Emergency Care in Trauma

1. Prepare by:
RN Arpana Bhusal
BNS

2. EMERGENCY CARE
Emergency care is that care must be
rendered without delay.
3.2 PRINCIPLE OF EM CARE:
One of the first principle of emergency care
is triage

3. Cont…….
Emergent :
 Patients have the highest priority
their conditions are life
threatening and they must been
immediately.
Urgent :
 Patients have serious health
problem but not immediately life
threatening ones , they must be
seen within 1 hour.

4. Cont…..
 Non urgent :
 Patients have episodic illness that can be
addressed within 24 hours without increased
morbidity.

5. TRAIGE

6. PURPOSES OF TRIAGE
• Triage is necessary for the following
purposes:
To separate out the minor injuries to reduced
burden on the management of critical cases.
To provide the equitable and rational
distribution of resources.
A “color code” will be given to establish the
priority of access. To treatment on the basis
of the seriousness of the cases.

7. Cont….
In an advanced triage process injured
people are sorted into categories:
RED:
• very critical , danger of death , immediate
treatment , life threatening condition.
Typical problems are:
 Respiration / airway
 Pulse

8. Cont…..
 Mental status
 Severe burn which compromise airway.
YELLOW:
 Fairly critical , high level of risk , potential
danger of death , treatment can not be delay,
Typical problems are:
 Burn patient without airway problem
 Major bone and joint injuries.

9. Cont……
 Back and spine injuries,
GREEN:
 Not very critical , no risk of condition
worsening , treatment can be delayed
Typical problems are:
 Minor cuts
 Minor painful and swollen
 Minor soft tissue injuries.

10. Cont….
BLACK:
 Victim is extremely critical and dying.
 They are used for the decreased and for
those whose injuries are so extensive.
 They are will not be able to survive given
the care that is available.

12. PRINCIPLE OF TRIAGE SYSTEM
Should be simple.
Does not require advanced assessment skill.
Does not specific diagnosis.
Should be easy to perform.
Should provide for rapid and simple life
saving intervention.
Should be easy to teach and learn.

13. BENEFITS OF TRIAGE
Identify patients who requires rapid
medical care to save life.
Provides rational distribution of casaulties.
 By separating out the minor injuries ,
reduced urgent burden on each hospital.

14. GENERAL TRIAGE GUIDELINES
 Greet client and family in a
warm manner.
 Perform brief visual
assessment.
 Documents the
assessment.
 Triages clients into priority
group using appropriate
guideline.

15. Cont….
Transport client to treatment
area when necessary.
Keeps patient / families aware
of delays.
Reassesses waiting client to
is necessary.
Instruct client to notify triage
nurse of any change in
condition.

16. TRIAGE TEAM MEMBERS
1. Physician
2. Nurses - junior and senior
3. Student nurse
4. Lab technician
5. Sweeper
6. Clearner
7. Compounder
8. Security guard
9. Driver

17. TRIAGE SET- UP
Ventilator
Pulse oxymetery
Defibrillator
X – ray , scanning
Oxygen , suction
equipment
Infusion pumps
Emergency trolley with
medication

18. Cont…
Tracheostomy and
intubation set
Solution and instruments
Ambulance

19. ROLE OF TRIAGE NURSES
Greet patients and identify
your self.
Maintain privacy and
confidentiality.
Visualize all incoming patients
even while interviewing other.
Maintain good communication
between triage and treatment
team.

20. Cont….
Use all resources to maintain
high standard of care.
Teaching ….. Use of
thermometer , first aid??
Avoiding lecturing.
Crowd control.
Telephone
Communicate with team
leader and seek feedback on
decision.

21. D-I-S-A-S-T-E-R
Triage
For any hospital
while responding to
a mass casualty
event; the goal is to
save as many lives
as possible with the
available resources

22. D-I-S-A-S-T-E-R
Triage
● This could mean
application of the
principles of field
triage in casualty
● The purpose of
which is to
determine who
gets what kind
of care

23. D-I-S-A-S-T-E-R
Triage
● The term comes
from the French
verb trier
● Meaning to
separate, sort, sift
or select

24. D-I-S-A-S-T-E-R
Triage
A process of prioritizing patients
based on the severity of their
condition, in order to treat as
many as possible when
resources are insufficient

25. D-I-S-A-S-T-E-R
Triage
All to be treated
immediately is
impossible, so one
has to select the
suitable patients
for immediate
care based on
certain criteria ❏ Right Patient
❏ Right Place
❏ Right Time

26. Colour Category Time span
Red Emergent Within 15 minutes
Yellow Urgent Within 30 minutes
Green Delayed Within 60 minutes
Black Deceased Post mortem
D-I-S-A-S-T-E-R
Triage

27. Delayed
Yes
Open airway & Look for
movements/ Respiration
Able to walk
No
Look for Breathing
No
No
Dead
Immediate
Yes
Yes
Normal Breathing ?
No
Yes
Normal Capillary refill?
No
No
No
Yes
Normal Capillary refill?
Yes
Follow commands?
Yes
Urgent
Triag
e
Siev
e

29. D-I-S-A-S-T-E-R
Triage - Badge
● It is selected by
the Triage Nurse /
officer and worn
on each patient
involved.
● It helps for any
other staff to
immediately
identify
seriousness of the
case

30. D-I-S-A-S-T-E-R
Triage - Tape
Instead of the
triage badge,
one may use
triage tape to be
worn around the
wrist

31. D-I-S-A-S-T-E-R
Triage - Tag

32. D-I-S-A-S-T-E-R
Triage - Nurse
❏ The triage nurse
should be in view of
the waiting area of
the casualty at all
times
❏ Prioritize the waiting
patients periodically

33. D-I-S-A-S-T-E-R
Triage - Nurse
● Greeting patients and families
in a warm, empathetic manner
● Performing brief visual
assessments
● Documenting the
assessments triaging patients
into priority groups using
appropriate guidelines

34. THANK YOU