Quote from sbtr50
I had a situation today. I was out with my husband with some friends. A motorcycle lost control pulling off the parking lot and the rider went down hitting his head and knocking him unconscious. I'm a new RN of 2 weeks on the job and an Lpn of many years. I responded along with others but I was the only nurse along with a " medic". I monitored pulse and respirations while someone else held his head stable. I was also concerned if the neck strap to his helmet may be a little tight and affect his breathing so I went to feel for tightness and the medic told me not to. I also was concerned for vomiting and possibility of seizures. I wanted to check his pupils too but the medic again told me no. The patient regained consciousness and went in the ambulance when they arrived. I didn't speak to actually say what my intentions were and I feel I may have been timid and should have took more control or spoken up more. The patient was taken care of and that's most important. I find in other situations other people tend to take over and I feel incompetent because I don't feel I took enough of a role. I don't really know how to react . I feel like I did the right thing but I'm not really the type that jumps up and yells "I'm a nurse!!" Because I'm not that confident yet.
You did some stuff very right:
You were concerned for airway. You were aware vomiting in a head injury is not unlikely.
You were concerned for breathing. While a helmet chinstrap is unlikely to cause breathing problems, it is correct to assess for the problem, and correct it if needed. Loosening a helmet strap is highly unlikely to exacerbate a spine injury, and if it caused a breathing problem, should be loosened.
So far, you have addressed A and B. Now, on to C. Breathing, so clearly has a pulse. Any reason to suspect a life threatening bleed? No obvious blood on scene, and given your description of the mechanism and presentation it's not likely. In a perfect world, somebody would have donned gloves and done a sweep under the pt, but again, not likely.
D- you were concerned for disability- Checking pupils at that point is not wrong, and not going to cause any problems. Assuming you can't think of any other helpful assessment or intervention, no harm, and it provides a bit of information. The medic was also concerned for D, and was protecting the spine by limiting movement.
That is your primary survey. Given your location, a secondary assessment isn't critical, but if you had the time, that would be the point at which you would do a quick head to toe, get a set of vitals, and med history. On an unresponsive patient, you would do that by checking for medic alerts, medications being carried, med lists, etc. Out in the middle of the street in an urban environment, what you did sounds about right.
The one thing I would add would be what pre-hospital providers do before the primary assessment. Scene size up. This is the point at which you make sure that nobody else is going to get hurt, especially you. That means having somebody directing traffic, leaving your vehicle in a position in which t protects you, that sort of thing.
I have no idea why this stuff is not taught in nursing school. Nurses have the knowledge and skills to be effective first responders with just a little extra training. Like 1-2 days out of the 2-4 years of training.