TRAUMA

Question 1

What is part of the primary assessment for a trauma patient?

Answer 1

Catastrophic haemorrhage control
A: airway and c spine precautions
B: breathing and adequate ventilation
C: circulation and haemorrhage control
D: disability (neurology and pupils)
E: exposure (keep warm)

Question 2

What is part of the secondary survey

Answer 2

Secondary survey requires a set of vitals, history and head to toe assessment, inspect the back/investigations, jot it down and debrief

A: Allergies
M: medications
P: past medical history
L: last meal
E: events surrounding injury

Question 3

Identify life threatening traumatic injuries and provide a definition of each and the relevant nursing management points

Answer 3

1. Tension Pneumothorax
   air accumulated between the lung and chest wall.

Management – immediate needle decompression, chest drain

Presentation: difficulty breathing, resp distress, pain

2. Flail chest
   2 or more rib fractures in 2 or more places on the same rib = free moving ribs

• Ensure adequate O2 and ventilation
• Analgesia – IV opioid, intercostal nerve block

3. Massive haemothorax
   a collection of blood between the lung and chest wall.

Management – promote O2, chest drain, large bore IVC, transfusion of blood products

4. Open chest wound
   - Management – promote ventilation and O2
   - Cover wound with 3-sided dressing
   - Chest drain, analgesia, IV antibiotics
   - Washout and debridement

Question 4

Nursing roles of caring for the trauma patient in the acute and long term

Answer 4

Acute:
- GCS
- Signs of secondary injury
- DVT prophylaxis (TEDs, calf compressors)
- Positioning (pillows, blankets)
- Family care (limited visiting, consistency in routine)
- Nutrition
- Bowel movement
- Pain management
- Ongoing assessment: vitals, GCS, appearance, limb movement, spO2, RR

Long term:
- Rehabilitation
- Physio, Speech pathology, OT, Social work
- Support
- Assistance with ADL’s
- Pain management
- Airway management