Closed Head Injury

2066 words 9 pages
Closed Head Injury Case Study

Y.W. is a 23-year-old male student from Thailand studying electrical engineering at the university. He was ejected from a moving vehicle, which was traveling 70 mph. His injuries included a severe closed head injury with an occipital hematoma, bilateral wrist fractures, and a right pneumothorax. During his neurologic intensive care unit (NICU) stay, Y.W. was intubated and placed on mechanical ventilation, had a feeding tube inserted and was placed on tube feedings, had a Foley catheter to down drain (DD), and had multiple IVs inserted. He developed pneumonia 1 month after admission.
Closed Head Injuries: Closed head injuries result from a blow to the head as occurs, for example, in a car accident when the
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7. Y.W.’s medication list includes clindamycin 150 mg per feeding tube q6h, ranitidine (Zantac elixir) 150 mg per feeding tube bid, and phenytoin (Dilantin) 100 mg IV piggyback (IVPB) tid. Indicate the reasons for each.
• Clindamycin 150 mg per feeding tube q6h: Treatment of respiratory tract infections; to treat Y.W.’s pneumonia. (Skyscape, 2012).
• Ranitidine (Zantac elixir) 150 mg per feeding tube BID: Used to treat and prevent stress ulcers (stress-induced GI bleeding in critically ill patients). Due to head injury, overstimulation of the vagus nerve from TBI.
• Phenytoin (Dilantin) 100 mg IVPB TID: Used to treat and prevent tonic-clonic seizures and complex partial seizures. Seizure is seen in 5% of patients with a non-penetrating head injury (Lewis, et al, p. 1445).

8. A STAT portable chest x-ray (CXR) is ordered after each central venous catheter (CVC) is inserted. According to hospital protocol, no one is permitted to infuse anything through the catheter until the CXR has been read by the physician or radiologist. What is the purpose of the CXR, and why isn’t fluid infused through the catheter until after the CXR is read?

The chest x-ray confirms the proper placement of the central venous catheter. If fluid is infused through the catheter before a CXR has confirmed placement, the patient is at high risk for systemic infection or possible pneumothorax (which would occur if the catheter were to be entered into the


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