Question

Following a gun shot wound to the abdomen, a young adult male had an emergency bowel. Multiple blood products while in the operating room. His current blood pressure is 78/52. He is being mechanically ventilated, and his oxygen saturation is 87%. His laboratory values Grams / dl (70 mmol / L SI), platelets 20,000 / mm 3 (20 x 10 9 / L (SI units), and white blood cells. Based on these assessments findings, which intervention, should the nurse implements first?

Answer 1

The nurse should first address the 'ABCs' of trauma care—airway, breathing, and circulation—by ensuring optimal mechanical ventilation to improve oxygen saturation and commencing fluid resuscitation and blood product transfusion to stabilize blood pressure and correct coagulopathy.

Step-by-step explanation:

Emergency Intervention for Hypotension and Potential Hemorrhagic Shock

The priority intervention for a patient with a gunshot wound to the abdomen who currently has a very low blood pressure of 78/52 mm Hg and compromised oxygen saturation at 87%, is to stabilize the patient's hemodynamics and oxygenation. The reference to the patient's low platelet count (20,000 / mm3) indicates a critical situation which places the patient at risk of bleeding and further hemodynamic instability. Rapid administration of blood products, including platelets and possibly plasma, to correct coagulopathy, and the use of vasopressors to maintain adequate mean arterial pressure (MAP) are central interventions. Additionally, optimizing mechanical ventilation settings to increase oxygen saturation levels is immediately necessary.

In the context of the provided references, a patient with dangerously low blood pressure but normal blood colloid osmotic pressure can experience altered net filtration pressure, potentially leading to edema. Furthermore, it describes a scenario where immediate transfusion with universal donor blood (Type O negative) might be necessary due to the critical condition and lack of time to determine blood type.