Scenario Overview
Patient: Eligh, 14-year-old male
Event: High-impact motorbike accident on a rural trail
Initial Presentation:
- Severe left-sided chest pain
- Difficulty breathing
- Bruising across the left chest wall
- Diagnosed with pneumothorax and rib fractures (left 4th and 5th)
Immediate Actions Taken:
- Trauma alert issued, ATS Category 2
- Chest tube (ICC) inserted with 10cm HβO suction
- Patient monitored for oscillation, air entry, and drainage
- Administered patient-controlled analgesia (PCA) β 1 mg morphine/5 min lockout
Vital Signs Timeline & Progress
Monday, 1730 β Emergency Department
- HR: 110 bpm |Β RR: 24 |Β SpOβ: 98% (2L NP)
- BP: 110/66 mmHg |Β Temp: 36.8Β°C |Β Pain: 6/10
- Drain Output: 0 mL |Β Air Entry: L < R>Surgical Emphysema: No
Monday, 2215 β Paediatric Ward Admission
- HR: 108 bpm |Β RR: 24 |Β SpOβ: 98% (2L NP)
- Pain: 3/10 |Β Drain Output: 0 mL
- Parents present and actively involved in care
Tuesday, 0735 β Deterioration Begins
- Parents raise concern about discomfort and restlessness
- Pain managed with regular analgesics
- PCA usage noted to increase
Tuesday, 0753 β Neurological & Respiratory Decline
- GCS: 13 (E3, V4, M6) β indicates mild confusion
- HR: 135 bpm |Β RR: 32 |Β SpOβ: 94% (2L NP)
- Increased work of breathing, accessory muscle use
- Surgical Emphysema: Yes |Β Oscillation: Absent
- Air Entry: Still reduced on left side |Β Drain Output: 0 mL
Clinical Red Flags
- Absent oscillation: Indicates potential chest tube blockage or lung collapse
- Surgical emphysema development
- Increased PCA use + grimacingΒ = Inadequate pain control
- Neurological changes (β GCS)Β = Possible hypoxia or opioid side effects
- Elevated RR and HRΒ = Physiological distress
Recommended Nursing Focus Areas
- Close monitoring of chest tube function
- Reassessment of analgesic strategy (PCA effectiveness)
- Continuous GCS monitoring
- Escalate care immediately if deterioration continues
- Support and reassure distressed family members