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

http://www.car-accidents.com/mitsubishi-crash.html

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