Case Study Of Explorative Laparotomy

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Outline of Case and Objectives
 43 year old male
 Previous laparotomy about 10 years ago due to gunshot abdomen
 Presenting now with a single stab wound to the right epigastric region, pericardial effusion confirmed by ultrasound. Explorative laparotomy done- patient has right ventricular injury and right sided diaphragmatic injury
 The patient was intubated and ventilated
 The patient had the following devices in place: o Right Intercostal Chest Drain (ICD) for a haemothorax which drained 150ml. o Right sided mediastinal drain o Left sided pericardial drain o Left sided peripheral intravenous (IV) line o Right sided central venous line o Right radial Arterial line (A. line)
 Before this case I had not previously come across an A. line in hospital or prehospitally which is why I will be focusing on arterial line care and maintenance during interhospital transfers. I have extended my search to in hospital care as there is very little literature focusing specifically on prehospital care of A. lines.
As an Emergency Care Practitioner (ECP) you are often required to do interfacility transfers of critically ill patients. These patients oftentimes have devices in place that an ECP would not routinely come
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lines during transportation it is of utmost importance that the site of the A. line is adequately stabilised before an interfacility transfer. This reduces the risk of displacing the A. line. Wake county also states that the practitioner is to ensure that the A. line is not entangled in other intravenous lines or monitoring equipment- This would decrease the chance of displacing the A. line. If a line is suspected to have tissued, it’s immediate removal is required and pressure is to be applied for a minimum of five minutes; once completed a re-evaluation of the patient is required to establish hemostasis. (Wake County EMS System STANDARDS and PRACTICE 2013,

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