19 year old male brought in by EMS after a high-speed motor vehicleaccident. He was an unrestrained

19 year old male brought in by EMS after a high-speed motor vehicleaccident. He was an unrestrained driver and was found more than 10 feet from his car. He was unconscious at the scene but is becoming more arousable. He complaints of neck and head pain and cannot recall the details of his accident. He smells of alcohol and is bleeding from several lacerations on his head, arms, and legs. PMH/PSH/Meds/All: None PE: Vitals: Temp: 99.8 HR: 64 RR: 16 BP: 90/64 He is awake, but alert to only self and time. He is unaware of his location or situation. He is anxious and diaphoretic. His cranial nerve examination is normal but he has diminished tone to his lower extremities. He is able to shrug his shoulders with normal strength, he can flex his elbows, but his strength is weak against resistance. He is unable to extend his elbows against gravity and his ability to abduct his fingers is significantly diminished. He has sensation about the lateral aspect of his arms, but the medial aspect is diminished to pinprick. His pulses are intact. His lower extremity exam is remarkable for nearly no motor and severely diminished sensation bilaterally. He has palpable pulses. His spine exam is notable pain and crepitus about his posterior cervical spine. There is no further crepitus distally. His bulbocavernosus reflex is not intact.  How would you explain his hypotension with seemingly paradoxically low heart rate? How would you classify his neurologic injury? Level? Complete/incomplete?  Would you be able to tell if his injury is permanent at this point?  What other treatments must you employ at this point acutely? and chronically? Obviously this patient has a severe neurologic injury, but what does he need from you both in the ED and during his hospitalization in terms of rehabilitation, social services, etc?? Health Science Science Nursing NURS 6512 Share QuestionEmailCopy link Comments (0)

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