Professional Documents
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PICU
Worksheet
Student: Shawn Hekkanen_ Date: 2/2/16 Instructor: Danielle
Beasley__
M/F__M_ Age__11___Current Wt._84.3kg_____Date of
Admission__1/26/16___
Vital Signs: T__98.5F___ HR__70____ RR_24______
BP__136/74____ O2 Sat%_100____ Capnography__EtCO2
27mmHg_____
Oxygen/Type___mechanical ventilator /45%
O2__________________________________
Procedures___Left side craniotomy, _intracranial pressure
monitor with Licox bolt, OG tube, switched Dobhoff NG tube to
duodenum, attempted spinal fusion of C1/C2 delayed due to
complications associated with pneumonia, foley catheter
insertion, right chest tube for pneumothorax now removed,
endotracheal intubation, right arterial line
1. Indicate the diagnosis/reason the patient was admitted to
the PICU and define treatments for the diagnosis:
11 year old African American male, 84.3kg, admitted to TGH as
transfer from Lee Memorial Hospital, after MVA from rock truck that
rolled onto patients vehicle. Patient was trapped inside vehicle 30-40
minutes and freed by emergency responders. Patient was unresponsive
at the scene of accident. He is diagnosed with Left subdural hematoma
with shift, mild mass on left cerebrum, large liver laceration (grade 5),
right rib fractures 1-7, left rib fracture 1, pulmonary contusions, right
pneumothorax, spleen laceration (grade 2), mesenteric hematoma.
Patient was originally intubated by first responders. He currently an
endotracheal tube with PEEP 7, O2 45%, RR 24, 24cm at the mouth
center.
Left side craniotomy for frontoparietal subdural hematoma was
performed for relief of brain shift. Monitoring ICP via bolt. Direct
monitoring of brain oxygenation via Licox bolt, maintaining
pO2>15mm Hg by adjusting mechanical vent above 45% O2, as
needed to promote brain oxygenation. Spinal precautions with C1/C2
fusion pending, C7-T4 compression fractures, and ligamentous injuries.
Right chest tube had been placed d/t
pneumothorax/hemothorax(doctors reported that it was combination),
with serosanguinous output. Chest tube has been removed and there is
bilateral equal chest expansion. Hourly neural exam and assessment.
Coarse breath sounds. Localizes to pain except right upper extremity,
only withdrawals. Continous titration with PRN bolus for pain and
sedation, with fentanyl and versed, respectively. Treatment for
famotidine
Prevent
aspiration
,
antiulcer
(0.25mg/kg)
Actual: 20mg
BID WNL dose
less than
0.25mg/kg
Arrhythmia
,
agranulocy
tosis,
anemia
Cefepime
antibiotic
(50mg/kg q12
hr for 10
days)
actual1g in
5%
dextrose=50
mL/hr TID
Lower than
normal
dosage
Seizures,
diarrhea,
c.diff,
anaphylaxi
s
(10mg/kg/BID
)
actual:
StevensJohnson
rash, toxic
Keppra
anticonvu
lsant
Maintain
patient
airway if
overdose,
reversed
with
romazicon
.
Monitor
Hgb.
Assess for
occult
blood in
stool,
emesis,
gastric
aspirate..
Monitor
CBC.
False
positives
for urine
protein,
can raise
ALT, AST,
crt.
Monitor
for S/S of
anaphylax
is due to
allergy.
Keep
epinephri
ne
nearby.
Monitor
bowel
function
and lung
sounds.
Assess for
rash, life
epidermal
necrolysis
monitoring
of skin,
agranulocy
stosis lab
monitoring
threateni
ng.
Monitor
skin and
oral
lesions