This document provides an overview of trauma nursing and management of trauma patients. It discusses the roles and skills of trauma nurses, including triage, primary and secondary surveys, airway management, hemorrhage control, and monitoring for shock. It also outlines the trauma patient workflow through red and yellow areas and use of investigations like x-rays, CT scans, and FAST ultrasound. Regular training through simulations and mock drills is emphasized to ensure trauma nurses have the expertise needed to effectively manage trauma.

1. TRAUMA NURSING-
CLINICAL PEARLS
BY
REVATHY S NAIR
TRAUMA NURSE COORDINATOR
JPNATC, AIIMS NEW DELHI

2. TRAUMA
 A harmful event that results from the release of specific form of energy.
 Penetrating- Stab, gunshots
 Blunt- MVCs, falls
 Thermal injuries

3. TRAUMA NURSING
 Trauma nursing, as a discipline, refers to the varied roles nurses
assume when caring for a trauma patient.
 Skillful and competent, pace
 Leadership
 Critical thinking
 Communication
 coordination

4. TRIAGE • RED, YELLOW, GREEN AND BLACK
PRIMARY SURVEY • RESUSCITATION (ABCDE)
SECONDARY
SURVEY • NCCT, CECT TORSO
STABILIZATION
TRANSFER FOR
DEFINITIVE CARE
OVERVIEW OF TRAUMA MANAGEMENT

5. Triage Category
Green
Yellow
Red
STOP
GO
Black

6. Goal of Triage
PLACE THE
RIGHT PATIENT
IN RIGHT PLACE
AT RIGHT TIME
FOR RIGHT
REASON
TRIAGE

7. AIIMS TRAIGE PROTOCOL
Physiological parameters
• BP, HR, SPO2, GLASCOW COMA SCALE
Injuries identified
• Seat belt sign
• Steering wheel inury, open fracture, vascular injury
Mechanism of injury
• Co passenger dead, overturn or turnover
• Pedestrian hit with car

8. TRIAGING DONE BY NURSES
( TRIAGE OFFICER)
Pelvic compression test Chest compression test

9. TRIAGE FORM

10. RED AREA

13. INITIAL ASSESSMENT AND
MANAGEMENT
 PRIMARY SURVEY
 AIRWAY
 BREATHING
 CIRCULATION
 DISABILITY
 EXPOSURE
 SECONDARY SURVEY

14. PRIMARY SURVEY
1. CERVICAL COLLAR APPLICATION
2. PATIENT SHIFTED TO RED AREA RESUSCITATION TROLLEY
3. CALL GIVEN TO RADIOLOGIST FOR POCUS ( POINT OF CARE
ULTRASOUND- FAST )

15. AIRWAY MANAGEMENT
 Are you okay?
 Complete sentence spoken by patient-
 Airway is patent
 Breathing is intact
 Cerebral circulation in good

16. AIRWAY MANAGEMENT
 Airway patency
 Suctioning of secretions
 Chin lift/ jaw thrust
 Oropharyngeal airway
 Airway support
 Non rebreather mask oxygen administration
 Definitive airway ( GCS< 8) - head injury, facial burns
 Endotracheal intubation
 Surgical cricothyroidotomy

17. BREATHING MANAGEMENT
 INSPECTION
Tracheal deviation
Accessory muscle use
Retractions
Paradoxical chest wall movement
 AUSCULTATION
 Diminished or absent
breath sounds
 PALPATION
 Broken ribs
 Injuries to chest wall

18. Identify life threatening conditions
 Massive hemothorax
 Flail chest
 Rib fractures
 Open pneumothorax
 Pulmonary contusion
 Tension pneumothorax

19. CIRCULATION WITH HEMORRHAGE CONTROL
 Bleeding control
 Apply pressure bandage
 Vascular access- 2 large bore peripheral IV cannulas
/ IO access/ CVP/ venous cut down
 2 point R/L I/V stat- 1 litre ( warm fluids)
 Blood samples withdrawn for investigation
 Blood arranged – 4-4-4
 Pregnancy test for female< 45 years of age
 ABG and lactate levels ( to understand the grade of shock)
 Indwelling Foleys catheter insertion

20.  Massive transfusion protocol (MHP)
 4 RBC, 4 PLATELETS, 4 FFP
 Pelvic binder- unstable pelvis
Open book fracture

21. Hemorrhagic Shock - Grades

22. DISABILITY
 Glasgow Coma Scale/ AVPU scale
 Pupillary Assessment

23. Neurological trauma

24. Exposure
 Expose the patient
 Prevent hypothermia- blankets, Bair Hugger
warming unit
 Log roll the patient to examine back
Minimum 4 people required
Palpate thoracic and lumbar spine
Anal tone

25. Adjuncts to Primary Survey
 Chest X ray/ Pelvic X ray
 E- FAST
 ECG monitoring
 ABG
 Pulse oximetry

26. FAST:
Focused Assessment Sonography in Trauma
 Pericardium ( sub-xiphoid view)
 Peritoneal cavity
 Supra pubic
 E- FAST ( hemothorax, pneumothorax)

27. SECONDARY SURVEY
 Head to toe evaluation of trauma patient- Log roll
 Complete history (AMPLE)
 Reassessment of all vital signs
CECT TORSO, NCCT HEAD AND C SPINE
CT Angio
RGU

28. Red Area Report Book

29. Red area report book

30. YELLOW AREA

31. Yellow Area Patient Process Flow
Triage done by Triage Nurse
Initial assessment done by Junior Resident on duty
Initial treatment done by N2
Patient sent for hospital investigations
Patient received after investigation by N3, Reassesses and
informs N1
N1 coordinates and facilitates pts reviews from concerned departments, admission and discharge

32. Pain Management in ED
 Pain assessment- Visual Analogue Scale, Wong Baker Pain Scale
 Pain medications
 Opioid analgesics: Inj Fentanyl, Inj Tramadol
 NSAIDS ( Ketorolac, Inj Diclofenac )
 Inj Perfalgan
 Inj Ketamine
 Nerve blocks- Femoral Nerve Block, Intercostal Nerve Block

33. CONCLUSION
 Nurses play a vital role in management of trauma patient
 Trauma nurses must have adequate expertise in the field for better
management of the patient
 Regular CNE programs to be arranged
 SIMULATIONS AND MOCK DRILLS

34. REFERENCES
 1. ATLS 10TH EDITION
 https://www.ncbi.nlm.nih.gov/books/NBK555913/
 https://www.ncbi.nlm.nih.gov/books/NBK430854/