Week 3 - Trauma Systems, the Trauma Cycle, and Trauma Assessment Flashcards
For assessment of a primary injury, what is very important? What is used much more often to assess for bony injury? And percussion may be done to assess (Why)?
For assessment—inspection for symmetrical chest movement is very important, palpation is used much more often to assess for bony injury, and percussion may be done to assess for pneumo, etc (especially if a portable chest xray is unavailable)
In phase 4 of the trauma cycle What would you say is the biggest shift in philosophy of care at this point?
Out of the ICU: No longer intensive care unit….focusing on recovery
What is the big difference for assessments and interventions with our primary survery? What do we always want to consider?
Maintenance of C-spine stabilization is a big difference—we always want to consider a spinal cord injury until Xrays or an MDs physical exam rule that out. This means collar, backboard, and no neck manipulation AT ALL (suctioning, OPA, NPA, intubation, etc all need to be done with a neutral neck)
What Makes a Trauma Patient Different? (10 different reasons)
Sudden—no time to plan or prepare
Drugs and alcohol common
Potential for long term rehabilitative care
Psychological impact
Often young patients, but getting older
Legal implications (e.g. assault)
Injuries can be difficult to detect
High risk for complications
Early interventions lead to later problems
Economic burden of the family
Characteristics of a level 4 trauma centre?
Nearby Level I or II centre
Major trauma bypasses whenever possible
Variable services, usually simple trauma
Participate in injury prevention
Training usually by outreach
For the secondary survey, what does the inspection and palpation always include?
Inspection
Always includes checking for symmetry; lacerations, punctures, abrasions;rashes, lesions;burns, bleeding, bruising: edema, masses
Symmetry of facial expressions/movements
Eyes: Vision changes, periorbital ecchymosis…
Ears: Discharge, ecchymosis behind mastoid process…
Nose: Unusual drainage, position of septum…
Mouth: mucosa, teeth…
Palpation
Always includes checking for crepitus, tenderness, and deformity
Characteristics of a level 3 trauma centre?
Areas without timely access to Level I or II
Smaller urban communities or rural
Initial care / stabilization of all cases
Transfer complex cases to Level I or II
Participate in injury prevention
Training usually by outreach from bigger centres
which assessment is a brief, and is a systematic process to identify ALL injuries
the secondary survey
In phase 3 of the trauma cycle What information would be helpful for the PARR nurse to tell the ICU nurse?
In the critical care phase- need to know the surgy they performed, how the patient responsed, what happened in ER/leading up to event, family involvement,
In phase 1 of the trauma cycle what are you thinking/what is your key priority? What are some things you may need?
What essential components need to be in place to get you to a hospital alive!!
Need:
Need cell services/phone
Access to yourself
Need 911 services
Ambulances need trained staff
In phase 2 of the trauma cycle how does the OR need to function in order to provide emergent operative services to a multi system trauma patient?
OR needs to have good communication and teamwork, need to have surgeons/staff to respond to this patient
What is the trauma system?
Trauma system is not just the hospital, it is the system that encompasses the entire truma
What do we use to obtain a history for pediatrics? Why?
Some things are unique with kids—they can’t always tell us what’s wrong. So here are a different set of things to consider and ask the caregivers about
*This is generic and not specific to trauma!
C – Chief complaint
I – Immunizations
A – Allergies
M – Medications (OTC, prescription, herbal)
P – Past History (medical, surgical, family, social)
E – Events surrounding the illness or injury
D – Diet & Diapers
S – Signs and symptoms associated with injury
Characteristics of a level 1 trauma centre?
1.) Typically a university hospital!!!! - U of A hospital
Most complex trauma patients
Leadership:
All services
>650 major trauma cases/year
~1200 secondary trauma cases/year
Urban
Gives majority of care locally and regionally
Adult and/or pediatric
Usually university-affiliated
Lead injury prevention
Research and training
In phase 2 of the trauma cycle what are you thinking/what is your key priority?
What does the ER staff need to do in order to get you to the operating room alive?
What tubes and wires need to be considered when moving a patient?
In phase 3 of the trauma cycle What should the ICU nurse and interdisciplinary team do to prevent mortality from complications such as Systemic Inflammatory Response Syndrome (SIRS) and Multiple Organ Dysfunction Syndrome (MODS)?
ICU nurse – looking at how their functional status is either improving or declineing
What is the SAMPLE algorithm used for?
Patient-generated information can be obtained from a conscious patient utilizing the pneumonic SAMPLE
S- associated/absent/alarming symptoms (reported) and signs (observed)
A- allergies
M- Medications
P- past history (medical, surgical, family, social, environmental)
L- last everything (often will just give a tetanus booster to be safe)
E- events prior/leading up to the injury
What does the head-to-toe for the secondary survey include?
General Appearance
Head and Face
Neck
Chest
Abdomen
Pelvis and Perineum
Extremities
General appearance – Note the patient’s body position, posture, and any guarding or self-protection movements. Observe for stiffness, rigidity, or flaccidity of muscles. Characteristic positions of limbs (flexion or extension), trunk or head may indicate specific injuries. Note and document any unusual odors such as alcohol, gasoline, chemicals, vomitus, urine, or feces.
