NUR 445
Exam4
Module 8 - Trauma & Disaster Management
Trauma Care - Prehospital:
- Priority = STABILIZATION!
- Golden period: critical time between when an injury occurs and definitive care is initiated
- Field-Triage:
®) Assessments: respiratory, circulatory, neurological
®) A = airway = open and clear with maintenance of C-spine stabilization [spine in neutral alignment]
Gasping, gurgling, or no respirations = compromised airway % Box 69.3 Glasgow Coma Scale
B= breathing 2 auscultate lung fields, check O2 stat
Eye Opening Response
Not breathing on their own = bag-valve ventilation 4 = Spontaneous
3 = To verbal stimuli
C= circulation = perfusion and assessing for hemorrhage 2 =To pain
Hemorrhage control = direct pressure, IV fluids 1=None
D = disability 2 neurological function Verbal Response
5 = Oriented
Determine LOC using GCS 4 = Confused
3 = Inappropriate words
Table 69.1 ABCDE: The Primary Survey 2 = Incoherent
1= None
Letter Body System Assessment Motor Response
6 = Obeys commands
A Airway Airway with C-spine precautions 5 = Localizes pain
4 = Withdraws from pain
which is especially important if 3 = Flexion to pain; decorticate
airway is not patent 2 = Extension to pain; decerebrate
1= None
B Breathing Evaluate ventilation; apply high-
Total Scores
flow O, 15: Best score possible. Patient opens eyes spontaneously (E = 4), is oriented (V =
5), and obeys commands (M = 6)
Cc Circulation Evaluate perfusion and bleeding; 13-15: Minor brain injury
9-12: Moderate brain injury
includes hemorrhage control 8 or less: Severe brain injury
D Disability Evaluate neurological status and
evaluate resources necessary
for the care of the patient
E Exposure/environment Complete assessment of the
patient; prevent hypothermia
Trauma Care - Hospital:
Airway specialist Airway assistant
- Trauma team: team leader, airway provider, nurses, respiratory therapy, radiology,
technician, pharmacist, social worker, ancillary support staff
P
®) Team leader: establishes priorities for the patient’s care + delegates tasks el
Assessment g
®) Airway team = responsible for the airway
\‘ >
e
A
Primary Survey: AN
e Begins immediately on the patient’s arrival Nurse 2
e |dentify life-threatening conditions
e ABCD assessment
\‘ &
e
A
AN
e GCS = quick assessment of neurological abilities or disabilities Nurse T Doctor 2
Procedures
O Rapid Fluid Infuser: administer blood or boluses of fluid to the injured patient
O Triage: sorting of patients based on their need for treatment and resources available Team leader
Trauma Care - Interventions “ABCD”
Radiographer Surgeon
| A= AIRWAY
, 1. Open airway
Jaw thrust
a. Jaw thrust maneuver + suction
i. Creates a good seal with face
mask of bad-mask device
b. Chin-lift maneuver
2. Provide oxygen
3. Prepare for an advanced airway
a. Endotrachealintubation
b. Cricothyroidotomy
(] Safety Assessing Airway in a Trauma Patient
Alert
There is always a high index of suspicion for C-spine injury after trauma. It
is essential to maintain C-spine precautions and use the jaw thrust
maneuver when assessing airway and breathing and when placing a
definitive airway, if necessary.
Clinician Protection
Always wear full personal protective equipment (PPE) to guard against
splashes with body fluid. While exposing patients, be on the lookout for
sharp objects that may be on them or in their clothing.
B = BREATHING 1. Providing oxygen
a. 0O2viaface mask
b. Placed on pulse oximetry
2. Diagnosing and treating life-threatening breathing injuries
a. Chestx-ray
b. ABGs
c. Abnormal assessments:
i. Respiratory distress,
hemodynamic instability,
decreased breath sounds =
pneumothorax
1. Tx:chesttube
placement
2. Airenters the pleural
space
ii. Tension Pneumothorax: air enters the pleural space and cannot
escape on expiration, increases intrathoracic pressure
1. Mediastinal shift that compresses hear, trachea, etc
2. Tx: needle decompression (thoracostomy) 2 needle in
pleural space
C=CIRCULATION 1. Assessment and control of hemorrhage
Vascular access = two large bore [18G] IV catheters
D
Prep for central line insertion
o
Intraosseous Cather (I0) 2 placed into the marrow cavity of a bone
0
LAST RESORT = surgical cutdown [incision into a vessel that allows Cath to
0
be inserted] = saphenous vein
2. Volume Resuscitation
Exam4
Module 8 - Trauma & Disaster Management
Trauma Care - Prehospital:
- Priority = STABILIZATION!
