NR 341 Complex Adult Health: Week 5 Assignment on Trauma and Emergency Care

Trauma and Emergency Care Overview.

In the United States, more than 130 million people visit emergency departments (ED) annually, with approximately 16 million admitted for continued treatment (Centers for Disease Control and Prevention [CDC], 2021). The primary goal of emergency nursing is the early recognition of life-threatening injuries. This often necessitates immediate intervention to stabilize the patient before a medical diagnosis is made. Emergency nurses must remain calm and organized, rapidly adapting to unexpected situations while providing care for patients of all age groups and a variety of medical conditions. Common emergencies include heat- and cold-related injuries, submersion injuries, violence, penetrating trauma, and poisoning. It is crucial for nurses to quickly identify patients needing urgent treatment and determine appropriate interventions.

Primary and Secondary Surveys in Emergency Nursing

Primary Survey

The primary survey focuses on identifying life-threatening conditions to initiate immediate interventions. It includes:

• Airway and Alertness: Ensuring the airway is clear and assessing the patient’s level of alertness.
• Breathing: Monitoring for dyspnea, paradoxical chest movement, decreased breath sounds, and other signs of altered breathing.
• Circulation: Ensuring adequate blood circulation to prevent shock by monitoring pulses, skin temperature, mental status, and capillary refill.
• Disability: Assessing the level of consciousness using the Glasgow Coma Scale (GCS) and checking pupillary response.
• Exposure and Environmental Control: Removing clothing for a thorough assessment while preserving forensic evidence and preventing hypothermia.
• Facilitation of Adjuncts and Family: Allowing family presence during resuscitation and invasive procedures to reduce patient anxiety and provide comfort.

In addition, primary survey in the emergency department (ED) aims to identify life-threatening conditions so that immediate interventions can be initiated. The components of the primary survey include:

• Airway and Alertness: Ensuring the airway is clear and assessing the patient’s level of alertness.
• Breathing: Monitoring for signs of respiratory distress, such as dyspnea, gasping, and abnormal breathing patterns.
• Circulation: Assessing for adequate blood circulation to prevent shock by monitoring pulses, skin temperature, mental status, and capillary refill.
• Catastrophic Hemorrhage: Identifying and controlling severe bleeding.
• Disability: Evaluating the patient’s level of consciousness and neurological status using the Glasgow Coma Scale (GCS).
• Exposure and Environmental Control: Removing clothing to perform a thorough assessment while preventing hypothermia and preserving forensic evidence if necessary.

These steps are crucial for identifying life-threatening conditions and implementing necessary interventions to stabilize the patient.

Secondary survey

After the primary survey and life-saving interventions, the secondary survey identifies all injuries through a brief, systematic process. This includes obtaining a history using the SAMPLE mnemonic (Symptoms, Allergies, Medications, Past health history, Last meal, Events leading to injury), performing a head-to-toe assessment, and inspecting posterior surfaces for injuries.

More than 130 million people visit emergency departments annually in the United States, with around 16 million requiring hospital admission for further treatment (Centers for Disease Control and Prevention [CDC], 2021). The primary goal of emergency nursing is the early recognition of life-threatening injuries. This often means that interventions to prevent or reverse these situations take precedence over making a medical diagnosis. Emergency nurses must swiftly adapt to unexpected and unanticipated scenarios while remaining calm and organized. Comprehensive knowledge of care for all age groups with a wide range of health issues is essential. Common emergency situations include heat- and cold-related emergencies, submersion injuries, violence, penetrating trauma, and various types of poisoning. Nurses must quickly identify clients in need of emergent treatment and determine appropriate collaborative interventions.

Adjunct Measures for Monitoring

Key resuscitation aids, remembered by the mnemonic LMNOP, are essential:

• L: Laboratory testing
• M: Monitor electrocardiogram (ECG) for heart rate and rhythm
• N: Nasogastric tube to decompress the stomach and reduce aspiration risk
• O: Oxygenation and ventilation with continuous SaO2 monitoring
• P: Pain assessment and management

Triage in Emergency Nursing

Triage rapidly determines patient acuity, identifying and categorizing patients so the most critically ill are treated first. The Emergency Severity Index (ESI) is a 5-level system:

• ESI 1: Immediate life-saving intervention required.
• ESI 2: High-risk situation, potentially life-threatening, seen within 10 minutes.
• ESI 3: Stable, unlikely but possible life-threatening, seen within an hour.
• ESI 4: Stable, non-life-threatening, care can be delayed.
• ESI 5: Stable, non-life-threatening, minimal resources needed, care can be delayed.

Handling Specific Trauma Cases

Head Trauma

A patient with periorbital bruising and a dysconjugate gaze may have a skull fracture. Insertion of a nasogastric tube is contraindicated; an orogastric tube is preferred. Inspection for cerebrospinal fluid (CSF) from the ears or nose is essential, as is pharmacologic pain control and a CT scan to assess the extent of injury.

Chest Trauma

Blunt and penetrating chest injuries can be fatal. Blunt trauma may result in rib fractures, pneumothorax, or pulmonary contusion. Penetrating trauma, such as gunshot or stab wounds, requires immediate intervention to control hemorrhage and maintain ventilation. Rib fractures and flail chest need pain management and support for lung expansion. Tension pneumothorax, a medical emergency, requires chest tube insertion.

Abdominal Trauma

Abdominal trauma, from blunt or penetrating injuries, can result in severe internal bleeding and organ damage. Management includes airway, breathing, and circulation stabilization, control of external bleeding, and preparation for surgery if necessary. Monitoring for signs of peritonitis or compartment syndrome is crucial.

Management of Hypothermia and Hyperthermia

Hypothermia

Hypothermia occurs when the body cannot maintain core temperature. It is classified as mild, moderate, or severe based on temperature and symptoms. Treatment includes passive and active rewarming techniques, monitoring for cardiac dysrhythmias, and maintaining airway patency.

Hyperthermia

Heat-related emergencies include heat cramps, heat exhaustion, and heatstroke. Treatment focuses on reducing core temperature, managing airway and circulation, and correcting fluid and electrolyte imbalances. Cooling methods and controlling shivering are vital.

Emergency Preparedness

Healthcare facilities must have emergency operating plans for internal and external emergencies, including loss of power, fires, natural disasters, and mass casualty incidents (MCI). Efficient victim triage using colored tags ensures the most critically injured receive immediate care. Continuous training and drills prepare healthcare providers for these situations.

Conclusion

Emergency and trauma nursing require a comprehensive understanding of primary and secondary surveys, rapid triage, and specific trauma management. Nurses must be prepared to handle a variety of critical situations with calmness and expertise, ensuring the best possible outcomes for their patients.

References

Centers for Disease Control and Prevention. (2021). Emergency department visits. Retrieved from https://www.cdc.gov/nchs/fastats/emergency-department.htm

Asselin, M. (2020). Burn injuries and their management. Journal of Burn Care & Research, 41(3), 432-440. https://doi.org/10.1093/jbcr/iraa003

Please ensure to add more scholarly references from the latest available journals to provide a robust and updated discussion.