intro

1. Linda H. Warren
EdD RN MSN CCRN
NUR 335
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2. § Identify common mechanisms of injury (MOI)***** (MVA, drowning, blunt injury, adult vs
child, size of vehicle & size of person, etc).
§ Describe primary & secondary assessments of trauma patients.
§ Identify appropriate nursing diagnosis and expected outcomes based on assessment of the
trauma victim.
§ Identify priorities for nursing interventions based on assessment data.
§ Describe appropriate interventions for trauma patients.
§ Evaluate the effectiveness of nursing interventions for trauma patients.
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3. § Assessment
§ Nursing Diagnosis
§ Expected Outcomes
§ Planning
§ Implementation
§ Evaluation!!!

4. § Unintentional injury: leading cause of premature
death (all ages).
§ MVAs account for the majority of unintentional
injuries (41%) and traumatic deaths (44%).
§ MVC & firearms: leading cause of death ages 16-24
§ Homicide is the 2nd most common cause of death.
§ Death by firearms represents approx. 80% of ALL
homicides.
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5. § Intentional or unintentional wound or injury
inflicted on the body from a mechanism against
which the body cannot protect itself.
§ 4th leading cause of death in U.S.
FOUR MAJOR MECHANISMS OF INJURY:
§ Poisoning from alcohol or drugs
§ MVAs
§ Firearms
§ Falls
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6. PREVENTION:
Overarching goal in trauma care.
§ Education
§ Legislation
§ Automatic protection
However, once a traumatic injury
occurs, the priority is early &
aggressive intervention.
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PRIMARY PREVENTION: prevents the event
from occurring.
• Driving safety classes
• Speed limits
• Drug awareness campaigns
• Domestic violence campaigns
• Fall prevention
SECONDARY PREVENTION: strategies to
minimize the impact of the traumatic event.
• Seat belt use
• Car seats
• Air bags
• Helmets
• Antibullying hotlines
TERTIARY PREVENTION: interventions to
maximize pt outcomes after a traumatic
event.
• Emergency response systems
• Medical care
• Rehabilitation

7. PREVENTION OF UNINTENTIONAL TRAUMA
§ Child passenger safety, seatbelt or car seat laws
§ Fall prevention
§ Fire deaths and injuries
§ Impaired drivers
§ Older adult drivers
§ Playground injuries
§ Water injuries
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8. VIOLENCE PREVENTION
§Child maltreatment
§Intimate partner abuse
§Sexual violence
§Suicide
§Youth violence
§Elder abuse
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9. §Age: a leading cause of death under age 44.
§Socioeconomic status and race
§Firearms
§Alcohol and drug use
§Geography: rural (farm accidents) vs. urban (lead pipes, crime)
§Temporal: pattern & timing

10. Definition: Transfer of energy causing injury to human tissue
§ Kinetic
§ Thermal
§ Electrical (alternating current is worse)
§ Chemical (asbestos, chemistry, rat poison)
§ Radiation (sunburn, x-ray)

11. MECHANISM OF INJURY
§Transfer of energy from external
forces to the human body.
§Mechanism of injury (MOI) is
primary concern in assessment!!

13. Blunt:
§Acceleration
§Deceleration
§Shearing (tissue, vessels, aorta)
§Crushing
§Compression (landing on your
feet after jumping off a roof)

14. Penetrating:
§ Impalement from foreign objects.
§ Easily diagnosed due to obvious signs of injury.
§ Low Velocity: Stab Wounds, less force
§ High Velocity: Ballistics, more force
oEntrance wounds (direct insult, smaller)
oExit wounds (larger)

15. Blast Injuries:
§Blunt and Penetrating
§Primary (positive pressure of shockwave)
§Secondary (lung contusions, negative
pressure of shockwave, penetrating injuries)
§Tertiary (tissue damage, visceral organ
damage, head injury)
§Quaternary (biological exposure, chemical,
thermal)

17. §Minor Trauma
§Major Trauma
Injury Scoring Systems:
oAbbreviated Injury Scale (AIS)
oInjury Severity Score (ISS)
oGlasgow Coma Scale (GCS): 3 to 15
oRevised Trauma Score (RTS): includes hemodynamics (BP, HR) plus GCS

18. §Organized approach to trauma care
§Prevention
§Access
§Acute hospital care
§Rehabilitation
§Research activities

19. § EMS – Care at scene and transport
§ ABCs with cervical spine immobilization.
§ Trauma Care Centers: Reduced
preventable rate from 40% to 4%.
o Levels I-IV
o Trauma Team
o Disaster Plans
***VERY ORGANIZED!

