A patient of road traffic accident present with BP 76/34 mm of Hg and pulse-133. He is conscious and oriented. Only injury observed was fracture of long bone of right leg with profusely bleeding wound. What immediate action should be taken?

1. A

   IV fluid and oxygen.

2. B

   IV fluid and prophylactic antibiotic

3. C

   Stop bleeding by using tourniquet in thigh.

4. D

   Call surgeon

Appeared in: NCL (MP) Nursing Officer - 2020

Explanation

• The patient's vital signs (BP 76/34 mmHg, Pulse 133/min) are indicative of severe hemorrhagic shock.
• In trauma management, the first priority is to control catastrophic external hemorrhage, following the XABCDE (or C-ABC) protocol.
• Applying a tourniquet is the most effective and immediate life-saving intervention for controlling profuse arterial bleeding from an extremity.
• Stopping the source of blood loss must occur before or simultaneously with fluid resuscitation to ensure the fluids are effective and do not worsen the bleeding.

Why Other Options Were Wrong

• Option A: While IV fluids and oxygen are crucial components of resuscitation, they are secondary to controlling the source of massive bleeding. Giving fluids without stopping the hemorrhage is like trying to fill a leaking bucket.
• Option B: Prophylactic antibiotics are important for preventing infection in an open fracture, but this is not an immediate life-saving measure. Hemorrhage control is the priority.
• Option D: Calling the surgeon is a necessary step for definitive care, but it is not an immediate, hands-on intervention to stop the patient from bleeding to death. The nurse must act first to stabilize the patient.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Prioritization of care in a trauma patient with hemorrhagic shock helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• This scenario emphasizes the critical nursing role in the primary survey of a trauma patient, where rapid assessment and intervention can be life-saving.
• Nurses must be proficient in recognizing hemorrhagic shock and implementing immediate hemorrhage control techniques, including tourniquet application, as part of the 'Stop the Bleed' initiative.
• What if the bleeding was described as 'oozing' instead of 'profuse'? In that case, direct pressure and a pressure dressing would be the first intervention, and a tourniquet would likely not be the immediate choice. The priority would then shift more quickly to establishing IV access and fluid resuscitation (Circulation).

How to Approach the Question

• First, analyze the patient's vital signs. The BP is very low (76/34 mmHg) and the pulse is very high (133/min). This combination immediately points to shock, likely hypovolemic/hemorrhagic given the context.
• Next, identify the cause of the shock. The stem explicitly states 'profusely bleeding wound' from a leg fracture. This is a catastrophic external hemorrhage.
• Recall the priority framework for trauma care: XABCDE or C-ABC. The 'X' or 'C' stands for Catastrophic Hemorrhage and is always the first priority.
• Evaluate the options based on this framework. The only option that directly addresses controlling the catastrophic hemorrhage is applying a tourniquet.
• The other options (fluids, oxygen, antibiotics, calling a surgeon) are all important but come after the immediate life threat of exsanguination is controlled.

Concept Tested & Keywords

• Concept Tested: Prioritization of care in a trauma patient with hemorrhagic shock.
• Stem keywords: road traffic accident, BP 76/34 mm of Hg, pulse-133, profusely bleeding, fracture of long bone, immediate action
• Lead-in keywords: immediate action
• Clinical cues: The combination of severe hypotension (BP 76/34) and tachycardia (pulse 133) is a classic sign of hemorrhagic shock, indicating significant blood loss.
• Clinical cues: The term 'profusely bleeding' signifies a life-threatening hemorrhage that requires immediate control.

Question ID

Q428IKOpxjaQ9rNXHu-sfb

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 pp. 117-119, 120-122