I consider myself an accidental trauma nurse. Yes, I am a retired Navy Reserve nurse with two tours of duty in Afghanistan, but most of my reserve nursing experiences were in civilian hospitals and primarily in an adult medical ICU setting. When I worked in a military medical facility, I usually cared for retirees with medical conditions and an occasional sailor or marine with typically minor traumatic injuries. The fact is that only a few military medical facilities in the U.S. treat trauma patients, so the bulk of my preparation for war was as a medical ICU nurse and serving in a war zone learning from my colleagues.
When I was assigned to the Role 3 field hospital at Kandahar Airfield, I realized what I had practiced so far was insufficient to care for a trauma patient. I needed to supplement my skills with trauma education and experiences. There are probably many nurses working in nontrauma settings who might become accidental trauma nurses too.
The best example I can give you is a 10-year-old boy I cared for in Afghanistan. He was playing soccer with a group of friends when a rocket-propelled grenade landed near them. He became my patient when I was an ICU nurse supplementing the trauma teams in the trauma bay because of the large number of casualties we were receiving. A typical trauma assessment starts with fully exposing the patient and assessing them in a systematic manner from head to toe, with a logroll to examine the back. It is important to be systematic and complete the entire assessment when a trauma patient is first received because of the risk of missing an injury.
However, we could not stabilize this patient’s blood pressure; so the trauma assessment was stopped before the logroll and posterior examination in order to get him to surgery. I learned about the trauma assessment process from the Trauma Nurse Core Course (TNCC) and Emergency Nursing Pediatric Course (ENPC). Both courses were required or recommended by the Navy and important for nurses like me who needed to know the basics of trauma care. I knew I would have to complete the trauma assessment as soon as possible, but this course also taught me that I had to prioritize his hemodynamic stability to obtain the best outcome. I knew we had to stop the bleeding, and he had to get to the OR. Everything else could wait.
Like the care we gave this patient with hypovolemia, massive transfusion was a regular part of the care I provided to my other trauma patients. As lifesaving as a blood transfusion is, I also learned a lot about what can go wrong. These articles from Critical Care Nurse, AACN’s clinical practice journal, describe some of those lessons and treatments. “Hemostatic Management of Trauma-Induced Coagulopathy” and “Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model” address the issues related to massive blood loss and transfusion.
Postoperatively, the boy was again my patient in the ICU. It took about another 24 hours for us to fully stabilize him. It was then that I discovered he was unable to move anything below his shoulders. This likely meant we missed an injury, because we could not examine his back in the trauma bay. So, with the help of the ICU team, I finished the full trauma assessment by logrolling him and discovered a very small laceration on his right shoulder that was made by a piece of shrapnel that entered his right shoulder and traveled across his upper back, severing his spinal cord between T1 and T2, and lodging near his left shoulder. My familiarity with trauma assessment from those two courses enabled me to safely identify this missed injury.
The Traumatic Brain and Spinal Cord Injuries assignment from Essentials of Critical Care Orientation (ECCO), “Caring for Patients with Neurologic Disorders, Part 2,” was very helpful for learning how to manage adults with these types of injuries. Another potential issue with trauma patients is managing the open abdomen. “Open Abdomen in Trauma and Critical Care” addresses management of patients with abdominal trauma. The problem with intra-abdominal hypertension is also covered in the ECCO module: Caring for Patients with Gastrointestinal Disorders.
“Trauma Care After Resuscitation (TCAR)” is a course I discovered just after I retired from the Navy Reserve. What I love about this course is the focus on care beyond the trauma bay. It focuses on patient care from the ICU through rehabilitation. Like the TNCC and ENPC, you receive a certification that is good for two years and then needs to be renewed. The course is available in a live two-day format or online. For nurses with a pediatric focus, “Pediatric Care After Resuscitation (PCAR)” is also available.
A few more resources I have come to appreciate and are available from AACN include “Trauma Nursing - From Resuscitation Through Rehabilitation, 5th ed.,” a textbook that also covers comprehensive care of the trauma patient. I think this would make a great reference to have on hand just in case your hospital becomes the closest one in a mass casualty event. Another great resource is “AACN Procedure Manual for High Acuity, Progressive and Critical Care,” 7th ed. Every ICU/PCU should have this on hand for step-by-step procedure guidance. A number of procedures in the manual are really useful in caring for trauma patients.
What helpful resources have you found to care for patients with trauma? Please share your experiences in the comments!
Are you sure you want to delete this Comment?