Master Nurse PanelMaster Nurse Panel

Kentucky Trauma Symposium Kentucky Trauma Symposium 20132013

TopicsTopics

1. Pretransfer: How much do we do?1. Pretransfer: How much do we do? 2. Sedation Protocols2. Sedation Protocols 3. Identifying Critical Errors 3. Identifying Critical Errors 4. PI / QA / Training new staff4. PI / QA / Training new staff 5. Resuscitating the clinically Brain 5. Resuscitating the clinically Brain

DeadDead 6. Starting/Maintaining a Trauma 6. Starting/Maintaining a Trauma

ProgramProgram

Case #1Case #1

57M: Restrained driver involved in an 57M: Restrained driver involved in an MVC (speed likely 20-30 mph). MVC (speed likely 20-30 mph). Arrives to your ED with diffuse mild Arrives to your ED with diffuse mild contusions, a GCS 15, HDA, and c/o contusions, a GCS 15, HDA, and c/o moderate generalized abdominal moderate generalized abdominal pain.pain.

The key to managing trauma victims The key to managing trauma victims is getting them to a facility that can is getting them to a facility that can manage the suspected / identified manage the suspected / identified injuries an efficient manner.injuries an efficient manner.

Work up should be focused. Question Work up should be focused. Question doing a test that you will be unable doing a test that you will be unable to act on.to act on.

Case #2Case #2

28M soccer player arrives from scene 28M soccer player arrives from scene with lower leg and ankle trauma. with lower leg and ankle trauma. There is concern for vascular There is concern for vascular compromise and you need to compromise and you need to attempt reduction. attempt reduction.

How would pain / sedation be How would pain / sedation be handled?handled?

Case #3Case #3

During sedation of the injured soccer During sedation of the injured soccer player, a medication error results in player, a medication error results in heavy over sedation, aspiration and heavy over sedation, aspiration and intubation.intubation.

How is the Error Found and How is the Error Found and Addressed?Addressed?

Case #4Case #4

23M tractor rollover while 23M tractor rollover while transporting equipment between transporting equipment between farms. Isolated catastrophic head farms. Isolated catastrophic head injury. Upon EMS arrival there is a injury. Upon EMS arrival there is a faint pulse with no respiratory effort. faint pulse with no respiratory effort. He arrives to your ED with secured He arrives to your ED with secured airway and systolic BP in 90s.airway and systolic BP in 90s.

Case #5Case #5

35M sharp chest pain while running. No 35M sharp chest pain while running. No Hx of trauma. Attending physician Hx of trauma. Attending physician evaluates pt and thinks its an element of evaluates pt and thinks its an element of bronchospasm. bronchospasm.

Treated with a broncodialator, says he Treated with a broncodialator, says he feels slightly better, but is clearly feels slightly better, but is clearly laboring.laboring.

As the patient is getting prepped to As the patient is getting prepped to leave, you notice his CXR.leave, you notice his CXR.

The physicians say: “Oh your just The physicians say: “Oh your just overreacting, he’ll be fine.”overreacting, he’ll be fine.”

Case #6Case #6

Starting / Maintaining a Trauma Starting / Maintaining a Trauma ProgramProgram

KYHA.com (Trauma Resource KYHA.com (Trauma Resource Manual)Manual)

ObjectivesObjectives

Objectives: Objectives:

1. Photo review of common traumatic 1. Photo review of common traumatic

injuries.injuries.

2. Review initial management.2. Review initial management.

3. Review possibly associated trauma 3. Review possibly associated trauma based on common patterns seen with based on common patterns seen with specific injuriesspecific injuries

ChestChest

Things you could talk aboutThings you could talk about

Airway, Breathing:Airway, Breathing:

PTX, HTX, Tracheobronchial InjuryPTX, HTX, Tracheobronchial Injury

Circulation: Blunt Cardiac Circulation: Blunt Cardiac Injury(dysrythmia),Injury(dysrythmia),

Cardiac Tamp. Cardiac Tamp.

ManagementManagement

Field:Field: IntubationIntubation Needle DecompressionNeedle Decompression ACLSACLS

ER:ER: Formal Chest TubeFormal Chest Tube Selective Airway IntubationSelective Airway Intubation FAST, PericardiocentesisFAST, Pericardiocentesis

Heat InjuryHeat Injury

Things you could talk aboutThings you could talk about

AirwayAirway Fluid ShiftsFluid Shifts Initial Management of the Actual Initial Management of the Actual

Burns Burns Eschar RestrictionEschar Restriction

ManagementManagement

FieldField Remove Source of Burn Remove Source of Burn Intubation (low threshold)Intubation (low threshold) IVFIVF Cover Wounds with Clean DRY ClothCover Wounds with Clean DRY Cloth

ERER EscharotomyEscharotomy Targeted Fluid ResuscitationTargeted Fluid Resuscitation Intial Wound CleaningIntial Wound Cleaning

Cold InjuryCold Injury

Mention rewarming techniques / Rate Mention rewarming techniques / Rate of rewarmingof rewarming

Watch for Cardiac ProblemsWatch for Cardiac Problems

Electrical BurnElectrical Burn

Things you could talk aboutThings you could talk about

FluidsFluids Cardiac IssuesCardiac Issues Potential for devastating internal Potential for devastating internal

injuries, even with a mild appearance injuries, even with a mild appearance on the outsideon the outside

SnakebiteSnakebite

Things you could talk aboutThings you could talk about

Just a brief review of managementJust a brief review of management Indications for antivenomIndications for antivenom

Femur FractureFemur Fracture