Trauma Week 2024 Day 2

Keri Bryant, an ER trauma nurse with 20 years of experience, shared information on managing trauma patients in the ER. She offered volunteers a hands-on opportunity to practice two critical skills: performing a chest tube insertion and rolling a patient to assess the posterior side for injuries. When a trauma patient arrives at the hospital, a complex and well-coordinated response is set into motion, especially in the case of an alpha trauma alert. This type of alert mobilizes a team, including the trauma or surgical attending physician, trauma residents, ER nurses, respiratory therapists, radiology technicians, neuro and orthopedic specialists, and emergency medicine staff. As part of the preparation, the CT table is cleared, and an OR suite is reserved in case immediate surgery is required. In this scenario, the pre-hospital call from South Flight announced the arrival of a 17-year-old female who had suffered injuries from an ATV accident. The report detailed her extrication from rough terrain and critical injuries. She had been found 15 feet from her ATV without a helmet, with a loss of consciousness at the scene. Initial assessments indicated a possible spinal cord injury, as she had diminished sensation and movement below the umbilicus. Her left lung sounds were diminished, and her oxygen saturation was 89% on room air. A needle decompression was performed in the field, and she was intubated with a 7.5 ET tube. The flight team administered sedation and secured IV access with bilateral 18-gauge lines, infusing one liter of lactated Ringer's solution. Upon transport, her vital signs were stable but concerning, with a heart rate of 120, a respiratory rate of 24, and a blood pressure of 110/65.

Upon arrival in the trauma bay, the South Flight nurse provided a comprehensive hand-off to the trauma team, detailing scene findings, interventions performed en route, and the patient’s current condition. This took place while the patient was transferred to the hospital stretcher. The trauma team immediately began their assessment, starting at the head of the bed and ensuring the patient’s cervical spine was immobilized. The patient was carefully log-rolled to inspect the posterior side, a critical step for identifying hidden injuries. The team followed the CABC approach: circulation, airway, breathing, and circulation. They conducted an “across-the-room” assessment to look for signs of external bleeding, confirmed the airway was secured with the ET tube, and assessed breathing by checking chest rise, fall, and lung sounds. The trachea was midline, and circulation was evaluated by checking pulses and skin color. Initial findings revealed no external signs of bleeding. The patient’s airway was secured with a 7.5 ET tube, and the needle decompression site on the left showed decreased breath sounds but a midline trachea. The patient was placed on a ventilator, and a chest X-ray was performed to confirm ET tube placement. A thorough examination of the abdomen and pelvis showed no injuries, and there were no long bone deformities. However, when the patient was log-rolled, step-offs were noted at T2-T5 and L1, indicating spinal damage. Poor rectal tone, bruising on the left scapula, and posterior rib injuries were also discovered.