TRAUMA ACROSS THE LIFE SPAN

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TRAUMA ACROSS THE LIFE SPAN

• Madeline Gervase RN, MSN, CCRN, FNP
• Union County College

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CASE REVIEW

• A tractor trailer jacknifed and swerved in front
  of a minivan carrying a family of five. The
  driver of the truck was killed instantly. The
  mother in the right front seat of the van died on
  the way to the hospital.

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• The father (driver) had to be extricated from the
  van. He had lower extremity deformities, chest
  wall pain and lacerations on his face. In the
  middle seat of the van was a 14 mos old infant in
  a car seat directly behind the driver. The
  infant was crying but had no apparent injuries.
  (continued)

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• In the rear seat was an 8 year old male (drivers
  side) and a 78 year old female (maternal
  grandmother).
• Both were unconscious at the scene briefly as
  reported by a witness to the accident. The
  grandmother complained of lower abdominal pain
  and a headache. The 8 year old was upset,
  crying, and had no specific complaints. All were
  wearing seat belts properly.

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Priorities of Care

• A Airway
• cervical spine
• teeth or foreign objects
• bleeding, emesis, edema
• B Breathing
• Look, listen, count
• Assess color
• Jugular vein distention and tracheal position

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More assessment

• Circulation
• Pulses
• Color, temperature of skin
• Level of consciousness
• Capillary refill
• Bleeding

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• D Disability
• Level of consciousness
• Coma scale
• Extremity movement
• Pupillary response
• E Exposure and environmental control
• F Full set of vitals

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• G Give comfort measures
• H Head to toe assessment and history
• I - Inspect posterior surfaces

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Age Related Issues

• Initial response to trauma
• Rehabilitation time
• Co-morbidity
• Grieving/loss

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Where should they go????

• Level I Trauma
• Level II Trauma
• Other
• Which one and why?

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Trauma Centers

• Level I
• Cooper Hospital (Camden)
• Robert Wood Johnson UH (NB)
• UMDNJ (Newark)
• Level II
• MMH, Hackensack, SJHMC, Jersey Shore,...

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Is trauma center just the ED?

• Diagnostic testing
• ICU
• OR
• Specialty units (Peds, neuro, ortho)
• Rehabilitation
• Psychological services
• Chaplain
• Care management

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What are the similarities and differences?

• Research
• Availability of specialists
• Diagnostic equipment
• Critical care facilities
• Trauma surgeons

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Pre-hospital care and transportation

• EMTs
• Paramedics
• Ambulances
• Helicopters

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Pre-hospital Care

• Cervical spine immobilization
• Immobilization of suspected fractures
• Oxygen
• Intubation
• Intravenous access
• Medications
• Bleeding control

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• Pre-hospital care for the
• Driver
• Infant in car seat
• 8-year old
• Grandmother

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What happens when we get to the ED?

• Driver
• Infant
• 8-year old
• Grandmother

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Emotional impact on..

• Victims
• Staff
• Pre-hospital care providers
• De-briefing

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What comes after the ED?

• ICU
• OR
• Speciality unit
• Rehabilitation
• Reintegration
• Post traumatic stress disorder (PTSD)