Cervical spine precautions

Bryan is a 19 year-old male who lost control of his car and struck a tree. Witnesses reported that he was not wearing a seat belt, and his face hit the windshield on impact. When paramedics arrived, Bryan was responsive but confused, had significant facial swelling, and reported pain in his right wrist and left forearm. The paramedics initiated cervical spine precautions, strapped him to a backboard, started oxygen (O2)
at 15L/min via non-rebreather mask, and started a 16 gauge IV with 0.9% normal saline
(NS).His vital signs (VS) were 120/75, 125, 36, SaO2 94%.
CASE STUDY
On arrival to the Emergency Department(ED) 15 minutes later, Bryan’s VS were BP
110/62, P 110 (reg), R 28-32 and shallow, SaO2 99%. An additional 16 gauge IV was
inserted and the following labs were drawn: CBC, type and crossmatch, (T &C),
complete metabolic panel (CMP), PT/PTT INR, and alcohol (ETOH) level. He was seen
and assessed by the neuro-surgeon and subsequently admitted to the neuro trauma
intensive care unit.
The trauma nurse completed a head-to-toe assessment and found the following: obeys
commands, responds to voice but not oriented to time or place. Generalized facial
edema with full-thickness 5-cm cheek laceration and bilateral mandibular depressed
fractures. Blood behind left tympanic membrane (TM), edema with slight discolouration
over left mastoid process. Clear drainage coming from the left nare. Mid to upper chest
contusions without crepitus, breath sounds clear. Abdomen slightly firm, but non tender.
Bryan was catheterized for 500ml clear, yellow urine; negative for blood, glucose,
ketones. He had a positive deformity of right wrist and diffuse tenderness of left lower forearm.
WHAT ARE THIS SUBJECTS IN REGARDS TO THE CASE STUDY?

Cervical C-spine precautions:

Oxygen 15L/min non-rebreather mask:

16 gauge IV with NS:

VS at scene:

VS in ED:

Additional 16 gauge IV inserted:

CBC:

Cross-type:

CMP:

Pt/PTT INR:

EToH:

Obeys command/oriented x1:

Generalized facial edema:

Full-thickness laceration 5cm:

Bilateral mandibular depressed fractures:

Blood behind left tympanic membrane:

Edema + discolouration over left mastoid process:

Clear drainage from left nare:

Mid/upper chest contusions with no crepitus – breath sounds clear:

Abdo slightly firm/non tender:

500 cc pale yellow urine, no blood/ketones/glucose:

Deformity R wrist:

Tenderness left lower arm: