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    Emergency Nursing of the Trauma Patient

    By Kane Guthrie

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    About Me Nothing to declare ED nurse

    Researcher Blogger

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    Trauma can be 2cary Kee# your cool "e all set the tone

    Kno! your role0 follo! the leader 3ollo! an algorithm Don$t get distracted

    4ou no! this stu5 Traumatic arrest have around 66-

    mortality

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    Trauma Deaths The (7(7( rule8 Pt die in ( mins from9 air!ay

    :breathing com#romise0 :hy#ovolaemic shoc &scene'

    ( Pt die in t!o hours from9hy#ovolaemic shoc&ED'

    * Pt die in t!o !ee s from9 se#ticshoc &.;

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    Be Pre#ared Trauma or Monitored bay Ensure ade=uate sta5

    Assign roles ;hec e=ui#ment "earing lead

    Pain relief7blood #roducts ready .s decontamination re=uired>

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    Trauma Bay

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    "hat ?a##ens @ 2;G?

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    2hoc is the EnemyHaemorrhagic Causes Non-Haemorrhagic Causes

    E ternal bleeding Tension #neumothora

    .ntrathoracic bleeding Myocardial contusion

    .ntra abdominal bleeding Pericardial tam#onade

    Pelvic fractures 2#inal cord transection%ong bone fractures ;oincident medical &AM.0 seiCure'

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    The A##roach

    ; 9;atastro#hic haemorrhageA9 Air!ay ; s#ine

    B9 Breathing;9 ;irculationD9 Disability

    E9 E #osure

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    The A of Trauma

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    %ife threatening air!ay#roblems

    Air!ay obstruction artial orcom#lete'

    .nhalation inHury 3acial trauma7deformity Blunt : #enetrating nec trauma

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    %ife threatening breathing#roblems

    Tension #neumothora Pneumothora

    ?aemothora 2uc ing chest !ound &o#en PTJ' 3lail chest

    3ull thic circum burn to thora

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    ;irculationAssessment Interventions

    ?eart sounds> Access0 &.+0./0;+;>'

    Pulses> 3luids +s Blood #roducts>

    +ital signs> E ternal direct #ressure

    E ternal Bleeding> Pelvic binder3alling ?b0 increasing lactate> Pericardiocentesis

    2hoc y> Thoracotomy

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    %ife threatening circulation#roblems

    E ternal haemorrhage &am#utation' Penetrating trauma

    Blunt trauma Pericardial tam#onade Traumatic aortic ru#ture

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    Massive Transfusion 3ocuses more on blood #roducts than

    uidsPredicting !ho needs M7T

    Penetrating mechanism2BP L6)mm?g

    ?R 8()b#mPositive 3A2T abdominal vie!s89898 Ratios &PRB;20 33P0 Platlets'

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    Trendelenburg Position Time honored tradition %imited evidence &more harm than good' E5ects are short lived;om#lications

    dys#nea0 hy#oventilation and atelectasisAbdo organs into chest cavity decreasing

    venous return to heartRis of as#irating gastric contents

    >%eg elevation better than nothing

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    ;ervical 2#ine Try and clear nec early ;ollars cause ; s#ine #ain

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    DisabilityAssessment Interventions

    G;2 Elevate head of bed

    Gross motor strength Mannitol7hy#ertonicsaline7hy#erventilation

    Pu#ils 2TAT imaging

    Rule out other causes for decreasedGCS/agitation ET/?

