Unit 3: Trauma Flashcards
What is the leading cause of unintentional injury?
falls
What is the leading cause of death?
motor vehicle collisions (MVCs)
Trauma Risk Factors
> Age
-majority of deaths from motor vehicle trauma occur in individuals between 15 and 45
-patients older than 65 years have greatest risk of dying from unintentional injury’s b/c of comorbidities
Gender
Race and socioeconomic background
Geographical location and time of year
alcohol, smoking, and substance abuse
Connection Check: As an emergecy nurse in an inner-city ED, you are responsible for developing a trauma prevention program for your community. Who will be your priority patient population?
A. 10 to 34 year old African American males
B. 10 to 34 year old Caucasian Females
C. 75+ year olds
D. 10 to 34 year old Hispanic males
A. 10 to 34 year old African American males
Trauma Center
- hospitals specially equipped to provide comprehensive emergency care to patients suffering from a traumatic injury
- to be designated as a trauma center, certain criteria must be met
- designated as level I, II, III, or IV
- life support equipment, blood and blood products, and diagnostic tools need to be maintained in the highest state of readiness so that they are available when the patient arrives
How did Trauma Centers come into existence?
from the realization that traumatic injury is a disease process requiring specialized multidisciplinary treatment and resources
How to be considered a designated Trauma center?
- must meet certain criteria
- hospital must maintain a specialty trained workforce that is prepared to provide a range of emergency care 24/7 and must also ensure access to the equipment that is needed to provide immediate lifesaving care to critically injured patients
Higher Level Trauma Centers
- have trauma surgeons and other specialists, such as neurosurgeons and orthopedic surgeons
- highly sophisticated medical diagnostic equipment
Lower Level Trauma Centers
may be able to provide only initial care and stabilization and arrange for transfer of the injured patient to a higher level of care
What does the hospital have to do to maintain trauma center designation?
-must ensure all staff members receive ongoing education in trauma and maintain their competency is trauma care
Level I Trauma Center
- Regional resource hospital that is central to the trauma care system
- Provides total care for every aspect of injury from prevention through rehabilitation
- Maintains resources and personnel for patient care, education, and research
- Meets minimum requirement for volume of trauma patients
Level II Trauma Center
- Provides comprehensive trauma care, regardless of the severity of injury
- Might be most prevalent facility in a community and manages majority of trauma patients or supplements the activity of a level I trauma center
- Can be an academic institution or a public or private community facility located in an urban, suburban, or rural area
- Where no level I TC exists, is responsible for education and system leadership
Level III Trauma Center
- Provides prompt assessment, resuscitation, emergency surgery, and stabilization and arranges transfer to a higher level facility when necessary
- Maintains continuous general survey coverage
- Has transfer agreements and standardization treatment protocols to plan for care of injured patients
- Provides back-up care for rural and/or community hospitals
Level IV Trauma Center
- Rural facility that supplements care within the larger trauma system
- Provides initial evaluation and assessment of injured patients
- Must have 24-hour emergency coverage by a provider
- Has transfer agreements and a good working relationship with the nearest level I, II, or III TC
Golden Hour/Golden Period
- the critical time between when an injury occurs, and definitive care is initiated
- during this period, if bleeding is uncontrolled and there is inadequate tissue perfusion, damage occurs throughout the entire body
- if bleeding and tissue oxygenation are not quickly controlled, chances of survival drop
- this period varies; may be much less than an hour for some patients, while others have more time
What are the priorities of Prehospital Care?
- Stabilization
- Transport
What is the Systematic Method to rapidly assess patients presenting with traumatic injury?
