table of contents - trauma nurses · donna has spent all 21 years of her nursing career in trauma...

© 2004 by the STN

Table of Contents

The Electronic Library of Trauma Lectures® Editors ....................................................................... 1 Editor Biographies ..................................................... 2 Disclaimer.................................................................. 3 Dedications................................................................ 4

Contributors............................................................... 6

Preface ...................................................................... 8 Acknowledgements ................................................... 9 Detailed Table of Contents - Presentations ............. 10 Presentation Objectives........................................... 11 Presentation Summaries – Indexed......................... 16 Bibliography............................................................. 20

© 2004 by the STN 1

Editors

The Electronic Library of Trauma Lectures® Edited by: Michele K. Ziglar, RN, MSN Lead Editor Trauma Program Manager Shands at the University of Florida Gainesville, Florida Vicki Bennett, RN, MSN, CEN, CCRN Director, Staff Development Cleveland Clinic Hospital Weston, FL Donna Nayduch, RN-CS, MSN, ACNP, CCRN Trauma Clinical Nurse Specialist Evans, Colorado Genell Hilton, RN, MS, CRNP, CCNS, CCRN Graduate Research Assistant Department of Physiology School of Medicine University of Maryland Acute Care Nurse Practitioner Department of Surgery Baltimore, Maryland


Editor Biographies

Michele K. Ziglar, RN, MSN Michele has dedicated her past 20 years of nursing to trauma program development and research. She is well published in the care of trauma patients and has presented at many national symposiums. She is a past member of the Board of Directors for the Society of Trauma Nurses and participates on the Education Committee. She is currently the Trauma Program Manager at Shands at the University of Florida in Gainesville.

Vicki J. Bennett, RN, MSN, CEN, CCRN Vicki is an accomplished nursing professional offering over 20 years of experience with demonstrated success in a variety of clinical, educational, and leadership positions within the trauma arena having most recently functioned as a Trauma Program Manager until 2003. Currently, she is the Director of Staff Development at a South Florida hospital.

Donna Nayduch, RN-CS, MSN, ACNP, CCRN Donna has spent all 21 years of her nursing career in trauma care with 17 of those as a trauma coordinator. She is a Forensic Clinical Nurse Specialist as well as a Trauma ACNP. She has published extensively and lectured or presented research around the world. She has participated in the board of directors for both the American Trauma Society and the

Society of Trauma Nurses. She is also faculty for the ATS Trauma Coordinator and Registrar courses as well as the AAAM AIS-coding course. Genell Hilton, RN, MS, CRNP, CCNS, CCRN Genell has been involved in trauma nursing for over 24 years, in both Emergency and Critical Care departments. She has worked as a Clinical Nurse Specialist, Critical Care Educator and has served as faculty in academic settings in both undergraduate and graduate nursing programs. She is currently a PhD candidate in Physiology, researching excitotoxic brain injury in neonates. She also works as an Acute Care Nurse Practitioner in the Surgical Intermediate Care Unit at the University of Maryland.


Disclaimer

Society of Trauma Nurses PMB 300 223 North Guadalupe Santa Fe, New Mexico 87501 www.TraumaNurseSoc.org Lead Editor: Michele K. Ziglar President: Kate FitzPatrick Immediate Past President: Heidi Hotz Copy Editor: Ann White Format Editors: Holly and Larry Mandelkehr Notice Trauma Nursing is an ever-changing field. Standard safety precautions must be followed, however, as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy become necessary or appropriate. Readers are advised to check the product information currently provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician relying on experience and knowledge of the patient to determine dosages and the best treatment of the patient. Neither the Publisher nor the editor assumes any responsibility for any injury and/or damage to persons or property.

The Society of Trauma Nurses The Electronic Library of Trauma Lectures® Copyright © 2004 by the Society of Trauma Nurses. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing form the Society of Trauma Nurses.


Dedications

I dedicate my work to my parents Ann and Mike Ziglar who gave me the opportunity to be successful in my career. I attribute my success and perseverance of completing the Electronic Library of Trauma Lectures project to members of the Executive Board (Heidi, Beverlee and Katie) who believed in me.

Michele K. Ziglar I have so many reasons to thank my family, friends, and colleagues for their unwavering support, encouragement, and love. To my family whom I love dearly. To my brother who has been my mentor, my friend, and my confident. To my parents whose sacrifices and love have supported me through life's journey. Your lives demonstrated such faith and courage that I strive to emulate. And, for my dear father who passed away during the work on this project. I am grateful for the influence you have had in my life and for your gift of humor. Your strength of conviction and your commitment to integrity instilled values and taught lessons that inspires and endures.

