Kevin suffered a cardiac arrest on  scene

You are working in the Intensive Care Unit and caring for Kevin Mauve.

Kevin Mauve is 28 year old male. He was  stabbed in the chest yesterday evening.

Kevin suffered a cardiac arrest on  scene,  but was resuscitated successfully by a paramedic crew.
On arrival  in ED –  he was taken care of by the trauma team.

The  injuries found were:

• Penetrating  stab wound to left side chest – mid clavicular line 4th intercostal  space
• Haemothorax left side
• Ultrasound found bleeding in pericardium – cardiac tamponade found

Patient history

Treatment in  ED:

• Left sided intercostal underwater seal chest  drain sited
• Patient given rapid sequence sedation using Fentanyl, Rocuronium and Midazolam
• Intubated with  size 7.5 endotracheal tube
• 1 litre of Compound Sodium Lactate administered IV
• 2 units of O negative blood administered
• Transferred to OR for emergency surgery

Operating  Theatre:

• Emergency Thoracostomy performed
• Tear to pleura left lung – repaired
• Penetrating wound to pericardium  left ventricle
• Myocardium intact – repaired

PAST MEDICAL HISTORY:

PAST MEDICAL HISTORY:

Appendicectomy – 10 years ago

Seasonal asthma

Hayfever

ALLERGIES – NKA

SOCIAL HISTORY:

Lives with girlfriend in Rockingham.

Employed as apprentice electrician.
Parents unaware of admission

Pathophysiology and nursing care

With reference to recent evidence discuss the following issues that relate to patient in this case:

Discuss  the pathohysiology of a hypovolaemic shock. Your answer should:

• demonstrate your knowledge of how normal physiology is altered
• outline how vital signs might be altered and why they would be altered. How might the problem be found during a primary survey
• describe the difference between a hypovolaemic shock and cardiogenic shock
• provide a discussion of immediate management of hypovolaemic shock in the Emergency Department

2. Pharmacodynamics

Kevin was administered three drugs when he was intubated in a technique known as Rapid Sequence Induction. With reference to the pharmacodynamics of each of the drugs used for this intervention in this case study, explain why each drug was used and why it was necessary to administer all three drugs. In your answer you should discuss current evidence surrounding the intervention and issues all nurses dealing with this intervention should be aware of.

3. Pharmacokinetics

The effect of drugs on the body is significantly affected by pharmacokinetics (what the body does to the drug). This includes absorption, distribution, metabolisation and excretion.

• Please explain the how Kevin’s condition might affect the pharmacokinetics of two of the drugs used in this case.
• Would the clinical team have faced any difficulties in administering the drugs?
• You should discuss complications or adverse effects the drugs might cause.

Please refer to current evidence in your discussion.

4. Ethico-legal aspects of nursing

The Police attend the area you are working in and demand details of Kevin’s condition and want a sample of blood to be taken as they believe he may have been involved in a crime.
With reference to Australian law and the Registered Nurse Code of Conduct and Standards for Practice discuss what ethical legal issues this request raises for the Registered Nurse.