Working in a Trauma Center but nervous about Traumas, advice appreciated

[Catch22Personified]

Hi everyone,

Back again so it's been like 7 Months working at the Level 1 Trauma Center and basically now I've been an ER Nurse for nearly 14 months now. I like working in the higher acuity areas as part of the reason I transferred to the ER (besides the fact my Tele position was cut and my transfer to the ER was my only choice) was to give me critical care experience, I have less patients but can focus on them. I don't mind dealing with chest pains, chf, and copd patient's, and SAH's. I still absolutely cannot stand abdominal pain patients and lady partsl bleeds due to the abdominal pain workup and for lady partsl bleeds I'm a dude so I cannot even witness the pelvic exam due to the patient population(I'm going for my FNP and my classmates tell me get ready to do a lot of them). Maybe it's the floor nurse in me that still loves having structure and predictability but still being flexible.

I'm not an adrenaline junkie and sometimes when crap hits the fan I still freeze up. I get horribly nervous when Trauma patient's come in especially when they don't have IV access. The trauma team can't survey the patient's back until I establish access the line, so I'm all nervous with that as well. I get a sign of relief as horrible as it sounds when the trauma is a high acuity/transfer where ALS/other facility 95% of the time puts in some form of access. I don't mind helping out in these situations but I'm always nervous when I'm the primary RN.

A week ago though I felt like a complete idiot, we had a patient that got hit by a semi but somehow survived so the trauma team wanted basically a mass transfusion of blood products, uncrossed and all that. The patient was so severe my charge nurse sent in another nurse to back me up. I always check the blood tags to make sure the donor ID's are the same/info and the other nurse was like: "You don't have time to do that, you have to transfuse now!" and she refused to even cross check the blood with me so I had no choice to transfuse without checking. These kind of situations I'm not experienced in but I felt like I was doing the wrong thing.

I'm studying for the TNCC thats coming up in November. If I pass it I'm going to take the CEN will these two things further help my competence in the ER?

[buckeyeRNED]

I'm confused what exactly you were checking on the label? Uncrossed blood has nothing on the label to match to the patient. Honestly it sounds like a situation where the priority was to get the blood going ASAP and worry about anything else as secondary. Not that I take transfusion reactions lightly, but I would rather treat a transfusion reaction in a live trauma patient, than be prepping a dead trauma patient d/t blood loss. All of our uncrossed blood is O anyway, so the risk of reaction is lower.

Coming from an ICU to ED, I know how difficult it can be to get used to things like that, when it's been beat in your head for years that you ALWAYS double-check. But in a true emergency, it's all about prioritizing... sometimes you have to take the big risks because it's a bigger risk NOT to do it.

I don't think anyone feels COMFORTABLE doing those things. Whether ED, ICU, or Med-Surg, nursing in general will put you in situations you're uncomfortable with all the time. It's all about how you react, despite feeling uncomfortable, ... which I believe those things just come with experience. The nurse who was backing you up probably has faced this choice before. Somewhere down the road, you'll be in her shoes, coaching someone else through it.

[abundantjoy07, RN]

Traumas are no different in my mind than any other case. I kid you not. You do all the basics and then troubleshoot from there. Monitor, line, labs, meds...ABCs...assessment...Usually when traumas come in everyone goes to the room to assist. Maybe I've just been doing it for a while that it doesn't phase me anymore. Granted there will always be iffy situations, but for the most part it's basic...especially after you've done it for a while.

[oldandintheway]

I agree that traumas should be basic, primary assessment, ABC, DEF on down the line. Initial response to a trauma will attract a lot of help. One thing about trauma response it requires delineation of responsibilities and a single leader. I have observed some situations that the room may fill with a bunch of "high speed, low drag, hot shots" and without leadership it could deteriorate into an ego contest amongst some of the nurses to the detriment of the patient.

I have seen four nurses race to be the one that puts the "big pipe" into the veins, throwing their arms up to claim triumph and none of them looks to see if the patient is breathing. I've seen nurses with pockets full of open epi, amiodorone, atropine, etc at the end of a code because they don't listen to med orders. Most codes do not need to be big sloppy messes.

As far as blood, band them, type and cross them, but give them O neg straight from the bank if they are in extremis. Be as prepared as practical before a code or trauma in order to prevent chaos. Sometimes all the dramatic, heroic crap is actually a manifestation of a lack of leadership.

That being said when it all hits the fan, rules get splattered against the wall in order to save the patient. Sometimes the one who is not elbow deep in it is the one looking at the big picture versus the minutiae, and comes up with the life saving intervention.

[LEFTFLANKPAIN]

Caffeine. Be sure to have a steady source of caffeine that's easily accessible at all times.

[rearviewmirror, BSN, RN]

TNCC... then take trauma cases!

[Dragonnurse1, ASN, RN]

If this was your first trauma with uncrossed blood it is understandable that you froze a bit on the blood. Just remember that when the next one comes in. As far as the IV thing try to start as many IV's every shift you can even the difficult ones. IV's are something you get better with as you do them over and over. Keep your head if multiple people rush in and you are the primary - delegate jobs to the others depending on what the patient needs and what the Doc is saying. There will always be something that will come in you are not "ready" for just keep moving and you will be fine. Stick your head into other traumas (if you are not busy) and just watch. Did that once and ended up putting in an IV across the arch of the patients foot while all the others (including Surgeon) were trying to find an access in order to intubate. Announced access ready and got hugs from EMT's and pats from the OR team. I had slipped out of the room and they found me. It is just doing everything over and over again... All of us pause when we see something we have never experienced before. Keep going you are just fine.