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Question: kl a 25yrold korean american was not wearing his seat...

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K.L., a 25-yr-old Korean American, was not wearing his seat belt when he was the driver involved in a motor vehicle crash. The windshield was broken, and K.L. was found 15 ft from his car. He was face down, conscious, and moaning. His wife and daughter were found in the car with their seat belts on. They sustained no serious injuries, but were upset. All passengers were taken to the emergency department (ED). K.L. states, “I can't breathe” and cries out when abdomen is palpated. BP 80/56 mm Hg; apical pulse 138 but no palpable radial or pedal pulses; carotid pulse present but weak. Lungs: respiratory rate 38 breaths/min; labored breathing with shallow respirations; asymmetric chest wall movement; absence of breath sounds on left side. Trachea deviated slightly to the right. Abdomen: slightly distended and left upper quadrant painful on palpation. Musculoskeletal: open compound fracture of the lower left leg. Chest x-ray: Hemothorax and six rib fractures on left side. Hematocrit: 28%. Left chest tube is draining bright red blood. IV access obtained via one peripheral line and right subclavian central line. Fluid resuscitation started with crystalloids. High-flow O2 via non-rebreather mask. Surgical procedures to be performed include Splenectomy, Repair of torn intercostal artery, and Repair of compound fracture. ECG shows Sinus Tachycardia.


1. What types of shock is K.L. experiencing? What clinical manifestations did he display that support your answer?

2. What were the causes of K.L.'s shock states?

3. What are other types and causes of shock?

4. What are the priority nursing responsibilities and ongoing nursing assessment parameters essential for this patient?

5. What are his potential complications?

6. Why are crystalloids used instead of colloids for fluid resuscitation?

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