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ConceptsEmergency TraumaNursing

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1/19/24
Concepts
Chapter 10
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The priority concepts in this chapter are
Safety
Teamwork and Collaboration
Ø Communication
Ø
Ø
Concepts of
Emergency and Trauma Nursing
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Environment of Care (1 of 2)
Emergency Departments (EDs)
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Provides services too all seeking care
Responsible for safety via public surveillance
and emergency disaster preparedness
Interprofessional specialty teams
Critical Access Hospitals
Multispecialty environment
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Rapid change
Fast paced
Challenging, stimulating
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Demographic Data and
Vulnerable Populations
Environment of Care (2 of 2)
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Most common reasons people seek ED care
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Abdominal pain
Ø Breathing difficulties
Ø Chest pain
Ø Fever
Ø Headache
Ø Injuries (especially falls in older adults)
Ø Pain (the most common symptom)
Ø
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Care provided across the lifespan
Vulnerable populations
Homeless
Poor
Ø Those with mental health issues
Ø Those with substance abuse concerns
Ø Older adults
Ø
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The Impact of Homelessness (1 of 2)
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The Impact of Homelessness (2 of 2)
553,000 people in the U.S.
Factors that contribute to homelessness
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Maintain situational awareness
Attend to personal safety needs
Ø Use Standard Precautions
Ø Demonstrate behaviors that promote trust
Ø Enact and maintain clear professional boundaries
Ø Develop individualized plans of care
Ø
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Economic hardship
Ø Escape domestic abuse
Ø Behavioral health needs
Ø Substance abuse
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Nurses must:
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Interprofessional Team Collaboration
(1 of 2)
Special Nursing Teams:
Interprofessional Team Members
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Ø
Ø
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Forensic nurse examiners (RN-FNEs)
SANEs
SAFEs
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Psychiatric crisis nurse team
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Emergency nurse
Prehospital emergency medical services
(EMS)—EMTs, paramedics
Emergency medicine physician
NPs and PAs
Residents (in teaching hospitals)
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Interprofessional Team Collaboration
(2 of 2)
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Prehospital Care Provider
Respiratory therapists
Social workers
Case managers
Nursing assistants
Clerical staff
Images above: advanced life support helicopter arriving at ED landing
zone.
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Communication (1 of 2)
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Communication (2 of 2)
Hand-off communication process from ED to
next point of care
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Situation
Background
Ø Assessment
Ø Recommendation
Ø
Situation
Ø Pertinent medical history
Ø Assessment and diagnostic findings (especially
critical results)
Ø Transmission-Based Precautions and safety concerns
Ø Interventions provided in the ED, and response to
interventions
Ø
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Ø
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Staff and Patient Safety Considerations
(2 of 2)
Staff and Patient Safety Considerations
(1 of 2)
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Staff safety
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Recognize the potential for disease transmission
Ø Recognize the potential for personal safety needs
Ø Protect self and others by isolating patients as
needed, and wearing PPE
Ø Security guard
Ø Metal detectors
Ø Panic buttons
Ø Remote door access
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Patient safety
Fall risk
Medical errors or adverse events
Ø Patient misidentification
Ø Skin breakdown
Ø
Ø
Ø
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Core Competencies (1 of 2)
Scope of Emergency Nursing Practice
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Encompasses management of patients across
the life span
All health conditions that prompt someone to
seek emergency care
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SBAR method
Patient assessment
Priority setting
Clinical decision-making
Documentation
Communication
Cognitive knowledge base
Flexibility
Adaptability
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Core Competencies (2 of 2)
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Training and Certification
Initiates collaborative interprofessional protocols
Technical skills performed in high-pressure
environment
Assists providers with procedures
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Emergency nurse specialty certification
BLS
ACLS
PALS
Trauma Nursing Core Course
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Triage
Emergency Nursing Principles
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Emergent, Urgent, and
Nonurgent Categories
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Immediate threat to life or limb
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Emergency Severity Index (ESI)
Canadian Triage Acuity Scale (CTAS)
Urgent
Ø
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Other Multi-Tiered Models
Emergent
Ø
Requires quick treatment but immediate threat to life
does not exist at the moment
Nonurgent
Ø
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Sorting or classifying
Highest-acuity needs receive quickest
intervention
RN often performs triage/rapid assessment
Can wait several hours for care without significant risk
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Case Management
Disposition
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Provider determines whether patient is:
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Admission to hospital
Transferred to specialty care center
Ø Discharged to home with instructions and followup
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Arrange appropriate referral and follow-up
Review ED census and trends
Collaborate to find safe environments for
patients of vulnerable populations
Coordinate the discharge plan and continuing
care with social worker, case manager
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Death in the ED (2 of 2)
Death in the ED (1 of 2)