Vicki J. Bennett Dedicated to the extraordinary staff with whom I have had the honor to work throughout my career as a trauma coordinator and with gratitude to the surgeon who helped me step out the door and enter the world of Trauma care, Michael Rhodes, MD.

Donna Nayduch For my husband, Chris, and children, Brittany, Thai, Jared and Adam.

Genell Hilton The Trauma in the Elderly chapter is dedicated in loving memory to Bruno & Dolores Laskowski, my parents, who died in 2003 from injuries caused by a motor vehicle crash.

Linda Laskowski


Dedications The Trauma Rehabilitation Chapter is dedicated to the memory of William H. Shull, MD (1960 -2003). Director of Neurotrauma Rehabilitation in the Department of Rehabilitation at the University of Pennsylvania Medical Center in Philadelphia. In this life, he always "seized the day' and will be remembered as a scholar, dedicated patient advocate, caring physician, colleague, teacher and humanitarian; he touched so many with his knowledge, compassion, and joy of life. Thank you on behalf of the many trauma patients and families who lives are better because of you.

Kate FitzPatrick


Contributors

Joseph Adler, MS, PT Adjunct Faculty Arcadia University Senior Level II Physical Therapist Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Trauma Rehabilitation Lisa Barnhill, RNC, BSN, MSN Perinatal Clinical Nurse Specialist Holmes Regional Medical Center Melbourne, Florida The Pregnant Trauma Patient Vicki J. Bennett, RN, MSN Director, Staff Development Cleveland Clinic Hospital Weston, FL Abdominal Injuries • Musculoskeletal Injuries • Soft Tissue Injuries and Wound Healing Beth Broering, RN, MSN, CEN, CCRN Trauma Clinical Nurse Specialist Inova Fairfax Hospital Falls Church, Virginia Maxillofacial and Ocular Injuries Scott Christopher, RN, BBA, BSN Trauma Care Coordinator Nacogdoches Memorial Hospital Nacogdoches, Texas Soft Tissue Injuries and Wound Healing Kate FitzPatrick, RN, MSN Clinical Administrator Division of Traumatology & Surgical Critical Care, Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Trauma Rehabilitation

Kathy Haley, RN, BSN Trauma Program Manager Columbus Children’s Hospital Columbus, Ohio Pediatric Trauma Susan McDaniel Hohenhaus, RN, BS, FNE Project Manager, EMS for Children Duke University Medical Center Durham, North Carolina Substance Abuse and Interpersonal Violence Doreen Klee, RN, BSN Resource Nurse Sumner Redstone Burn Trauma Plastics Unit Massachusetts General Hospital Boston Massachusetts Burn Injuries Jorie Klein, RN Director, Trauma Product Service Line, Network & Injury Prevention Parkland Health & Hospital System Dallas, Texas Mechanism of Injury Linda Laskowski-Jones, RN, MS, APRN, BC, CCRN, CEN Director, Trauma, Emergency and Aeromedical Services Christiana Care Health System Newark, Delaware Trauma in the Elderly Connie Mattice, RN-C, MS, CCRN Trauma Program Manager Butterworth Hospital, Spectrum Health System Grand Rapids, Michigan Initial Management of Traumatic Shock


M. Clifann McCarley, RN, BSN Associate Director of Nursing Parkland Health & Hospital System Trauma Services Department Dallas, Texas Injury Prevention Denise M. Meredith, RN, MSN, CRNP, BC Surgical Critical Care Nurse Practitioner Division of Traumatology & Surgical Critical Care, Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Analgesia, Sedation & Neuromuscular Blockade in the Trauma Patient Donna Nayduch, RN-CS, MSN, ACNP, CCRN Trauma Clinical Nurse Specialist Evans, Colorado Genitourinary Injuries and Renal Management • Substance Abuse and Interpersonal Violence Sally Ossewaarde, RN, MSN, CNS Unit Coordinator Bronson Methodist Hospital Kalamazoo, Michigan Psychosocial Impact of Trauma Tammy Russo-McCourt, RN, BSN, CCRN Full Partner, Neurotrauma Critical Care University of Maryland Shock-Trauma Center Baltimore, Maryland Spinal Cord Injuries Liza Severance-Lossin, RN, MSN, CS Clinical Nurse Specialist, Neurotrauma ICU, Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Traumatic Brain Injury

