Nursing Care for Patient with Multiple Trauma and Hemorrhagic Shock from Intraabdominal Hemorrhage in The Emergency Phase: Case Study.

Abstract

      This study is a case study aimed at examining the nursing care of a multiple trauma patient with hemorrhagic shock due to intra-abdominal bleeding in the emergency phase. The subject was a 13-year-old male who suffered a motorcycle accident crashing into an electric pole, with a history of unconsciousness for 30 minutes prior to hospital arrival. Upon initial assessment in the emergency room, the patient was unconscious with a Glasgow Coma Scale score of 6. He presented with a laceration under the chin, multiple abrasions across the body, and a deformed right thigh. Initial radiological examinations revealed no abnormalities, but a FAST scan detected intra-abdominal blood at hepatorenal and splenorenal spaces. The preliminary diagnosis indicated severe traumatic brain injury associated with blunt abdominal trauma, with a right acetabulum fracture. During the course of care, the patient experienced a decreased level of consciousness and developed hemorrhagic shock from intra-abdominal bleeding. Once his vital signs improved following medical resuscitation, he was sent for computed tomography scans of the brain, chest, and abdomen. The findings suggested diffuse axonal injury (DAI) of the brain and a grade IV splenic injury. Consequently, an emergency exploratory laparotomy with a splenectomy was performed, successfully saving the patient's life in a timely manner.

      The study revealed major emergency-phase problems: the risk of cerebral hypoxia from diffuse axonal injury (DAI) and acute circulatory failure from hemorrhagic shock. Nursing care included securing the airway with intubation, rapid resuscitation with large-bore IV fluids and blood products, and closely monitoring vital signs, consciousness, neurological signs, and signs of increased intracranial pressure with the head elevated at 30 degrees. Additionally, the nurse coordinated CT scans and prepared the patient for an emergency splenectomy.