case study on medical scenario

Given the case study below: Mohamad, a 41-year-old courier, is admitted to the ED after he was involved in a single vehicle motor vehicle crash. He crashed into a tree at 0530 hours. The weather conditions were cold and wet. Mohamad has no significant medical history but smokes 25 cigarettes per day. Mohamad’s injuries include cerebral contusions, multiple ribs fractured and a right-sided haemopneumothorax. Clinical assessment reveals: RR 42 breaths/minute short and shallow SpO2 86% HR 120 beats/minute BP 87/60 mmHg Temperature 35.5ºC Pain Visual analogue scale 8/10 GCS 13 Pale and diaphoretic On initial admission Mohamad’s Arterial blood gas was: pH 7.3 PaO2 60 mmHg PaCO2 50 mmHg HCO3………..19 mmol/L BE -4 Management includes: C spine – semi rigid collar Oxygen via a mask at 6 litres/minute IV fluids – Hartmann’s stat 2 units of packed cells Intercostal catheter Warm blankets Morphine 2.5 mg increments titrated to pain CXR ---------------------------------------------------------------------------------- answer the following question: 2500 words ± 10% Weighting: 60% (minimal acceptable grade pass) This assessment has three questions and relates to the case study of Mohammad introduced to you in your case study document and in your Learning guide. The case analysis will provide synthesis for the content of this subject to integrate your learning with your clinical practice. Question 1 ( approx 1000 words) Analyse Mohammad’s respiratory changes in relation to his current clinical condition. Include in your analysis: • effects on his mechanics of breathing • changes in intrapulmonary pressure • physical factors influencing Mohammad’s pulmonary ventilation • ramifications on Mohammad’s V/Q ratio. Question 2 ( approx 700 words) Identify the reasons for Mohammad’s haemodynamic changes. Considering these haemodynamic changes, predict the consequences on Mohammad’s preload, contractility and afterload. Identify the specific adrenergic receptors that are stimulated. Discuss the relationship between increased heart rate and cardiac output. Question 3 ( approx 800 words) Interpret and analyse Mohammad’s arterial blood gas. In your analysis include: • buffering systems • regulatory mechanisms • pressure gradients • solubility of gases. Relate the interpretation to the oxygen-haemoglobin dissociation curve The case analysis rubric available on the front page of your subject shell will assist you in meeting the requirements of this assessment