Discussion: Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery
This week, you study neurologic and orthopedic conditions with plastic surgery considerations. Both neurologic and orthopedic conditions are seen in the trauma areas of the hospital. These conditions encompass cardiovascular, pulmonary, and metabolic aspects of care in the ICU. For this Discussion, focus on adolescent patients, and consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.
Case Study 1
A 17-year-old male was celebrating his birthday with friends and alcohol. At one point he jumped into the hotel pool three stories below, hitting the side of the pool with his chest. EMS arrived and packaged him with spinal support. He arrives in the ER with breathing difficulty, chest pain, GCS 10, and O2 sat of 94%. You do initial assessment in the first 10 minutes and find that his chest is asymmetric for breathing and contusions are noted all over his chest. His CXR shows multiple rib fractures on both sides and pulmonary contusions. His cervical spine is stable in a collar. His thoracic and lumbar films are negative for fractures. In the next hours, what are your priorities, and what plan would you have for this patient as he moves to the ICU? At what stage of development is he, and how does that affect his care?
Case Study 2
A 13-year-old female restrained passenger of a vehicle was involved in an MVA at 60 mph on the highway. The vehicle experienced a frontal impact. The patient arrived in the ER with closed fractures of the left tibia and fibula with angulation, dislocation of the right ankle, multiple pelvic fractures, and femur fracture on the left side. Her BP is 92/54 with pulse of 130. What is your plan for this patient, and what are the considerations to prevent further morbidity? At what stage of development is she, and how does that impact her care?
Case Study 3
A 19-year-old male private in the U.S. Air Force was driving with friends when they dared him to “surf the car.” He fell off the roof of the car while it was moving at a speed of approximately 40 mph. He landed face first. He is now in the ICU with a closed head injury. His intracranial pressure is elevated, and his pupillary response is slowing. At this time, what medications do you recommend, and what other medical treatments do you recommend? In addition, after the acute situation is controlled and the patient awakens, what medication do you use for his agitation?
To prepare:
Review and select 1 of the 3 provided case studies. Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
Consider strategies for educating patients and families on the treatment and management
Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of neurologic and orthopedic conditions.
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