TRAUMA
Leigh Anne Wilmot RN, CEN, CLNC
Lecture Adapted from Nancy Jenkins
& Charlene Morris
Types of Trauma

Minor traumaCauses injury to a single part or system
 Treated in practitioners office, hospital, or ER


Major or Multiple traumaSerious single system or multiple system trauma
 Immediate intervention with focus on survival
 Most often result of MVC
 Often require long periods of ICU

Types of Trauma

Blunt trauma


MVC, falls, assaults and sports
Can affect head, spinal cord, thorax, and
abdomen
Penetrating trauma

Result of foreign objects set in motion
Can affect internal organs



Intestines, liver, spleen, and vascular system
Ex: Gun shot wounds, shrapnel
Other types of trauma

Inhalation, thermal, & blast force
Forensics



Trauma victims are
often victims and/or
perpetrators of crime
as well.
Maintain the chain of
evidence
Work collaboratively
with the Police
Department
Assessment of
Trauma Victims




Start with the ABCs: PRIMARY Survey
A- airway obstruction- blood, teeth,
tongue,
or vomiting
B-breathing-look for pneumothorax and tension
pneumothorax
C- circulation-look for signs of hemorrhage(external
and internal) and hypovolemic shock
Chest trauma-bleeding into pleural space
 Abdominal trauma-bleeding into abd. cavity
 Pelvic fracture-bleed into retroperitoneal space
C – Cervical Spine

Assessment of Trauma Victims
Head to Toe ( SECONDARY Survey)
Remember to Start with “D” for Disability


Integumentary


contusions, abrasions, punctures, lacerations.
Consider risk for infection
Abdominal-high risk for hemorrhage and peritonitis




Bowel ischemia and infarction
Rupture of large bowel-peritonitis
Lacerate or compress solid organs – liver, spleen, pancreas
Displacement of organs
Assessment of Trauma Victims
 Musculoskeletal
 High



priority if threatens life or limb
Dislocated hip
Pulseless extremity
Significant blood loss from pelvic fracture
 Neurological Psychological-
head and spinal cord injuries
sudden death or serious injury
Pre-hospital Care

Injury identification-rapid assessment at scene
Penetrating injuries to abdomen, pelvis, chest, neck or head
 Spinal cord with deficit
 Crushing injury to head, chest or abdomen
 Major burns


Critical interventions


providing life support, immobilizing the cervical spine,
managing the airway, and treating hemorrhage and shock
Rapid transport-ASAP to regional trauma center
Triage Tag
MIEMSS
A V P U
A V P U
A V P U

Patient Information

Triage Status

Tourniquet @ _______
Chief Complaint
Extremity Splint
Gauge

Transportation

Peel - off Bar Codes

Transport Record

Vital Signs

History

Treatment
PASG
Inflated at _______________
Gross Decon.
Final Decon.
TRIAGE TAG
HOSP NOTIFIED
Maryland Emergency
Medical Services
Maryland Department
of Transportation
Triage Status Section


Universal color coding system
Space provided for four individual evaluations
Initial assessment - apply tag for priority assignment
 Secondary reassessment (in treatment area)
 Blank - can be used in the treatment area or during
transportation
 Hospital

Chief Complaint Section



Major obvious injuries or illness can be circled
Indicate injuries on the human figure
Additional information is added on the comments line
Emergency Room

Paramedics communicate
with ED



Brief report about client
with ETA
Severity of condition
determines ED response
Champion Revised
Trauma Scoring System
Diagnostic Tests

Blood type and cross
Blood alcohol level
Urine drug screen
Pregnancy test

What others can you think of?



Diagnostic Tests cont.


X-Ray, CT, MRI
Diagnostic Peritoneal
Lavage (DPL)
Abdominal Ultrasound Focused Assessment with
Sonography for Trauma
(FAST)

Medications
1.
2.
Blood, crystalloids, (volume expanders)
Inotropic drugs after IV fluids
Dopamine, dobutamine, isoproterenol
Increase myocardial contraction
3.
Vasopressors
dopamine, epinephrine
4.
5.
Opioids - pain control
Tetanus prophylaxis
1.
2.
Toxoid
Human toxin-antitoxin (TAT)
Nursing Diagnosis

Ineffective airway clearance
Assess airway
 O2 sats – pulse oximeter = or > 92%
 LOC





Risk for infection
Impaired physical mobility
Spiritual distress
Risk for post-trauma syndrome
Emotions range from fear, anger denial and shock.
 May experience flashbacks and nightmares

Nursing Diagnosis

Risk for post-trauma
syndrome
 Emotions
range from fear,
anger denial and shock.
 May experience flashbacks
and nightmares
Disaster Management





Natural Disasters/Severe Weather
Chemical Emergencies
Radiation Emergencies
Bioterrorism
Mass Casualties
http://www.bt.cdc.gov/
Natural Disasters/Severe Weather

Types:
Geological
 Hydrological
 Climactic
 Fire
 Health & disease
 Space


What events can you think of that have happened
recently?
Chemical Emergencies

Release of a hazardous
chemical that has the
potential for harm
Biotoxins
 Blood agents
 Pulmonary agents
 Nerve agents


Treatment depends on
chemical, some have no
treatment
Radiation Emergencies

Can be incurred from
handling of or exposure
to radioactive materials
Radiological technicians
 Weapons of Mass
Destructions


What do you think the
S/Sx of radiation
sickness are?
Bioterrorism
Mass Casualties


What examples can you think of?
What are the injuries you would expect to see, and
why do they occur?
Nursing Care in a Crisis Situation

Assessments
 ABCs
 Skin
 Pain
 GCS

Nursing Therapeutics
 First
 Secondary
 Mental

Status
Principles of Fluid
Therapy
aid concepts &
pain management
 Initial wound care,
fracture care
 Stabilization of
patients
 SCI
 Shock
 Blast
injuries
 Chemical exposures
ARC Guidelines for Disaster Nursing




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Assessment and triage of patient’s condition for priority care
Provision of care, treatment, and health protection
Appropriate utilization of nursing service personnel
Detecting changes in the event environment and organizing
activities to modify or eliminate health hazards
Dealing with mass casualties should it become necessary.
http://www.redcross.org/services/nursing
http://www.cdc.gov/masstrauma/guides