Dive into the world of trauma nursing from the FAST exam, to the operating room and subsequent inpatient care. Michelle Dedeo, trauma and neuro clinical nurse specialist, explains key trauma concepts such as the trauma assessment, the triad of death, and massive transfusion protocols.
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Primary Trauma Survey
The primary survey in trauma is a quick and structured evaluation to rapidly spot and manage life-threatening issues in a patient. It’s based on the ABCDE approach:
- A: Airway maintenance with neck protection.
- B: Breathing assessment and intervention.
- C: Check circulation and control bleeding.
- D: Evaluate neurological status.
- E: Expose for examination and maintain temperature.
This assessment focuses on immediate threats and is followed by a more detailed secondary survey to comprehensively assess the patient’s condition.
A FAST exam (Focused Assessment with Sonography for Trauma) is a rapid bedside ultrasound examination performed in trauma situations to quickly assess for free fluid or blood in the abdomen and chest.
The FAST exam typically focuses on four main areas:
- Pericardial Space: This involves assessing for fluid accumulation around the heart, which can indicate cardiac injury or tamponade
- Hepatorenal Space: Ultrasound is used to visualize the space between the liver and kidney to check for internal bleeding in the abdominal cavity.
- Splenorenal Space: Similar to the hepatorenal space, this space is examined for the presence of fluid or blood, which can indicate injuries to the spleen or other abdominal organs.
- Pelvic Space: The pelvic area is examined for the presence of fluid, which might indicate pelvic fractures.
Trauma Triad of Death
The trauma triad of death involves three critical conditions:
When these occur together in trauma patients, they worsen each other, leading to higher mortality risks. Hypothermia impairs clotting and cardiac function, while acidosis disrupts metabolism and coagulation. Coagulopathy exacerbates bleeding. Rapid intervention to address these factors is crucial for patient survival.
The Thromboelastography (TEG) test is a real-time test assesses clot dynamics, guiding tailored interventions to address coagulation issues. By analyzing parameters like clotting time, strength, and fibrinolysis, physicians adjust blood product administration to optimize clotting.
Massive Transfusion Protocol (MTP)
A massive transfusion protocol (MTP) is a structured and predefined set of actions that healthcare providers follow when a patient experiences severe bleeding and requires a large volume of blood products.
The goal of an MTP is to rapidly deliver the appropriate combination of blood products, including red blood cells, plasma, platelets, andother clotting factors, to address both the loss of blood volume and the need for clotting factors to control bleeding.
About the guest: Michelle Dedeo
Michelle Dedeo is a clinical nurse specialist in the Seattle, WA area. Her work as a clinical nurse, clinical leader, and nurse educator have focused in trauma and neuro critical care.
Brush up on neuroscience with Michelle’s SCRN Prep Podcast