Page 646 - ACCCN's Critical Care Nursing

Trauma Management 23

Louise Niggemeyer
Paul Thurman

The injury epidemiology for trauma differs with severity.
Learning objectives The majority of trauma patients requiring admission to
an ICU are those with more serious injuries that are asso-
After reading this chapter, you should be able to: ciated with motor vehicles, motorbikes and pedestrian
l identify the benefits and limitations of an organised trauma collisions. Falls, collisions and assaults are less common,
system but still frequent, causes of trauma requiring critical care
l describe the rationale for a systematic approach to the admission. A significant proportion of injured patients
patient who has sustained injuries admitted to critical care have experienced neurotrauma,
l discuss the benefits of appropriate nursing care of the while other common injuries include multiple fractures
patient with serious injury and/or multitrauma and injury to internal organs in the thorax and abdomen.
l describe the acute nursing management of the patient The systematic organisation of trauma systems and
with multiple serious fractures improved delivery of prehospital care has resulted in
l describe the acute nursing management of patients with improved survival of trauma patients in recent years.
burn injuries, abdominal injuries and chest trauma Consequently, a greater number of patients with severe
l describe the nurse’s role in managing the trauma patient multiple injuries are now admitted to critical care units.
undergoing interim damage-control surgery. These patients generally require complex nursing care,
often for lengthy periods, both within the critical care
unit and beyond. This chapter reviews the common trau-
matic injuries that result in admission to critical care and
outlines the principles of management.
Key words
TRAUMA SYSTEMS AND PROCESSES
trauma
multitrauma A trauma system can be defined as:
transport an assembly of health care processes intended to improve sur-
fractures vival among injured patients by reducing the time interval
spinal injuries between injury and definitive treatment, and by assuring that
burns appropriate resources and personnel are immediately available
damage-control surgery when a patient presents to a hospital’.
8, p. 643
Without trauma systems in place, a range of organisa-
tional and clinical errors in the management of trauma
INTRODUCTION patients have been identified. These errors occur at all
stages of care, including prehospital, emergency, operat-
Trauma refers to physical injury that is caused by mechan- ing theatre, intensive care unit, wards, and during trans-
ical injury, also known as kinetic injury. Injury remains fers between hospitals. The majority of errors identified
9
the leading cause of death in adults under 45 years of age, were errors in management of patients, although approxi-
and is a leading cause of preventable mortality and mor- mately 20% of errors occurred as a result of system inad-
bidity in Australia and New Zealand, as well as the rest equacies. A smaller number of technique or diagnostic
1-4
of the world. Furthermore, injury represents a major errors occurred.
cost to injured individuals, the healthcare system and
5,6
society. More than 5.2 million people throughout the Over the past 20 years there has been increasing emphasis
world die due to injury, with 90% occurring in low- to on the development of trauma systems that cover geo-
middle-income countries. According to the World Health graphical areas, such as a nominated state or region. The
Organization, injury accounts for 16% of the world’s introduction of trauma systems has resulted in a 15–30%
disease burden. 7 reduction in the risk of death, primarily in the area of 623