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Thomas Good, a 56-year-old male arrives in the ED after being involved in a MVA

Health Science

Thomas Good, a 56-year-old male arrives in the ED after being involved in a MVA. He was an unrestrained driver verses an 18-wheeler. There is extensive damage to the front of the car. The client needed to be extricated from the vehicle. He has massive bruising to the chest, head, and neck.
You are the ICU nurse: The report you receive from the ED nurse:
Sedated with versed 5 mg after receiving 20 mg Etomidate and 100 mg of succinylcholine for intubation. Prior to intubation the GCS was 7.
He will receive a Versed drip from the pharmacy, it will be tubed to the unit. Versed to run at 8 mg/hr. patient weight 180 lbs
8.0 endotracheal tube is in place 21 cm at the lip.
Vent settings are: Vent rate 12, TV (tidal volume) 500 ml, PEEP 5 ml, Fio2 21%
Chest tube to 20 cm of suction 200 ml of serious drainage, site dry and intact, Lungs sounds diminished, with wheezes upper airway, crepitus felt in upper left chest
Skin warm and dry


Several lacerations and bruising of the chest, neck, and head Febrile at 101, ST 110, RR 12, BP 100/64
Bowel sounds present all 4 quads, incontinent of urine and stool upon arrival to ED
You take over care: you begin your assessment; the vent alarms are going off. The respiratory therapist had to leave the room for a code. How do you care for the patient?
Is the client on the vent for ventilatory or oxygenation problem? What is the cause of the alarms?
What is the first action required? What is the next action required?
How will you position the client with a flail chest?

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