J.R. is a $28$-year-old man who was doing home repairs. He fell from the top of a $6$-foot stepladder, striking his head on a large rock. He experienced a momentary loss of consciousness. By the time his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room.

Differentiate between a primary and secondary head injury.

J.R. is a 28-year-old man who was doing home repairs. He fell from the top of a 6-foot stepladder, striking his head on a rock. He experienced a momentary loss of consciousness. By the time his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room. Differentiate between primary and secondary head injuries.

J.R. is a 28-year-old man who was doing home repairs. He fell from the top of a 6-foot stepladder, striking his head on a large rock. He experienced a momentary loss of consciousness. By the time his neighbour got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbour drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room.
What steps will you take to assess J.R.?

J.R. is a 28-year-old man who was doing home repairs. He fell from the top of a 6-foot stepladder, striking his head on a large rock. He experienced a momentary loss of consciousness. By the time his neighbour got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbour drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room.
What types of injuries may J.R. have sustained?

Define Type I and Type II error for each scenario, and identify the cost(s) of each type of error.

Approaching O'Hare for landing, a British Air flight from London has been in a holding pattern for $45$ minutes due to bad weather. Landing is expected within $15$ minutes. The flight crew could declare an emergency and land immediately, but an FAA investigation would be launched and other flights might be endangered. The null hypothesis is that there is enough fuel to stay aloft for $15$ more minutes.

J.R. is a $28$-year-old man who was doing home repairs. He fell from the top of a $6$-foot stepladder, striking his head on a large rock. He experienced a momentary loss of consciousness. By the time his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room.

Identify at least five signs and symptoms of increased ICP.

J.R. is a 28-year-old man who was doing home repairs. He fell from the top of a 6-foot stepladder, striking his head on a rock. He experienced a momentary loss of consciousness. By the time his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room. List at least 6 components of a neurologic examination.

You complete your neurologic examination and find the following: Glasgow Coma Scale (GCS) score of 15; pupils equal, round, reactive to light; and full sensation intact. J.R. complains of a headache and is somewhat drowsy. His vital signs (VS) are 120/72, 114, 30, 98.7 degree F (37.1 degree C) and Spo2 94%. As the radiology technician performs a portable cross-table lateral cervical spine x-ray examination, J.R. begins to speak incoherently and appears to drift off to sleep.
What are the next actions you will take?

J.R. is a $28$-year-old man who was doing home repairs. He fell from the top of a $6$-foot stepladder, striking his head on a large rock. He experienced a momentary loss of consciousness. By the time his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room.

The physician orders a $25\%$ mannitol solution IV. What is mannitol, and why is it being administered to J.R.?

You are the trauma nurse working in the emergency department (ED) of a busy tertiary care facility. You receive a call from the paramedics that they are en route with the victim of gunshot wounds to the chest and abdomen. They started two large-bore IV lines with lactated Ringer's and oxygen by mask at 15 L/ min. The patient has a sucking chest wound on the left and a wound in the right upper quadrant of the abdomen. Vital signs in the field are 80/36, 140, and 42. The patient is diaphoretic, very pale, and confused. The estimated time of arrival is 4 minutes.
List at least six things you will do to prepare for this patient's arrival.

J.R. is a $28$-year-old man who was doing home repairs. He fell from the top of a $6$-foot stepladder, striking his head on a large rock. He experienced a momentary loss of consciousness. By the time his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room.

What is a normal intracranial pressure (ICP), and why is increased ICP so clinically important?

Study of why EMS workers leave the job. A study of fulltime emergency medical service (EMS) workers published in the Journal of Allied Health (Fall 2011) found that only about $3 \%$ leave their job in order to retire. (See Exercise $3.45$, p. 158.) Assume that the true proportion of all fulltime EMS workers who leave their job in order to retire is $p=.03$. In a random sample of 1,000 full-time EMS workers, let $\hat{p}$ represent the proportion who leave their job in order to retire. Describe the properties of the sampling distribution of $\hat{p}$.

Three-year-old C.E. is admitted to the Emergency Department (ED) fast track clinic. Her mother tells the nurse that C.E. has had a low-grade fever for $2$ days and is complaining of ear pain and a sore throat. Mrs. E. states that C.E.'s appetite has been “off,” but she has been drinking and using the bathroom as usual.

Mrs. E. is given a new prescription for azithromycin (Zithromax) PO $160$ mg qd $\times$ $5$ days.

5. Azithromycin is dispensed $200$ mg/$5$ mL. Calculate the dosage for Mrs. E. to administer to C.E

J.R. is a $28$-year-old man who was doing home repairs. He fell from the top of a $6$-foot stepladder, striking his head on a large rock. He experienced a momentary loss of consciousness. By the time his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room.

You find that J.R. has become unresponsive to verbal stimuli and responds to painful stimuli by abnormally flexing his extremities (decorticate movement). He has no verbal response. The right pupil is larger than the left and does not respond to light.

What is J.R.'s GCS score at this time? Indicate what this means.