Page 662 - Clinical Application of Mechanical Ventilation

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at 40% during the night. The F O was increased to 50% at times during periods
I
2
of desaturation on 40% oxygen.
Her hematocrit increased from 25% to 30% ( female average 42%) after several trans-
fusions of Hespan, plasma, and packed red blood cells. Her most recent vital signs
before discharge were: SpO 90%, heart rate 95/min, blood pressure 140/90 mm Hg,
2
and CVP 20 mm Hg (normal 1 to 7 mm Hg). Her ABG results on discharge were simi-
lar to the baseline values from her previous hospitalization.

CASE 4: HEAD INJURY

INTRODuCTION

T.A., a 16-year-old, 52-Kg female, was brought to the emergency department after
sustaining multiple traumatic injuries from a moving vehicle crash. She was a pas-
senger in a small car involved in a high-speed collision with a truck. It was unknown
if she was restrained prior to the accident but paramedics required approximately
30 to 45 min to extract her from the vehicle. She was reportedly conscious at the
scene but became combative and hysterical when she arrived at the hospital. Her
blood pressure (BP) was 149/87 mm Hg, pulse 104/min, temperature 34.8°C,
and she was able to move all of her extremities.
Due to the extent of her injuries, she was chemically paralyzed temporarily,
orally intubated, and maintained by sedation. The routine trauma laboratory stud-
3
ies revealed the following results: WBC count of 2.3 3 10 (normal 3.2 to 9.8 3
Leukopenia (decrease 10 ), hematocrit (HCT) 37% (female normal 42%), platelets of 269 3 10 (normal
3
3
in WBC) may be due to the
3
trauma or adverse effects of 130 to 400 3 10 ), prothrombin time (PT) of 13 sec (normal 9 to 12 sec), and
drugs. partial thromboplastin time (PTT) of 27 sec (normal 22 to 37 sec). Radiographs
of the abdomen and chest were unremarkable. However, due to the extent of her
head injuries, she was flown by air transport to a nearby trauma center.
A Glasgow coma score of Throughout transport, she was reportedly in and out of consciousness, and upon
3 reflects a severe coma state. her arrival to the trauma center her BP was 119/70 mm Hg, pulse 92/min, She
had a Glasgow coma score of 3 with no spontaneous eye opening and no move-
ment of her arms or legs. During her initial assessment, she was nonverbal and
Pupils that are reactive noted to have a cephalhematoma in the right frontal region with a large laceration
to light mean that cerebral in the occipital area of her skull. Pupils were equal, round, and reactive to light.
circulation and oxygenation
are adequate. She was in a normal sinus rhythm, had equal breath sounds, and her SpO was
2
®
100% while being manually ventilated via Ambu bag on 1.0 FO .
I
2
Indications

A computerized tomography (CT) scan of her head revealed an occipital condylar
fracture on the right with a small intrahemispheric subdural hematoma that did

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