Question

Client Presentation and Vital Signs Assessment

A client has a penetrating wound to the anterior upper right chest. The client is alert and oriented with a Glasgow Coma Scale score of 15. The client's shirt is covered with bright red blood, and they report a pain level of 6 on a scale of 0 to 10. Shortness of breath is noted.

Current Vital Signs (Ambulance Crew Report - 2330):

Heart rate: 125/min
Respiratory rate: 28/min
Temperature: 36° C (96.8° F)
Blood pressure: 145/90 mm Hg
SaO2: 90% on oxygen 2 L/min via nasal cannula
Option 1:
a) Administer analgesics for pain relief.

Option 2:
b) Initiate high-flow oxygen therapy.

Option 3:
c) Apply direct pressure to control bleeding.

Option 4:
d) Prepare for immediate surgical intervention.

Answer 1

In a case of a penetrating chest wound with the presented vital signs, priority interventions include applying direct pressure to control bleeding, initiating high-flow oxygen therapy, preparing for immediate surgical intervention, and administering analgesics for pain relief after stabilization.

Step-by-step explanation:

Initial Management for a Penetrating Chest Wound

A client with a penetrating wound to the chest requires immediate assessment and intervention. The patient is alert with a Glasgow Coma Scale score of 15, but presents with a heart rate of 125/min, a respiratory rate of 28/min, a temperature of 36° C, a blood pressure of 145/90 mm Hg, and an SaO2 of 90% on oxygen at 2 L/min via nasal cannula. Given the bright red blood on their shirt and reported pain level, along with shortness of breath, priority interventions would include:

• Apply direct pressure to control bleeding.
• Initiate high-flow oxygen therapy to address the shortness of breath and hypoxemia, which could potentially proceed to shock if not managed quickly.
• Prepare for immediate surgical intervention because a penetrating chest wound may involve damage to vital organs and large blood vessels.
• Administer analgesics for pain relief once the patient is stable and bleeding is controlled to not mask symptoms of worsening condition.

These interventions align with advanced trauma life support (ATLS) protocols and focus on stabilizing the patient's condition to prevent further morbidity or mortality. An Emergency Department (ED) evaluation should include a rapid primary survey following the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach, emphasizing the importance of establishing and maintaining airway patency, breathing, and circulation.