A construction worker fell approximately 30 ?feet. He is semiconscious with rapid, shallow respirations. Further assessment reveals deformity to the thoracic region of his spine. His blood pressure is 70/50mm hg, ?his pulse is 66 ?beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization and rapid transport, the most appropriate treatment for his patient includes:
The correct answer and explanation is:
Correct Answer:
The most appropriate treatment for this patient includes high-flow oxygen, cautious fluid resuscitation, and continuous monitoring for signs of neurogenic shock.
Explanation:
The patient has suffered a high-energy fall (approximately 30 feet), leading to spinal trauma, specifically in the thoracic region. His vital signs indicate neurogenic shock, a condition that occurs due to disruption of the autonomic nervous system from spinal cord injury. In neurogenic shock, sympathetic nervous system function is impaired, leading to unopposed parasympathetic activity, causing hypotension (low blood pressure), bradycardia (slow heart rate), and warm, dry skin due to loss of vasomotor tone.
Key Aspects of Management:
- Spinal Immobilization:
- Since the patient has a suspected spinal injury, full spinal immobilization with a cervical collar, spinal board, and head support is critical to prevent further damage.
- Airway and Breathing Management:
- The patient has rapid, shallow respirations, which may indicate impaired respiratory effort due to spinal cord injury affecting the intercostal muscles and diaphragm.
- High-flow oxygen via a non-rebreather mask (NRB) or assisted ventilation with a bag-valve mask (BVM) should be initiated.
- If respiratory effort worsens, endotracheal intubation and mechanical ventilation should be considered.
- Circulatory Support:
- Fluid resuscitation should be done cautiously to maintain perfusion without causing fluid overload.
- Administer IV fluids (normal saline or lactated Ringer’s) in small boluses (250–500 mL) and reassess blood pressure.
- If hypotension persists despite fluids, vasopressors (e.g., norepinephrine, dopamine) may be needed to maintain adequate perfusion.
- Rapid Transport to a Trauma Center:
- Given the high risk of multi-system trauma, the patient should be transported immediately to a level 1 trauma center for neurosurgical evaluation.
Now, generating an illustrative image related to this emergency scenario.
Here is the generated image depicting the emergency response to the construction worker’s fall. Let me know if you need any modifications or additional details!
