Trauma Nursing Principles

AH4 WK 12

Trauma Definition

Bodily injury resulting from intentional or unintentional events

Major health concern due to high rates of preventable death and long term consequences particularly among younger populaitons

Continuum of Trauma Nursing

• Injury prevention

• Prehospital care

• Emergency and acute treatment

• Rehabilitation

• Reintegration into the community

Trauma Informed Care Definition/Nursing Actions

Recognizes that the injury and surrounding circumstances affect both the patient's psychological and physiological responses.

Nursing Actions:

• Support safety and trust by explaining care

• Reducing unnecessary loss of control

• Involve the patient when possible

• Recognize certain patient behaviors may be a trauma response

Trauma Level Center Categorization Principle

Categorized by the resources and capabilities provided, describing the facility's role within the trauma system (not simply hospital size).

Every level plays a vital role via rapid recognition, stabilization, communication, and transfer.

Level I Trauma Center Characteristics

• Location: Usually large teaching hospitals in densely populated areas; most comprehensive regional resource.

• Capabilities: Provides a full continuum of trauma services for adult and/or pediatric patients across all stages (prevention through acute treatment and rehabilitation).

• Unique Requirement: Conducting research and scholarly activity is a requirement for verification, alongside major responsibilities for education, leadership, and trauma system development.

Level II Trauma Center Characteristics

• Location: Typically located in a community hospital.

• Capabilities: Provides care to the vast majority of injured patients.

• Transfer: Transfers patients to a Level I center or specialty facility if needs exceed resource capabilities.

Level III Trauma Center Characteristics

• Location: Typically located in a community or rural hospital.

• Capabilities: Provides initial assessment, resuscitation, and stabilization for patients with major injuries.

• Transfer: Essential for beginning life-saving care before transferring patients whose needs exceed resource capabilities

Level IV Trauma Center Characteristics

• Location: Usually located in rural and remote areas.

• Capabilities: Provides basic trauma patient stabilization and advanced life support within available resource capabilities prior to transfer.

Mechanism of Injury Assessment Purpose

Describes the manner in which a traumatic event occurred.

Knowing the MOI helps clinicians anticipate hidden injuries that may not yet be obvious on physical exam.

Blunt Trauma Characteristics

Force applied without penetrating the body (e.g., motor vehicle crashes, falls, sports injuries, assaults).

• Significant internal injury can exist even when external injuries appear limited.

Acceleration-Deceleration Injury

Rapid movement followed by sudden stopping or a rapid change in direction (e.g., whiplash/coup-contrecoup).

• Internal organs continue moving after the body stops, creating shearing or stretching forces and internal injury.

Penetrating Trauma Characteristics

An object enters the body (e.g., knife or projectile/bullet).

• Injury severity depends on object velocity, entry site, trajectory, and internal structures encountered.

Blast Effect Characteristics

Injuries produced by an explosion

Exposes the patient to multiple simultaneous injurie patterns:

• Pressure effects

• Blunt trauma

• Penetrating trauma

• Burns

• Acceleration - Deceleration Forces

Primary Survey Characteristics

• Rapid, organized framework (Immediate: 0–5 minutes) to identify and manage immediate threats to life.

• Treat as You Find: Assessment and resuscitation occur simultaneously. When a life-threatening problem is identified, intervene immediately rather than waiting to finish the entire survey.

Primary Survey ABCDE Characteristics

• A — Airway with Cervical Spine Protection/Control:

  • Determine if the airway is open and maintainable.

  • Clear secretions or debris while maintaining cervical spine alignment/immobilization.

  • Significantly impaired consciousness may require an advanced airway and mechanical ventilation.

• B — Breathing:

  • Assess respiratory effort, chest expansion, breath sounds, oxygenation, and evidence of chest/pulmonary injury.

  • Provide supplemental oxygen or ventilation support as indicated.

• C — Circulation & Hemorrhage Control:

  • If uncontrolled catastrophic external hemorrhage is present, controlling that bleeding is the immediate survival priority. (CAB)

  • Assess pulse, blood pressure, perfusion, and evidence of bleeding.

  • Control external hemorrhage promptly: start with direct pressure and escalate hemorrhage control measures (e.g., tourniquet) as necessary.

  • Initiate vascular access (IVs) and fluid/blood resuscitation according to patient condition.

• D — Disability (Rapid Neurological Assessment):

  • AVPU: Alert, responsive to Voice, responsive to Pain, or Unresponsive.

  • Glasgow Coma Scale (GCS): Detailed assessment of Eye opening, Verbal response, and Motor response.

• E — Exposure & Environment:

  • Remove enough clothing to identify hidden injuries and complete the assessment.

  • Actively prevent hypothermia (warm blankets, temperature control)—trauma patients lose heat rapidly, and hypothermia worsens coagulopathy and resuscitation outcomes.

Secondary Survey Characteristics

Systematic Head-to-Toe Assessment

• Timing: Begins only after immediate threats in the Primary Survey have been addressed and the patient is stable.

• Critical Rule: The Secondary Survey never replaces the Primary Survey and is not a signal that the patient is permanently stable (trauma patients deteriorate rapidly). If the patient deteriorates or develops new ABC/hemorrhage issues, return immediately to Primary Survey priorities.

• Ongoing Monitoring & Interventions: Continuously reassess vital signs, neuro status, pain, perfusion, and response to interventions.

• Perform gastric decompression (NG/OG tube) when indicated, urinary catheterization (Foley) when appropriate, and prepare for diagnostic studies.

Tertiary Survey Characteristics

• Timing: Within 24 hours.

• Purpose: Comprehensive completeness checklist to catch missed injuries:

  1. Repeat physical exam

  2. Review imaging (CT/X-ray)

  3. Review labs

  4. Functional check

  5. Document injuries