Sam went to the beach with some

Sam went to the beach with some friends and hit his head on a sand bank when diving into the water. He was floating face down in the water for about 30 seconds before his friends realised that he wasn’t fooling around. His friends alerted the lifeguards who arrived very quickly. The lifeguards retrieved sam from the ocean using a spinal board and maintaining spinal precautions as best as they could. The paramedics were called who arrived 15 minutes later. Cues: Paramedics Neurological assessment:ââ GCS:âeye-opening – spontaneous; verbal – orientated although drowsy; motor – can obey commands (blinking eyes, poking tongue out); some recall of the accident Pupillary assessment:âpupils equal, round, and reactive to light and accommodation Motor function:âunable to move arms and legs Sensation:âreporting no sensation in arms and legs Vital signs:â RR: 28 bpm (shallow) SpO2: 92% on O2 15L/min via non re-breather mask BP: 100/72âmmHg (MAP 81 mmHg) HR: 82 bpm T: 35.2oC Triage Vital signs:â RR: 32 bpm (shallow) SpO2: 89%âon O2 15L/min via non re-breather mask BP: 94/55âmmHgââ (MAP 68 mmHg) HR: 64 bpm T: 37.9oC (tympanic)â Primary survey:â Airwayâ- intact and unobstructedâ Breathingâ- O2 required to maintain SpO2; shallow, symmetrical chest movements; RR rapid; nasal flaring Circulationâ- MAP 68 mmHg; HR: 64 bpm; peripheries warm and pinkâ Disabilityâ – reflexes – minimal biceps brachii stretch reflexes with no triceps or wrist extensors reflexes, all other muscle stretch reflexes in the upper and lower extremities were absentâ -ââsensationâ- perception of sensory stimuli ended bilaterally at an imaginary line drawn across his chest 2 cm above the nipples, some sensation in his arms, but could not localise touch or describe texture with any consistencyâ – strengthâ- able to elevate shoulders and isometrically contract biceps brachii slightly in both arms, could not raise either arm against gravity; lower limbs flaccid, nil ability to moveââ – blood glucose – 5.5 mmol/Lâ Exposureâ – nil evidence of injuriesâ Pain assessment: Provoking/palliating – nothing particularly provokes the pain, it is just present Quality – stabbing and aching Region/radiation – neck area Severity – 8/10 Timing – worsening since the accident Neurological assessment: GCS: eyes – 4; Verbal – 5; Motor – 6 Pupils: pupils equal (4 mm), round, and reactive to light and accommodation (PERRLA) Limb movements: as above in “Disability” notes Assessment and investigation data Computerised Tomography report Exam Information Modality: CT Body Part: NEURO Description: CT Brain and C-Spine Performed Date: 25/3/Year Time: 1330 Final Report CT BRAIN AND C-SPINE CLINICAL NOTES: Witnessed dive into shallow water at beach. Immediately unable to reposition himself from being face-down in the water. Findings: A non-contrast CT has been acquired. C6 lesion with no vascular haemorrhages noted but some bloodâevident at C5 – 6 with bone fragments in the spinal canal.â Mild frontal lobe contusionâ IMPRESSION: Unstable C6 compression fracture X-ray Chest – decreased lung expansion upon inhalation; mild pulmonary oedemaâ Arterial blood gases pHâ-â7.27 (ref range: 7.35 – 7.45) PaO2â-â60 mmHg (ref range:â75 – 100 mmHg) PaCO2â-â52 mmHgâ(ref range: 35â- 45âmmHg) HCO3- -â25.2 mmol/L (ref range:â22 – 26 mmol/L) SaO2â-â88% Questions: Please do not provide a generalised answer because i have already researched on google. i am looking for detailed explanation for these answers. Consider sams arterial blood gas results. . Using physiological and pathophysiological mechanisms, and describing anatomical structures involved, explain why sam is presenting with this assessment data. infusion. a) Provide a rationale for this therapy by: describing the mechanism of action for the vasopressor therapy, describing the physiological mechanism for intravenous fluid therapy, describing the aim of these therapies for sam, identifying guidelines for use of these therapies identifying ONE risk of these therapies. b) describe the Evidence of the effectiveness of these therapies. 3. why Intravenous fluid therapy is administered and what vasopressors will do for sam? consider sam’s cardiovascular data and his injury. Explain What is happening to him and Why would he need circulatory support?

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