NEED HELP WITH #6
N.R. is a 49-year-old lumber worker admitted to the emergency department after a severe laceration of his left thigh. He lost about 4 units of blood prior to effective control of bleeding and closure of the wound. He received several hundred milliliters of normal saline during the procedure. Postsurgical clinical data are as follows: vital signs lying down, HR 115, BP 98/60, RR 28; sitting, HR 140, BP 92/62, RR 28; Hct 22, Hb 8, PaO2 90, SaO2 98% breathing room air. N.R. continues to have significant oozing from his sutured wound postoperatively, prompting his physician to order a coagulation screen that has the following results: platelet count 250,000, bleeding time more than 10 min, PT and aPTT within normal ranges.
Discussion Questions
- In view of N.R.’s history and vital signs, do you think he is hypovolemic? Support your conclusion.
- Calculate N.R.’s arterial oxygen content (CaO2) using the following formula: CaO2 = (PaO2 × 0.003) + (Hb × SaO2 × 1.34). What does his CaO2 indicate?
- What would be the effect on N.R.’s CaO2 if he were given a blood transfusion that increases his hemoglobin to 12 g/dl?
- What would be the effect of administering 100% oxygen to N.R. that increases his SaO2 to 99% and his PaO2 to 500 mm Hg?
- Do you think N.R. has a bleeding disorder? Support your answer.
- What information from a history taken from his wife might be helpful in determining the cause of the prolonged bleeding time?
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