- Golden period: critical time between when an injury occurs and definitive care is initiated
- Field-Triage:
®) Assessments: respiratory, circulatory, neurological
®) A = airway = open and clear with maintenance of C-spine stabilization [spine in neutral alignment]
Gasping, gurgling, or no respirations = compromised airway % Box 69.3 Glasgow Coma Scale
B= breathing 2 auscultate lung fields, check O2 stat
Eye Opening Response
Not breathing on their own = bag-valve ventilation 4 = Spontaneous
3 = To verbal stimuli
C= circulation = perfusion and assessing for hemorrhage 2 =To pain
Hemorrhage control = direct pressure, IV fluids 1=None
D = disability 2 neurological function Verbal Response
5 = Oriented
Determine LOC using GCS 4 = Confused
3 = Inappropriate words
Table 69.1 ABCDE: The Primary Survey 2 = Incoherent
1= None
Letter Body System Assessment Motor Response
6 = Obeys commands
A Airway Airway with C-spine precautions 5 = Localizes pain
4 = Withdraws from pain
which is especially important if 3 = Flexion to pain; decorticate
airway is not patent 2 = Extension to pain; decerebrate
1= None
B Breathing Evaluate ventilation; apply high-
Total Scores
flow O, 15: Best score possible. Patient opens eyes spontaneously (E = 4), is oriented (V =
5), and obeys commands (M = 6)
Cc Circulation Evaluate perfusion and bleeding; 13-15: Minor brain injury
9-12: Moderate brain injury
includes hemorrhage control 8 or less: Severe brain injury
D Disability Evaluate neurological status and
evaluate resources necessary
for the care of the patient
E Exposure/environment Complete assessment of the
patient; prevent hypothermia
Trauma Care - Hospital:
Airway specialist Airway assistant
- Trauma team: team leader, airway provider, nurses, respiratory therapy, radiology,
technician, pharmacist, social worker, ancillary support staff
P
®) Team leader: establishes priorities for the patient’s care + delegates tasks el
Assessment g
®) Airway team = responsible for the airway
\‘ >
e
A
Primary Survey: AN
e Begins immediately on the patient’s arrival Nurse 2
e |dentify life-threatening conditions
e ABCD assessment
\‘ &
e
A
AN
e GCS = quick assessment of neurological abilities or disabilities Nurse T Doctor 2
Procedures
O Rapid Fluid Infuser: administer blood or boluses of fluid to the injured patient
O Triage: sorting of patients based on their need for treatment and resources available Team leader
Trauma Care - Interventions “ABCD”
Radiographer Surgeon
| A= AIRWAY
, 1. Open airway
Jaw thrust
a. Jaw thrust maneuver + suction
i. Creates a good seal with face
mask of bad-mask device
b. Chin-lift maneuver
2. Provide oxygen
3. Prepare for an advanced airway
a. Endotrachealintubation
b. Cricothyroidotomy
(] Safety Assessing Airway in a Trauma Patient
Alert
There is always a high index of suspicion for C-spine injury after trauma. It
is essential to maintain C-spine precautions and use the jaw thrust
maneuver when assessing airway and breathing and when placing a
definitive airway, if necessary.
Clinician Protection
Always wear full personal protective equipment (PPE) to guard against
splashes with body fluid. While exposing patients, be on the lookout for
sharp objects that may be on them or in their clothing.
B = BREATHING 1. Providing oxygen
a. 0O2viaface mask
b. Placed on pulse oximetry
2. Diagnosing and treating life-threatening breathing injuries
a. Chestx-ray
b. ABGs
c. Abnormal assessments:
i. Respiratory distress,
hemodynamic instability,
decreased breath sounds =
pneumothorax
1. Tx:chesttube
placement
2. Airenters the pleural
space
ii. Tension Pneumothorax: air enters the pleural space and cannot
escape on expiration, increases intrathoracic pressure
1. Mediastinal shift that compresses hear, trachea, etc
2. Tx: needle decompression (thoracostomy) 2 needle in
pleural space
C=CIRCULATION 1. Assessment and control of hemorrhage
Vascular access = two large bore [18G] IV catheters
D
Prep for central line insertion
o
Intraosseous Cather (I0) 2 placed into the marrow cavity of a bone
0
LAST RESORT = surgical cutdown [incision into a vessel that allows Cath to
0
be inserted] = saphenous vein
2. Volume Resuscitation
