Nursing Priorities of trauma management


Definition of Emergency Medicine

Emergency Medicine is a medical specialty which:

• Evaluates & treats unexpected (episodic) illness and injury

• Patient population is largely unknown to the physician

• Encompasses a unique body of knowledge

• Depth and breadth of understanding

• Multi-system illnesses in an unknown patient

• Operates under a paradigm that is different from the “traditional” approach

• Manage “unknown” patients

• Manage multiple patients at once

• Assume the worst and look for the unusual before accepting the probable

• 24 hour operations

• Focus on the immediate – get results now


• Identify correct sequence of priorities.

• Outline primary and secondary surveys.

• Identify and discuss history and injury mechanism.

• Explain treatment guidelines used during resuscitation and definitive care phases.



A safe and reliable method to :

• Assess condition rapidly, accurately.

• Resuscitate/ stabilize via ABC priorities.

• Determine if needs exceed capabilities.

• Arrange for interhospital transfer.

• Assure optimum care is provided.


Rescuer protection

Goggles, gloves, gown, mask, over shoes, head cover.



Sorting of patients according to ABC and available resources


Triage in medicine

  • Field Triage

I) mass casualty or Disaster Triage

II) trauma Triage

  • ED Triage
  • In-hospital Triage
  • On-line Triage…..!?

The Concept

Triage Priority (for Rx or transport )is dependent upon:

(a) ABDE Priority :

  • A irway Compromise +/- management (with C-spine supp )
  • B reathing compromise +/- management
  • C irculation compromise +/-management
  • D isability ; AVPU
  • E xposure/ Environment

(b) Severity and/or combination of injuries

(c) Available Resources(manpower, equipments, hospitals level in the area,..etc.


Who can do Triage ?

  • Triage Officer
  • Triage Nurse
  • MD Personnel

The goal

To provide the greatest good for the most victims given a certain amount of resources.







Primary survey

• Adult / Pediatric priorities

• A- Air way with C- spine control

• B- Breathing

• C- Circulation with hemorrhage control.

• D- Disability: Neurologic status

• E- Exposure / Environment


Assume C-Spine injury

• Multisystem trauma

• Altered level of consciousness

• Blunt injury above clavicle



• Assess

• Oxygenate

• Ventilate



• Assess Blood Volume loss and Cardiac out put.

• Level of Consciousness.

• Skin Color.

• Pulse.


Disability (Neurological Evaluation)

• Level of consciousness.

A- Alert.

V- Responds to voice.

P- Responds to pain.

U- Unresponsive.

• Pupils.


Exposure / Environment

• Undress patient completely

• Protect from hypothermia



• Manage life threatening injuries in sequence.

• Need to transfer.


Secondary survey

• Complete History Taking

• Head – to – toe evaluation

• Complete neurologic exam

• Roentgenograms

• Special procedures

• “Tubes and fingers in every orifice”

• Re- evaluation


Complete History Taking

ATLS Dictum

• In Trauma, like other diseases,……………….

An accurate ,complete and correctly interpreted HISTORY “after initial resuscitation” can lead to an indication or suspicion of 90% of a patient injuries.

(This entails :type of accident, estimation of energy exchange and mechanism of impact or colloision)


Types of Motor Vehicle Collisions

  • Frontal impact.
  • Lateral impact.
  • Rotational impact.
  • Rear impact.
  • Rollover.


Deceleration and Acceleration

Compression Injury




• Critical Factor

– Height

• Increased height + Increased injury

– Surface

• Type of impact surface increases injury

– Objects struck during fall

– Body part of first impact

• Feet

• Head Buttocks

• Parallel

Assess body part that impacts first, usually sustains the bulk of injury

Think about the path of energy through body and what other organs/systems could be impacted (index of suspicion)


Gunshot Wounds - Cavitation



Yawing and Tumbling Projectiles

Yawing and Tumbling Projectiles


  • Some projectiles are designed to tumble.
  • Tumbling creates greater tissue damage and more tissue destruction.


WP: Burning







Universal Patient Care Protocol



• A llergies.

• M edication.

• L ast meal.

• E vents / Environment.


Mechanism of injuries

• Blunt.

• Penetrating.

• Hazards to community.


Records and legal considerations

• Concise, chronological documentation.

• Consent for treatment.

• Forensic evidence.


Priorities of trauma management include:

• Primary survey

• Resuscitation

• Secondary survey

• Definitive care

Related posts:

Posted in Critical Care Nursing Tagged with: , ,

FaceBook Page

(function(i,s,o,g,r,a,m){i[\'GoogleAnalyticsObject\']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,\'script\',\'\',\'ga\'); ga(\'create\', \'UA-69237529-7\', \'auto\'); ga(\'send\', \'pageview\');