VERBAL EVALUATION 2

CASE 5: MAJOR TRAUMA

Mr. K, 25–year-old man, with a gunshot wound (GSW) to the abdomen was being treated in the
emergency department. The entrance wound was observed in the left lower quadrant as a small
hole with mild bleeding. The exit wound was present in the right upper flank on the back with
moderate bleeding. He was scheduled for a diagnostic laparotomy. He was alert, talking, and
states that he was having severe abdominal pain. He admitted smoking marijuana the day before.
Diagnostic data showed that hemoglobin, 10.1 g/dl; hematocrit, 30.5%; Platelets, 235,000 per
microliter; Electrolytes: sodium, 141 mEq/l; potassium, 3.9 mEq/l; chloride, 107 mEq/l; carbon
dioxide, 25 mEq/l; blood glucose, 97 mg/dl; and computed tomography (CT) scan reveals blood
in the peritoneum. His height was 173 cm and his weight was 73 kg. The vital signs showed that
BP: 136/91 mmHg; Pulse: 121 bpm; RR: 20 bpm; room air oxygen saturation, 100% on face
mask O2 at 15 liter/min flow; and T: 36°C.

QUESTIONS

Preoperative Period
1. Explain the importance of a head-to-toe physical exam for this patient!
2. Identify the rationale for administering antibiotics during the preoperative period!

Intraoperative Period
3. Explain the intraoperative anesthetic maintenance for this patient!

Postoperative Period
4. Explain the concerns for postoperative pain management after penetrating abdominal injury!