings as charted. Resp Rate 12, Spo2 99%.
GIT: NG feeds at 40 ml/hour, bowel sounds active. BNO
Renal: Urine output 60ml/hour, clear.
Skin Integrity. Surgical sited all intact, pins look clean on external fixation, Dressings due in two days.
Social: Family notified of admission and waiting to see patient once settled into ICU.

Questions

• For one (1) injury in each injury group, identify one (1) potential complication associated with that injury which may cause Billy’s current condition to deteriorate. You must identify two (2) potential complications in total.
• For each potential complication, state what changes in assessment data you would expect to see.  Discuss the pathophysiological mechanisms which lead to these changes and explain why they occur.
• For each complication, identify a suitable intervention to prevent further deterioration and justify your choice. Collaborative interventions must include an in-depth focus on the nursing role.
• State how you would evaluate the effectiveness of your intervention and what changes in assessment data you would expect to occur should it be successful.

ANSWER

Managing Potential Complications in a Multi-Trauma Patient: A Nursing Approach

The case of Billy, a 13-year-old boy admitted to the ICU after being struck by a car, presents a complex clinical scenario with multiple injuries and potential complications. In this essay, we will identify potential complications associated with two injuries and discuss their assessment, pathophysiological mechanisms, interventions, and evaluation strategies.

Injury Group 1: Open Book Pelvic Fracture – External Fixation

Potential Complication: Hemorrhage

Assessment Changes: A decrease in blood pressure (BP), tachycardia, increased heart rate, and pallor may occur. Hemoglobin levels may drop, leading to anemia. Skin may feel cold and clammy due to vasoconstriction.

Pathophysiological Mechanisms: Hemorrhage occurs due to damage to blood vessels in the pelvic region. Blood loss can lead to hypovolemia, causing decreased tissue perfusion and oxygen delivery.

Intervention: The nursing role involves closely monitoring vital signs, assessing hemoglobin levels, and observing for signs of internal bleeding. Administering blood products, fluids, and vasoactive medications may be necessary.

Evaluation: If successful, interventions will stabilize vital signs and maintain appropriate hemoglobin levels. Improvement in BP, heart rate, and skin color would indicate effective intervention.

Injury Group 2: Left-Sided Contrecoup Subdural Hematoma – ICP Monitoring

Potential Complication: Increased Intracranial Pressure (ICP)

Assessment Changes: GCS score may decrease, pupils may become unequal and sluggish, and BP may increase. Severe headache, vomiting, and altered mental status might occur.

Pathophysiological Mechanisms: Subdural hematoma causes pressure on brain tissue, leading to elevated ICP. As ICP rises, cerebral perfusion decreases, potentially causing neurological deficits.

Intervention: Nursing interventions include ensuring head elevation, maintaining a calm environment, monitoring neurologic status, and administering prescribed osmotic diuretics or antiepileptic medications as indicated.

Evaluation: Successful management would result in stabilized neurologic status, improved GCS score, and normalized pupil size and reactivity.

Conclusion

Nurses play a pivotal role in identifying, preventing, and managing potential complications in multi-trauma patients like Billy. By closely monitoring assessment data, understanding the underlying pathophysiological mechanisms, and implementing appropriate interventions, nurses can significantly contribute to patient safety and positive outcomes. Continuous evaluation of interventions based on changes in assessment data is crucial to ensuring that patients receive timely and effective care.