Post on 07-May-2015
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Nurse's Role in ER Resuscitation Room
Prepared by : Ms.S Peter,
SDU, Mubarak Al-Kabeer Hospital Kuwait
This study and presentation is dedicated to
The Emergency room Health Team-
Doctors -and Especially Nurses
in Mubarak Hospital - for their sincere
effort and efficiency in saving
life-&-limb of each trauma victims
DEFINITION: TRAUMA
Trauma is a wound or injury characterized
by a structural alteration or
physiological imbalance resulting
from acute exposure to mechanical,
thermal, or chemical energy
TRAUMA --- BLUNT & OPEN injuries
Trauma has been long recognized as a major cause of
morbidity and mortality
in all age groups
The time frame - patient in the resuscitation
(Reso) room in Emergency department
is called the 'Golden hour' for victims.
The concept of the Golden Hour is
the window of
opportunity for the institution of
Life–and–limb measures
60% of the hospital deaths from trauma occurred this crucial period
Data Collected for -
Duration : 1 year
January 1st – December 31st ,2009
TOTAL CASES : 712 ( in RESO Room)
Multiple trauma cases with EMERGENT conditions only included in this assessment
Road Traffic Accidents – Automobile collisions / pedestrians
Motorcycle Accidents Buggy (ATV) accidents Fall from height / heavy object fall Stab wound /blunt trauma – Quarrel/ self induced
Gunshot
The injuries caused by-------
414
142 11435 6 10
50
100
150
200
250
300
350
400
450
Gunshot ( 1 case)
ATV(Buggy)accidents(0.8%)
Motorcycle accidents(5%)
Stab/blunt injuries(16%)
Fall injuries(20%)
Road Traffic accidents(58.2%)
Grand Total patients ( in all categories)
received in Medical Surgical
ER Mubarak Hospital
1st Jan – 31st Dec 2009 : 241649As per Interior Ministry statistic Total accident victims brought to Mubarak
Hospital during this period = 1503
Let’s STOP ………a while ---- & do a simple calculation…
– Emergent TRAUMA patients received Mubarak Hospital resuscitation room = 712 for 1 year
If we calculate for 6 Regional Hospitals
It will be ----------
6X 700 = 4200 (approximate)
234
275
17429
Kuwaity(33%)
Arabs(39%)
Non Arabs(24%)
Unknown(4%)
Nationality
SEXSEX
535
177
Male (75%)
Female(25%)
Age Groups
223
119 11582 70 69
0
50
100
150
200
250
51-65 yrs (10.4%)
2-11yrs (9.8%)
41-50 yrs (11.5%)
31-40yrs(16.2%)
11-20yrs ( 16.8%)
21-30yrs (31.3%)
Casualties brought to ER -
93 63
581
EMT(81.6%)
Relatives(13%)
Others(9%)
Upon Arrival in ER
0
100
200
300
400
500
600
Dead/Resuscitated(0.4%)
Progressed to unconsc(9.3%)
Unconscious/Gasping(7%)
confused/irritable(29%)
Conscious(81.6%)
Type of major Injuries -
97
38
192
27 320
50
100
150
200
1 2 3 4 5
Severe Cutwounds(4.5%)
GI,G.U,/Bleeding (4.5%)
#s Extremities (27%)
Chest (5.3%)
Head/spine(13.6%)
Primary Nursing Survey & Stabilizing Emergent CasualtyA : Airway Maintenance & Cervical
spine protection
B : Breathing & Ventilation
C : Circulation & Hemorrhage
control
D : Disability – Neurological Status
E : Exposure – Environmental
control Eg. prevent hypothermia
Nursing Interventions :
Non-invasive & Invasive procedures :
Monitoring – ECG,BP,SPO2 (97%)
Oxygen administration (97%)
Intra Venous access (97%)
Blood extraction ( 97%)
Preparing /Assisting/performing invasive procedures
Blood Transfusion (12%) E.T Intubation & Ventilatory support (11%) ABG Assessment (12%) Chest Tube insertion (3%) Naso Gastric Tube insertion (10%) CVP insertion (3%) Foley’s Catheter Insertion (23%) Control of bleeding, Suturing in Reso room – (26%) Dressing (33%)
Contacting Other Departments
46%
48%
3%
3%
0%
Orthop(338)
Surgery(351)
Neurology(20)
F.Maxillary(23)
Spine (7)
Transporting/transferring victims
Inside Hospital Radio-diagnostic studies /Ultrasound :97%
Main OT : 4%
ICU : 13%
Surgical Wards : 13%
Outside Hospital
Razi Hospital : 19%
Ibnsina Hospital : 2%
Duration of stay in Reso room
6143 37
110
50
100
150
200
250
1-2hrs 2-3hrs 3-4hrs 4-5hrs 5-6hrs 6-7hrs >7hrs
>7hrs (2%)
6-7hrs (5.1%)
5-6hrs (6%)
4-5hrs (8.6%)
3-4hrs(16.2%)
2-3 hrs (26%)
1-2 hrs (32%)
The expected outcome is positive
for each client.
If succeed each of the team will say-
Otherwise –
“We tried our maximum, but -
we could not make it “
WE did It ………… ( or ) “We tried our maximum, but - we could not make it “
Suggestions & Recommendations:
Public awareness to the types of emergencies and its impacts – to reduce the incidence of accidents and strict implementation of rules and regulation in collaboration with different ministries
Education of public through different media , especially for school children
Conduct study on the Quality-Care- cost of hospitalizing multiple trauma victims and their rehabilitation
News clip from KUNA
KUWAIT, March 1 (KUNA) –
Road accidents in Kuwait have claimed the lives of 77 people in January and February 2010, a senior security official said here Monday. Extremely concerned over the growing number of victims of car accidents in Kuwait .
REMEMBER –
This is the Traffic Awareness Period in Kuwait
Sincere thanks to:
Ms Awatef Al-Qatan
(Director Nursing Department)
REFERENCES:
Sowell, R., & Meadows, R. (1994). An integrated case management model: developing standards, evaluation and outcome criteria. Nursing Administration Quarterly, 18(2), 53- 64.
PAMELA J. HOLMQUIST, MBA, BSN, RN, is Director, Trauma, Utilization Management, Social Work, Mercy Hospital and Medical Center, San Diego, CA.
Holmquist, P., Songne, E.A., Shaver, T.E., & Peirog, L.J. (1991). Trauma case manager development and implementation as a nursing role in a community trauma center. The Journal of Trauma, 1001(31),103-106.
Kenneth L Mattox, David V etal, , Trauma 4th Edn McGraw-Hill, NY,2000
Thomas AC ,Jefrry : 2nd Edn , Emergent management of Trauma , Mcgraw hill 2001
William PB, David C Yearbook of Emergency Medicine 2001
J Emergency Nursing:Vol 32,issues 4, Aug 2006
Web sites:
www.caraccidentskwt.com
www.traumanurses.org