Suzanne Frey Sherwood, RN, MS Full Partner, Trauma Resuscitation Unit, R. Adams Cowley Shock Trauma Center, Clinical Instructor, University of Maryland School of Nursing Baltimore, Maryland Thoracic Injuries Corinna P. Sicoutris, RN, MSN, CRNP, BC, CCRN Surgical Critical Care Nurse Practitioner Division of Traumatology & Surgical Critical Care, Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Analgesia, Sedation & Neuromuscular Blockade in the Trauma Patient Jacqueline Sullivan, RN, PhD Director, Translational Nursing Research, Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Traumatic Brain Injury David A. Wellons, RN, BSN Trauma Program Manager St. Vincent Mercy Medical Center/ Mercy Children’s Hospital Toledo, Ohio Musculoskeletal Injuries Ann White, RN, MSN, CCNS, CEN Assistant Clinical Professor Duke University School of Nursing Durham, North Carolina Copy Editor Shock and Multiple Organ Dysfunction Syndrome • The Pregnant Trauma Patient Michele K. Ziglar, RN, MSN Trauma Program Manager Shands at the University of Florida Gainesville, Florida Lead Editor Evolution of the Trauma Cycle


Preface

The Electronic Library of Trauma Lectures® The Society of Trauma Nurses (STN), a premier nursing organization representing nurses world-wide, is committed to advancing the trauma nursing profession through continuing education. The STN strives to enhance the delivery of care through collaboration and education across the globe to improve patient outcomes that save lives. The STN brings value to nursing education by introducing one of the most respected educational resources available for teaching nurses. The Electronic Library of Trauma Lectures® is a CD of trauma related presentations considered the pre-eminent industry resource on trauma nursing care. The Electronic Library is designed to complement the highly acclaimed text, Trauma Nursing: From Resuscitation Through Rehabilitation 3rd edition, (2002) by McQuillan, et al. and serves as a complete educational program for training nurses across the trauma continuum of care. Each presentation contains learning objectives, a detailed lecture format with built-in instructor notes and discussion questions. Additionally, there are post-test questions and answers for each presentation that may be used for self-assessment purposes. Clinical experts in the field of trauma care participated in the project both as authors and reviewers. Any comments or feedback regarding the Electronic Library are welcomed and may be e-mailed to the [email protected].

Michele K. Ziglar, RN, MSN Vicki Bennett, RN, MSN, CEN, CCRN

Donna Nayduch, RN-CS, MSN, ACNP, CCRN Genell Hilton, RN, MS, CRNP, CCNS, CCRN


Acknowledgements

The editors are especially grateful to our colleagues whose contributions to The Electronic Library of Trauma Lectures® made this book a success. Especially to the reviewers, Kate FitzPatrick and Heidi Hotz, who spent endless hours critiquing the content of the presentations. In particular, we wish to thank Ann White, RN, MSN, Assistant Professor, Duke University School of Nursing for her invaluable help validating the test questions and performing the copy editing for the Electronic Library. Thank you Kate, Heidi and Ann for your thoroughness and response to our needs. Additionally, we would like to acknowledge the nursing professionals across the globe who dedicate each day to achieving the highest possible standard in the delivery of patient care. The publication of this book represents a landmark in the STN’s publishing history. The prompt Electronic Library is our first book on a CD which is a revolutionary change in printing of a traditional textbook. Michele K. Ziglar, RN, MSN

Vicki Bennett, RN, MSN, CEN, CCRN Donna Nayduch, RN-CS, MSN, ACNP, CCRN Genell Hilton, RN, MS, CRNP, CCNS, CCRN


