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.

10. Advantages of autotransfusion in blunt chest injury – no transfusion reaction, decreased risk of communicable disease, lower potassium level, better oxygen-carrying capacity.

11. Hypothermia causes a left shift of the oxyhemoglobin dissociation curve - causes hemoglobin to hold onto oxygen.

12. Pelvic fracture – TX: apply the pelvic binder at the level of the greater trochanter, surgery or REBOA at Zone 3 if bleeding not controlled.

13. TEG and ROTEM are point-of-care testing to evaluate the efficiency of blood clotting, platelet function, clot strength, and fibrinolysis.

14. Tertiary injury prevention – EX: advocating for burn centers and trauma centers and keeping helicopter at rural facilities.

15. Tertiary trauma assessment within 24 hours of admission when patient is awake and can describe pain to find missed injuries.

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