TCRN Sneak Peek

1. Airway/Alertness, Breathing, Circulation are priorities unless massive hemorrhage (MARCH mnemonic) on across-the-room. Treat the greatest life-threatening condition first.

2. Keep cerebral perfusion pressure > 60 mm Hg in traumatic brain injury (TBI), do not allow permissive hypotension.

3. Elevate the head of the bed 30-45 degrees with head in neutral alignment for traumatic brain injury (TBI).

4. Early mobilization and DVT prophylaxis are important to reduce complications from trauma.

5. Tracheobronchial injury – S/S: Hamman’s sign, subcutaneous emphysema, dysphonia, and stridor. TX: Fiberoptic intubation or emergency repair.

6. Log roll can cause secondary injuries including spinal cord injuries (SCI), and hemorrhage in pelvic fractures.

7. Suspect spinal cord injury (SCI) if patient has absent bowel sounds and no abdominal injury.

8. Neurogenic shock - S/S: bradycardia (or lack of expected tachycardia), bradypnea, poikilothermia, priapism, anhydrosis, and hypotension. TX: Augment vascular tone with fluids and vasopressors.

9. Aortic dissection – aorta shears at ligamentum arteriosum. S/S: New onset murmur, widened mediastinum and obscured aortic knob on x-ray. TX: TXM 10 units, IVF’s, Labetalol to keep HR 60-80 and SBP 100-120 mm Hg.