1. An Upward Trend in Motorcycle Crashes By Joan M. Pirrung, RN, APRN-BC, and Pamela Woods, RN, CEN, BSN, SANE-A Nursing2009, February 2009 2.0 ANCC contact hours Online: www.nursingcenter.comwww.nursingcenter.com © 2009 by Lippincott Williams & Wilkins. All world rights reserved.

2. Statistics  Motorcycle crashes account for 10% of traffic fatalities  Fatal motorcycle crashes were 35/100 million miles traveled (cars 1.7/100) from 1993 to 2003  Most fatalities occur on weekends and on rural roads

3. Statistics  Motorcycle crashes are on the increase  Age of drivers is also on the increase  Greatest increase seen over age 59  Older drivers are at increased risk for complications from traumatic injuries

4. Injury patterns  Extremity fractures, abrasions, and traumatic amputations are common motorcycle crash injuries  Traumatic brain injury (TBI) is leading cause of death, especially in those not wearing a helmet

5. Injury patterns  Other common injuries: - tibial and radial injuries - spinal injuries - pulmonary injuries - pelvic fractures  Common due to the rider’s straddling position

6. Bad blood  Hematomas from vascular injury and bleeding are among TBIs that can be caused by motorcycle crashes.  Patient may develop epidural hematoma, subdural hematoma, or intracerebral hematoma depending on location of the injured vessel.

7. First steps in the ED  Initial assessment of ABCDEs: - airway- disability - breathing- exposure - circulation  Exposure is removal of patient’s clothing for injury inspection while preventing hypothermia

8. First steps in the ED  Primary survey - about 15 seconds; life- threatening injuries identified  Secondary survey - focuses on head-to- toe examination; non-life-threatening injuries identified and addressed (diagnostics, splinting, medication typically occur during secondary survey)

9. Management  Multiple trauma patients considered to be in hypovolemic shock  I.V. fluid administration with rapid infusion of warmed crystalloids  Standard fluid replacement is 3 for 1 (replace each mL of blood with 3 mL of crystalloid or PRBCs or a combination)

10. Management  Glasgow Coma Scale done at scene and repeated, assessing for possible head injury  Pelvic stabilization assessed  Urinary catheter inserted  Antibiotic prophylaxis given

11. Complications  Risk for compartment syndrome - includes ischemia, crush injury, edema, hemorrhage  Assess for six Ps: pain, paresthesia, polar (cold extremity), pallor, paralysis, pulslessness

12. Complications  Fasciotomy is treatment for compartment syndrome - reduces pressure, restores adequate tissue perfusion

13. Complications  Abdominal compartment syndrome - possible side effect of fluid resuscitation; monitor intake and output closely, monitor abdominal pressure readings  Clostridium difficile infection - possible side effect of broad spectrum antibiotic administration; discontinue antibiotic, private room with infection control

14. Complications  Rhabdomyolysis - due to extremity trauma or traumatic amputation; vigorous fluid resuscitation, diuresis, alkalinization can manage or prevent

15. Rehabilitation  Can include brain injury rehabilitation, physical and occupational therapy  If trauma caused limb amputation, patients can receive therapy  Complications of amputation in 67% of cases is phantom limb pain

16. Phantom limb pain  Can be treated with multimodal drug therapy  New treatment for phantom limb pain is mirror therapy

17. Mirror therapy  Placing patient in front of a mirror while he exercises affected limb  Mirror therapy has been found to reduce painful sensations by activating mirror neurons in the brain

18. Rehabilitation  Patients can learn upper body activities to cope with limb loss and perform activities of daily living  Patients can also be fitted for prosthesis and learn how to use them