December 10th, 2024 By: Keri Bryant BSN, CEN, TCRN
Patient Update
When the patient arrived at the emergency room, she was still intubated and had a C-collar on. She has a 7.5 ET tube with needle decompression on the left side and decreased breath sounds. She also had a midline trachea. Her abdomen was soft with no contusions or abrasions. There was a CXR obtained and Pt was placed on a vent. She had decreased sensation and motion below the umbilicus. Her vital signs were 110/65, 120 heart rate, and her O2 stats were up to 98%. Prior to her intubation, the patient was responsive on the AAO scale x1. She was expected to have neurological damage due to her spinal injury.
The Emergency Room
Once the patient arrives at the emergency room, they will perform a handoff with South Flight RN. This process takes a multitude of people to smoothly transfer the patient. However, before the patient arrives, the emergency room will gather a multitude of different physicians. Since this trauma is considered an Alpha Trauma, it entails the most human force. They will need a surgical trauma attending, three medical residents, three trauma nurses, a respiratory therapist, radiology, a cleared CT table, a reserved OR Suite, a Neurosurgeon, an emergency medicine MD, and an ortho resident. They will ready all items they will need; blood products, fluids, chest tubes, and anything needed for efficient treatment.
Assessment
Once the patient is secured in the ER, they will be assessment. The initial evaluation will come from the information received from the prehospital report from the incoming helicopter. When assessing a trauma patient they follow the CABC. This stands for circulation, airway, breathing, and circulation.
Circulation: across-the-room assessment, looking for outward s/s of bleeding
Airway: open, if it is effective or previously secured
Breathing: chest rise and fall, lung sounds, trachea midline, and tube in the correct place.
Circulation: Pulse (Carotid, femoral, radial) Color
They will assess the breathing functions and sounds, along with visible signs and symptoms of bleeding. They then will assess the posterior. They will look for any visible injuries and any step offs. They will also assess the rectal tone of the patient. This will be able to tell the doctors if there is any spine damage, if the rectum is lost then there is a possible spinal injury. After they finish their assessment, they will then insert a chest tube.
CHEST TUBE
A chest tube is inserted to help neutralize and stabilize the negative pressure in the lungs. If the pressure in the lungs is threatened, it is possible the patient will experience Hemo/Pneumothorax or Tesnion Pneumothroax. A Pneumothorax is when the negative pressure inside the lung cavity is obstructed by outside positive pressure and forced the lung to collapse. Hemopneumothorax is when blood enters the chest cavity, acts as the positive pressure, and forces the lungs to collapse. A tension pneumothorax occurs when a large collection of air builds up in the chest cavity, pushing the thorax to the side. This compromises the cardiac functions and the respiration of the patient. To prevent this, a chest tube neutralizes the negative pressure in the chest cavity.
After securing the chest tube, the patient gets taken to imaging. After imaging, we discovered that our patient has T2-T5 spinous process fractures, an L1 burst fracture, a left rib fracture on ribs three through seven, and a left scapula fracture. Now, the patient should be taken to the STICU.
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