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January 2011, Volume 41 Number 1 , p 72 - 72


  • Michael W. Day MSN, RN, CCRN


THE EMERGENCY MEDICAL technicians (EMTs) bring Madison Perez, 22, to your ED on a backboard with her cervical spine immobilized. Because her SpO2 dropped during transport, she's receiving supplemental oxygen via a non-rebreather mask.Ms. Perez was rock-climbing when a piton anchor gave way. She slid 20 feet down the rock face and landed hard on a gravel bed at the cliff base. Her friends called 911.An initial evaluation by the EMTs showed a left ankle deformity and numerous small abrasions on her chest and right arm. As soon as Ms. Perez is moved to the ED stretcher, she states that she "can't catch her breath." You know her airway is patent because she's talking to you, but she's dyspneic and tachypneic.Because of Ms. Perez's mechanism of injury, the ED physician arrives immediately and you assess her together. You attach Ms. Perez to a cardiac monitor, obtain I.V. access, and initiate pulse oximetry. Her vital signs are heart rate, 130; respiratory rate, 36 with accessory muscle use;

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