Monitor for Occult Trauma-Help

[rainswhisper,RN]

I need help with a prioritizing exercise....

The patient admitted thru the ED. 7 hours post MVA. The "ED ruled out initial chest and abdominal trauma, however, he is being monitored for occult trauma".

I think occult trauma would be trauma that may not have been apparent at initial assessment, or may not show itself until later?

What exactly would you do to "monitor for occult trauma"?

Thanks for any help

[VickyRN, MSN, DNP, RN]

Hi and welcome to the Nursing Student Assistance Forum :balloons:

Think about hemorrhage, internal hemorrhage that is, which is very common with trauma. No bleeding outwardly, but blood loss is occurring internally. What would be some of the signs and symptoms of this? How would you monitor the patient for this possibility?

[Daytonite, BSN, RN]

Occult means obscure or concealed.

When trauma occurs, the body may have sustained any number of types of injury that include such things as blunt force and crushing. Keep in mind that during a car accident where there is velocity involved, things happened fast and objects were moving that included both the patient's body as well as vehicles and who knows what other objects might have been set into motion. All were capable of colliding with each other in a matter of an instant. How the body, and the cells in particular, responds to injury is what you need to consider. Injured cells can do one of two things: recover or die. Keep in mind that the response of a cell when it is going to recover is the activation of inflammation and immunity responses in the body. These responses are powerful enough, if there has been enough injury, to cause damage to normal uninjured cells and tissues. Cell death and hypoxia are certainly something that needs to be kept in consideration as well as how they might occur. The problem is that you can't see cells. You can only look for the manifestations of what might be going on.

With abdominal injuries internal tissues can rupture leading to internal swelling and stalling of peristalsis. A section of bowel can become incarcerated and eventually become necrotic if during the trauma it's immediate blood supply is somehow physically cut off. That kind of injury may not be immediately noticed. A pneumothorax not seen initially on a CXR can develop insidiously from a microscopic rupture of one of the pleural tissues and over a few hours turn into a full blown breathing crisis.

[woo234]

I came to the same place to ask the same question :) How's the rest of the assignment going?? (I came to the conclusion that Mr. O could not be delegated to the new nurse...)