Trauma Resuscitation. Shelley Atkinson RN, MSN, ANP-BC, ACNP- BC. Objectives. Identify the correct sequence of priorities for assessment of a multiple injury trauma patient .
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Shelley Atkinson RN, MSN, ANP-BC, ACNP- BC
Leading cause of death for ages 1-44
$ 500 billion dollar annual cost
Estimated 20-50 million injuries occur per year (40 % of emergency room visits)
Leading causes of trauma are motor vehicle crashes, falls, and assaults
Assess the patient’s condition rapidly and accurately
Resuscitate and stabilize the patient according priority
Determine if patient’s needs exceed a facility’s resources/or doctor’s capabilities
Arrange for transfer (what, where, when, who, and how)
A hospital equipped to provide comprehensive emergency medical services to patients suffering traumatic injuries.
Mechanism of Injury
Mechanism of Injury
Primary survey and resuscitation of vital functions are done simultaneously.
A team approach
D. All of the above
Class I Class IIClass IIIClass IV
EBL <750 750-1500 1500-2000 >2000
HR <100 >100 >120 >140
BP NL NL LOW LOW
UO >30 20 - 30 5 - 15 MIN
Exemplified by the patient that has donated one unit of blood
Uncomplicated hemorrhage for which crystalloid fluid resuscitation is required
Complicated hemorrhagic state in which at least crystalloid infusion is required and perhaps also blood replacement
Considered a pre-terminal event, and unless very aggressive measures are taken, the patient will die within minutes
**Observe for neurologic deterioration
20 year old male, unrestrained driver, in a motor vehicle that collides into a large tree. +LOC at the scene and unresponsive. Starred windshield. Life flight transported to VUMC.
VS: 120/70 mm Hg, HR= 110-115, RR= 15
Receiving oxygen 100% NRB
What is the number one priority during the initial assessment of this trauma patient?
What Level One Criteria does the patient meet?
1- GCS < or = 8
2- Head injury with LOC > 5 min
3- moderate to severe respiratory distress
4- all the above
True or False.
The patient’s need for airway protection and ventilation is due to unconsciousness.
Which two steps listed below are early steps in the RSI procedure?
1- Pre-oxygenate with 80% oxygen & apply cricoid pressure
2- perform chin lift/jaw thrust to open airway& pre-oxygenate with 100% oxygen
3- administer a paralytic & ventilate
How do I know the ETT is in the correct position?
1- presence of CO2 in the end tidal CO2 detector only?
2- equal breath sounds bilaterally and gurgling in the epigastrium
3- presence of CO2, equal bilateral breath sounds and CXR
True or False.
This patient does not meet Level One Criteria.
What trauma imaging is needed for this patient?
1- CXR only
2- CT of the chest
3- CXR, CT chest/abd/pelvis, Left femur XR
4- Head CT
What do you think is wrong with this patient based on the CXR provided?
1-labored breathing due to pain
What should be assessed in the secondary survey?
1-pulses of right leg only
2-roll the patient for posterior check
3-roll patient over (posterior check) and assess pulses (Fem, DP,PT)
4-secondary survey excluded because the patient states, “I am fine”
18-20 year old male unrestrained passenger. Car hit a bridge. Driver DOA. Reported by EMS, “Initially awake, not acting right”. Gradually more confused & verbally uncooperative. 2L NS in air craft. BP=110 and decreasing. HR=120. RSI per life flight.
What signs/symptoms are the patient exhibiting that he needs resuscitation?
1- decreased mentation
2- increasing HR and decreasing BP
The patient has increasing HR =130s BP= 84P
What stage of shock is the patient in?
1- Stage 1
2- Stage 2
3- Stage 3
4- Stage 4
The patient was given 2L of NS during his flight and was unresponsive to this. What is the next step? BP 84P HR=130
1- order a 3rd liter of crystalloid
2- order 2 U PRBCs
3- do nothing
4- give 4 FFP
What trauma imaging is needed at this time? Secondary survey noted left lower abdominal ecchymosis.
2- CT chest/abd/pelvis
3- FAST exam
4- one and two only
True or False.
A FAST exam (focused assessment sonography)is used to rapidly identify hemorrhage or potential hollow viscous injury
FAST study positive for a large amount of fluid in the abd. What intervention is needed for the patient at this time?
1- Go to the operating room
2- Activate the trauma exsanguination protocol
3- Go immediately to CT scan
4- Both one and two
What is the trauma exsanguination protocol or Massive transfusion protocol?
1- 2 L crystalloid
2- 2 U PRBC
3- 2 L crystalloid and 2 U PRBC
4- 6 U PRBC, 4 U FFP, 1 pack plts