TRAUMA NURSING

OBJECTIVES
At the end of the discussion, participants will be able to:
1. Identify and distinguish different kinds of trauma
2. Explain and differentiate Trauma Nursing from the other fields of
Nursing

3. Define wound, classify and characterize its types

4. Determine certain procedures towards diagnosing a trauma
5. Recognize the different approaches towards management of trauma

TRAUMA
Any injury from any extrinsic force,
that has the potential to cause
prolonged disability or death.
There are many causes of trauma,
blunt and penetrating, including falls,
motor vehicle collisions, and stabbing
and gunshot wounds.
Depending on the severity of injury,
quick management and transport to an
appropriate medical facility (called a
trauma center) may be necessary to
prevent loss of life or limb.

 In 2012, unintentional and intentional injuries were the

fifth and seventh leading causes of deaths worldwide,
accounting for 6.23% and 2.84% of all deaths.
Trauma is the sixth leading cause of death worldwide,
resulting in five million or 10% of all deaths annually.
It is the fifth leading cause of significant disability.

TRAUMA NURSING
It is a field of nursing which specializes in caring for patients
injured through trauma, be it accidental or intentional.
Trauma nurses must be well versed in stabilizing patients and
rapidly recognizing impending life threats. Patients will range in
age from neonates to centenarians.
Care of these patients can range from short-term in the
emergency department (ED) or dedicated trauma unit to long-term
in ICUs and rehabilitation units.

 When these patients enter the system, they don't

necessarily arrive with an obvious diagnosis and can
benefit from the clinical acumen of experienced trauma
nurses.
This specialty also requires close coordination and
communication with members of the treatment team,
ancillary services, and family members.

SKILLS/QUALITIES
Trauma nurses should possess excellent assessment skills to
identify and reverse potential life threats.
Oftentimes, trauma nurses are the first to see trauma patients; as
such, rapid recognition and identification of issues is essential.
The environment is fast-paced and constantly changing, and a
trauma nurse must be able to thrive in the chaos of trauma
resuscitation.
As trauma resuscitation methods are constantly changing and
improving through research, trauma nurses should constantly seek
new evidence-based information via professional journals and
online networking.

A typical trauma room

Causes of Trauma
Injuries can be caused by any
combination of external forces that act
physically against the body.
Leading causes of traumatic death are
blunt trauma, motor vehicle collisions
and falls.
Trauma may also be associated with a
particular activity, such as an
occupational or sports injury

Classifications of Trauma
Injuries are generally classified by either
severity (minor or major), the location of
damage (abdominal, thoracic, head,
maxillofacial, etc.) or a combination of both.
Trauma may also be classified by
demographic group, such as age or gender.
It may also be classified by the type of force
applied to the body (e.g. blunt trauma or
penetrating trauma)
Or it can be classified based on the cause of
the said trauma (burns, sports related
injuries)

WOUND
It happens relatively quickly
in which skin is torn, cut, or
punctured (an open wound),
or where blunt force trauma
causes a contusion (a closed
wound).
It has two main
classifications (OPEN and
CLOSE wounds)

Types of Open Wounds

ABRASION
A scraping or scratching. Generally
quite superficial, and affecting only
the surface layers of the epidermis.
No internal organs, nerves, or blood
vessels other than capillaries, are
affected.
This may be the result of a fall, or of
sliding (friction) against rough
surfaces.

 INCISION
caused by a clean, sharpedged object such as a
knife, razor, or glass splinter

 LACERATIONS
irregular tear-like wounds
caused by some trauma

 PUNCTURED
caused by an object
puncturing the skin, such as
a splinter, nail or needle

 AVULSED
injury in which a body
structure is forcibly detached
from its normal point of
insertion by either trauma or
surgery

Types of Close Wound

Hematomas
caused by damage to a
blood vessel that in turn
causes blood to collect
under the skin.
Contusion - Hematomas that
originate from an external
source of trauma

How is Trauma Diagnosed?

1. PHYSICAL EXAMINATION
undertaken to identify any life-threatening
problems, after which the secondary
examination is carried out.
This may occur during transportation or
upon arrival at the hospital. The secondary
examination consists of a systematic
assessment of the abdominal, pelvic and
thoracic areas, a complete inspection of
the body surface to find all injuries, and a
neurological examination.

 Injuries which may manifest themselves later may be missed

during the initial assessment, such as when a patient is brought
into a hospital's emergency department.
Generally the physical examination is performed in a systematic
way that first checks for any immediate life threats (primary
survey), and then taking a more in depth examination (secondary
survey).

2. IMAGING
Persons with major trauma commonly
have chest and pelvic X-rays taken, and
depending on the mechanism of injury
and presentation a focused assessment
with sonography for trauma exam to
check for internal bleeding.
For those with relatively stable blood
pressure, heart rate, and sufficient
oxygenation, CT scans are useful.

 Full-body CT scans, known as pan-scans, improve the survival rate

of those who have suffered major trauma.
These scans use intravenous injections for the radiocontrast agent,
but not oral administration.
There are concerns that intravenous contrast administration in
trauma situations without confirming adequate renal function may
cause damage to kidneys, but this does not appear to be a
significant concern.

3. SURGICAL TECHNIQUES
Surgical techniques, using a tube or catheter to drain fluid from
the peritoneum, chest or the pericardium around the heart, are
often used in cases of severe blunt trauma to the chest or
abdomen, especially when a person is experiencing early signs of
shock.
In those with low blood-pressure, likely because of bleeding in
the abdominal cavity, cutting through the abdominal wall
surgically is indicated

MANAGEMENT OF TRAUMA
PRE-HOSPITAL
Stabilization techniques (use of
immobilization devices)
Control of ABCs ( ET tubes, bag mask, use of
hemostatic agents/devices or torniquet if
severe bleeding persists)

 IN HOSPITAL
Perform a primary survey that
evaluates a person's airway, breathing,
circulation, and neurologic status.
After immediate life threats are
controlled, a person is either moved
into an operating room for immediate
surgical correction of the injuries, or a
secondary survey is performed which is
a more detailed head-to-toe
assessment of the patient

IV Fluids
Traditionally, high-volume intravenous fluids were
given to people who had poor perfusion due to
trauma.
This is still appropriate in cases with isolated
extremity trauma, thermal trauma, or head injuries.
Current evidence supports limiting the use of fluids
for penetrating thorax and abdominal injuries,
allowing mild hypotension to persist.
Targets include a mean arterial pressure of 60
mmHg, a systolic blood pressure of 7090 mmHg or
the re-establishment of peripheral pulses

MEDICATIONS
Tranexamic acid decreases the
mortality rate in people who are
bleeding due to trauma.
However, it only appears to be
beneficial if administered within
the first three hours after trauma

 For severe bleeding, for example

from bleeding disorders,
recombinant factor VIIaa protein
that assists blood clottingmay be
appropriate

SURGERY
The decision whether to perform
surgery is determined by the extent of
the damage and the anatomical location
of the injury.
Bleeding must be controlled before
definitive repair can occur
The main principle of the procedure
involves performing the least number of
procedures to save life and limb; less
critical procedures are left until the
victim is more stable.

THANK YOU AND GOODMORNING! SMILE!