Carlos adams was involved in a motor vehicle accident and suffered blunt trauma to his abdomen. upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9 f; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm hg. his abdomen is firm, with bruising aroung the umbilicus. he is alert and oriented, but complains of dizziness when changing positions. the patient is admitted for management of suspected hypovolemic shock.
the following orders are written for the patient:
place two large-bore ivs and infuse 0.9% ns at 125 ml/hr/line
obtain complete blood count, serum electrolytes
oxygen at 2 l/min via nasal cannula
type and cross for 4 units of blood
flat plate of abdomen stat
questions:
a. describe the pathophysiologic sequence of events seen with hypovolemic shock.
b. what are the major goals of medical management in this patient?
c. what is the rationale for placing two large-bore ivs?
d. what are the advantages of using 0.9% ns in this patient?
e. what is the rationale for placing in a modified trendelenburg position?