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Trauma Management

Trauma Management. By: Michael Putnam RN Adapted from ENA; TNCC. Overview. Trauma patients are treated very differently depending on the type hospital you are in People usually attend to the most graphic of injuries first This often lead to other more serious injuries being missed.

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Trauma Management

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  1. Trauma Management By: Michael Putnam RN Adapted from ENA; TNCC

  2. Overview • Trauma patients are treated very differently depending on the type hospital you are in • People usually attend to the most graphic of injuries first • This often lead to other more serious injuries being missed

  3. Overview con’t • The Emergency Nurses Association (ENA) established a set of evidence based practices that could be used internationally: Trauma Nursing Core Curriculum (TNCC) • In York Region most trauma is diverted to Sunnybrook based on the field trauma triage guidelines • Peads Trauma goes to Sick Kids

  4. Patient Management • A – Airway • B – Breathing • C – Circulation • D – Disability • E – Expose/Environment • F – Five Interventions/Full Vitals • G – Give Comfort • H – History/Head to Toe • I – Inspect the Back

  5. IMPORTANT Like all things they must be done in order. 1 comes before 2 and A comes before B

  6. EMS History Taking MIVT format • Mechanism • Injuries Sustained • Vital Signs • Treatment Rendered

  7. Airway • Assess • Patent? Obstruction? Vocalizing? • Interventions • Suction, Jaw Thrust, OPA, NPA, ETT, NTT, surgical airway. • C – Spine must be maintained!

  8. Breathing • Assess • Breathing? (rate, rhythm) chest symmetry, integrity of chest, accessory muscle use, chest auscultation, trachea position, jugs • Interventions • O2 by NRB • BVM if necessary • Chest tube, chest seal, needle decompression if needed

  9. Circulation • Assess • Pulse? Present? Skin condition, exsanguating trauma, BP (if enough people), heart sounds • Interventions • CPR • Control bleeding, elevate, • IV (2X 14G or 16G): Use warmed solutions when possible or central line? Blood or N/S • Labs • Thoracotomy

  10. A Note on Fluid Resuscitation • Bigger is better…a 14 G peripheral line is better than a 3 Lumen Central Line. • Central Line options • 6 – 8.5F cordis, 2-3 lumen, 1-3 lumen slic • Crystalloid versus colloid • Saline versus Ringers • IV line choices • Gravity versus pump

  11. Disability (mini-neuro) • A- Alert • V – Verbal • P – Painful • U – Unresponsive • Pupils: Size - Equal, Reactive to Light? • GCS… Sum of its parts more important than the total

  12. Secondary • Identify most life threatening injuries by this point • Secondary assessment will identify other minor injuries

  13. Expose/Environment • Removal of all clothing, board straps, etc. • Attempt to maintain warmth where possible • Warmed fluids, blankets

  14. Five Interventions • Monitor with SpO2 and BP (12 lead) maintain SpO2  95% • Foley – Contraindicated? • N/G Tube – Contraindicated? • Labs (if not done in “C”) • Family

  15. Give Comfort • Pain control • Verbal reassurance • Stimuli reduction

  16. History • MIVT • Domestic Violence ? • PmHx, Meds, Allergies, LNMP • Tetanus Status

  17. Head to Toe • Soft Tissue Injuries • Bony Deformities • Full Neuro exam • Eyes, Ears, Nose, Neck • Chest, Abdo, Pelvis, Extremities

  18. Inspect • Roll Patient off Back Board inspect the back/posterior with Log Roll • Keep Neck Stable at all times!

  19. trauma.org

  20. trauma.org

  21. Charting Example • Pt arrived to 14B @1432 CTAS 1 • M – 32 y/o female belted driver into concrete embankment at minimum 100km/h, no airbag, star pattern on windshield, 30 minute extrication time. • I - ? Closed head injury was initially conscious GCS 13 now GCS 3, ? # L femur • V – initially 138/70 HR 110 Resp 24 now 100/50 HR 130 Resp 6 • T – OPA, collar, board, assist resps with BVM, sager to L femur, IV 18 G to R Hand with N/S at KVO • A – clear, no vomit, no blood, no teeth OPA in place no apparent gag, intubation by MD lidocaine 100mg iv @ 1435 etomidate 20mg IV by MD @ 1436 Sux 80mg IV by MD @ 1437. Insert 8.0 ETT 23cm at teeth, positive bilateral breath sounds, and positive ETCO2. Easy to bag. • B – ventilate at 12/min chest clear, no trauma identified, chest stable no crepitus or deformity. • C – pulse 95/min strong and regular. Skin pale warm and dry, B/P 95/40. 2nd iv 14 G into L A/C with N/S at KVO labs drawn from reseal. • D – pupils L 4 R 6 non reactive.

  22. Organ Donation… Salvation from tragedy…

  23. Questions trauma.org

  24. Take Home Points • A,B,C,D • Keep them warm • IV’s bigger the better • Only do what needs to be done to get them out, or does not delay transfer.

  25. Summary • We don’t get much trauma • What we do get we can be better at • Think transfer early

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