theajoftrauma

8/9/2019 theajoftrauma

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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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