ICUman gave a good description. My ICU gets a lot of MVCs/motorcycle crashes, occasional snowmobile crash in winter, pedestrians/cyclists hit by vehicles, lots of GSWs, assaults, falls, and occupational freak accidents.
How about hemodynamics? Do you utilize ICP monitoring/Ventriculostomy frequently?
We don't monitor hemodynamics as closely as you do in the CV pt...actually in my ICU, the only pts who get PA lines are the CV surgical pts. Of course unstable pts have central lines and art lines for close monitoring of BP/CVP and for giving pressors etc; peripheral access is preferred though for lowered risk of infection. Yes, lots of EVDs, sometimes fiber optic ICP monitoring, sometimes Licox for watching PbO2 and brain temp. We do therapeutic normo- and hypothermia quite a bit in brain trauma pts also.
I also agree trauma is a mixed bag. We sometimes get the pt who is still open, brought up from the OR to die. We do massive transfusions where you zip multiple units of blood products in over a few minutes each. We have pts progress to brain death, and then care for them as pre-op organ donors. We have pts who may be reasonably stable from their injuries, but then go into ARDS.
And then there's ones who really aren't badly injured, but are intubated in the ED because they were too agitated to safely care for. A few months ago I discharged a pt maybe 16 hours after he was admitted; he had NO injuries but was intubated because they'd had to sedate him. Obviously that's not the norm.
The hardest part for me is there's no time for families to process the dx before getting admitted. A pt who had surgery for a brain tumor was likely dx'ed in clinic. The trauma pt might have kissed her husband goodbye, left for work and then T-boned at highway speeds. Now she has a non-survivable TBI among myriad injuries...and then the chaplain brings in the husband. Understandably, he is distraught.
Sometimes the family chooses to transition to confort care, and we become the hospice nurse if the pt doesn't die right away (after a few hrs they transfer to the floor; the floor rooms are more private, and of course we may need that bed for an admission). More often they get a trach and shipped to an LTACH to continue to work on vent weaning.
What's really cool is we frequently have pts come back to thank us for saving their life. Sometimes they tell us about all the stuff they've been able to do -- walk their dtr down the aisle, meet a new niece, attend their sister's graduation, start college, etc -- because of what we did for them. I'm getting choked up now.