Welcome to the Trauma Alert Education Newsletter brought to you by Beacon Trauma Services.

Edition 2

Trauma Basics  Trauma resuscitation is the initial stabilization and early life saving interventions provided to the trauma patient. It doesn’t mean that CPR was performed.  When assessing the trauma patient it is important to recognize clues that indicate what is wrong now and what could go wrong later. Investigating the mechanism of injury is one of the most important clues to evaluate. This can be done by listening carefully to the MIST report from EMS and utilizing the 60 second time out for EMS to give report

Source: https://tinyurl.com/ycjssbr3

What is wrong with me? EMS MIST 43 year old male M= unrestrained driver, while texting drove off road at 40 mph into a tree, with impact to driver’s door, 20 minute extrication time I= Deformity to left femur, pain to left chest, skin pink and warm S= B/P- 110/72, HR- 128 normal sinus, RR- 28, Spo2- 94% GCS=14 (Eyes= 4 Verbal= 4 Motor= 6) T= rigid cervical collar, IV Normal Saline at controlled rate, splint left femur What are your concerns? (think about the mechanism and the EMS report), what would you prepare prior to the patient arriving?

Ten minutes after arrival in the emergency department the patient starts to have shortness of breath with stridorous sound. He is now diaphoretic and pale. B/P- 80/40, HR- 140, RR- 36 labored. Absent breath sounds on the left.  What is the patients’ underlying problem?- Answer later in the newsletter

Excellence in Trauma Nursing Award Awarded in May for National Trauma Month This year the nominations were very close so we chose one overall winner and two honorable mentions. Thank you for all the nominations and for the excellent care you provide to our trauma patients

2020 Winner

Jacob Downs RN

Emergency Care Center

2020 Honorable Mention 2020 Honorable Mention

Tracey Daggy RN Tami Fuller RN

Med Flight Pediatrics/PICU

Did you guess right?

Source: https://tinyurl.com/ycrrtshk

“A Tension Pneumothorax develops when a “one way valve” air leak occurs from the lung or through the patient’s chest wall. When this occurs air is forced into the pleural space with no means of escape, which eventually collapses the affected lung”. (ATLS 10th edition, p. 65). It is a DRS (dead real soon) life threatening injury and requires immediate intervention with management of the airway, needle decompression and chest tube by the EMS, physician/surgeon or Trauma Nurse Practitioner.

 Immediate signs are: severe SOB, ill appearing, vitals reveal shock, and decreased/absent breath sounds on affected side. o Don’t delay treatment to get a chest x-ray.  Other signs include tracheal deviation, JVD, and cyanosis but these are all late signs. Recognition and treatment should occur before they develop.  A tension pneumothorax can develop at any time during the patient’s course  There are two sites that can be used for the needle decompression- (see photos below) o Needle decompression should be followed by a chest tube placement o If the EMS indicates in their report that a needle decompression was preformed then immediately prepare for a chest tube prior to the patient’s arrival o The decompression needle should be at least 7- 8 cm long (preferable longer with a more rigid catheter). . “Evidence suggests that using that a 5 cm over the needle catheter will reach the pleural space >50 % of the time, whereas an 8 cm over the needle catheter will reach the pleural space >90% of the time”. (ATLS 10th edition, p 66). . During the 3rd trimester of pregnancy the uterus pushes up on the diaphragm and the chest tube may need to be placed 2-3 spaces higher depending on the patient o If using a less rigid catheter the patient should be ventilated 3-4 times before removing the stylet to allow the tissue to expand and not collapse around the catheter.

Source: https://tinyurl.com/ycrrtshk

Source: https://tinyurl.com/ycrrtshk 5th intercostal space mid axillary- recommended site by ATLS 10th edition

Source: https://tinyurl.com/ycrrtshk 2nd intercostal space mid clavicular- Site is taught in TNCC/ENPC however it is not the preferred site for the adult patient

Pediatric Corner and Thoracic Injuries

 Rib fractures are NOT common in children under age 8 so if present always investigate for abuse  Ribs/sternum are pliable, lung compliance and capacity is lower so a tension pneumothorax is more likely especially in the intubated pediatric patient  Due to the less protective thoracic cavity a pulmonary and/or cardiac contusion is more common in the absence of a rib fracture

Source: https://tinyurl.com/yd3dp4pd

Test Your Knowledge

Source: https://tinyurl.com/yaq4y9qk

1. What is an early sign of tension pneumothorax? a. Tracheal deviation b. Respiratory distress c. Increased cardiac output d. Epistaxis

2. What is the most common medical intervention required for patients with thoracic trauma? a. Decompression and Chest tube b. Thoracotomy c. Pericardiocentesis d. Insertion of nasogastric tube

3. Which of the potentially life threatening chest injuries develops with respiratory distress slower over time rather than occurring instantaneously? a. Pulmonary contusion b. Tracheobronchial tree injury c. Tension pneumothorax d. Hemothorax

Answers at the end

Recognition/Thank You

 National Nursing Assistant Week (10th -17th )  National Safety Month  Father’s day- June 21st New Indiana Law

Source: https://tinyurl.com/ycvl54f8

INDIANAPOLIS (AP) — Drivers will be banned from using handheld cellphones on Indiana roads starting in July under legislation Gov. Eric Holcomb has signed into law to combat distracted driving.

Holcomb signed the measure Wednesday, making Indiana the 22nd state to prohibit drivers from holding or using a handheld mobile device while operating a moving vehicle. People violating the law after it takes effect on July 1 can be fined up to $500 and potentially lose their driver’s license if violations are repeated.

“Distracted driving increases the risk of a crash by more than 3½ times and is a leading killer of teenagers in America. This is unacceptable and avoidable,” Holcomb said.

Texting while driving is currently banned in Indiana, but law enforcement has found it difficult to enforce.

Once the new law takes effect, touching a phone to, for example, check the weather or look at a photo while driving will be banned. The new measure specifies, however, that it will be legal for drivers to use phones if they’re mounted on a vehicle’s dashboard or in hands-free mode.

Drivers will be able to hold and use a mobile device when their vehicle is stopped.

One provision of the law states that motorists who are ticketed before July 1, 2021 for using a cellphone while driving will not receive points on their license, which can lead to license suspension.

Welcome Julie Haschel BSN, RN, CFRN, NREMT-P

Trauma Services QI Coordinator

Julie comes to Trauma Services from a level II trauma center in Texas. She has served in roles as an ER manager, flight nurse, clinical educator and transport liaison.

Source: https://tinyurl.com/y9qy28c6

Test your knowledge Answers- 1-b 2- a 3- a

References- 1. Casey, Roger. (2019), Thoracic and neck trauma. TNCC provider manual edition 8. pp 121-139. 2. Thoracic Trauma. In ATLS student manual (10th edition). Pp 65-66. 2018. American College of Surgeons. 3. http://tinyurl.com 4. Trauma care after resuscitation. TCAR education programs. (2016). p.14.

For questions or future submission requests contact Stacie Bobeck MSN, RN, CEN, CPEN, TCRN, SANE-A, Beacon Trauma Educator and Outreach/Injury Prevention Coordinator at [email protected]