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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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