Trauma In The Emergency Department. A Nurse s s Perspective
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1 Trauma In The Emergency Department A Nurse s s Perspective
2 GODERICH: Prettiest Town In Canada!
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4 Alexandra Marine & General Hospital
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9 Stats April Nov month period 171 traumas years old or greater 82/171 - transferred out
10 Types of Trauma Pediatric/School bus 1 Cyclist Collisions 5 Motorcycle Collisions 12 MVC 15 ATV 3 Sailboat 1 Falls 107 Struck by thrown or falling object 5 Machinery/Crush Injuries 6 Submersion 1 Sports/Recreation 4 F/B into/through eye or natural orifice 3
11 Always Behave Like a Duck Keep Calm and Unruffled on the Surface But Paddle like Heck Underneath
12 Case Review Time June hrs Receive call from Dispatch: 3 causalities involved in MVC Mechanism of Injury 2 vehicle head on Collision at Highway speed ETA minutes
13 Pre Arrival Preparation Prepare room heart and v/s monitor - O2 and intubation equipment - flush IVs ( fluid warmer and pressure infuser - slider board for transfer for x-raysx - call back up doctor - call floor for help - call xray staff in
14 24 yr old male belted driver, airbags deployed, awake and alert, c/o lower abd pain and bilateral ankle pain, bruise over left iliac crest, /86 SaO2 98%, full C-Spine C precautions, med hx seizure disorder, Crohn s s with previous bowel resection, Meds Dilantin
15 82 yr old female front seat belted passenger, boarded and collared, spider crack on windshield, left lower leg splinted, obvious deformity of left wrist, /49 SaO2 95%, GCS 15, meds Atenolol, Altace, Meloxicam, Hx MI 3yrs ago, Cardiac bypass 1 yr ago, unrepaired AAA
16 60 yr old female belted driver, airbag deployed, boarded and collared, no LOC, c/o chest pain, left knee and right ankle pain, /86 SaO2 99%, awake and alert
17 The rest of the ER Department comes to a standstill because both nurses are consumed with the trauma patients until stabilized
18 Nursing Duties when Patient Arrives Help transfer pt to stretcher Take history from paramedic ABC check Administer O2 and Assist with intubation and care for ventilated patient Cut clothes off and keep pt warm V/S including neuros 2 large bore IV starts Documentation
19 Nursing Duties Enter lab/x-rays and call them to come Do ECG Log roll patients Help in x-rayx Do procedures Administering medications or blood products Documentation and Reassessments
20 Arranging Transfer CritiCall PTAC number Call Central Dispatch for transfer Photocopy lab results and notes Call in staff if needed for transfer sometimes work short in dept until nurse returns Air transport dependent on weather - doesn t t deplete ER staff
21 24 yr old male belted driver, airbags deployed, awake and alert, c/o lower abd pain and bilateral ankle pain, bruise over left iliac crest, /86 SaO2 98%, full C-Spine C precautions, med hx seizure disorder, Crohn s s with previous bowel resection, Meds Dilantin
22 82 yr old female front seat belted passenger, boarded and collared, spider crack on windshield, left lower leg splinted, obvious deformity of left wrist, /49 SaO2 95%, GCS 15, meds Atenolol, Altace, Meloxicam, Hx MI 3yrs ago, Cardiac bypass 1 yr ago, unrepaired AAA
23 60 yr old female belted driver, airbag deployed, boarded and collared, no LOC, c/o chest pain, left knee and right ankle pain, /86 SaO2 99%, awake and alert
24 Challenges in Transporting Patients
25 Tubes and Equipment Physician accompanies Portable Ventilator Use Thomas tube holder CO2 monitor Use ambulance cardiac monitor Secure equipment Hang urinary drainage bag where it can be seen
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28 IV s Take extra fluids Y-tubing blood set Good secure large bore IV s Mark IV s - Rt and Lt and bag # Fully charged IV pumps Pressure infuser Height needed
29 Drugs Needless System, Positive pressure caps Draw up medications Have enough Gravol medical directive
30 Documentation Written Doctor s s orders Photocopies stay with patients Original documentation return to our hospital Messy
31 Weather Road closures Helicopter grounded Bumpy roads Coat Fanny pack Wear seat belt
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41 Hope for the best, but prepare for the worst
42 Goderich ER staff
Restore adequate respiratory and circulatory conditions. Reduce pain
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