Emergency Department Clinical Reflection

Write one to two paragraphs for each question below

1.

Identify one patient from your shift in the ED. Indicate the medical diagnosis
and describe what you noticed about this patient from your initial contact with
the patient/family and their expectations for required care. Patient was in
motorcycle accident going 50 miles an hour and hit a van. Patient flew over the
van and ended up about 50 feet from the site of impact. Patient was a trauma
brought in ambulance to the trauma room in the ER. Patient was in severe pain,
when the cut the clothes off I noticed two large lacerations underneath his
scrotum that were bleeding profusely.

2. What did you interpret from your interaction with the patient identify what
information you obtained from talking with the patient and health care providers
(narrative), assessment data (analytic), and your concerns about this patients
health status (intuitive).
Patient had a CT scan done and it was determined that both iliac crests opened up
like a book, a very badly fractured femur, and multiple fractures on the other leg.
His blood pressure was low when he came in and he lost a lot of blood I heard
estimates of 4 liters or more. The patients bleeding slowed from his lacerations,
however he developed what I thought looked like a hernia but was actually blood
pooling in the abdomen. Patient was in very bad shape, I was fully stoked to be a
part of this.

3. What were your nursing goals in working with this patient? How did your goals
differ from the team/patient goals? Evaluate patient and get him stable enough to
ship to Eugene or Portland.
As this patient was a trauma patient I did my best to help, and not get in the way.
The nursing staff did not bark at me or pretend I wasn't there they allowed me to
help where I could and asked me to get things I had no idea where they were at,
but did my best, usually about four steps behind where I needed to be. Again the
patient had lost a lot of blood and had a very low blood pressure so they pumped
him full of fluids, 3 liters of normal saline, 3 units of blood I don't know if they

were RBC's or whole blood or what", and two units of fresh frozen plasma. The
flight crew took another two units of blood with them for the flight in case his
blood pressure dropped below 90 systolic.

4. How did this patients condition change during the time you worked with him or
her?
Patient was held in the trauma room for about four hours. His vital signs were
stable he received three liters of crystalloids, two units of fresh frozen plasma,
and three units of blood. Patient was still agitated somewhat when he left with the
flight crew to go to OHSU emergency room.

5. What actions were taken in providing care for this patient? Discuss the
interventions performed in caring for this patient. Who performed these
interventions? What interdisciplinary collaborative behaviors did you observe?
This patient had a CT scan, and four X-rays done while he was here. In all I believe
a total of 20mg of Haldol was given, 25mg Diphhenhydramine, and 15mg of another
pain medication during the time he was here. With all that medication I was really
surprised his respirations did not go below 10 but I guess when youre in that much
pain it would be pretty hard to become sedate.

6. Describe the outcomes (based on nursing interventions that you would identify)
when providing care for this patient. What were important reflections while
performing the interventions? Did your reflections change how you were managing
this patients care? At first I thought the guy had lost one of his testicles. I
couldn't tell, as I took a second look it was a blood clot the size of a turkey liver
its the only thing that I could compare it too, having worked with food for years".
I helped clean the patient, "helped" place IV's, moved the patient from stretcher
to stretcher, keep patient from pulling IV lines out and keeping an accurate blood
pressure. Over all a great experience!

7. Briefly summarize the overall care provided for this patient and whether the
final outcome was expected or unexpected given the health status of the patient
and the care provided.
Well I guess I was surprised that they shipped him. Of course I have no real idea
of how severe his lacerations were and what it would involve to fix this man. The
nurse, Alan, that ran the trauma was very competent and professional new exactly
what to do when he needed to do it. The blood warmer IV infuser was very
interesting to me. I had no idea you could give a unit of blood in four minutes and
have it be okay?! The patient ended up in stable condition with blood pressures in
the 115"s/ 75-80's. I don't know how this guy will end up I hope he can make a full
recovery. The trauma coordinator said I should come back to the debriefing to
find out what happened to the guy and get a report on how it all ended up? I don't
know if I can come in for it but I will try.

Rev. 6/10/09(2014 PW)