Question 1: Pain Significance
The student’s pain is exhibited by radiation from the lower thoracic region through the axillary line to the anterior midline. The pain is precipitated by the cough sessions indicating serious thoracic injury. Even though the student denies pain radiation, it is evident that intensification of pain in response to thoracic movements and the acuteness are important aspects of categorizing the pain based on the thoracic interconnection with pain rising through the midline.
Question 2: Findings Significance
First, the patient is thin with evidence of hyper-resonance in relation to chest percussion show signs of pleural walls inflammation (thickening) which is also attributed to the distance in chest sounds. Trachea deviation to the left (right to midline) is a result of traumatic experience leading to a barrel chest, i.e. reverse ribs movement with extended diameter. His heart rate is and blood pressure is high, with associated high respiration rate, i.e. 30 per minute meaning that he is struggling to ensure proper ventilation and oxygenation as evident in low oxygen level even with increases subject processes ( Zhang, Tang, Xie & Wang, 2015) .
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If I were the recommending therapist, I would order for immediate medical checks to assert the state and allow for better chest examination. I would choose an appropriate eyelid laceration repair technique, specifically the suture method. Therefore, I would consider chest X-rays, a radiograph or chest CT scan for advanced and sufficient medical information. These tests would assess the damage and extent of the injury on ribs and lung components in contexts of fractures for proper management. According to the flail chest results, I would recommend immediate ventilation processes, pain relief medications and physiotherapy procedures to be scheduled.
Question 3: Assessment Interpretation and Chest X-ray
Using chest x-ray imaging is significant in discovering abnormalities in vessels, bones, tissues and body organs in the chest cavity. Due to its fast and non-invasive quality, it efficiently determines the extent of damage and facilitates further decisions of management. The next steps of management are immediate ventilation facilitated by pain relief strategies. After the patient has guaranteed ventilation, then rehabilitative therapy can begin to ensure normal organ setup and positioning. The protocols to follow include: stabilizing ventilation and pulmonary action, mitigating pneumothorax risks while managing rib injuries and fractures ( Manley & Maish, 2019) .
After recommending a partial rebreathing mask (non-rebreather mask) to assist in ventilation for oxygen supplementation, it would require assessment for intervention success. Therefore I would use an arterial blood gas (ABG) test in comparing the oxygen-carbon dioxide exchange status. The test aims to check the sufficiency of oxygen, proper elimination of carbon dioxide and enhance physical therapy through practice breathing.
Question 4: ABG Interpretation
The patient’s pH is 7.5 which is slightly higher than the recommended 7.45 upper limit. This translates to mild acidosis in the blood facilitated by high carbon dioxide amounts. The partial pressure of carbon dioxide is (28) lower than the lowest recommended value of 38mm/Hg limit. The partial pressure of oxygen is also extremely lower than the limit. However, bicarbonate levels are between the acceptable ranges of 22-28 milli-Eq. Per Liter. Moreover, oxygen saturation is also normal therefore describing a state of partial compensation.
About the extended pain score (level 10), I would recommend endotracheal intubation accompanied with analgesics for pain management even in sedation. Since the patient was involved in an accident, I would prefer sedation and EI management in specifics of invasive positive-pressure ventilation while aiming for complete ABG compensation.
References
Zhang, Y., Tang, X., Xie, H., & Wang, R. L. (2015). Comparison of surgical fixation and nonsurgical management of flail chest and pulmonary contusion. The American journal of emergency medicine , 33 (7), 937-940.
Manley, N. R., & Maish, G. O. (2019). Blunt Chest Wall Trauma. In Clinical Algorithms in General Surgery (pp. 633-635). Springer, Cham.
