darkhorse
Forum Elite
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A 29-year-old truck driver is transferred to the general medical floor from the intensive care unit where he was being treated after sustaining multiple fractures from a motor vehicle accident. It is determined that the patient was under the influence of alcohol at the time of the accident. He has been in the intensive care unit for 20 days following open reduction and internal fixation of bilateral femur, tibia, and fibula fractures. The patient is otherwise doing well and has full use of his upper body. Legal proceedings will begin subsequent to discharge, and the patient states he is committed to ceasing alcohol consumption. Past medical history is significant for alcoholism. Medications include imipenem and morphine administered via patient-controlled analgesic pump. At this time, the patient is at greatest risk for
A. alcohol withdrawal
B. deep venous thrombosis
C. fat emboli to lungs
D. narcotic addiction from the morphine
E. suicide
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| Doc750
transfer:step 3 prison
Topics: 52
Posts: 636
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C
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| dr.wad
Forum Senior
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B_DVT ....prolonged immobilization.
fat embolism occurs within 24 hours of fracures.
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| titly
Forum Elite
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Posts: 290
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B
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| aaroho
Forum Junior
Topics: 8
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D narcotic addiction from morphine
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| aaroho
Forum Junior
Topics: 8
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yep guys it must be B i was wrong
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| dr penicillin
Forum Junior
Topics: 2
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D
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| dr penicillin
Forum Junior
Topics: 2
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he is about to discharge so no more risk for DVT
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
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The correct answer is B. This patient is profoundly immobile due to multiple fractures of both legs and he is at increased risk for developing a thrombus in the veins of his lower extremities. Deep venous thrombosis (DVT) prophylaxis with subcutaneous heparin should already have been started. DVT prophylaxis is necessary in all immobile patients, especially those who have sustained major orthopedic injury.
Alcohol withdrawal (choice A) usually occurs a few hours to 10 days after the last drink. Most typically, it occurs in the first 48 hours. Symptoms include acute psychosis with hallucinations, delusions, disorientation, agitation, and tremors. In this patient, alcohol withdrawal is very unlikely to start now, 20 days after the injury.
A fat emboli (choice C) from bone fractures occurs in close temporal proximity to the fracture or to the surgery. The patient is now 10 days postoperative and 20 days after the initial injuries, making this unlikely.
Narcotic addiction (choice D) from patient controlled analgesia is very rare and allows the patient to participate in his medical care. Care must always be taken to balance analgesia and addiction potential.
Suicide (choice E) is unlikely given the hopeful outlook of this patient and lack of history of depression or suicidal tendencies.
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