Skills Practicum

IED Blast InjuryRight Femur Fracture and Left Lower Leg AmputationSkills Practicum1YouAre working in the ER as a nurse.

Patient20 year old Male arrived at Emergency Room by HelicopterWas on patrol when an IED went off and he was thrown 10 metersNo loss of consciousnessAccident was 60 minutes ago

What do you do?

Initial vitals: Temperature: 37.2C Respirations: 26Blood Pressure: 118/72 Pulse: 110 Pulse Oximetry: 88% room air

Patient is showing:Initial treatment: Right leg deformity, edema upper thigh and discolorationLeft leg amputationEdema 4 second capillary refill on R

Initial treatment: Oxygen, Vital signs, lab, X-Ray, IV, Pain control, control bleeding, treat for shock, keep warm4Initial vitals: Temperature: 37.2C Respirations: 26Blood Pressure: 118/72 Pulse: 110 Pulse Oximetry: 88% room air

What you seeRight leg deformity with discoloration and edema4 second capillary refill Right footLeft lower leg amputationInitial vitals: Temperature: 37.2C Respirations: 26Blood Pressure: 118/72 Pulse: 110 Pulse Oximetry: 88% room air

AssessmentRight leg deformity with discoloration and edema4 second capillary refill Right footLeft lower leg amputation

6What do you see - Left Leg

What do you see - Right leg

X-Ray Right leg

Initial Treatments

Blood SweepPlace patient on monitors to get Vital signs and track patient statusTreat for shock: Start Oxygen Start IV Keep warm

10Initial treatments (cont)

Draw any blood labs ordered by doctorStart IVMedicate for pain11AssessmentBlood Sweep Primary SurveySecondary SurveyWhat you hear

Lungs are clearBowel sounds are presentGrating sounds present with palpation of Right leg

13Assessment Findings Alert and orientedPupils equal and reactive to light, briskLeft leg amputation but bleeding controlledAirway open, breathing on his own, lungs clear, heart sounds normalGrating sounds present with palpation of injured Right LetCapillary Refill 4 seconds Right legPatient has Pale, cool, clammy skinBowel sounds are present

14Vitals on monitor 10 minutes later (repeated vitals)Temperature: 37.2C Respirations: 26Blood Pressure: 100/62Pulse: 125Pulse Oximetry: 94% on Oxygen (high flow)Whats Happening?What do you think is wrong with the patient?What treatment should he receive?What complications might he have in the next 8 hours?How can you prevent complications?Treat for shock: Increase rate if IV fluids, provide O2, elevate legs, keep patient warm, monitor vital signsAssess patient: Head to Toe assessment Focused AssessmentExtremities - Assess circulation (cap refill)Head - Assess Neurological status Compare Left leg to Right leg to help evaluate abnormal vs. normalObtain X-Ray of both legsSplint FractureBandage open woundsContact/coordinate for treatment by Orthopedics MD should come to evaluate the patient

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Continued Care and ConcernsShort term Risks and concerns No circulation Loss of sensationBleedingMid and Long term risks and concernsInfectionCompartment syndrome