Nursing clinical reasoning

trauma Nurse Case Study
Mechele Br posted
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How could that be that the family did not drown?

Perhaps it wasnt a deep river, and that it took a while for responders to arrive to the remote location. Or, if the river was deep, it is possible that a window was broke open, or someone was able to access the trunk and trunk release cord.

What are two assumptions you have related to this case?

Timing of arriving responders
Depth of river and survival skills of family members

What questions do you want to ask?

Estimated time of arrival to prepare a team, I work in a rural critical care access hospital and studies have shown that deaths from non-collisions (single vehicle, overturning) and collisions (crash) behaved differently with respect to population density, with a higher risk of dying in a car accident by non-collision in areas of low population density. Related to this, the role of access to health services has been questioned as a risk factor of mortality in rural or low population density areas (Leveau, 2015).

Were they wearing seat belts, and were there any signs or symptoms of substance abuse related to the accidents?  Alcohol-impaired driving and speeding among adults also were examined because these risk factors are related to lower rates of seat belt use (Beck, 2017).

Responders state all family members were alive, however, are there any injuries, did was anyone projected from the car? Was there any loss of consciousness before, during or after the incident? In 2012, an estimated 2,519,471 emergency department visits resulting from nonfatal crash injuries occurred in the United States, with 7.5% of these visits resulting in hospitalization, accounting for an estimated 1,057,465 hospitalization days in 2012 (Bergen, 2014). 

What ages are the family members? Teens and young adults aged 1529 years account for 21% of the population but accounted for 38% of the costs for patients treated and released for crash injuries (Bergen, 2014).

What interventions took place by responders/law enforcement prior to arrival to the hospital and current VS of all members?

Question: I once encountered a situation where EMTs arrived with a patient who was involved in a MVA roll over where a patient was ejected from the vehicle,  it was reported that the patient was walking and talking when EMTs arrived to location of the roll-over and were currently A&O X4.  By the time the patient arrived to the ED she was unresponsive. We transferred the patient via flight and the patient had major internal injuries at which the patient did not survive. Have you ever encountered a situation where a patient was A&O upon report, but arrived unresponsive? If so, did that change your reaction mentality to MVAs?

Beck, L. F.-S. (2017). Rural and Urban Differences in Passenger-Vehicle-Occupant Deaths and Seat Belt Use Among Adults. MMWR Surveillance Summaries, 1-13.

Bergen, G. P. (2014). Vital Signs: Health Burden and Medical Costs of Nonfatal Injuries to Motor Vehicle Occupants. MMWR: Morbidity & Mortality Weekly Report, 894-900. Retrieved from

Leveau, C. M. (2015). Residence place as a risk factor in different types of fatal car accidents. International Journal of Injury Control & Safety Promotion, 95-99.

This is the second time this semester that I have forgotten to copy and paste my references, I apologize and will pay closer attention.

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