T8 Management of Trauma and Medical Emergencies

• Progressive shortness of breath with a chest injury, but airway and circulation are intact is a sign of what?

  Pneumothorax.
• What is the name for periumbilical bleeding?

  Cullen's sign.
• What is the trend regarding patients in the ED?

  Increasing census with more complex needs are starting to be seen.
• What are the levels of trauma?

  I, II, III, IV.
• What happens in a level 4 trauma?

  Provides advanced trauma life support (ATLS) prior to transfer.
• What is the primary goal for a level 4 trauma?

  Resuscitate and stabilize the patient and arrange for immediate transfer to a higher level of care.
• What happens in a level 3 trauma?

  Prompt immediate emergency care and stabilization of patient with transfer to a higher level of care.
• What is the difference between a level 3 trauma and level 4 trauma center?

  Level 3 trauma centers serve communities that do not have immediate access to a level 1 or 2 center.
• What happens in a level 2 trauma center?

  Provides comprehensive trauma care as a supplement to a level 1 center and meets the same provider expectations for care as a level 1 center.
• What is the difference between a level 2 and level 1 trauma center?

  Level 2 trauma centers are not required to participate in education and research.
• What happens at a level 1 trauma center?

  Provides comprehensive trauma care and serves as a regional resource center providing leadership in education, research and systems planning.
• What is available at a level 1 trauma center?

  Providers such as trauma surgeon, anesthesiologist, physician specialists, and nurses.
• What is a trauma team made up of?

  Emergency department physicians and specialists, nurses.
• What are ancillary services to the trauma team?

  Radiologic technologists, laboratory technicians, respiratory therapists, social workers.
• What are the three levels of prevention?

  Primary, secondary, tertiary.
• What happens with primary prevention?

  Prevention of the event itself. (Driving safety classes, speed limits, campaigns to not drink and drive)
• What happens with secondary prevention?

  Minimize the impact of the traumatic event. (Seatbelts, airbags, carseats, helmets)
• What happens with tertiary prevention?

  Maximize patient outcomes after traumatic event through emergency response systems, medical care, and rehabilitation.
• What is the ENA or emergency Nurses Association for?

  • Specialty organization aimed at advancing emergency nursing practice
  • Provides standards of care for nurses working in the ED
  • Offers certification processes to become a CEN (Certified Emergency Nurses)
• What is an important goal of emergency nursing?

  Recognition of life-threatening illness or injury.
• What is triage in emergency nursing?

  • Process of rapidly determining patient acuity
  • Represents a critical assessment skill
  • Life-threatening problems are treated before others
  • Identifies and categorizes patients so most critical are treated first
• Initiation of interventions to reverse or prevent a crisis often precede medical diagnosis.
• Intervention begins with first contact with a patient.
• What do emergency nurses need to be aware of?

  Prompt identification of patients who need immediate treatment.
• What is the ESI?

  Emergency Severity Index.
• What is the Emergency Severity Index?

  A 5 stage level triage system that determines who should be treated first.
• What is the ESI supported by?

  ENA and American College of Emergency Physicians.
• What does it mean if someone has an ESI level of 1?

  Assess for threats to life and patient may be imminent danger of dying.
• What does an ESI level of 2 mean?

  Patient is a high risk who cannot wait to be seen due to abnormal vital signs.
• What does an ESI level of 3-5 mean?

  Patient's vitals are stable.
• What are examples of ESI level 1?

  Cardiac arrest, intubated trauma patient, overdose with bradypnea, severe respiratory distress.
• What are examples of ESI level 2?

  Chest pain from ischemia.
• What are examples of ESI level 3?

  Abdominal pain, gynecological disorders unless in severe distress, hip fractures in old patients.
• What are examples of ESI level 4?

  Closed extremity trauma, simple lacerations, cystitis.
• What are examples of ESI level 5?

  Cold symptoms, minor burn, recheck on wounds, prescription refills.
• How are trauma patients assessed?

  Primary survey and secondary survey.
• How are nontrauma patients assessed?

  Primary survey and focused assessment.
• What are the parts of the primary survey?

  • Catastrophic bleeding
  • Alertness, airway
  • Breathing - effort and effectiveness
  • Circulation - perfusion, control bleeding
  • Disability - Neuro, LOC, GCS
  • Exposure - other injuries, environment
  • Full set of vitals and family presence
  • Getting other monitoring devices
• What are signs of a compromised airway?

  Gasping (agonal) breaths, inability to speak, dyspnea, foreign body in airway, trauma to face or neck.
• What are the airway interventions from least to most invasive?

  • Jaw-thrust maneuver (avoid hyperextension of neck)
  • Suctioning or foreign body removal
  • Nasopharyngeal or oropharyngeal airway (unconscious patients only)
  • Ventilate with 100% O2 and BVM device before endotracheal intubation
  • Emergency: cricothyroidotomy or tracheostomy