    B2% Pre hos#ital medications #ac in bladder 2urgeon at bedside

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    E #osure ;om#letely undress0 and log roll Then ee# them !arm0

    Blan ets0 !arm uids0 monitortem#erature Reverse shoc and coagulo#athy

    Avoids hy#othermia #reventsO thelethal triad1 Burn #atients

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    3ull set vital signs ;ardiac monitor Pulse o imeter

    BP &invasive vs1 non vasive'

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    Give comfort measures +erbal reassurance Thera#eutic touch

    %iaise !ith family Pain relief &!hich drug is best>'

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    ?istory AMPL Allergies

    Medications currently used Past illnesses7Pregnancy %ast meal7 uids

    Events leading u# to trauma

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    ?ead 2 ull : 3ace

    %oo for9 %acerations &scal# lac$s often

    underestimated' Ecchymosis Mid face instability

    Drainage from nose and ears &;23' Raccoon eyes0 battle sign ;hec #u#ils0 &ocular bleeding0

    s!elling'

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    ?ead 2 ull : 3ace

    .nterventions9 Pain relief Maintain air!ay #atency Remove contact lenses ?aemorrhage control &di cult'

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    ;ervical 2#ine : Nec Remove anterior #ortion of collar9%oo for9 "ounds0 bruising0 deformities0

    distended nec veins3eel for9

    Tenderness0 bony cre#itus0 deformity0sub I em#hysema0 tracheal #osition

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    ;ervical 2#ine : Nec

    .nterventions Maintain s#inal alignment &head

    hold0 ta#e0 sandbags' ;onsider changing from hard collar

    to soft collar &Philadel#hia'

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    ;hest

    %oo for9 Breathing rate :de#th0 !ounds0 deformities0

    bruising0 accessory muscle use0 #arado ical

    movement0 e #ansion and symmetry%isten to9 Breath and heart sounds3eel for9 Tenderness0 bony cre#itus0 sub I

    em#hysema0 deformity to clavicles andshoulders1

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    ;hest

    .nterventions9 Pre#are for needle decom#ression

    &tension PTJ' Pre#are for chest tube insertion &PTJ

    or ?aemPTJ' Pre#are for #ericardiocentesis

    ericardial tam#onade'

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    Abdomen : 3lan s

    %oo for9 2ounds0 distension0 ecchymosis0

    seat belt sign0 scars%isten for9 Bo!el sounds in all =uadrants

    3eel for9 Tenderness0 rigidity0 guarding0masses0 femoral #ulses

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    Abdomen : 3lan s

    .nterventions9 3A2T or E3A2T scan .nsert NGT or .D; Antici#ate for further imaging AJR

    ;T abdo

    Maintain high inde of sus#icion ifseat belt sign #resent

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    Pelvis : Perineum

    %oo for9 "ounds0 deformities0 lacerations1 Bruising0 #ria#ism0 blood at urinary

    meatus or #erineal area3eel for9 Pelvis instability0 anal s#hincter tone0

    #rostate #osition0 rectal7vaginal !allintegrity

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    Pelvis : Perineum

    .nterventions9 A##ly e ternal #elvic immobilisation

    elvic binder0 sheet' Antici#ate for su#ra#ubic catheter0

    urethrogram

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    E tremities

    Assess all limbs0 and hands and feet%oo for9 Deformity0 o#en !ounds0 bruising0

    s!elling0 rotation0 shortening3eel for9 Abnormal bony movement0 Hoint

    instability0 tight com#artmentsAssess for9 Motor : sensory deFcits0 circulation0

    ca#illary reFll

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    .maging

    Bedside Testing9 AP ;JR AP Pelvis ray 3A2T0 E3A2T ; s#ine rayDP% is out1

    DeFnitive Testing ;T scan &Donut of death' 2urgical E #loration &%a#arotomy0 Angio'

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    .nterventions #ternal

    A##ly direct #ressure0 2uture %acerations Long $one %

    2#lint Q7 reduce Chest

    .;;0 Pigtail A&domen

    Emergency %a#arotomy Retro!eritoneum

    E ternally stabilse #elvis0 Emergency Angiogram

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    2#ecial ;onsiderations Elderly Athletes Pregnancy Medication ?y#othermia

    Pacema er /besity

    T # i h T

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    Trans#orting the TraumaPatient

    E #erience counts Pre#are for the !orst 2tabilise before transferring Avoid the donut of death if unstable

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