Trauma Nursing Student Version PDF

12/2/24 1 Trauma Nursing Amber Thomas, DNP, MBA, RN, NPD-BC NURS 486 2 Objectives 1.Discuss assessment and emergency stabilization of the multiple trauma patients. 2. 2.Discuss measures for treating hypovolemic shock in the trauma patient. 3. 3.Apply r...

12/2/24 1 Trauma Nursing Amber Thomas, DNP, MBA, RN, NPD-BC NURS 486 2 Objectives 1.Discuss assessment and emergency stabilization of the multiple trauma patients. 2. 2.Discuss measures for treating hypovolemic shock in the trauma patient. 3. 3.Apply research findings to the care of the patient with trauma. 4. 4.Describe discharge planning and community resources available to patients following traumatic injury. 5. 5.Discuss ethical issues related to the care of the patient with trauma. 6. 6. 3 Triage 4 Triage 5 Triage- ESI 6 Triage-ESI 7 Triage 8 Primary Survey 9 Primary Survey ABCDEFG 1 6 7 8 9 Primary Survey ABCDEFG Alertness and airway with cervical spine stabilization and/or immobilization Breathing Circulation/Control of Hemorrhage Disability Exposure and Environmental control Full Set of Vitals and Family Presence Get Monitoring Devices and Give Comfort 10 Primary Survey Uncontrolled external hemorrhage stands for “catastrophic hemorrhage” ABC reprioritized to ABC Direct pressure followed by pressure dressing to obvious bleeding sites Must be controlled first 11 Alertness & Airway Alertness and Airway with cervical spine stabilization and/or immobilization Assessment Assess for distress Check for loose teeth or foreign bodies Assess for bleeding, vomitus, edema Manifestations of compromised airway Dyspnea Inability to vocalize 12 13  Dyspnea Inability to vocalize Gasping/agonal breaths Presence of foreign body in airway Trauma to face or neck 12 Alertness & Airway 13 Alertness & Airway Maintain airway: Least to most invasive method Open airway using the jaw-thrust maneuver Avoid hyperextension of neck Suction and/or remove foreign body Insert nasopharyngeal/oropharyngeal airway Endotracheal intubation Emergency: cricothyroidotomy or tracheotomy Rapid-sequence intubation Preferred procedure for unprotected airway Involves sedation or anesthesia and paralysis Aid in intubation, reduce aspiration risk & airway trauma 14 Alertness & Airway Jaw thrust maneuver 15 Alertness & Airway Stabilize/immobilize cervical spine Suspected spinal cord injury: stabilize cervical spine at same time of airway assessment (if not already done) Stabilize cervical spine Manual stabilization Rigid cervical collar (C-collar) Keep HOB flat and continue to monitor airway and breathing 16  16 Breathing Assess for dyspnea, cyanosis paradoxical/asymmetric chest wall movement, decreased/absent breath sounds, visible wound to chest wall, cyanosis, tachycardia, hypotension Administer high-flow O2 via a nonrebreather mask Bag-valve-mask (BVM) ventilation with 100% O2 and intubation for life-threatening conditions Treat underlying cause Monitor patient response 17 Circulation 1 Assess quality and rate of carotid or femoral pulse Peripheral pulses may be absent because of injury or vasoconstriction Assess skin for color, temperature, moisture Assess for signs of shock Mental status and capillary refill 2 Insert two large-bore IV catheters Use upper extremities unless contraindicated Options: intraosseous or central vein Initiate aggressive fluid resuscitation using normal saline or lactated Ringer’s solution Blood products/packed RBCs Use O negative for emergency transfusion 18  Blood products/packed RBCs Use O negative for emergency transfusion 18 Disability Glasgow Coma Scale Pupils Size, shape, response to light, equality 19 Exposure Exposure/Environmental control Remove clothing for physical assessment Do not cut through forensic evidence Do not remove impaled objects Provide temperature control—avoid hypothermia Warm blankets, warm IV fluids, overhead warmers Maintain privacy 20 Full Set of Vitals & Family Presence BP, HR, RR, O2 saturation, and Temp Family presence during resuscitation and invasive procedures Benefits for patients, caregivers, and staff Provide comfort, advocate, remind staff of the person behind the trauma Assign someone to explain care and answer questions 21 