Detailed Table of Contents - Presentations

Presentation Objectives ................................................................ 11 Section 1 – General Concepts #1 - Evolution of the Trauma Cycle............................................... 11 #2 - Injury Prevention.................................................................... 11 #3 -Trauma Rehabilitation............................................................. 11 Section 2 – Clinical Concepts #4 - Mechanism of Injury............................................................... 11 #5 - Shock and Multiple Organ Dysfunction Syndrome................. 12 #6 - Initial Management of Traumatic Shock................................. 12 #7 - Analgesia and Sedation and Neuromuscular Blockade ......... 12 #8 - Psychosocial Impact of Trauma............................................. 13 Section 3 – Single Systems #9 - Traumatic Brain Injuries......................................................... 13 #10 - Maxillofacial and Ocular Injuries .......................................... 13 #11 - Spinal Cord Injuries ............................................................. 13 #12 - Thoracic Injuries .................................................................. 13 #13 - Abdominal Injuries ............................................................... 14 #14 - Genitourinary Injuries and Renal Management.................... 14 #15 - Musculoskeletal Injuries....................................................... 14 #16 - Soft Tissue Injuries and Wound Healing.............................. 14 Section 4 – Unique Populations #17 - The Pregnant Trauma Patient.............................................. 15 #18 - Pediatric trauma................................................................... 15 #19 - Trauma in the Elderly........................................................... 15 #20 - Burn Injuries......................................................................... 15 #21 - Substance Abuse and Interpersonal Violence ..................... 15 Presentation Objectives - Indexed ................................................ 16


Presentation Objectives

#1 - Evolution of the Trauma Cycle

• Describe four important points related to the epidemiology of trauma • Discuss trauma system development • Discuss the evolution of trauma nursing in regard to the impact on trauma

system development

#2 - Injury Prevention

• Discuss the history of injury prevention activities • Describe the process for program development • Identify the components of injury prevention evaluation • Discuss ideas for injury prevention activities in one’s own community

#3 -Trauma Rehabilitation

• Provide an operational definition of trauma rehabilitation • Provide an overview of the history of trauma rehabilitation • Define the populations of patients requiring trauma rehabilitation • Discuss current issues in trauma rehabilitation: funding, acceptance of

disabled, trauma prevention • Review the role of the trauma rehabilitation nurse • Understand components of the rehabilitation team • Demonstrate awareness of factors influencing rehabilitation potential • Describe the differences in rehabilitation settings: inpatient, outpatient,

and residential/home-based • Discuss the differences in approach to rehabilitation across the continuum

of care #4 - Mechanism of Injury

• Describe the risk of injury • Understand the effect of injury on society • Understand how knowledge of the mechanism of injury assists in patient

evaluation • Compare blunt trauma injury patterns to penetrating trauma injuries • Describe the incidence of traumatic brain injuries • Describe the incidence of spinal injuries • Describe the biomechanics of fractures and injury patterns


#5 - Shock and Multiple Organ Dysfunction Syndrome

• Identify shock categories and their various presentations in the trauma patient

• Describe phases of shock state regardless of pathology • Recognize compensatory changes in hemorrhage • Discuss defects in cellular signaling leading to SIRS and MODS and their

management in trauma • Summarize interventions that positively influence resuscitation outcomes

#6 - Initial Management of Traumatic Shock

• Define shock • Discuss types of shock • Describe the four classes of shock & associated clinical signs and

symptoms • Recognize clinical indicators for endpoints of resuscitation • Discuss the components of the trauma resuscitation primary survey and

associated interventions • Prioritize treatment goals in the management of the patient in hypovolemic

(hemorrhagic) shock • List the fluid options for treating volume deficit in the resuscitation phase

#7 – Analgesia, Sedation and Neuromuscular Blockade

• Define pain • Describe mechanisms of pain • Describe physiologic effects of pain • Identify indications for sedation • Identify appropriate agents for pain management and sedation • Describe appropriate nonpharmacologic interventions for pain and

sedation management • Describe the normal physiologic response of the neuromuscular junction • Discuss the indications for neuromuscular blockade in the trauma patient • Explain nursing assessment and monitoring of the chemically paralyzed

patient • Describe assessment of analgesia and sedation in trauma patients

throughout all phases of care • Identify age appropriate pain assessment tools for use throughout the

trauma care continuum • Describe analgesia and sedation considerations in select patient

populations


#8 - Psychosocial Impact of Trauma

• Define crisis • List three critical factors of crisis • Differentiate between family and patient perception of crisis • Discuss post traumatic stress syndrome

#9 - Traumatic Brain Injuries

• Identify the functional anatomy of the brain and how traumatic brain injury (TBI) affects it

• Describe the neurological assessment of the TBI patient • Explain management strategies which reduce the risk of secondary injury

to the brain following TBI #10 - Maxillofacial and Ocular Injuries

• Discuss assessment priorities for a patient with maxillofacial trauma • Prioritize the care of a patient with facial injuries • Discuss psychosocial support for a patient with maxillofacial injuries

