Question

Upon reassessment of a trauma patient who fell from 25 feet with a traumatic brain injury, three anterior rib fractures on the right side, a small pneumothorax on the right, and a Grade III liver injury, the patient was intubated and placed on a ventilator with PEEP. A chest tube was deferred at this time. Which finding is most concerning?

a) The traumatic brain injury showing increased intracranial pressure.

b) Worsening respiratory distress and increased PEEP requirements.

c) Increasing pain and tenderness over the fractured ribs.

d) Continued bleeding and signs of ongoing shock from the Grade III liver injury.

Answer 1

The most concerning finding is continued bleeding and signs of ongoing shock from the Grade III liver injury.

Step-by-step explanation:

The most concerning finding among the options given is d) Continued bleeding and signs of ongoing shock from the Grade III liver injury. A Grade III liver injury is a significant injury that involves a deep laceration and possible rupture of the liver, leading to internal bleeding. If the bleeding continues and signs of ongoing shock are present, it indicates that the patient is not stabilizing and may require immediate intervention to control the bleeding and restore hemodynamic stability.

Answer 2

The most concerning finding is worsening respiratory distress and increased PEEP requirements, indicating potentially life-threatening complications in the patient's ability to oxygenate the blood, which takes precedence over other injuries.

Step-by-step explanation:

The most concerning finding in a trauma patient who fell from 25 feet with a traumatic brain injury, three anterior rib fractures on the right side, a small pneumothorax on the right, and a Grade III liver injury, would be b) Worsening respiratory distress and increased PEEP requirements. This indicates that the patient's respiratory system is not able to adequately oxygenate the blood due to the pneumothorax and possibly the lung injury from the trauma. The increased PEEP requirements suggest that the patient's lungs are becoming less compliant, and the pneumothorax could be expanding, which could lead to a tension pneumothorax, a life-threatening condition. On the other hand, the traumatic brain injury with increased intracranial pressure is always worrying, but in the immediate setting, worsening respiratory function directly threatens the patient's ability to oxygenate and thus takes precedence. Increasing pain over the fractured ribs is expected and less concerning, and the signs of ongoing shock from the Grade III liver injury would have been addressed immediately during the primary survey and management of a trauma patient.