Page 674 - ACCCN's Critical Care Nursing

Trauma Management 651

Research vignette, Continued
that were reversed or did not result in death. The other major dying for those patients who were hypothermic on arrival to the
trauma criteria include the admission to ICU with ventilation or trauma centre in the study population. This was independent of
specified urgent surgery for intracranial, truncal, spine or pelvic measured risk factors. The researchers highlight a number of key
injury. points in their discussion that are supported with the results from
this sample population. Of particular note is the discussion around
The inclusion criteria included adults who presented with serious
injury and met the major trauma patient criteria as described by mitigating strategies for heat loss which was supported by this
the Victorian State Trauma System definition. Exclusions were study, with only a small number of patients failing to warm in the
those aged <18 years of age and all non-traumatic cardiac arrest ED. This supports the utility of nursing strategies to prevent heat
patients. It must be remembered that the state of Victoria in loss and facilitate patient warming.
Australia has a State-based trauma system that funnels all major Fundamentally, this is a well-designed and executed study,
trauma patients into two Level 1 adult trauma centres. With the however, limiting the study population to a predetermined major
caseload of The Alfred Hospital, this makes this study cohort a large trauma definition was a lost opportunity. While outcomes such as
and representative sample of major trauma across both an urban mortality, ICU length of stay (LOS) and hospital LOS are important
and rural settings. endpoints, this study missed an important subset of time-critical
minor trauma patients who present hypothermic. Using time-
The study identified hypothermia as a temperature <35°C on arrival critical status, such as trauma team activation, as inclusion criteria
to the trauma centre. The researchers also collected a variety of would have captured that subset of minor trauma patients. While
other parameters to help describe the nature and characteristics that group are not high users of ICU, they are high consumers of
of the hypothermic patient population. Mechanism of injury, pre- hospital services and subject to complications of injury such as
hospital time and prehospital intubations, mortality, ICU admis- infection, identified to be statistically significant in the hypother-
sion, the Injury Severity Score and length of stay were all included mic population. This study demonstrates the clinical significance
in the analysis. Data analysis consisted of both univariate and and incidence of accidental hypothermia in a major trauma popu-
multivariate analyses which incorporate many of the potential lation from an inclusive established state-based Trauma System.
confounders.
The implications for nursing are significant as over 10% of major
Of the 820 patients eligible for inclusion into the study, 732 were trauma patients have the potential to be hypothermic on arrival to
included for analysis. The enrolled population was representative the ED. This was irrespective of season or time of day. Nurses must
of the spectrum of injury including age and gender distributions. be vigilant in looking for, mitigating and reversing, hypothermia as
The key finding of this study was a threefold increase in risk of it is associated with a three-fold increased risk for death.

Learning activities

Learning activities 1–5 relate to the clinical case study. 6. Briefly describe the tenets on which all trauma systems are
1. Describe the implications of the type of accident experienced based.
by Chris for his likely injuries and treatment. 7. Undertake a trauma tertiary survey assessment, discussing the
2. Explain the rationale for pleural decompression and manage- process and findings with a senior clinical colleague.
ment of a pneumothorax in the early care of Chris. 8. Briefly describe why the mechanism of injury is important
3. Discuss the components of the ‘trauma triad’ and outline prac- information in diagnosing injuries.
tices that should be undertaken to prevent or ameliorate the 9. Describe why the patient’s positioning in the bed is an impor-
triad. tant consideration for trauma nursing care.
4. Identify the likely causes of Chris’ respiratory failure and agita- 10. What is ‘damage-control surgery’ and why is this so important
tion and discuss the various preventive and treatment to survival in trauma patients?
approaches that are available. 11. Describe the nursing observations of a patient with an inter-
5. Describe the practices that could be incorporated in Chris’ care costal underwater seal drainage system in situ.
to reduce his psychological distress.

NSW Trauma Management Guidelines, http://www.itim.nsw.gov.au/go/
ONLINE RESOURCES itim-trauma-guidelines
Royal Australasian College of Surgeons, www.surgeons.org
American College of Surgeons, www.facs.org Society of Trauma Nurses, www.traumanursesoc.org
Australasian College of Emergency Medicine, www.acem.org.au Victorian State Trauma System http://www.health.vic.gov.au/trauma/review99/
Australasian Trauma Society, www.atsoc.com.au index.htm
Australian and New Zealand Burn Association, http://www.anzba.org.au/ World Health Organization, http://www.who.int/topics/injuries/en/
Eastern Association for the Surgery of Trauma, www.east.org
An independent, non-profit organisation providing global education, information FURTHER READING
and communication resources for professionals in trauma and critical care,
www.trauma.org Moloney-Harmon PA, Czerwinski SJ. Nursing care of the paediatric trauma patient.
NSW Trauma System, http://www.itim.nsw.gov.au/index.cfm Cambridge: Elsevier; 2003.