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Jana Turnbull: The Case

Problem Based Learning guide for 1st Year medical students.

 

The Case

 

HPI:

Jana Turnbull is a 23-year-old patient who is brought to a university teaching hospital and trauma center via ambulance after a multivehicle motor vehicle accident in which she was a restrained driver with intrusion into the vehicle on the driver’s side.

The EMT gives the following report to the trauma team assuming care of Jana at 3:00 pm:

“This wreck was a mess. A dump truck crossed the median and hit a semi, and about 10 cars piled up. Her car was a little sedan, and she had a direct intrusion of a max duty pickup into the front driver’s side panel. Fire Department had to extricate her with equipment, but a fire erupted before they could get to her inside the driver’s compartment so she has some bad leg burns. She is also complaining of abdominal pain. She was restrained, and the airbag deployed. She was placed in a c-collar and on a board at the scene, we started an IV and hung a bag of normal saline. HR 120’s, blood pressure in the field was 100/60. Normal mental status throughout.”


Trauma room events:

VS:

T  95.1F
HR  135
BP  90/60
Sp02   99%

Initial exam done by ER physician, with findings reported verbally to team as exam is conducted. Jana’s backboard is lifted to the stretcher and her remaining clothes cut off to evaluate additional injuries. Jana is crying and shaking in pain but interacting with the team appropriately. She is covered with shallow abrasions and several small bleeding lacerations, and is burned with blackening and peeling of the top layer of skin with whiteness of the underlying areas. The burn covers the anterior surface of both legs from the ankle to the mid-thigh as well as some medialand posterior surfaces of the left leg. She says the burns “kind of hurt” but that her abdominal pain is worse than the pain from her legs. She has bruising visible over the left upper abdomen and is tender to palpation with guarding on palpation. Her lung sounds are symmetric and clear bilaterally, and her distal pulses are palpable.

An additional large-bore IV is placed with a second liter of crystalloid now infusing and the Trauma service is paged to the ER to help evaluate and treat the patient.

The trauma team assesses Jana’s airway, looking for singed hair of the nose and face, hoarseness or black mucous. They determine that she is able to maintain her airway and agree with the lung findings. She is bruised and tender on her left chest wall.

VS update:

T  94.9F
HR  150
BP  80/40
Sp02   99%

Two additional liters of crystalloid are given and a focused assessment using sonography for trauma (FAST) exam is performed.

Bedside ultrasound screens of the pericardium, thorax, and abdomen are done with free fluid visible in the left splenorenal view.

Clinical Librarian

Ansley Stuart's picture
Ansley Stuart
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