Introduction to Trauma LIZZIE BARRETT NURSE EDUCATOR, INTENSIVE CARE UNIT NEPEAN HOSPITAL, SYDNEY, AUSTRALIA P R E S E N TAT I O N A D A P T E D F R O M O R I G I N A L B Y E M M A J A RV I S , T R A U M A C N C , N E P E A N H O S P I TA L

What does ‘trauma’ even mean or look like?

 “Blunt or penetrating external force or energy that is exerted on the body

resulting in injury”

 THEFOLLOWINGSLIDESCONTAINGRAPHICIMAGES

What is MAJOR trauma? • MVC > 60km/hr MBC > 30km/hr

•  Ejection from the vehicle/Roll over •  Fatality in the same vehicle

• Fall from a height that is 3 times the patients height (PAEDS) OR >3m

• Pedestrian or cyclist hit by a vehicle

• Penetrating injury to head, neck or torso

• > 15% burns

• Fall or history of trauma in pregnancy

• Trauma + Age>65

• Paediatric Trauma

What is MINOR trauma? • One injury region

•  i.e: broken ankle, finger, broken jaw.

Response to trauma… • Pre-hospital services

•  Bystanders •  Emergency response systems (ambulance, specialist retrieval teams)

• ‘Front door’ services •  Triage •  BAT call

• ED services •  Resus room •  Initial team response/management/stabilisation •  Broader hospital services •  Ongoing management/follow-up/tertiary surveys/handover of care

• Data collection/long term follow up •  Improvement of services/treatment/patient experience/outcomes

Trauma Team

• Nursing and Medical Team Leaders (ED)

• Nurse 1- Airway

• Nurse 2- Circulation

• Nurse 3- Procedures

• Emergency Registrar

• Emergency Intern

• ICU Registrar

• ASU Registrar

• Anesthetics Registrar

• Clinical Assistant

• X-RAY

• Wards person

• Social Worker

• Trauma CNC- in hours

Getting the story straight: IMIST AMBO

• I – Identification

• M – Mechanism/medical complaint

• I – Injuries/information related to the complaint

• S – Signs

• T – Treatment & trends

• A – Allergies

• M – Medication

• B – Background history

• O – Other information

RESUS/ED Treatment • Completion of the primary survey: Treat any issues if found

•  Activation of various hospital protocols like a code crimson •  Active management of ABCD •  Actual/potential injury list •  Organise appropriate investigations/surgeries •  Think about most appropriate place to manage the patient – work towards this (definitive plan)

• Commencement/Completion of the secondary survey *THIS MAY NOT GET COMPLETED IN ED*

Ongoing patient management

• Completion of the secondary survey •  Clear, concise documentation of injury list,

treatment plan and goals of therapy

• Completion of the tertiary survey •  Occurs in 24 hours of trauma admission •  Top to toe assessment for missed or new

injuries •  Transfer of care to definitive team/discharge

Improving services

• Reviewing cases

• Feedback to staff regarding individual performance

• Feedback patient outcomes

• Collect data and review current hospital practices

• Education & training

Resources & References

1.  NSWIns*tuteofTraumaandInjuryManagement-www.aci.health.nsw.gov.au/networks/i*m

2.  Trauma.org:Careoftheinjured-www.trauma.org/

3.  WorldHealthorganisa*on:Guidelinesforessen*altraumacare-hHp://www.who.int/violence_injury_preven*on/publica*ons/services/en/guidelines_traumacare.pdf

4.  Interna*onalAssocia*onforTraumaSurgeryandIntensiveCare-www.iatsic.org