#11 - Spinal Cord Injuries

• Define the types of spinal cord injury • Identify the signs and symptoms of acute spinal cord injury • Discuss the systemic sequelae of spinal cord injury through the cycle of

trauma • State the standard medical and nursing modalities for the management of

spinal cord injury #12 - Thoracic Injuries

• Explain the importance of “mechanism of injury” related to thoracic trauma • Identify treatments for thoracic injuries • Discuss the nursing management of patients with thoracic injuries • Develop a plan of care for the patient experiencing a thoracic injury


#13 - Abdominal Injuries

• Describe the mechanisms of injury for abdominal trauma • State appropriate assessment and diagnostic studies for the patient with

abdominal trauma • Discuss various injuries of the abdomen • Describe complications of abdominal trauma • Discuss nursing care and list appropriate interventions for patients with

abdominal trauma through the continuum of care #14 - Genitourinary Injuries and Renal Management

• Describe the mechanisms of injury for genitourinary (GU) trauma • Identify the appropriate physical assessment and diagnostic studies for

ongoing assessment of the GU injured patient • List interventions appropriate during the critical care phase of injury for GU

injured patients • Identify interventions for GU injured patients in the intermediate phase of

care • Differentiate between the pathophysiology of prerenal, intrarenal, and

postrenal failure • Describe the clinical presentation of the patient in acute renal failure and

list treatment strategies • Compare and contrast hemodialysis, peritoneal dialysis, and continuous

renal replacement therapies #15 - Musculoskeletal Injuries

• Review the anatomy of the musculoskeletal system • Discuss the phases of musculoskeletal trauma care: resuscitation,

operative, critical care, and rehabilitation • Describe the classification of musculoskeletal injuries • Discuss the general management principles in caring for musculoskeletal

injuries • Discuss complication management principles involving musculoskeletal

trauma #16 - Soft Tissue Injuries and Wound Healing

• Describe soft tissue anatomical structures • Describe the various types of soft tissue injuries • Discuss wound assessment and management considerations from time of

the injury through complete healing of the wound


#17 - The Pregnant Trauma Patient

• Discuss the epidemiology of trauma as it relates to the pregnant woman • Identify physiologic and anatomic changes in pregnancy that affect

maternal assessment after traumatic injury • Describe key elements in the clinical management of the pregnant trauma

patient from the resuscitation phase through rehabilitation #18 - Pediatric trauma

• Explain unique characteristics related to pediatric trauma care • Describe management considerations for the pediatric trauma patient • Describe assessment strategies in caring for critically injured child

#19 - Trauma in the Elderly

• Analyze factors that increase injury susceptibility and severity in the elderly population

• Describe management strategies that promote optimal trauma care for elderly patients

#20 - Burn Injuries

• Discuss the care of the burn injured patient • Outline major pathophysiologic changes associated with burns • Discuss appropriate medical and nursing management of the patient with

burn injuries #21 - Substance Abuse and Interpersonal Violence

• Describe the epidemiology of substance abuse and injury • Discuss the clinical issues and management involved in caring for patients

with substance abuse • Define intimate partner violence • Discuss the care issues involved in caring for victims of intimate partner

violence


Presentation Objectives - Indexed Topic Presentation Abdominal Injuries ........................................................................ 13 Abdominal Injuries, complications................................................. 13 Abdominal Injuries, interventions .................................................. 13 Abdominal trauma nursing care ................................................... 13 Abdominal trauma, assessment and diagnostic studies for ......... 13 Abdominal trauma, mechanisms of injury .................................... 13 Acute renal failure clinical presentation and treatment strategies . 14 Acute spinal cord injury, signs and symptoms .............................. 11 Age appropriate pain assessment .................................................. 7 Agents for pain management and sedation .................................... 7 Analgesia assessment and considerations ..................................... 7 Anatomic changes in pregnancy after traumatic injury.................. 17 Anatomy of the musculoskeletal system....................................... 15 Assessment and diagnostic studies for abdominal trauma ........... 13 Assessment and monitoring of the chemically paralyzed patient.... 7 Assessment of analgesia and sedation .......................................... 7 Assessment of the TBI patient, neurological................................... 9 Assessment priorities, maxillofacial trauma .................................. 10 Assessment, Genitourinary (GU) trauma ...................................... 14 Assessment, pediatric trauma ...................................................... 18 Biomechanics of fractures and injury patterns ............................... 4 Blunt trauma injury patterns ........................................................... 4 Brain, functional anatomy and how ................................................ 9 Burn injuries, medical and nursing management ......................... 20 Burn injuries, pathophysiologic changes....................................... 20 Burn injury care............................................................................. 20 Cellular signaling defects leading to SIRS and MODS ................... 5 Chemically paralyzed patient, assessment and monitoring ............ 7 Classification of musculoskeletal injuries ...................................... 15 Clinical indicators for endpoints of resuscitation ............................. 6 Clinical management of the pregnant trauma patient ................... 17 Clinical signs and symptoms, shock ............................................... 6 Community activities, injury prevention........................................... 2 Complication management, musculoskeletal trauma.................... 15 Complications of abdominal trauma.............................................. 13 Continuous renal replacement therapies ...................................... 14 Crisis perception, differences between family and patient .............. 8 Crisis, critical factors ....................................................................... 8


