ER Day 3

How do you stabilize a trauma patient (Ch. 35)

A = Airway
B = Breathing
C = Circulation
D = Disability
Hearing loss
Movement
More neuro related
E = Exposure of the patient and environmental control O
Observe the whole patient to see if there is anything you missed
Want the resuscitation room to be cooler
Thermogenesis Control the body temperature
Golden hour Stabilization of the patient and depends on the amount of time it takes to extract
the patient from the situation, get them in the ambulance, and into the hospital
The first hour you have to stabilize the patient
Most patients are in shock and they are acidotic
The ER nurse would give IV fluids (normal saline, lactated ringers)
o Lactated ringers (RL) Made of
o Plasmanate A volume expander. Often given if patients dont want blood products.
o Volume expanders Crystalloid and colloids
-

T & C Type and cross match the patients blood

Also do a CBC, electrolyte, glucose, renal, and kidney function See how the body is reacting
to all this trauma
Once you get lab values back you will be adding electrolytes to the saline
If the glucose is low you will be giving 50% dextrose
Also be looking at the urinalysis, and blood alcohol levels (if there is a fatality)
Must draw blood alcohol levels with a witness or someone from the PD will come a draw it
because it starts getting into the legal aspect
Toxicology report
If patient still bleeding you would look at platelets, PT, and PTT
To check for sepsis you would look at lactic acid level
Sometimes blunt head trauma is not evident till 24-48 hours
o Dizziness, headache, disorientation
o Look at pupil constriction
If unequal
If patient is bent over something might be wrong with vagus nerve 10, or could be aneurysms
Liver can be lacerated, spleen can be ruptured, tear the bowel
Aortic trauma Could be aneurysm
o Slow leaking aneurysm which you are not aware of until the patient drops
o If they are stable and then their condition slowly drops start thinking about aneurysm
o If the small tear opens up then you have free blood in the abdominal cavity and they
could die
o Mottling of the skin See it all over and the patients skin is cool (one of the hallmark
signs). Blotching of the skin or changing of skin color
o You would want to make sure that you are careful giving TPA or some kind of blood
thinner
o There can also be a bulging of the aneurysm which is dangerous and ready to pop
Brain aneurysm Open the skull and locate the artery
Swelling on the brain Give Mannitol
Bleeding out Give IV and volume expanders
Abdominal aneurysms Surgery, and grafting

If the patients blood alcohol is too high you dont want to sedate them first because you
might kill them
Penetrating abdominal injury (youtube video)
o GSW or stabbing
o Liver most commonly injured
Blunt abdominal injury

Head trauma
Look at glascow coma scale
Facial, ocular, and DNT trauma
Geriatric and other trauma