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Clinical care
Psych-Mental Health Nurs
(Northwestern State University of
Louisiana)
EXAM 3
,Trauma B
• TBI
• Spinal cord injury
• Thoracic injury CVA(pg 31)
• Hemo/pneumothorax
Ischemic Strokes
• Tension pneumothorax Transient Ischemic Attack (TIA)
• Open pneumothorax Hemorrhagic Strokes
• Flail chest
• Pulmonary contusion
• Trachea-bronchial injury
• Cardiac Contusions Sepsis & Shock (pg 40)
• Chest Tubes Hypovolemic Shock
• Abdominal Injuries
Distributive Shock
• Maxillofacial Injuries
Sepsis
Multi Organ Dysfunction Syndrome
END OF LIFE (pg. 68) (MODS)
AKI (slide 30) (pg 55)
BURNS (pg 77)
Acute Kidney Injury (AKI)
, Trauma
Orange: Akins notes
Objectives
• Demonstrate understanding of priority actions of emergency nursing
• Able to identify SSC; px actions for increased ICP; TBI
• Able to identify SSC; px ations for pulm trauma
• Demonstrate understanding of px actions for client with a chest tube
• Demonstrate understanding of px actions for client with abdominal and other selected
types of trauma
Nurse
• The first person you see after saying “Here, hold my beer and watch this…”
Epidemiology
• Not called MVA anymore
o Called MVC: motor vehicile collision bc we could have possibly prevented these
things (wrong place, time….)
• Statistics via CDC, Trauma Registry; Youth Risk Behavior Scale
o Leading COD in ages < 46 y/o
• ENA/AACN -> TLS/ACLS/PALS -> certification programs
• No longer considered accidental
o Unintentional injury ; collision
• Intimate Partner Violence (IPV)
o Becoming recognized as major health issue
o Leading cause of injury to women in US with estimated 1.5 million women and
834,700 men raped or physically assaulted by IP
o Sexual Assault Nurse Examiner (SANE) nursing
▪ SANE nurses – need special credentials
• Legal/Ethical Issues
o Anyone on police hold – requires police presence by bedside and to be cuffed to bed
by law
o often noteworthy cases, media coverage
Can cause issues with confidentiality (ppl/coworkers asking questions)
o
• ETOH and substance abuse STARTED TAKING NOTES HERE
o 51 % MVC; 31% of fatalities & 1:7 boating deaths
▪ What we know, suspect more
o MVC kills someone q 30 min. with nonfatal injuries q 2 min
▪ Even with seatbelts, aitbag, safety precautions, still happends
• 585 billion $
• Mortality/Morbidity
o What were curious about:
o MVC?
o single/multiple car?
, o Ejection?
▪ You moving forward (acceleration movement)
• Backward (deceleration mvmt)
• Ppl not wearing seatbelt, rely on airbag
o Airbag can come at you very very fast (200mph*)
• Internal organs going forward and back – can be bruised by slamming &
momentum
o May look fine on outside, internal hemorrhage
o Rollover?
▪ Bounce all over inside of car with each time they roll
• Lot of spinal cord injuries
• Boating accidents:
o Pulmonary/drowning
• Surgery & postop issues
o Impact immune system
Phases of Trauma Care
• Nursing management of the patient with traumatic injuries begins the moment a call for
help is received and continues until the patient’s death or return to the community. Care
of the trauma patient is seen as a continuum that includes six phases: prehospital
resuscitation, hospital resuscitation, definitive care and operative phase, critical care,
intermediate care, and rehabilitation.
