Trauma Nursing Jen Denno RN, BSN, CENFall 2011

Types of injuries-BLUNT

• Falls-axial loading

• Consider: age, distance fallen, energy absorbed (surface landed on), pre-existing conditions of pt, anatomic pt of impact, energy leaded into pt at time of impact

• MVA• 33% head injury

• 25% chest injury

• 25% abdominal injury

Types of injuries-PENETRATING

• Stab wounds: tissue injury dependent on length of device, velocity at which force applied, angle of entry

• Firearms: tissue damage related to projectile, mass, shape, fragmentation, type of tissue struck and striking velocity• Temporary cavity forms along bullet path, stretch

phenomenon better tolerated by relatively elastic tissues vs nonelastic solid organs

Primary assessment

• Airway

• Breathing

• Circulation

• Disability (neuro status)

Secondary assessment

• Exposure

• Farenheit (keep pt warm)

• Get VS

• History

• Head to toe assessment

• Inspect posterior surfaces

Airway

• Open and clear airway

• Jaw thrust

• Remove loose objects/foreign debris

• Stabilize cervical spine, do not remove any devices

• Suctioning

• Do not NT suction if:• Apnea

• Signs of mid-face fractures

• Signs of basilar skull fracture

• Leakage of CSF through nares

Breathing

• Spontaneous breathing

• Chest rise and fall

• Skin color

• Resp rate

• Integrity of soft tissue and bony structures of chest wall

• Use of accessory muscles

• Bilateral breath sounds

• Jugular veins and position of trachea• Pneumothorax-needle decompression with 14 gage needle

at the second or fifth intercostal space in the mid-axillary line

Circulation

• Pulse quality

• Skin color

• Signs of obvious bleeding

• BP

• 1:1 replacement of blood• Warm to 40 degrees, O negative

Disability-neuro

• AVPU• Alert

• Verbal

• Pain

• Unresponsive

• Pupils

Information gathering

• Scans: xray, CT of any potential injuries

• Labs• CBC, Chem panel, ABG, PT/PTT, blood type, tox screen

FAST exam: Focused Assessment withSonography for Trauma

• A positive FAST exam is defined as the detection of intraperitoneal fluid on any of the three abdominal windows or the detection of pericardial fluid on the cardiac window. The absence of intraperitoneal fluid on the three abdominal windows and the absence of pericardial fluid on the cardiac window constitute a negative FAST exam. An indeterminate examination is one in which any of the windows is inadequately visualized and there is no fluid detected on the views that are visualized.

Head to toe exam

• Inspect

• Auscultate

• Palpate

• Extremities-5 P’s• Pain

• Pallor

• Pulses

• Paresthesia

• paralysis

Distribution of blood

• Total blood volume 5Liters• 3 liters of plasma

• 2 liters of RBCs

• Systemic circulation 84%

• Heart 7%

• Pulmonary circulation9%

Trauma Triage

• http://www.sacdhhs.com/article.asp?ContentID=1122

Sacramento County

Current EMS Policies, Procedures and Protocols

• 1 critical

• 2 urgent

• 5 walking wounded

Skull fractures

Basilar skull fracture, Depressed skull fracture, Linear skull fractureBattle's sign - behind the ear

Raccoon eyes-anterior fossa fracture

What should you consider?

What should you consider?

What should you do?

What are you concerned about?

What is your intervention?

Warning…

Airway