Presentation and Initial Treatment • 27 yo female in MVA, ejected from car through windshield. BIBA unconscious, on spin
Posted: Thu Sep 16, 2021 5:02 am
Presentation and Initial Treatment
• 27 yo female in MVA, ejected from car through windshield. BIBA
unconscious, on spinal board with C-collar.
• Glasgow Coma Scale (GCS) 9
• PERRL (L>R).
• ABG: pH 7.33, PaCO2 56, HCO3 24, PaO2 75
• Intubated in ED and placed on AC with rate 20, TV 500 mL, PEEP
5, FiO2 100%
• R subclavian central line placed • R radial arterial line
• Foley inserted
• C-spine X-rays negative for fractures, basilar fracture
noted
• CT scan positive for L temporal parietal subdural hematoma
(SDH) with a cerebral mid-line shift Surgical Intervention
• Craniotomy for removal of SDH
• EVD placed Immediate Post-Op Diagnostic Data
• ICP: 25-27 mmHg
• VS: T 37.8C (100F); HR 110, NSR; RR 20; SpO2 100%; BP
103/68
• ABG: pH 7.43, PaCO2 36, HCO3 24, PaO2 476 Partial Review of
Pharmacologic Post-Op Orders
• Furosemide (Lasix) 20 mg IV q6h
• Phenytoin (Dilantin) 100 mg IV q6h
• Mannitol (Osmitrol) 25 g PRN q6h for ICP > 25 mmHg lasting
more than 30 minutes Clinical assessment 1 hour following
surgery:
• GCS 12 [EVM 3,4,5]
• ICP 23-26 mmHg
• VS: T 38.3C (101F); HR 122, NSR; RR 38; SpO2 100%; BP
130/88
• ABG: pH 7.48, PaCO2 30, HCO3 21, PaO2 431
6. What ventilator changes should be made following the post-op
ABG and why?
• 27 yo female in MVA, ejected from car through windshield. BIBA
unconscious, on spinal board with C-collar.
• Glasgow Coma Scale (GCS) 9
• PERRL (L>R).
• ABG: pH 7.33, PaCO2 56, HCO3 24, PaO2 75
• Intubated in ED and placed on AC with rate 20, TV 500 mL, PEEP
5, FiO2 100%
• R subclavian central line placed • R radial arterial line
• Foley inserted
• C-spine X-rays negative for fractures, basilar fracture
noted
• CT scan positive for L temporal parietal subdural hematoma
(SDH) with a cerebral mid-line shift Surgical Intervention
• Craniotomy for removal of SDH
• EVD placed Immediate Post-Op Diagnostic Data
• ICP: 25-27 mmHg
• VS: T 37.8C (100F); HR 110, NSR; RR 20; SpO2 100%; BP
103/68
• ABG: pH 7.43, PaCO2 36, HCO3 24, PaO2 476 Partial Review of
Pharmacologic Post-Op Orders
• Furosemide (Lasix) 20 mg IV q6h
• Phenytoin (Dilantin) 100 mg IV q6h
• Mannitol (Osmitrol) 25 g PRN q6h for ICP > 25 mmHg lasting
more than 30 minutes Clinical assessment 1 hour following
surgery:
• GCS 12 [EVM 3,4,5]
• ICP 23-26 mmHg
• VS: T 38.3C (101F); HR 122, NSR; RR 38; SpO2 100%; BP
130/88
• ABG: pH 7.48, PaCO2 30, HCO3 21, PaO2 431
6. What ventilator changes should be made following the post-op
ABG and why?