solved

Clinical Scenario
Identify
Patient Name
Mr Brian May,
Age/Date of Birth
62 years, 10/Nov/1960
Sex
Male
Situation

Mr May was admitted to the emergency department earlier today following a motor vehicle accident car versus tree on Old Stump Road, Wudinna that occurred at 5.30am. It is suspected that Mr May experienced a medical event that caused him to lose control of his car. At the time witnesses suggest the car was travelling at 50 km.hr.
Background

Mr May is recently widowed after his wife died of pancreatic cancer 6 months previously. He now lives alone in the rural town of Wudinna. He reported to the ambulance personnel and staff at the hospital that he is non-compliant with his medication leading to unstable status of his diagnosed type 2 diabetes mellitus.
Mr May’s past medical history includes:
Type 2 diabetes mellitus.
Hypercholesterolaemia.
Depression.
Hypertension.
Current smoker 25 cigarettes a day.
Recent weight gain of 15 kg in the last 3 months. BMI now 30.
ETOH 50 g daily.
His currently prescribed medications include:
Atenolol (100mg bd)
Atorvastatin (80mg daily)
Metformin (500 mg bd)
Assessment

In the accident, Mr May sustained the following injuries:
Left pneumothorax and blunt chest injuries.
Fracture left fibula.
Left sided laceration of his forehead.
Recommendations

Thus, it was recommended that.
Plaster cast be applied to fractured left fibula – The orthopaedic registrar applied the plaster of Paris cast in the ED.
Patient controlled analgesia commenced for pain relief. Fentanyl 500 microg in 50 mL of Normal Saline at 2 mL per bolus dose.
Oxygen therapy at 2 L. min administered via nasal specs.
Under water seal drain (UWSD) inserted in the Emergency Department by the trauma registrar.
Dressing to his head laceration.
Admission to the High Dependency Unit (HDU).
PCR testing for COVID-19.

Nursing Handover

It is 24 hours post admission, you are about to start your early shift in the High Dependency Unit and Mr May is your allocated patient.
During the morning bedside handover, the night duty Registered nurse (RN) reports Mr May had a restless night, slept for short periods only and at times was disorientated.
Tested positive for COVID 19 – enhanced respiratory precautions.
Vital signs (last measured at 0600): Temperature: 37.6oC.
Heart rate: 100 beats per minute and regular.
Respiratory rate: 24 breaths per minute. Mr May complains of pain on inspiration and his breathing continues to be laboured.
It is noted that he is pale and diaphoretic.
Blood Pressure 170/90 mmHg.
UWSD observations; no swinging, bubbling or drainage.
Oxygen therapy continues as ordered.
During the nightshift, a total of 240 microg of Fentanyl IV was administered via the PCA.
An arterial blood gas (ABG) was ordered and taken at 0600 also. The following results were obtained:

pH = 7.30
PaO2= 68 mmHg
PaCO2 = 59 mmHg
Hg SaO2 = 92%
HCO3-1 = 26 mEq.L-1

Mr May continues to be restless and is now complaining of chest tightness when he breaths.

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