NR 341 Week 5 Nursing Care: Trauma and Emergency

Grace J.
August 8, 2025August 8, 2025
CU BSN, NR-341

Student Name

Chamberlain University

NR-341 Complex Adult Health

Prof. Name

Date

Nursing Care: Trauma and Emergency

Primary Survey in Emergency Nursing

The primary survey is the initial and most critical assessment conducted in emergency care. Its purpose is to identify life-threatening conditions and initiate prompt interventions. The key components of the primary survey follow the ABCDE framework, often expanded with additional elements such as facilitation of adjuncts and family involvement.

Components of the Primary Survey

Airway and Alertness: Assess for signs of obstruction such as gasping, dyspnea, or facial trauma. Evaluate alertness using verbal and painful stimuli.
Breathing: Examine respiratory rate and effort, asymmetry in chest movements, and signs of hypoxia.
Circulation: Check pulse, capillary refill, skin color, and mental status. Establish IV access and administer fluids or blood as needed.
Disability: Assess neurological status using the Glasgow Coma Scale (GCS) and evaluate pupillary responses.
Exposure and Environmental Control: Fully expose the patient to assess injuries while preventing hypothermia through blankets and warm IV fluids.

Secondary Survey

The secondary survey begins once all life-threatening conditions are addressed. It is a thorough, systematic assessment to identify all injuries, even those not immediately apparent. It includes:

History using SAMPLE mnemonic:
- Symptoms
- Allergies
- Medications
- Past medical history
- Last oral intake
- Events leading to injury
Head-to-Toe Assessment: Evaluate the head, neck, chest, abdomen, pelvis, extremities, and posterior surface.
Inspection: With assistance, logroll the patient to inspect the back, maintaining cervical spine alignment if trauma is suspected.

Adjunct Measures and Resuscitation Aids

During the initial assessment and resuscitation, specific adjunctive interventions—summarized by the mnemonic LMNOP—support the patient’s physiological functions.

Letter	Action
L	Laboratory investigations
M	Monitoring with ECG
N	Nasogastric tube insertion (or orogastric for head trauma)
O	Oxygenation and ventilation support
P	Pain evaluation and management

Family Presence During Resuscitation

Allowing family members to be present during resuscitation or invasive procedures has been shown to reduce patient anxiety and provide emotional support, enhancing communication and advocacy for the patient.

Emergency Severity Index (ESI)

The Emergency Severity Index is a five-level triage system used to prioritize patients based on the severity of their condition and resources needed.

ESI Level	Description	Resource Use	Examples
ESI-1	Requires immediate, life-saving intervention	High	Cardiac arrest, severe trauma
ESI-2	High-risk situation, unstable vitals	High	Stroke, chest pain, unresponsive patient
ESI-3	Stable, but requires multiple resources	Medium to high	Abdominal pain, fractures
ESI-4	Stable, minimal resources needed	Low	Lacerations, mild infections
ESI-5	Stable, no resources needed other than exam	Very low	Minor burns, medication refill

Airway Management: Rapid Sequence Intubation (RSI)

RSI is used for emergency airway management and involves administering sedatives and paralytics to reduce aspiration risk and trauma. The process includes the Seven P’s:

Preparation – Gather equipment, brief team.
Preoxygenation – Administer 100% oxygen.
Pretreatment – Use medications like lidocaine or atropine for specific conditions.
Paralysis and Induction – Administer sedatives and paralytics.
Protection and Positioning – Protect cervical spine if needed.
Placement with Proof – Confirm with chest x-ray, auscultation, and capnography.
Post-Intubation – Secure tube and prevent complications.

Assessment and Interventions for Specific Injuries

Head and Facial Trauma

In patients with signs such as periorbital bruising or a dysconjugate gaze, nasogastric tubes are contraindicated due to the risk of intracranial insertion. Use orogastric tubes instead.

Thermoregulatory Emergencies

Heat-Related Conditions

Condition	Symptoms	Treatment
Heat Cramps	Muscle cramps, profuse sweating, nausea	Rest and oral rehydration with salt and fluids
Heat Exhaustion	Dizziness, tachycardia, weakness, confusion	IV/oral fluids, cooling with moist sheets
Heatstroke	Temp >104°F, altered LOC, no sweating, organ failure	Immediate cooling, airway support, prevent shivering

Cold-Related Conditions

Condition	Description	Treatment
Frostnip	Mild, reversible skin irritation	Warm slowly, dry clothing
Superficial Frostbite	Skin appears waxy; numbness; tissue frozen	Rewarm in 37–40°C water, sterile dressing, analgesia
Deep Frostbite	Involves muscles and bones, high gangrene risk	Surgical debridement may be needed; aggressive rewarming

Hypothermia Stages

Severity	Core Temp (°C)	Signs
Mild	33.9–35	Shivering, confusion, lethargy
Moderate	30–33.9	Bradycardia, hypotension, metabolic acidosis, arrhythmias
Severe	<30	Loss of reflexes, dilated pupils, coma, risk of cardiac arrest

Submersion and Penetrating Trauma

Submersion Injuries: Typically seen in children, these can result in significant hypoxia, pulmonary edema, and neurological damage. Treatment focuses on oxygenation and fluid balance.

Penetrating Injuries: These involve objects breaking the skin and may affect critical organs. Gunshot and stab wounds are common. Prioritize bleeding control, airway management, and imaging.

Mass Casualty Triage: START System

Triage Category	Tag Color	Criteria	Examples
Immediate	Red	Life-threatening injury requiring immediate attention	Severe trauma, airway obstruction
Delayed	Yellow	Serious but not immediately life-threatening	Stable fractures, large wounds
Minor	Green	Walking wounded with minor injuries	Minor lacerations, bruises
Deceased/Expectant	Black	No signs of life, non-survivable injuries	Decapitation, massive head trauma

Emergency Preparedness

Emergencies are classified as internal (e.g., fire, power loss) or external (e.g., chemical spills, natural disasters). Nurses must be trained in triage, incident command systems, and communication protocols to manage disasters efficiently.

