Trauma Nursing Core Course 7th Edition Chapter 5: Initial Assessment Instructor Course: Microteach Lecture Set 1 Trauma Nursing Core Course 7th Edition Chapter 5: Initial Assessment, begins on page 39 of the TNCC Provider Manual.

Objectives Recognize competence in the initial assessment process. It is the foundation of trauma nursing practice. Demonstrate the components of the initial assessment process Differentiate between goals of the primary and secondary surveys Determine actual and potential threats to life and limb using the initial assessment process Select interventions to manage life-threatening conditions identified during the initial assessment process

Approach to Trauma Care Systematic process Efficient and timely Easy to learn and implement Teamwork and communication Trauma care is a team sport, and as a team sport, it requires a game plan with well-defined roles, common goals, strong communication, and teamwork. To produce optimal outcomes that plan or approach needs to be systematic, efficient, and timely. As well, it needs to be easily learned and implemented by the trauma team.

Initial Assessment Preparation and Triage Primary Survey (A,B,C,D,E) Resuscitation Adjuncts (F,G) Reevaluation Secondary Survey (H,I) Reevaluation Adjuncts Reevaluation and Post Resuscitation Care Definitive Care or Transport The trauma team works within a framework of steps as outlined on the slide. The A–I mnemonic is embedded into the framework. Note that there are two reevaluation points. The first one can be used to reevaluate the patient after the primary survey If there is suspected internal hemorrhage, a focused assessment with sonography for trauma (FAST) exam and/or chest/pelvis radiograph can be expedited. If injuries have been found that require transfer to a trauma center or to the surgical or angiography suite, those preparations can begin proactively. The second reevaluation occurs after the secondary survey and takes into account all reevaluation adjuncts (laboratory data and other diagnostic data) to determine post resuscitation and definitive care needs

A-I Mnemonic A–Airway and Alertness w/cervical spinal immobilization B–Breathing & ventilation C–Circulation & Control of hemorrhage D–Disability (neurologic status) E–Exposure & Environmental control F–Full set of vital signs & Family presence G–Get resuscitation adjuncts (LMNOP) H–History & Head-to-toe assessment I – Inspect posterior surfaces The A–I mnemonic helps the trauma nurse to rapidly assess for and intervene in life-threatening injuries in the primary survey and identify all injuries in a systematic manner in the secondary survey. Let’s go through the initial assessment step by step.

Preparation and Triage Safe practice Personal protective equipment (PPE) Hazardous exposure Safe care Right care Right trauma facility Right time Right resources The approach to trauma care typically begins with notification that a trauma patient is about to arrive in the emergency department (ED). The trauma nurse receives the prehospital report and begins to plan safe practice, safe care for that patient. Safe practice means team safety: Don personal protective (PPE) and consider the potential for any hazardous exposure. Be prepared to decontaminate as the situation demands. Safe care is guided by trauma triage criteria and guidelines developed by the American College of Surgeons Committee on Trauma Communication with prehospital providers and the call for trauma team activation are necessary when determining the right care needed for the patient, which includes: The right team members: Specialists such as a neonatal team for obstetric trauma, neurosurgeon for head trauma, and others The right trauma facility: Does the patient need a burn center, pediatric center, or higher level of care? The right time: Is the closest facility the definitive facility or the best choice for stabilization before transport? Field triage is key to the use of community resources, with the most severely injured patients being transported directly to the highest level of trauma care in the community. The right resources are a part of long-range planning and include appropriate supplies, equipment, education, and training of the team

Trauma Triage Criteria Who needs a trauma center? Physiologic criteria Anatomic criteria Mechanism/evidence of high energy impact Age and special considerations Trauma triage criteria are divided into categories. Step 1 is consideration of physiologic criteria: Glasgow Coma Scale (GCS) score ≤ 13 Systolic blood pressure (BP) < 90 mm Hg Respiratory rate < 10 or > 29 breaths/min Step 2 is consideration of anatomic criteria and includes specific high-risk injuries needing care provided in a trauma center (such as a flail chest or a fractured pelvis). Step 3 is consideration of mechanism of injury (MOI) when there is high energy transfer (such as a head-on collision or an adult fall from >20 feet). Step 4 relates to age and special patient considerations: The very young and the older adult are at risk for increased morbidity and require specialized trauma care Special considerations include injuries such as burns and spinal cord injuries The trauma nurse anticipates and assembles essential equipment based on the prehospital report. A sufficient number and qualified trauma team members gather. The team is prepared when the patient arrives.