Weeks 1 and 2 Blood on the Road WHAT DO WE KNOW? PBL1 Notes Car accident Patient is alive There is a bad wound/ patient is bleeding Low BP (hypotensive) Tachycardic Thready pulse Chest bruising ?rib fractures Tackypnoeic (fast breathing) Thirsty (dehydration/ blood loss??) PBL2 Notes BAL= 0.18 Smoker Family history of alcoholism Compound fracture of the femur Laceration of the femoral artery No blood borne diseases Unemployed Patient is a binge drinker Patient has a punctured left lung and a pleural effusion PBL3 Notes The left Bronchus and pulmonary vein has been repaired in surgery Still in shock – anaphylactic/ obstructive (from a fat emboli??)/ cardiogenic/ hypovolaemic Poor perfusion of the extremities Extremely low ejection fraction (31%) WE DO WE NEED TO KNOW TO UNDERSTAND THE PROBLEM? PBL1 Notes Was anyone else in the car? Vital signs (temp, pulse, BP, responsiveness, appearance) Cause of the crash (fatigue, drink/drugs, concussion) Nearest hospital / how long until help can arrive? Is it safe for us to help out? How much blood has been lost Character of the breathing (shallow etc.) Past medical history Medications eg. NSAIDs, Warfarin, Alcohol PBL2 Notes Mental state of the patient (i.e. depression?) Liver function Has he experienced physical harm as a result of the alcohol – i.e. toxins, albumin levels, brain, Thiamin depletion, peripheral nerves, pancreas, cerebella dysfunction etc. as well as the social and psychological effects of the alcohol? Has the patient been taking any over the counter medications (including NSAIDs) and/or any other drugs? Relationship between unemployment and the PBL3 Notes Has the pericardial sac been drained? Could it be possible that the wrong blood type could have been given? – anaphylactic shock? ?stridor? Breathing needs to be investigated – rate and quality General appearance, temperature – hypo or hyperthermic? What meds were administered in theatre? How much blood was lost during surgery? alcohol MECHANISM UNDERLYING THE PROBLEM (HYPOTHESIS) PBL1 Notes Crashed due to an impairment of sorts Leg injury is the result of the crash Lacerated leg artery (femoral) Patient suffering from shock PBL2 Notes There could be another possible rupture in the body The heart is under pressure PBL3 Notes None WHAT INFORMATION DO WE NEED TO SOLVE THE PROBLEM? PBL1 Notes Necessary investigations: chest Xray, blood tests (WBCs, RBC count, alcohol/drugs, platelets, liver function, renal function (want to check urea and Creatinine levels for an indication for renal function), blood type, pulse oximetry, temperature – is he hypothermic?) PBL2 Notes The consequences of alcohol, including the social, psychological and physical PBL3 Notes What compensatory mechanisms does the body utilise?