What is the nurses priority in a trauma (new to ER)

netglow, ASN, RN · Mar 3, 2011

Hey you, you know it, just think a bit.

...ABC

...LOC

...

netglow, ASN, RN · Mar 3, 2011

Wow, I guess nobody else is going to answer. I got a rotation in the ER, but not an ER nurse. But I did much in ICU level 1 and 2 centers. You mentioned hips for ex - if MVA for instance... looking for rapid bleedout from bad fx cut into major vessels. You check and recheck color warmth of extremities/vitals/abd. looking for blood or lack of blood. All the while looking for all other signs of bleedout...LOC, etc.

Basically you are looking for the big bad and stopping that if you can or before it happens if you can. All of it will be you. Best to anticipate, because you will be rushing to save and ideally I would want to be dxing in my head along with the doc. What I see/doc sees, it doesn't matter who sees it first. It's a race to see it and fix it.

needlefoxRN · Mar 3, 2011

I was about to answer it but actually nailed it - ABC :) We also did "rapid assessments" in the ER where I was assigned.

TravelinCEN · Mar 3, 2011

In my opinion, the best thing that you can do to help get a clearer understanding of nursing role in a trauma is to take a TNCC class first, then CATN. Go to ena.org to find a class in your state.

Nurses should do a complete assessment just like the physicians. Your are already an experienced nurse and have the skills you need. A TNCC course will just help you get all of the pieces together.

Good Luck...

nurse2033, MSN, RN · Mar 3, 2011

As part of the team it is your job to assess the patient from head to toe, and voice any findings and concerns. The experiences of everyone is unique and one tiny detail that is noticed may make a huge impact on patient outcome. Yes, the legal responsibility falls on the doc but they rely on us because we spend more time the patients. I have saved the doctor's a** on many occasions for critical findings that occurred when they were not present.

To answer your question, we should always be thinking and ruling out the worst case scenario, and anticipating complications.

EmergencyNrse · Mar 3, 2011

1) Keep 'em breathing.

2) Find the things that will make them stop breathing.

3) Ship them off to the people that will fix whatever will stop their breathing.

We don't "fix" in the ER. A good trauma shouldn't be there long enough for you to worry about.

Shell5 · Mar 3, 2011

Thanks everyone. Gave me lots to think about and do.

allnurses Guide · Mar 3, 2011

Second the TNCC class. I think what you were describing after the IVs etc., is what is called the secondary survey. The ABCs always and first, but then we go over the body head to toe for a detailed second look.

A: Recheck the efficacy of the airway interventions,

B: breathing effort, and thorough listening to the lungs

C: perfusion of extremities, color, and IVs, etc, EKG/monitor if not on

D: deformity/deficit (head to toe)

E: expose (look at all the skin and joints, head to toe)

F: farenheight (prevent/address hypothermia)

G: get vs

H: history

Good question!

FF-PHRN · Mar 3, 2011

Third vote for a TNCC class. I only have to add maintaining C-spine in with airway in the A of the ABCs if not covered by prehospital. It is a trauma pt, so airway and C-spine are the first step. Good luck.

EmergencyNrse · Mar 3, 2011

Second the TNCC class. I think what you were describing after the IVs etc., is what is called the secondary survey. The ABCs always and first, but then we go over the body head to toe for a detailed second look.
A: Recheck the efficacy of the airway interventions,
B: breathing effort, and thorough listening to the lungs
C: perfusion of extremities, color, and IVs, etc, EKG/monitor if not on
D: deformity/deficit (head to toe)
E: expose (look at all the skin and joints, head to toe)
F: farenheight (prevent/address hypothermia)
G: get vs
H: history

Why not try some straight talk here instead of going through the alphabet?

Textbook? yea, Helpful? NO. Hell, you can Google that.

Try and give some insight that might reduce anxiety about trauma.

The reality about trauma is that you really don't do much of anything.

(Even you high-speed, low-drag level 1 types).

If you're primary nurse all you really do is get report from the medic.

After that you are never closer than 4 people from ever putting hands

on YOUR patient.

If you're secondary nurse then woo-hoo!, you get to put them on a monitor

(if there is no tech/cna on the trauma team) and you might even get to place

a 2nd large bore IV before they're gone.

Although I will concede that TNCC has some good information

you never actually get to use it. Get use to neuro checks. Because if

your patient really isn't seriously hurt then you usually end up sitting in

a cold, well-lit room doing neuro checks for hours until the doctors decide

what to do with the patient.

Don't sweat trauma.

FF-PHRN · Mar 3, 2011

Respectfully, I gotta disagree with ya there chief.

The assessment tool tought in TNCC has been very helpful to me over the years. In my experience the hands on aspect in trauma cases is much more than other pts. I guess you could argue the point depending on the type of pt, but I use that alphabet, as you say, all the time. I say, get your assessment down... then... dont sweat the traumas.