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May occur sudden and unexpectedly, or be
anticipated (e.g., terminal illness)
Family presence may be granted during
resuscitation (depending on agency)
ED staff members usually prepare the body and
room for family viewing
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For trauma deaths, suspected homicide, and
abuse cases: leave IV lines, indwelling tubes in
place
Communicate with family members in crisis
Ø
Use appropriate words, e.g., “death” or “died” to avoid
confusion
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Trauma Nursing Principles
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Trauma Centers
Trauma – bodily injury
Unintentional injury – leading cause of death in
U.S. for individuals under 35 years old
Trauma-informed care (TIC)
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Level 1
Ø
Ø
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Level 2
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Usually community hospitals that can provide care to vast
majority of injured patients
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Level 3
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Level 4
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Regional resource facility that provides leadership and total
collaborative care from prevention through rehabilitation
Usually are large teaching hospitals that serve dense
populations
Usually smaller, rural hospitals that focus on initial injury
stabilization and patient transfer if necessary
Usually located in a rural or remote settings; offers ACLS and
transfers patient after stabilization
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Trauma Systems
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Mechanism of Injury (MOI)
Organized and integrated approach to trauma
care
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Blunt trauma
Blast effect
Ø Acceleration–deceleration
Ø Penetrating trauma
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Ø
Access to care
Ø Timely availability of prehospital emergency care
Ø Rapid transport to qualified trauma center
Ø Early provision of rehabilitation services
Ø System-wide injury prevention, research, education
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Manner in which traumatic event occurred
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Primary Survey and
Resuscitation Interventions
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Secondary Survey and
Resuscitation Interventions
Primary survey
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(A) Airway/cervical spine
(B) Breathing
Ø (C) Circulation
Ø (D) Disability
Ø (E) Exposure
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Exception
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In presence of excessive bleeding, use CAB
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Comprehensive head-to-toe assessment
Identifies other injuries/issues (after
immediate life threats have been addressed)
The nurse anticipates
Insertion of gastric tube and urinary catheter
Preparation for diagnostic studies
Application of splints, temporary dressings
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Disposition
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Transport to OR or interventional radiology suite
Admission to inpatient unit
Transfer to a higher level of care
Before disposition is determined
Chapter 10
Audience Response System Questions
Assess psychosocial needs
Consult with social services and rehab team
Ø Coordinate with other support services as needed
Ø Be alert for signs of human trafficking
Ø Implement SBIRT
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Answer to Question 1
Question 1
ANS: D
Which client will the emergency nurse triage as
the priority?
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A. 21-year old with ankle fracture
B. 33-year old with with vomiting, flank pain,
and a history of kidney stones
C. 49-year-old with profound weakness and
103° F fever
D. 59-year-old with sweating, jaw pain,, and
pain in the left arm
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Based on the information provided, the patient experiencing
sweating, jaw pain, and left arm pain should be triaged first.
Jaw and left arm pain are signs of referred chest pain which
may indicate a myocardial infarction—an emergent condition.
The emergent triage category implies that a condition exists
that poses an immediate threat to life or limb. The urgent
triage category indicates that the patient should be treated
quickly but that an immediate threat to life does not exist at
the moment. Examples of patients who typically fall into the
urgent category are those with kidney stones, complex
lacerations not associated with major hemorrhage, displaced
fractures or dislocations, and temperature greater than 101° F
(38.3° C).
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Answer to Question 2
Question 2
ANS: C
While performing a history, a client becomes
unconscious. What is the priority nursing action?
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A. Obtain vital signs.
B. Assess the airway.
C. Contact the ED physician.
D. Evaluate the patient’s level of consciousness.
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The primary survey organizes the approach to the
patient so that immediate threats to life are rapidly
identified and effectively managed. The primary
survey is based on a standard “ABC” mnemonic with
a “D” and “E” added for trauma patients:
airway/cervical spine (A), breathing (B), circulation
(C), disability (D), and exposure (E). The highest
priority intervention is to establish a patent airway.
All other actions can be completed after the airway
is established.
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Answer to Question 3
Question 3
The nurse is caring for a female client who has been seen
at the ED multiple times recently for sexually transmitted
infections and various physical concerns. When the client’s
boyfriend goes for coffee, what is the priority nursing
action?
A.
B.
C.
D.
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ANS: C
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Look for tattooing or ‘branding’ marks.
Complete a psychosocial assessment.
Ask, “Does anyone you know make you feel unsafe?”
Follow agency policy for contacting local authorities
to report the concern
After establishing a therapeutic relationship, the
nurse should ask the client if she feels unsafe as
soon as the boyfriend leaves to get coffee. It is
important to obtain information quickly while the
client is alone before the boyfriend returns, so
that the client can freely express any concerns
she has. The nurse can then complete the other
portions of the assessment and report, if
indicated, to authorities.
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