Adequate Resuscitation Parameters

Parameter	Target
Core body temperature	Normal
Serum lactate	< 2 mmol/L
Arterial pH	7.35–7.45
Hemoglobin	> 9 g/dL
Coagulation profile	Within normal limits
Serum electrolytes	Normal calcium and potassium
Pain	Effectively managed

Triage and Emergency Assessment of Trauma Victims

What triage tags are assigned to trauma victims based on condition?

Triage is a critical process during mass casualty events to prioritize victims based on the severity of injuries. The following table outlines triage decisions based on key physiological indicators:

Victim Description	Respiratory Rate	Pulse	Mental Status	Triage Tag
Apneic, no pulse, unresponsive	0	Absent	Unresponsive	Black (Expectant)
Unconscious, weak and thready pulse	13/min	Weak	Unresponsive	Red (Immediate)
Conscious, can follow commands	22/min	Normal	Obeys Commands	Yellow (Delayed)
Walking, minor injuries	Normal	Normal	Alert	Green (Minimal)

Black tag indicates deceased or unsalvageable; red tag implies immediate attention; yellow tag suggests observation; and green tag reflects ambulatory individuals needing minor care (Federal Emergency Management Agency [FEMA], 2017).

Case Assessment: Admitted Trauma Client

What are the clinical findings in a patient admitted with multiple trauma injuries?

The client presented on a backboard with cervical immobilization and a visibly deformed left leg. A warmed IV saline infusion was initiated. Vital signs indicated hypovolemia and mild hypothermia: BP 89/68 mmHg, HR 125 bpm, RR 16/min, SaO₂ 93%, and a temperature of 94°F (34.4°C). Neurological assessment showed GCS 15, equal pupils with brisk reactivity, and drowsiness with orientation intact. Swelling in the jaw and left cheek was noted, but the airway remained patent with symmetrical breath sounds. Cool skin and weak carotid pulse were consistent with early shock signs. Immediate interventions included removing wet clothing, maintaining oxygen saturation, drawing blood for tests, and ensuring ECG monitoring.

Trauma by System: Head Injuries

What are different types of traumatic brain injuries (TBI)?

Traumatic brain injuries range from mild concussions to life-threatening hematomas and are typically caused by falls, motor vehicle accidents, assaults, and sports injuries (Centers for Disease Control and Prevention [CDC], 2020). The severity is assessed using the Glasgow Coma Scale (GCS):

TBI Classification	GCS Score
Mild	13–15
Moderate	9–12
Severe	3–8

Types and Characteristics of TBIs

Type of Injury	Description	Signs and Symptoms	Urgency
Concussion	Temporary neuronal disruption	Amnesia, confusion, headache	Often self-resolving
Contusion	Localized brain bruising	Neuro deficits, LOC changes	Depends on bleeding
Epidural Hematoma	Bleeding between dura and skull	LOC → lucid → rapid decline	Requires surgical evacuation
Subdural Hematoma	Bleeding between dura and arachnoid	Gradual LOC change	Can be chronic and subtle

Surface findings may include facial bruises (Battle’s sign), skull fractures, and raccoon eyes, while neurologic indicators encompass CSF leaks, unequal pupils, and posturing.

Acute Spinal Cord Injury (SCI)

What are the types and manifestations of spinal trauma?

Spinal trauma leads to varying degrees of paralysis and sensory loss based on injury location. Initial complications include spinal shock, characterized by areflexia, sensory loss, and flaccid paralysis. Neurogenic shock typically follows cervical or high thoracic injury and results in unopposed parasympathetic activity, leading to bradycardia, hypotension, and poor perfusion.

Type	Cause	Key Features	Duration
Spinal Shock	Acute trauma	Areflexia, flaccidity, loss of sensation	Days to weeks
Neurogenic Shock	High SCI (T6 or above)	Bradycardia, hypotension, temp instability	1–3 weeks

Autonomic Dysreflexia (AD)

What are the signs and interventions for autonomic dysreflexia?

AD is a life-threatening hypertensive crisis seen in patients with injuries at T6 or above. It is triggered by noxious stimuli such as a full bladder or impacted bowel. Key symptoms include:

Sudden hypertension
Pounding headache
Flushing and sweating above the injury level
Bradycardia
Blurred vision and nasal congestion

Immediate Actions (In Order):

Sit the patient upright.
Identify and remove the stimulus (check for bowel/bladder distention).
Loosen tight clothing.
Notify the provider.
Document the event.

Failure to act promptly can lead to seizures, stroke, or myocardial infarction (National Spinal Cord Injury Statistical Center, 2021).

More Sections to Come

This is just the beginning. Due to the length of the content, I’ll continue with structured sections in the next responses:

Ocular and Chest Trauma
Abdominal Trauma
Fractures and Musculoskeletal Emergencies
Burn Management and Phases
Fluid Resuscitation (Parkland Formula)
Pharmacologic & Nutritional Therapy in Burns

Would you like me to continue with the rest of the document in the same format?

References

Centers for Disease Control and Prevention. (2020). Traumatic brain injury & concussion. https://www.cdc.gov/traumaticbraininjury

Federal Emergency Management Agency. (2017). START Triage: Simple Triage and Rapid Treatment. https://training.fema.gov/

National Spinal Cord Injury Statistical Center. (2021). Spinal cord injury facts and figures at a glance. https://www.nscisc.uab.edu/

American College of Emergency Physicians (ACEP). (2023). Emergency care protocols.