Page 283 - Critical Care Nursing Demystified

268 CRITICAL CARE NURSING DeMYSTIFIED

NURSING ALERT

Secondary injuries can lead to death. The nurse needs to be vigilantly observant for
signs of infection and respiratory failure after an initial injury has occurred.

Evaluating Reports From the Field

2 Deaths that occur as a result of trauma are said to take place in a trimodal
distribution (Trimodal Distribution Peaks) that involves three peaks. The first
peak includes victims who die immediately from the trauma insult before med-
ical attention can be provided. The second peak is when death occurs within a
few hours after injury. The third peak is when death occurs days to weeks after
injury due to complications such as embolism, infection, or multiple organ
dysfunction syndrome (MODS).
There is a 60-minute time frame or interval called the Golden Hour that
can support and increase the individual’s chances for survival if particular
trauma measures can be implemented within that time frame after injury.
These measures include the activation for help, responses, and communication Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
of the EMS (Emergency Medical System), evaluation of what happened to
the victim/victims (mechanism of injury [MOI]), prehospital stabilization
and triage (which means the sorting out of the nature of injuries according to
severity which is done to prioritize the urgency of treatment), transportation
to the appropriate trauma care facility, rapid in-hospital resuscitation, and
definitive care.
Sources describe two theories about the prehospital management of patients
in the field. The first theory is the “Stay and Play” theory, in which time is spent
and utilized to stabilize the patient’s condition in the field prior to transport.
The second theory is the “Scoop and Run” theory, where only the most life-
threatening issues should be addressed in the field and immediate transport
should take priority.

Trauma Center Levels and Classifications

3 Trauma centers are categorized according to expected levels of care
provided to injured individuals and the availability of support services (see
Table 6–1).