1  Assign someone to explain care and answer questions 21 Get Monitoring Devices & Give Comfort 1 Give Comfort Primary report from most patients Protocols for early treatment Combination of strategies Pharmacologic Nonpharmacologic Advocate for comfort measures 2 Get Monitoring Devices—LMNOP L- laboratory tests M- monitor ECG N- nasogastric tube or orogastric tube O- oxygenation and ventilation assessment P- pain assessment and management 22 Secondary Survey 23 Secondary Survey 24 Secondary Survey SAMPLE S- symptoms A- allergies and tetanus status M- medication history P- past health history L- last meal/oral intake E- events or environmental factors preceding illness or injury 25 Secondary Survey Head Bruises, contusions, lacerations, bony deformity Neck 25 Neck Neck for stiffness Pain in cervical vertebrae Tracheal deviation Distended neck veins Difficulty swallowing Subcutaneous emphysema Face Eyes, ears, nose mouth 26 Secondary Survey Chest Observe respiratory rate, depth, and effort; note chest wall movements and use of accessory muscles Palpate for subcutaneous emphysema Auscultate breath sounds Pneumothorax, open pneumothorax, rib fractures, pulmonary contusion, blunt cardiac injury, hemothorax Obtain chest x-ray and ECG Inspect for external injuries 27 Secondary Survey Abdomen and flanks Evaluate frequently for subtle changes Blunt trauma Penetrating trauma: do not remove objects Inspection of external signs of injury Auscultate bowel sounds Palpate masses, guarding, and femoral pulses FAST: focused abdominal sonography for trauma; intraabdominal hemorrhage CT scan for retroperitoneal bleeding 28  intraabdominal hemorrhage CT scan for retroperitoneal bleeding 28 Secondary Survey Pelvis and perineum Inspect and gently palpate pelvis Do not rock the pelvis Pain may indicate pelvic fracture and need for imaging Assess genitalia Bleeding, bladder distention, hematuria, dysuria, or inability to void Rectal exam may be performed by HCP 29 Secondary Survey Extremities Observe for external injury Evaluate movement, strength, and sensation Point tenderness, crepitus, deformities Immobilize/splint and elevate injured extremities; apply ice packs Check pulses A pulseless extremity is a time-critical emergency Compartment syndrome Compromises viability of muscles, nerves, arteries 30 Secondary Survey Inspect posterior surfaces Logroll patient (protect cervical spine) to inspect the posterior surfaces Requires 4 or more people Inspect and palpate for 31  Inspect and palpate for Deformities, bleeding, lacerations, and bruising Palpate entire spine 31 Secondary Survey Just Keep Reevaluating VIPP (vital signs, injuries sustained and interventions, primary survey, and pain level) ABC’s are always priority LOC and vitals should be monitored closely Notify HCP with changes Insert an indwelling catheter as indicated Evaluate need for tetanus prophylaxis 32 Secondary Survey Prepare to: Transport for diagnostic tests (e.g., x-ray, CT) Transport to OR Admit to general unit, telemetry, or intensive care unit Transfer to another facility 33 Ethical Considerations & Death in the Emergency Department 34 Ethical Considerations §EMTALA § §Not required to stop and provide aid, but if you do stop, you must 33 34 § §Not required to stop and provide aid, but if you do stop, you must stay until sufficient help has arrived §Good Samaritan Law § §Abuse and Assault § §Trauma Codes 35 Pulseless Electrical Activity (PEA) 1 Hypovolemia Hypoxia Hydrogen ion (acidosis) Hyper-/hypokalemia Hypothermic Hypoglycemia 2 Toxins Tamponade (cardiac) Tension pneumothorax Thrombosis (coronary and pulmonary) Trauma 36 Death in the ED 1 Sudden death is stressful Shocking for family and friends Identify and manage your own reaction/feelings Help family and friends begin grieving Provide comfort Ensure privacy Offer chaplain visit, if appropriate Collect personal belongings Make mortuary arrangements 2  2 May need to contact medical examiner or coroner Autopsies Upon family request In cases of death within 24 hours of ED admission When suspected trauma or violence or unusual death has occurred 37 Death in the ED 38 Gerontological Considerations 39 Gerontologic Considerations 40 References