History of Present Illness
US is a 41-year-old Caucasian male who presented to the emergency department (ED) 24 hours ago via EMS after suffering a motorcycle accident. According to bystanders, US hit a patch of loose gravel and was ejected from the motorcycle, landing on the pavement approximately 10 feet away. Upon presentation to the ED, US was found to have a Glasgow Coma Score (GCS) = 8 and a negative focused assessment with sonography in trauma (FAST) exam. Following a trip to the operating room for an open reduction, internal fixation (ORIF) of the left knee, US was transferred to the intensive care unit (ICU), intubated and sedated.
ORIF of left knee 12 hours ago
Annual influenza vaccination, otherwise unknown at present time
Propofol continuous infusion, currently at 150 mcg/kg/min
Hydromorphone continuous infusion, currently at 0.7 mg/h
Hydromorphone 0.2 mg IV bolus PRN breakthrough pain—no doses received
Cefazolin 1 gr IV q8h × 6 doses
Gentamicin 5 mg/kg as a single dose—received in ED
Heparin 5000 SQ q8h
Lorazepam 1 mg IV q2h PRN agitation—no doses received
Low level sliding scale insulin protocol—no doses received
Electrolyte replacement protocol—no doses received
Famotidine 20 mg PO bid
Tmax since admission 99.5°F, BP 108/92 mmHg, HR 86 bpm; RR 18 breaths/min; Ht: 180 cm, Wt: 112 kg
Intubated and sedated male patient.
PERRLA; otherwise deferred.
PRCV ventilation setting.
Soft, nondistended, hypoactive bowel sounds.
Foley catheter visualized, otherwise deferred.
GCS = 8 on admission, no changes appreciated. RASS = +1, CPOT = 2, CAM-ICU = negative.
Significant abrasions appreciated on all four extremities; fresh incision, without purulence or erythema, visualized under dressing on left knee.