51.2 Monitoring an injured patient

You have now done all you can for an injured patient for the moment, but there may be more to do at any time, so assess him thoroughly at definite intervals of time to observe any changes in his condition, because changes will then be more obvious. Change is gradual, and you are more likely to observe it if you retain a mental picture of him at one moment and then return 15 minutes or half an hour later. You may perhaps observe a change of 10 points in his pulse, increasing pallor, or the onset of sweating. These last two cannot easily be measured and charted, yet they often preceed a catastrophic fall in his blood pressure. If you have even a simple intensive care unit, this is the place for him while he is seriously ill, before and after his operation (19.1).

MONITORING A SEVERELY INJURED PATIENT

Record the patient’s pulse and his blood pressure and, when necessary, his CVP (A 19.2)-if you are skilled enough to be able to insert a central venous line. When necessary, record his state of consciousness with a head injury chart (63.2), his fluids with a fluid balance chart (A 15-5), and his abdominal girth (66-2).

Make sure that the nurses who make these charts know that their role is life-saving.

CAUTION ! Watch him carefully for the development of a silent pneumothorax. Percuss his lungs daily. Reduced vocal resonance is a useful sign of a haemothorax.

Figure 51.6: A DOUBLE INJURY-HEAD AND BRACHIAL PLEXUS. This patient has been thrown from his motor cycle, injuring his head and his brachial plexus. He might also easily fracture both his upper and lower arms and his legs, and have internal injuries, especially a ruptured spleen. From an unknown source.