A 38 year old male presents to the Emergency Department following a hunting accident, with a 12 gauge shotgun wound to the anterior right thigh.
On examination, the patient is pale, irritable and in severe pain. Blood pressure is 88/50, with pulse 120 beats per minute. Weight is 80 kg. Multiple blood soaked pressure dressings are in place over the entry site in the anterior mid- femoral region, and packed within a cavity of the exit wound posteriorly. The thigh is markedly swollen, and the limb is numb and pale below the level of the injury without a palpable pulse in the ankle or foot. Movement of the limb cannot be assessed due to pain. Radiographs show a comminuted extra-articular fracture of the distal femoral diaphysis, surrounded by multiple metallic fragments and extensive soft tissue swelling.a.(Identify) While blood is on order, intravenous fluid (Ringer’s lactate) is given by rapid intravenous infusion. 4 ml/kg is given over 15 minutes, followed by a maintenance rate of 2 ml/kg per hour.
If a 1000 ml bag of fluid is hung, how many minutes until the bag is empty?
b. (Analysis) A 2 gram dose of intravenous Cefazolin, an antibiotic, is ordered prior to surgery. Twelve 500 mg vials are in stock in the ED. How many of these vials will be used for this patient?
c. 3. (Conclusion) In peripheral nerves with intact cell bodies, regeneration can occur at the rate of 1.5-3 mm per day. If there is complete transection of a major nerve of the proximal lower limb 75 cm above the toes, how long could regeneration take?