What interventions could you do for your primary survey? (ABCDE)
Remember ABCDE from 370
For general appearance in the secondary survey what do we want to note?
General appearance – Note the:
-patient’s body position, posture, and any guarding or self-protection movements.
-Observe for stiffness, rigidity, or flaccidity of muscles.
-Characteristic positions of limbs (flexion or extension), trunk or head may indicate specific injuries.
-Note and document any unusual odors such as alcohol, gasoline, chemicals, vomitus, urine, or feces.
What other interventions might we do for a trauma injury that is apart of our primary survey? (what is a standard? what might be done as a last resort? what might be done in extreme cases)
For interventions, like above, there is a bigger chance of needing to put direct pressure on wounds.
As a last resort we might tourniquet a heavily bleeding extremity (never seen it personally).
Inserting two large bore IVs is standard. IOs are possible if venous access is difficult.
Warmed fluids is far more common (though that’s technically E not C), as well as blood products.
In extreme cases, we might do an open thoracotomy (open chest surgery) or pericardiocentesis (drain fluid from pericardial space with needle)
For our primary assessment, what is there a bigger chance for? Why? what do we vigilant in looking for?
For assessment, there is a bigger chance for bleeding simply because the patient is injured instead of ill. So be vigilant in looking for external and internal bleeding
In the trauma team, what other roles may nurses perform? What are they based off of?
Nurses may perform the roles done by RT, lab technicians, and ECG technicians depending on the trauma centre and its
Nurses may also step into the role of Leader if there is no MD/NP available – but only with proper training and hospital policies (e.g. a rural hospital in the middle of the night with physicians on call)
What intervention is always done during our primary injury? (regardless of (blank)?
oxygen generally applied to ALL patients, regardless of SpO2. Until we can rule out significant injury, we assume that the patient has increased oxygen demands
Patient-generated information can be obtained from a conscious patient by utilizing what pneumonic?
A- allergies
M- Medications
P- past history (medical, surgical, family, social, environmental)
L- last everything (often will just give a tetanus booster to be safe)
E- events prior/leading up to the injury
In phase 5 of the trauma cycle What is the ultimate goal of rehabilitation?
Focus is to restore function and decrease further loss of function that the patient may have
Characteristics of a level 5 trauma centre?
*Rural setting
*No immediate access to Level I, II, or III
Bypass whenever possible
*Stabilize and transfer
Limited services
*Access to air evacuation
Participate in injury prevention where possible
Training by outreach and education by telehealth
Characteristics of a level 2 trauma centre?
2.) Have most services
Doesn’t see the same complexities of trauma as level 1
Most services
~300 major trauma cases/year
~1200 secondary trauma cases/year
Regional leader of smaller urban centre or support for Level I in larger centre
Maybe university-affiliated
Lead or support injury prevention
Research and training optional
What are the components of the secondary survey? (think F-J)
F – Full Set of Vital Signs / Family Presence
G – Get Monitoring Devices and Give Comfort
L – Labs
M – Monitor (Cardiac)
N – Nasogastric or orogastric tube
O – Wean oxygen based on Oximetry and assess capnography (if sedated or intubated)
P – Pain assessment and management
H – History and Head to Toe
I – Inspect Posterior Surfaces
J – Jot it down / Just keep revaluating
Characteristics of a level 2 pediatric trauma centre?
Most services
>100 cases/year
Together or separate from adult centre
Regional leader of smaller urban centre or support for Level I in larger centre
Maybe university-affiliated
Lead or support injury prevention
Research and training optional
What are the 5 components of the trauma system?
Administration: funding, evaluation, facilitating legislation. Directs and organizes
Clinical components: pre-hospital care, acute care facilities, and rehab and community care
Injury prevention: prevention programs, reporting, surveillance
Research, education, and training: develop and deliver training programs, research new interventions, etc.
Disaster planning: develop plan to be ready for mass casualty and disaster events
What are the 7 principles of the trauma system?
1.) Preplanned, organized, and coordinated control of and response to injuries
2.) Based on a population of 1-2 million people
1-2 major trauma centres
Several acute care facilities
Different regions coordinated by a provincial trauma plan
3.) Has an identified lead agency
4.) Is publicly funded, administered, and accountable
5.) Engages in
Surveillance, reporting, and prevention of injuries
Research and training
6.) Delivers comprehensive care
7.) Develops emergency preparedness plan
Characteristics of a level 1 paediatric trauma centre?
Leadership in pediatric trauma system
Liases with other centres
All services
>200 cases/year
Together or separate from adult centre
Gives majority of care locally and regionally
Multidisciplinary
Usually university-affiliated
Lead pediatric injury prevention
Research and training
What are the 6 phases of the trauma cycle?
- Field Stabilization and Resuscitation
2.) In-hospital Resuscitation and Operative Phase - (ER)
3.) Critical care phase- (ICU)
4.) Intermediate and Acute care phase - (Med-surg units)
5.) Rehabilitation - (Glenrode)
6.) Prevention
In phase 2 of the trauma cycle What challenges might the OR face by having little to no history from you?
Challenges they might face without having is allergies, aspiration (I/O), bleeding disorders, etc.