• Six Phases
o Prehospital resuscitation
▪ EMS
o Hospital resuscitation
▪ ER - triage
o Definitive care and operative phase
▪ OR
o Critical care
▪ ICU
o Intermediate care
▪ Stepdown unit
▪ “on the vent, off the vent, out of here” criteria to transfer out of ICU
o Rehabilitation
Triage
• Adapted from military ~ “to sort”
o Emergency severity index (ESI) - 5 categories
▪ Identifies/Categorizes according to acuity
• Life threatening see first, then serious …
• Level 1: need everybody on board – lab, MD, all the peeps
• Tx Algorithms
o Rapid, best practice actions -> best outcomes
▪ What do we need to do 1st, 2nd, 3rd
• Assigned according to
o Stability of vital functions (ABCs)
▪ Temp
o Life or organ threatening
o How soon need to be seen by ER MD
Clinical care
Psych-Mental Health Nurs
(Northwestern State University of
Louisiana)
EXAM 3
,Trauma B
• TBI
• Spinal cord injury
• Thoracic injury CVA(pg 31)
• Hemo/pneumothorax
Ischemic Strokes
• Tension pneumothorax Transient Ischemic Attack (TIA)
• Open pneumothorax Hemorrhagic Strokes
• Flail chest
• Pulmonary contusion
• Trachea-bronchial injury
• Cardiac Contusions Sepsis & Shock (pg 40)
• Chest Tubes Hypovolemic Shock
• Abdominal Injuries
Distributive Shock
• Maxillofacial Injuries
Sepsis
Multi Organ Dysfunction Syndrome
END OF LIFE (pg. 68) (MODS)
AKI (slide 30) (pg 55)
BURNS (pg 77)
Acute Kidney Injury (AKI)
, Trauma
Orange: Akins notes
Objectives
• Demonstrate understanding of priority actions of emergency nursing
• Able to identify SSC; px actions for increased ICP; TBI
• Able to identify SSC; px ations for pulm trauma
• Demonstrate understanding of px actions for client with a chest tube
• Demonstrate understanding of px actions for client with abdominal and other selected
types of trauma
Nurse
• The first person you see after saying “Here, hold my beer and watch this…”
Epidemiology
• Not called MVA anymore
o Called MVC: motor vehicile collision bc we could have possibly prevented these
things (wrong place, time….)
• Statistics via CDC, Trauma Registry; Youth Risk Behavior Scale
o Leading COD in ages < 46 y/o
• ENA/AACN -> TLS/ACLS/PALS -> certification programs
• No longer considered accidental
o Unintentional injury ; collision
• Intimate Partner Violence (IPV)
o Becoming recognized as major health issue
o Leading cause of injury to women in US with estimated 1.5 million women and
834,700 men raped or physically assaulted by IP
o Sexual Assault Nurse Examiner (SANE) nursing
▪ SANE nurses – need special credentials
• Legal/Ethical Issues
o Anyone on police hold – requires police presence by bedside and to be cuffed to bed
by law
o often noteworthy cases, media coverage
Can cause issues with confidentiality (ppl/coworkers asking questions)
o
• ETOH and substance abuse STARTED TAKING NOTES HERE
o 51 % MVC; 31% of fatalities & 1:7 boating deaths
▪ What we know, suspect more
o MVC kills someone q 30 min. with nonfatal injuries q 2 min
▪ Even with seatbelts, aitbag, safety precautions, still happends
• 585 billion $
• Mortality/Morbidity
o What were curious about:
o MVC?
o single/multiple car?
, o Ejection?
▪ You moving forward (acceleration movement)
• Backward (deceleration mvmt)
• Ppl not wearing seatbelt, rely on airbag
o Airbag can come at you very very fast (200mph*)
• Internal organs going forward and back – can be bruised by slamming &
momentum
o May look fine on outside, internal hemorrhage
o Rollover?
▪ Bounce all over inside of car with each time they roll
• Lot of spinal cord injuries
• Boating accidents:
o Pulmonary/drowning
• Surgery & postop issues
o Impact immune system
Phases of Trauma Care
• Nursing management of the patient with traumatic injuries begins the moment a call for
help is received and continues until the patient’s death or return to the community. Care
of the trauma patient is seen as a continuum that includes six phases: prehospital
resuscitation, hospital resuscitation, definitive care and operative phase, critical care,
intermediate care, and rehabilitation.
• Six Phases
o Prehospital resuscitation
▪ EMS
o Hospital resuscitation
▪ ER - triage
o Definitive care and operative phase
▪ OR
o Critical care
▪ ICU
o Intermediate care
▪ Stepdown unit
▪ “on the vent, off the vent, out of here” criteria to transfer out of ICU
o Rehabilitation
Triage
• Adapted from military ~ “to sort”
o Emergency severity index (ESI) - 5 categories
▪ Identifies/Categorizes according to acuity
• Life threatening see first, then serious …
• Level 1: need everybody on board – lab, MD, all the peeps
• Tx Algorithms
o Rapid, best practice actions -> best outcomes
▪ What do we need to do 1st, 2nd, 3rd
• Assigned according to
o Stability of vital functions (ABCs)
▪ Temp
o Life or organ threatening
o How soon need to be seen by ER MD