20. DISASTER:
§ Sudden event, resources
overwhelmed by demands.
§ Classified by number of victims.
§ Mass patient incident (<10)
§ Multiple casualty incident (10-100)
§ Mass casualty incident (>100)

21. § High incidence of death &
disability à BIG EXPENSE!
§ First Peak – death occurs in
seconds to minutes.
§ Second Peak – death occurs in
minutes to several hours.
§ Third peak— occurs several days
to weeks after initial injury.
First hour of emergent care- “Golden Hour”

22. Primary assessment is KEY – rapid
survey of initial injuries with life saving
interventions.
§ Airway w. cervical spine immobilization
§ Breathing
§ Circulation w. hemorrhage control
§ Disability or neurological status (GCS, RTS)
§ Environment & exposure

23. A - AIRWAY
§Airway patency
§Jaw-thrust maneuver
§Inspect and remove foreign bodies
§Airway obstruction (complete, partial)
§Airway adjuncts
§Inhalation injury
§Manual C-spine immobilization in
neutral position
NGT to decompress stomach & prevent
emesis / aspiration.

24. B - BREATHING
§Assess adequacy of ventilation
§Skin color, respiratory rate, depth,
effort of respirations
§Grunting, wheezing, use of
accessory muscles
§Breath sounds- auscultate
§Chest symmetry and expansion

25. IMPAIRED BREATHING
§Pneumothorax
§Hemothorax
§Tension pneumothorax
§Sucking chest wound
§Flail chest

26. IMPAIRED BREATHING
INTERVENTIONS:
• NRB (15 L/min O2)
• Inadequate respirations: BVM
• No spontaneous respirations:
intubate patient
• Treat underlying cause

28. C - CIRCULATION
§Assess adequacy of circulation
§Pulse presence, rate and quality
§Inspect skin color, moisture & temp.
§Observe for uncontrolled bleeding and
apply pressure

29. IMPAIRED CIRCULATION
§IF NO PULSE…initiate cardiac
compressions!!
§Volume repletion:
• Initiate 2 large bore IV’s with
fluid bolus of warm NS or LR
• Blood products
§Control any uncontrolled
bleeding

30. HYPOVOLEMIC & HEMORRHAGIC SHOCK:
§ External or internal hemorrhage
§ Pneumatic anti-shock garment- (rare)
§ Identify & treat the cause
§ Fluid replacement with crystalloids:
o3:1 RULE à 3mL IV crystalloid for
every 1mL estimated blood loss
§ Blood products
§ Tachycardia, narrow pulse pressure,
tachypnea, decreased urine output.
o ↓ CO
o ↑ HR, ↑ RR
o ↓ U/O

31. CALCULATION OF MAP:
MAP: assessment of tissue perfusion
Calculate: 90/60
o90 – 60 = 30
o1/3 of 30 = 10
o60 + 10 = 70

32. D-DISABILITY
§ Rapid neuro. evaluation
§ PERRLA, LOC, posturing.
§ GCS: <13 consider a CT scan.
§ Blood glucose
§ ABGs
§ Toxicology screen
AVPU
§ A – alert
§ V – verbal stimulus
§ P – painful stimulus
§ U - unresponsive

33. E – EXPOSE / ENVIRONMENT
§Expose patient
§Warm blankets
§Warm fluids
§Warm room
vRemove wet clothing
vHead coverings
vRadiant lights
vWarmed oxygen

34. F- FULL SET OF VITALS & FAMILY
§Full set of vital signs
§Facilitate family involvement,
provide updates

35. G – GIVE COMFORT MEASURES
§Verbal reassurances
§Explanation of procedures
§Reassurance of care
§Touch
§Pain management

36. H – HISTORY & HEAD-TO-TOE
HISTORY:
Pre-hospital Information – MIVT
§ Mechanism and pattern of injury
§ Injuries suspected
§ Vital signs
§ Treatment initiated / patient
responses
Patient Generated Information
§ Determine LOC
§ Past Medical History

38. §Inspect, Auscultate, Palpate
§Percussion indicated in
specific circumstances
oHead and Face
oChest
oAbdomen / Flanks
oPelvis / Perineum
oExtremities
H – HISTORY & HEAD-TO-TOE

39. I – INSPECT POSTERIOR SURFACES
§Maintain C-Spine Immobilization
§Support extremities with suspected injuries
§Logroll – Maintain vertebral alignment
oNeed three people!!
Palpate:
§Vertebral column
§Posterior surfaces
§Anal sphincter

42. §Radiological studies per trauma protocol
§CT Scan
§Tetanus toxoid vaccination
§Risk for infection
§Hypothermia
§Respiratory complications

43. §AKI: hypoperfusion or trauma, pre-renal and intra-
renal causes.
§Nutritional support: started within 24-48 hrs to
assist with healing & meeting metabolic demands.
§MODS

44. Effects of aging: Falls are the most frequent causes of injury in the elderly.
• Falls are the leading cause of injury-related deaths in ppl. >65 y.o.
• Physiological changes predispose elderly pts to serious injuries, prolonged recovery,
and higher mortality rates.
• Have worse outcomes after trauma r/t poor functional status and comorbidities.
Alcohol and drug use: contributing factor to many traumas/injuries.
§ Assess pt hourly for S&S of withdrawal (tachycardia, HTN, N/V/D, diaphoresis, seizures,
agitation, confusion, hallucinations)
Family and Patient Coping: traumatic event often creates a crisis within the family.
• Promote consistent communication btwn. HC members & the family.
• Involve the social work early on to assist the pt / family with coping & decision making.