ABCDs
>Airway, Breathing, Circulation, and Disability
Airway
- airway must be checked to make sure it is open and clear while maintaining C-spine stabilization
- if a patient is able to vocalize, there is likely a stable airway
- gasping, gurgling, or no respirations at all; compromised airway in need of emergent definitive management
Breathing
- Ventilation and oxygenation
- assessed by auscultating for breath sounds in both lung fields
- checking O2 saturation via pulse oximetry
- all patients must be placed on O2
- for patients who are not breathing on their own, prehospital provider must start assisting ventilation with a bag-valve mask device with supplemental O2
Circulation
- checking perfusion
- assessing for hemorrhage and circulatory system compromise or failure
- palpating pulses and measuring blood pressure can determine adequacy of circulation
- HR, skin color, capillary refill, and any obvious signs of bleeding (internal or external)
- management of circulatory compromise includes hemorrhage control
- direct pressure is most effective way of stopping external hemorrhage
- may also need IV insertion to provide IV fluids while in transport
Disability
- neurological function
- goal is to determine level of consciousness (LOC)
- Glasgow Coma Scale (GCS)
C-spine Stabilization
- when a patient is in a supine position with the spine in neural alignment (no rotation or bending of the spine)
- protects the patient from spinal cord damage and minimizes further damage
Prehospital Care: Transport
if life-threatening conditions are identified, the patient should receive necessary emergency care, be rapidly “packaged” (process of preparing a patient for transport), and transported to the nearest appropriate trauma facility
-recommended to notify the receiving hospital in advance so that the trauma team can assemble before patient arrival
Important Factors to be considered in determining appropriate transportation type and destination
- mechanism of injury
- transportation time to the medical facility
- if transportation by ground is too long, air transportation
- if no air transportation or close trauma facility, patient taken to the closets facility for stabilization then transported to a trauma center
- others: age, pregnancy > 20 weeks, and bleeding disorders
- if in doubt, EMS can consult the trauma center and closest facility to obtain guidance on the best initial treatment location of the patient
Connection Check: The nurse understands priority prehospital interventions include which of the following?
A. Transporting the patient as quickly as possible to the nearest trauma center
B. Treating all injuries found and then transporting the patient
C. Notify the local hospital of the transport of a trauma patient and transporting the patient quickly
D. Assessing the patient using ABCs, treating life-threatening conditions, then transport to the hospital
D. Assessing the patient using ABCs, treating life-threatening conditions, the transport to the hospital
>always stabilize first (ABCs)
Hospital Care
- Hospital personnel
- Triage
- Trauma Assessment
- Interventions
Once the patient has arrived to the trauma center, the aim of the trauma team is what?
- provide safe and efficient evaluation and treatment
- team must identify all injuries and initiate definitive management of such injuries in an expedient manner
- the staff at trauma centers are specially trained to function smoothly in the most challenging and chaotic circumstances
Trauma Team
- Trauma team leader
- Airway provider
- Surgical provider
- Nurses
- Respiratory therapy
- Radiologist
- Clinical technician (highly trained nursing assistant or EMT)
- Social work and/or Pastoral care
- Ancillary support staff
Connection Check: The nurse caring for a trauma patient understands which team member will establish priorities for the patient's care and authorize the interventions and procedures? A. Trauma surgeon B. Trauma team leader C. Anesthesiologist D. Radiologist
B. Trauma Team Leader
Role: Trauma Team Leader
- does not physically touch the patient
- orchestrates the care of the patient through delegation and supervision of the other providers and staff in the room
- establishes priorities for the patient’s care
- authorizes interventions based on the assessment of the patient and all diagnostic results
- must be clear and in control of the situation; the captain of the team
- the trauma room should be quiet so that all members of the team can heat the voice of the team leader
Role: The airway, surgical, and ED providers
- responsible for establishing and maintaining an airway, ordering medications, and performing surgical procedures at the direction of the team leader
- primary survey
- some overlap in roles is necessary between the general surgeons and ED providers to ensure that tasks continue simultaneously, and no time is lost
Role: The airway, surgical, and ED providers
- responsible for establishing and maintaining an airway, ordering medications, and performing surgical procedures at the direction of the team leader
- primary survey
- some overlap in roles is necessary between the general surgeons and ED providers to ensure that tasks continue simultaneously, and no time is lost
Primary Survey
- the first quick assessment and initial management of life-threatening injuries
- performed by airway, surgical, or ED provider
Role: Nurses
- administration of all medications and IV fluids
- set up of equipment for wound management and surgical procedures
- a nurse can serve as a scribe; responsible for full documentation of trauma assessment and care
- after stabilization, provide updates to the family
Rapid Fluid Volume Infuser
- used to administer blood or boluses of fluid to the injured patient who has lost large volumes of blood
- when in use, nurse is dedicated to its management, ensuring empty fluid bags are replaced as necessary and fluid intake is closely monitored
Nurses role as a scribe
- responsible for full documentation of the trauma assessment and care
- records must include: the details of the patients care, such as time of arrival, personnel present at call, physical findings, and fluids and drugs administered
Role: Clinical technicians, EMTs, or Paramedics
delegated duties within their scope of practice: establishing IV access, performing chest compressions during CPR, preparing equipment, obtaining vital signs, and placing patient on cardiac monitor
