need to brush up on flow during trauma cases

**NickiLaughs, ADN, BSN, RN** · Nov 12, 2014

We have different rules depending on their code level, and have you taken TNCC? Most trauma hospitals attempt to flow with that. Of course it can get confusing when so many people decide they are in charge. We usually do a palp blood pressure. Followed by airway, breathing, circulation, disability (neuro status, exposé everything, full set of vs, etc. most times because of how many see involved we have multiple staff doing different parts. The key is really not being scared to yell what you are doing.communication is key.

zmansc, ASN, RN · Nov 12, 2014

Hello everyone, it's been about 4-5 months since my ED transition, and I am doing fairly well. I am pretty outgoing and personable character, so thankfully getting along well with my night crew, folks tell me I fit well in ED, and made good acquaintance with the docs. I am pretty comfortable with the ED now. Start with the simplest such as foot pain or abd pain to little more sick folks like active GI bleed, sepsis, emergent hypernatremia, etc etc, I think I am doing okay since my team helps me a lot.
One thing does concern me though, is not knowing the flow of things in the trauma bay rooms, especially the level I and II trauma activations (because intubation or codes mostly occur in rooms unless they roll in while coding, although this hasn't happened to me yet).
I seem to learn better when there are organized flow chart or outline. How can you simplify the whole CC room events into an outline so I can grasp the big picture?

Good to hear things are going well for you OP, seems like you are enjoying your decision to transition to the ED. I hope it has been better than you feared!

TNCC (Trauma Nurse Core Course) is the course that teaches a standard way to approach all trauma patients, and quite frankly is appropriate for even non-trauma emergencies. It is a very good basic way to go about assessing and treating your patient. Like much of emergency medicine it builds on the ABCs that you have learned and put into practice. In this case the acronym goes from A-I.

I'm guessing that TNCC is either required or desired at your unit, so I would suggest you try to sign up for a class through your facility if you can. I put it right up there with ACLS as the most important classes needed for an ED RN. If your facility does not require or offer it, I'm sure there are probably primers all over the internet, a quick google should find you many a primers on it. You might also be able to find a used TNCC book for cheap and figure it out that way if your facility is too cheap to pay for your education, although if you are going to be an ED nurse for any length of time, having a TNCC cert would be very beneficial!

As NickiLaughs mentions, the key is the same as it is in any other critical situation when the excrement is hitting the fan, keep calm and communicate with your team. I find that even if it's not a trauma, if I have a new patient, who is critically unstable, I go through the acronym in my head as we are working on the patient, just trying to figure out what else needs to be done and what could be causing this patient to be acting the way they are.

I took TNCC about 6 mo after starting in the ED. Working in a small community hospital's ED, we don't get alot of patients that need TNCC, so it's not required, but it is good to have. I think one of the main things it taught me was that you really need to get two large bore IVs in these patients. The instructors of the course harped on that to us, and I didn't really believe them while I was going through the course, but then I researched and did a little math on what the actual flows are between a 16g vs an 18 or 20g needle. WOW! I don't mess around with the small needles anymore. I also waste alot of blood tubing in critical situations. When I started we would just hang regular tubing, then we would need to give blood and have to switch the tubing out. TNCC taught me to always hang blood tubing in a serious trauma, that way if you need it, it's already there. It was alot of little things like that which you pick up in the course and probably won't pick up otherwise that make the course so worth it.

Good Luck, and hopefully that will give you a direction to go on!