Nursing Priorities of trauma management

accident

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

Objectives:

• 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.

 

MANAGEMENT GOALS

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.

 

Triage

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.

 

FIELD TRIAGE CARD

FIELD TRIAGE CARD

 

Triage

 

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

 

Breathing

• Assess

• Oxygenate

• Ventilate

 

Circulation

• 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

 

Resuscitation

• 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

 

 

Falls

• 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

Burning

 

DIME INJURIES

DIME INJURIES

 

 

Universal Patient Care Protocol

 

History

• 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

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