<p>Janie, a 53 y.o. w/f, admitted c c/o SOB. VS -- BP - 128/92, T - 98.2, P – 102, R – 32 and labored. Skin cool and cyanotic. </p><p>Dx: pneumonia. Orders: O2 per n/c at 4 L/min IV of D5W at 125ml/hour NPO CBC BR c BRP Trauma Scenarios</p><p>Car Accident</p><p>1. Driver </p><p>Head-on 30mph impact, not restrained, airbag deployed. Steering wheel bent. </p><p>A: Clear B: Rapid, weak, shallow, BS clear C: Rapid, weak radial pulse; 3 second cap refill; no visible bleeds D: Response V, anxious, confused, PEARL E: No findings; patient cold and shivering </p><p>Cause: internal bleeding, shock, chest trauma </p><p>Changes: circulatory shutdown, u/c unless O2 given quickly </p><p>2. Front passenger </p><p>Side-on impact on his side, restrained, no airbag. Legs trapped under dashboard. </p><p>A: Clear B: Rapid, normal, BS clear C: Rapid, normal radial pulse, cap refill OK. Serious venous bleeding from left leg. D: Response A, anxious, in considerable pain. E: Open fracture of left tib/fib, deformations around kneecaps. </p><p>Cause: fractures to lower limbs, emotional shock </p><p>Changes: pain increases, shock develops unless bleeding stops </p><p>3. Rear passenger </p><p>Head-on 40 mph impact, not restrained. Went through windscreen, lying face-down on car hood. </p><p>A: Noisy, blood and teeth B: Slow, deep, BS clear C: Pale face, warm dry arm skin, no external bleeds D: Response U E: No muscle tone from abdomen downwards </p><p>Cause: low C-spine fracture from contra-coup against windscrren Changes: if moved, respirations stop; if airway not cleared, resp and circulatory arrest </p><p>Fight</p><p>4. Fists </p><p>Picked fight with rugby player in drunken stupidity. Got beaten around head and lost. </p><p>A: Clear, a few teeth gone, bleeding nose B: Rapid, normal depth, BS clear C: Rapid strong pulse, slowing D: A but sometimes talks nonsense, dizzy E: Strong smell of alcohol, bruising all around head </p><p>Cause: alcohol, concussion and a subdural haematoma </p><p>Changes: lowering LOC, goes u/c immaterial of treatment, postures and pupils go wide </p><p>5. Knife </p><p>Argument about possession of a boyfriend. Opponent wielded kitchen knife and plunged into left upper chest. Knife still in there. </p><p>A: Clear B: Rapid, shallow, frothy blood on lips. Left lung very noisy. C: Pulse 100+, weak, cap refil 3s, sweaty pale skin D: Numbness in left side below waist E: No other wound visible, casualty cold and shivering </p><p>Cause: Knife penetrated lung and damaged spinal cord </p><p>Changes: Tension pneumo / haemothorax in left lung develops </p><p>6. Gun </p><p>Argument at a hunt meeting; shotgun (small shot) discharged accidentally at range of 5m into abdomen and legs of saboteur </p><p>A: Clear B: Hyperventilating, breath sounds clear C: Pulse 120+, normal. Cap refil 2 seconds D: Can't move due to pain in abdomen and legs. E: Lots of small wounds with shot all over abdomen and upper legs. Substantial capillary blood loss. Cause: Obvious </p><p>Changes: None, no threatening injuries </p><p>Industrial Accident</p><p>7. Lift shaft </p><p>Lift power accidentally restored while workman in shaft. Both legs trapped between car and wall; been there 15 minutes. </p><p>A: Clear B: Rapid, normal, BS normal C: Rapid normal pulse, no external bleeding, CR normal D: Response A, in severe pain, legs deformed E: No circulation or motor control past pelvis </p><p>Cause: Multiple bilateral fracture, pressure on blood vessels </p><p>Changes: Rapid collapse if released (crush syndrome) </p><p>8. Explosion </p><p>Oxy-acetylene cylinder detonated in lab. Worker blown halfway across lab and burned. </p><p>A: Noisy, burns around face and mouth B: Rapid, wheezing, BS noisy left, silent right C: Rapid normal pulse, no external bleeding, CR hard to get due to burns D: Response P E: Partial thickness burns on head, front torso and front of arms </p><p>Cause: Airway burns, surface burns, right lung blown out from blast </p><p>Changes: Pulse speeds up and weakens as shock sets in, breathing speeds up and becomes shallower as airway swells </p><p>9. Fall </p><p>Worker falls through roof 30 foot to concrete floor, landing on back. </p><p>A: Clear B: Very rapid (40+) and shallow, BS noisy C: Pulse 110 and weak, skin cold and clammy, CR 3s D: Response V, unable to move below arms, PEARL E: Pelvis clearly misshapen </p><p>Cause: "Paper bag" lungs, pelvic fracture </p><p>Changes: will resp arrest unless breathing assisted and O2 given </p><p>Sports</p><p>10. Ski-ing </p><p>Lost control of direction and hit a tree at bottom of trail. Was travelling very quickly. </p><p>A: Noisy, blood and teeth B: Resp rate 38 shallow, breathing painful, BS clear C: Weak radial pulse of 120 D: Response P E: Deformed right knee, helmet damage </p><p>Cause: Flail chest </p><p>Changes: Pulse slows and stops unless respiration assisted </p><p>11. American Football </p><p>Linebacker blocked hard, does not get up again. Wearing helmet with faceguard. </p><p>A: Snoring respiration B: Rapid, laboured breathing C: Strong, rapid radial pulse D: Response U E: No obvious trauma </p><p>Cause: Concussion causing u/c and partial blocked airway </p><p>Changes: Stops breathing unless airway cleared. </p><p>12. Netball </p><p>Patient was knocked u/c by banging head on back wall while reaching for a shot. Recovered after a minute u/c </p><p>A: Clear B: Normal, clear BS C: Normal D: Response A, PEARL E: Pulse 90, resp rate 16, BP 120/70 </p><p>Cause: Concussion </p><p>Changes: None, but remember possibility of slow haemorrage in brain </p>