trauma assessments

tridil2000, MSN, RN · Feb 1, 2006

I am a nursing student and I am doing a rotation in the ER this Friday. First of all I am excited, secondly I have a few questions. We are asked to do research on the assessments of certain traumas. What are some of the key assessment points in chest, head, abdomen and skeletal traumas? Or where could I find these resources? Also, do any of you veteran nurses have any advice for a student? What can I do to be helpful? When should I stay out of the way? :chuckle I appreciate your responses in advance! :)

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airway always takes priority. check out all the ways to administer O2 and all the different airways. look for suction around your bed and check out how it operates. i think if you focus on taking away all airway info on your first visit, you'll be more aware of a very critical component.

it may get so busy, and so much may happen that it all blurs. make learning airway management your 1st goal.

KatieBell · Feb 1, 2006

I'd try to get a copy of the Trauma Nurse Core Course...

Heres the general assessment for all traumas, you should see experienced nurses or other heath care providers actually go through this primary and secondary survey:

A= Airway

B= Breathing

C= Circulation

D= Disability think Neuro status

E= extremities

F= five interventions (cardiac monitor pulse ox, family prescence, etc

G= Give comfort

H=head to toe assessment

I= Inspect posterior surfaces

Of course, much of ti will be going on at the same time if there are a few providers in the room.

Essentially for your observation, I'd take cues from the nurse about being in the way etc...

I might have forgotten somethings, so anyone else feel free to correct.

Trauma Columnist · Feb 1, 2006

The Emergency Nurses Association website has lots of good info:

http://www.ena.org/

Also, try this site (I love it too):

http://www.trauma.org

Good luck...hope you love it!

elizabells, BSN, RN · Feb 1, 2006

Have fun! I loved my day in the ER!

My wonderful strategy for not irritating people in a rotation. Unless you're invited closer, keep your butt on the wall (you'll still be able to see, it's not like rooms in the ER are particularly big) but look attentive and interested, not timid or bored. You may end up being asked to run for supplies or something, but hey, that's still involvement. The one trauma I was in on, the trauma surgeon was an insufferable ass and was having a snipefest about territory ("YOU called the trauma team, now I'M RUNNING THIS TRAUMA!!!" like, dude, calm down, drunk guy tipped over and bumped his head, and they only called you because regs say they have to) with the ER staff OVER THE PATIENT and the last thing I wanted was him tripping over me and freaking out.

On the good side, I got two opportunities to stick people. That doesn't sound like much, but in our med-surg rotation, it's almost unheard of. They let you do stuff in the ER they don't on the regular floors.

JMBM · Feb 2, 2006

As another writer suggested, the TNCC book is a great resource. Your school should have copies. Failing that, grab any good EMT text (AAOS, Brady, Moseby) for the basic outline of a trauma assessment. Airway, Breathing, Circulation (pulse, controlled bleeding). If you don't have ABC, none of the rest matters. Disability (neuro), Exposure (remember those blankets), Five interventions, Head-to-Toe (always Look before you listen, auscultate before you touch chest, abd). As for hints, ask BEFORE if you can be in a room if there is a big trauma or code and, if yes, where is the best place to stand out of the way. Folks have assigned roles and places and move pretty fast. But remember that 99% of what you will see will not be dramatic trauma - it will be "routine" flu, migraines, ortho, abd pain, etc. Try to hook up as a shadow with a specific nurse. It makes it much easier to figure out the flow. If you are interested and willing, "your" nurse will likely try to find good experiences for you. Carry a little notepad to jot down stuff you might not understand and can look up later. Many times there is no time for questions. I know you'll be patient and polite. I've had one or two nursing students shadow me on a very busy, but routine, shift and leave with a nasty remark because they didn't "get to see anything cool". Sorry, I can't order up car wrecks or shoot-outs. Have a great time, wear comfortable shoes, and hit the bathroom right before you go on the floor.

PedsER-RN, BSN, RN · Feb 2, 2006

#1 concern, regardless of injury, is airway. if you don't have an airway nothing else is going to matter. someone else on here did a run-through of the rest of the trauma assessment from tncc (a-i list). on any trauma (any patient, really!) also pay attention to your vs-they can tell you alot! if you can get a hold of a tncc handbook it be helpful because they outline everything real well. for head injuries, always be aware of gcs, pupils, posturing. ortho injuries, i always hook up my pulse ox to the finger/toe distal to the injury-it can clue you in on compromised circulation if it's not evident through cap refill, pulses, color/temp, etc.

the best advice i can give to you so you don't feel like your in the way is to be in the room but give the nurses/docs/rt/rad. room to work. offer to hook up a patient to the monitor or tube blood. it'll at least show them you're trying to be helpful and want to learn. depending on your school's policy, if they offer you a procedure, take advantage and do it (even if you've done it before-nothing makes me more mad than offering a student a procedure and them saying, "oh-no, i've already done that before" :angryfire )! when i was rotating through er i had several nurses that were great-so willing to let me help and learn, and it made clinicals such a positive experience (i also wasn't the student that just hung around the nurses' station-i asked to do stuff, tagged along, jumped in on procedures, and really took advantage of the opportunities the er can have)!!!!

good luck! :chuckle

mommy2BCD · Feb 2, 2006

Thank you all for your great responses. I am so excited for Friday night. I'll let you all know how it goes :)

MMARN, BSN, RN · Feb 2, 2006

The one thing my prof has told us is to make sure you don't do NOTHING. If a nurse asks you to do something, don't tell her/him, "Oh, I've already been checked off on that"!! Nurses REALLY dislike this. Make sure you offer to help and stay out of the way. However, if someone asks you to get involved in any way (considering it is still in your scope of "practice" as a nursing student) do it. You'll learn more hands-on. Have fun and keep that sense of humor in place. Good luck and please let us know how it went.

Mave.

super_star · Feb 2, 2006

i m a RN working in icu adult who also works in ER on rotation basis.Likke many of the author suggested that first important is airway, if not maintained there is no use of what ever the management is as the brain dies within 3-4 minutes without the oxygen.in trauma mx, there is also the words "look,run,play" of which the Triage comes into play and the coding system.this is just my view and may be there r many mistakes and corrections from others are welcome.

By going thru' this forum m learning many things which r not there in our hospital settings

RN from BHUTAN