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Skills Practicum

Skills Practicum. IED Blast Injury Right Femur Fracture and Left Lower Leg Amputation. You. Are working in the ER as a nurse. Patient. 20 year old Male arrived at Emergency Room by Helicopter Was on patrol when an IED went off and he was thrown 10 meters No loss of consciousness

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Skills Practicum

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  1. Skills Practicum IED Blast Injury Right Femur Fracture and Left Lower Leg Amputation

  2. You • Are working in the ER as a nurse.

  3. Patient 20 year old Male arrived at Emergency Room by Helicopter • Was on patrol when an IED went off and he was thrown 10 meters • No loss of consciousness • Accident was 60 minutes ago

  4. What do you do?

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

  6. What you see • Right leg deformity with discoloration and edema • 4 second capillary refill Right foot • Left lower leg amputation

  7. What do you see - Left Leg

  8. What do you see - Right leg

  9. X-Ray – Right leg

  10. Initial Treatments

  11. Initial treatments (cont)

  12. Assessment • “Blood Sweep” • Primary Survey • Secondary Survey

  13. What you hear

  14. Assessment Findings • Alert and oriented • Pupils equal and reactive to light, brisk • Left leg amputation but bleeding controlled • Airway open, breathing on his own, lungs clear, heart sounds normal • Grating sounds present with palpation of injured Right Let • Capillary Refill 4 seconds Right leg • Patient has Pale, cool, clammy skin • Bowel sounds are present

  15. Vitals on monitor 10 minutes later (repeated vitals) • Temperature: 37.2 C • Respirations: 26 • Blood Pressure: 100/62 • Pulse: 125 • Pulse Oximetry: • 94% on Oxygen (high flow)

  16. What’s 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?

  17. Continued Care and Concerns • Short term Risks and concerns • No circulation • Loss of sensation • Bleeding • Mid and Long term risks and concerns • Infection • Compartment syndrome

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