Case Presentation: Severe Head Trauma
An 18-year-old man is admitted to the intensive care unit (ICU) after a motorcycle accident in which he sustained head trauma and a fractured ulna.
History and Physical Examination
The nurse obtains the following information about the patient:
He appears to be a well-nourished adult man.
The patient's mother reports that he is otherwise healthy with no allergies, comorbid conditions, medications, or substance abuse before admission.
Height 5'11", weight 160 lb.
Vital signs are stable:
Tympanic temperature: 97.8o F
Pulse: 78 beats/min
Respiration: On mechanical ventilation (assist control/pressure control, rate 14 breaths/min); clear bilateral breath sounds; minimal clear endotracheal secretions obtained upon suctioning
Blood pressure: 118/70 mm Hg
Oxygen saturation (via pulse oximetry): 97%
End-tidal carbon dioxide (ETCO2 via capnography): 38 mm Hg
Arterial blood gases are within normal limits:
PaO2: 93 mm Hg
PaCO2: 41 mm Hg;
HCO3: 23 mEq/L
Skin is pink and warm.
Head dressing is dry and intact.
Right ulnar fracture is casted; fingers pink with good nailbed refill.
The patient is unresponsive, demonstrating no movement or pain behaviors. He is receiving a propofol infusion for goal-directed (purposeful) sedation.
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Cite this: When a Patient Cannot Self-report Pain - Medscape - May 24, 2012.