Patient Care After Accident
Discussion 3 Question
Please describe how you would care for a patient who presents to the office after an accident at work. He complains of right rib pain, shortness of breath, and bleeding form a finger laceration. Remember to include ROS, PE, Differential Diagnoses and a treatment plan.
Discussion 3: Emergency Problems
The patient has come to the physician’s office following an accident at the workplace with complaints of right rib pains, dyspnea, and bleeding from a finger laceration. The first step is to obtain and document a comprehensive health and injury history to inform health care. The subjective data will include symptoms, demographic information, past, and existing medical conditions, surgical procedures, current medications, tetanus immunization status, allergies, developmental tasks, family, and social history. Information concerning how the wound happened is important as well as occupational hazards, causes of the accident, nature of injury, degree, mechanism, age of wound, delayed or instant presentation, foreign body, underlying injury, and infection potential. The mechanism of the finger wound helps determine the possibility of deep structure injury, infection risks, tissue damage, and associated injuries.
Next, the physical examination includes a general examination, vital signs, vascular injury, nerve involvement, tendon damage, located over joint, associated with fracture, range of motion, foreign body, avulsion injury, puncture, and wound contamination. The wound description should include length, depth, and type of defect (Dunphy, et al., 2019). For the finger, blanching and distal sensation should be assessed too. A gross neurological screening exam and identification of deep structure injuries and foreign bodies will help determine the closure. The physical exam is also conducted by listening for chest sounds of abnormal breathing via a stethoscope. The physician can tap on the chest listening for liquid sounds.
The other diagnosis methods include X-rays, CT Scans, and ultrasound. First, a finger x-ray is used to visualize the presence of joint violations by showing air in the affected joint, bony abnormality, or retained foreign body. Another upright chest x-ray film with lateral and posterior-anterior views is ordered for the patient who could have sustained blunt or penetrating chest trauma must have chest x-ray film to rule out pneumothorax or hemothorax. The chest X-ray image will reveal the presence of liquid in the patient’s chest cavity. A computed tomography scan is the definitive test if there is still doubt or a need for an accurate assessment of the size of the defect. The CT scan gives a complete image of the patient’s lungs and pleural cavity to reveal the causes and best treatment. A sample of the pleural fluid can be used for diagnosis. Finally, a saline-load test is performed for accurate determination of a finger joint violation.
The differential diagnoses for pneumothorax and hemothorax include pneumonia, pulmonary embolism, intercostal muscle strain, myocardial infarction, and angina. But, the differential diagnosis for the wound is typically not indicated since the diagnosis is obvious. Related injuries are fractures, strains, foreign bodies, and sprains. A simple wound or laceration can be treated in the office if the care setting has suturing capabilities. If over five years have passed, a tetanus booster is administered. The general management involves the cleansing of the finger wounds through irrigation with a high-pressure solution stream to lower the bacterial count. A good rule of thumb is infusing 50 to 100 mL of solution per cm of wound length using a splash shield (Dunphy, et al., 2019). Next, the wound is debrided of devitalized tissue using a sharp scalpel. Afterward, the wound closure is done to decrease the scarring size and risk of infections or other morbidities. The closure method used is determined by the type, size, and location of the wound. Sutures, tissue adhesives, skin-closure tapes, and staples are some of the options in outpatient care setting (Forsch, et al. 2017). The finger wound should be maintained clean, dry, and covered.
The antibiotic therapy constitutes parenteral administration of ampicillin ceftriaxone, or cephalexin, or as the initial treatment. Parenteral therapy is followed by oral antibiotic therapy for seven to ten days. The suitable choices for oral therapy are cefadroxil or cephalexin for most infections. Furthermore, the patient with a pneumothorax or hemothorax is cared for and managed in the ED; hence emergency medical services should be called after evaluation of respiratory and cardiovascular status. The patient must be admitted for constant observation and sequential chest x-ray films. Also, the patient should be placed on supplemental oxygen, even if the oxygen saturation is normal on room air to help resorption. Lastly, the clinician should consult respiratory therapy prior to discharge for incentive spirometry teaching to aid in recurrence prevention.
References
Dunphy, L. M. H., In Winland-Brown, J. E., In Porter, B. O., & In Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing. Philadelphia, PA: F.A. Davis Company.
Forsch, R., Little, S., & Williams, C. (2017). Laceration Repair A Practical Approach. American Family Physician, 95,10, 628-636.
Thomsen, T., Setnik, D, & Barclay, G. (2013). Performing Medical procedure: Basic laceration repair. The New England Journal of Medicine, 355:18 Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMvcm064238