1. Trauma Nursing Jen Denno RN, BSN, CEN Fall 2011

2. Types of injuries-BLUNT Falls-axial loading Consider: age, distance fallen, energy absorbed (surface landed on), pre-existing conditions of pt, anatomic pt of impact, energy leaded into pt at time of impact MVA 33% head injury 25% chest injury 25% abdominal injury

3. Types of injuries- PENETRATING Stab wounds: tissue injury dependent on length of device, velocity at which force applied, angle of entry Firearms: tissue damage related to projectile, mass, shape, fragmentation, type of tissue struck and striking velocity Temporary cavity forms along bullet path, stretch phenomenon better tolerated by relatively elastic tissues vs nonelastic solid organs

4. Primary assessment Airway Breathing Circulation Disability (neuro status)

5. Secondary assessment Exposure Farenheit (keep pt warm) Get VS History Head to toe assessment Inspect posterior surfaces

6. Airway Open and clear airway Jaw thrust Remove loose objects/foreign debris Stabilize cervical spine, do not remove any devices Suctioning Do not NT suction if: Apnea Signs of mid-face fractures Signs of basilar skull fracture Leakage of CSF through nares

7. Breathing Spontaneous breathing Chest rise and fall Skin color Resp rate Integrity of soft tissue and bony structures of chest wall Use of accessory muscles Bilateral breath sounds Jugular veins and position of trachea Pneumothorax-needle decompression with 14 gage needle at the second or fifth intercostal space in the mid-axillary line

8. Circulation Pulse quality Skin color Signs of obvious bleeding BP 1:1 replacement of blood Warm to 40 degrees, O negative

9. Disability-neuro AVPU Alert Verbal Pain Unresponsive Pupils

10. Information gathering Scans: xray, CT of any potential injuries Labs CBC, Chem panel, ABG, PT/PTT, blood type, tox screen

11. FAST exam: Focused Assessment with Sonography for Trauma A positive FAST exam is defined as the detection of intraperitoneal fluid on any of the three abdominal windows or the detection of pericardial fluid on the cardiac window. The absence of intraperitoneal fluid on the three abdominal windows and the absence of pericardial fluid on the cardiac window constitute a negative FAST exam. An indeterminate examination is one in which any of the windows is inadequately visualized and there is no fluid detected on the views that are visualized.

12. Head to toe exam Inspect Auscultate Palpate Extremities-5 P’s Pain Pallor Pulses Paresthesia paralysis

13. Distribution of blood Total blood volume5Liters 3 liters of plasma 2 liters of RBCs Systemic circulation84% Heart7% Pulmonary circulation9%

14. Trauma Triage http://www.sacdhhs.com/article.asp?ContentID=1122 Sacramento County Current EMS Policies, Procedures and Protocols 1 critical 2 urgent 5 walking wounded

15. Skull fractures Basilar skull fracture, Depressed skull fracture, Linear skull fracture Battle's sign - behind the ear Raccoon eyes- anterior fossa fracture

16. What should you consider?

18. What should you do?

19. What are you concerned about?

20. What is your intervention?

21. Warning…

22. Airway