Critical Thinking : Plan of Action and Rationale for a Trauma Case

Critical Thinking Week 5
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Summary of the Problem
This is a trauma case involving a 34-year-old male patient. It was not stated whether the injuries are secondary to blunt, penetrating, or both types of traumas. Furthermore, the patient’s neurologic status, vital signs, and the results of the primary and secondary surveys were not elaborated. The action plan was solely based on the provided data, including the brief history and the laboratory results.
The interpretation of his laboratory results is as follows: 1) Hemoglobin is significantly decreased at 7.9 g/dL, with the standard value set at 14 to 17.5 g/dL for males (Cleveland Clinic, 2018).; 2) The white blood cell (WBC) count is increased at 1800/L, with an average value of 4.5 to 11 x 109/L (Mount Sinai, 2021).; 3) The platelet count is decreased at 100, 000/L, with a standard value of 150 to 400 x 109/L (UCSF Health, 2019); 4) The Potassium is slightly elevated or mild at 5.5mmol/L, with a standard range of 3.6 to 5.2 mmol/L (Mayo Clinic Staff, 2020).
Plan of Action and Rationale
The plan of action includes the anticipation of cross-matching and provision of fresh blood or frozen plasma for blood transfusion, monitoring cardiac responses based on the serum potassium level, and monitoring inflammatory responses based on the WBC count.
Table 1. The Results of the Laboratory Tests and the Appropriate Actions
Result

Actions

Action

Action

Action


Anticipate type and cross-matching

Implement cardiac monitoring

Monitor for inflammatory responses

Anticipate either fresh or frozen replacement

Hemoglobin

X




White blood count



X


Platelet count




X

Potassium


X



Hemoglobin and Cross-Matching
Trauma cases require the preparation of blood or blood products in anticipation of possible fast deterioration of the patient’s status secondary to blood loss (Amin et al., 2021). Notably, in this case, the patient crashed on a tree, which may cause multiple fractures in the long bones, precipitating probable massive hemorrhage. According to Wijaya et al. (2016), death may abruptly follow after a massive hemorrhage, but this can be prevented by administering hemostasis and damage control resuscitation via blood transfusion. The patient can be transfused with a ratio of 1:1 of packed red blood cells (pRBCs), platelets, or fresh frozen plasma (FFP). Studies revealed that this method significantly increases the survival rate of massive trauma patients. Blood transfusion is accompanied by risks brought by transfusion reactions that can be abrupt or delayed, which happens for a few hours or weeks after the transfusion. Its signs and symptoms include itching, urticaria, fever, chills, hypotension, and acute respiratory distress (Suddock & Crookston, 2020). Cross-matching can be done to use group-specific blood type and rhesus factor to prevent antigen formulation from the antibody of the donor blood (Kaur et al., 2011).
As a health provider, this must be done as soon as the patient comes to the emergency room, even when the patient looks healthy and well upon inspection because there might be organ damage or fractures that are not seen during the primary survey. Moreover, the patient’s hemoglobin is significantly decreased. This will save time when the need arises and prevent the patient from rapid deterioration when a massive hemorrhage presents. Furthermore, this will determine if the patient is a candidate for a specific type of surgery, such that if a complete sur...