Crisis, definition............................................................................... 8 Diagnostic studies, Genitourinary (GU) trauma ............................ 14 Elderly patients, injury susceptibility and severity ........................ 19 Elderly patients, trauma management strategies ......................... 19 Epidemiology of substance abuse and injury................................ 21 Epidemiology of trauma regards pregnancy ................................. 17 Epidemiology of trauma .................................................................. 1 Evaluation, injury prevention........................................................... 2 Evaluation, patient .......................................................................... 4 Evolution of the Trauma Cycle....................................................................1 Evolution of trauma nursing ............................................................ 1 Facial injuries, prioritization of care............................................... 10 Fluid options for treating volume deficit in the resuscitation phase . 6 Genitourinary (GU) trauma, diagnostic studies ............................ 14 Genitourinary (GU) trauma, interventions ..................................... 14 Genitourinary (GU) trauma, mechanisms of injury ........................ 14 Genitourinary (GU) trauma, physical assessment ....................... 14 Hemodialysis therapies................................................................. 14 Hemorrhage, compensatory changes ............................................. 5 History of injury prevention ............................................................. 2 History of trauma rehabilitation ....................................................... 3 Hypovolemic (hemorrhagic) shock, treatment goals ....................... 6 Indications for sedation ................................................................... 7 Injuries of the abdomen ................................................................ 13 Injury prevention activities, history .................................................. 2 Injury prevention evaluation ............................................................ 2 Injury Prevention............................................................................. 2 Injury risk ........................................................................................ 4 Injury susceptibility and severity in the elderly population............. 19 Interventions, Genitourinary (GU) trauma ..................................... 14 Intimate partner violence............................................................... 21 Intrarenal failure pathophysiology ................................................. 14 Management considerations for the pediatric trauma patient ....... 18 Maxillofacial injuries, Psychosocial support .................................. 10 Maxillofacial trauma assessment priorities ................................... 10 Mechanism of injury for thoracic trauma ....................................... 12 Mechanism of injury ........................................................................ 4 Mechanisms of injury for abdominal trauma ................................. 13 Mechanisms of injury for genitourinary (GU) trauma..................... 14 Mechanisms of pain ........................................................................ 7


Musculoskeletal injury classification.............................................. 15 Musculoskeletal injury management principles............................. 15 Musculoskeletal system anatomy ................................................. 15 Musculoskeletal trauma care phases............................................ 15 Musculoskeletal trauma, complication management..................... 15 Neurological assessment of the TBI patient.................................... 9 Neuromuscular blockade in the trauma patient............................... 7 Neuromuscular junction physiologic response................................ 7 Nonpharmacologic interventions for pain/sedation mgt .................. 7 Nursing care, abdominal trauma .................................................. 13 Nursing management of thoracic injuries...................................... 12 Nursing, Trauma ............................................................................. 1 Pain assessment, age appropriate.................................................. 7 Pain management and sedation agents.......................................... 7 Pain, definition ................................................................................ 7 Pain, mechanisms........................................................................... 7 Pain, physiologic effects ................................................................. 7 Pathophysiologic changes associated with burns......................... 20 Pathophysiology of prerenal, intrarenal, and postrenal failure ...... 14 Patient evaluation ........................................................................... 4 Pediatric trauma assessment ....................................................... 18 Pediatric trauma care.................................................................... 18 Penetrating trauma injuries ............................................................. 4 Peritoneal dialysis therapies ......................................................... 14 Phases of shock ............................................................................. 5 Physiologic changes in pregnancy after traumatic injury .............. 17 Physiologic effects of pain .............................................................. 7 Physiologic response of the neuromuscular junction ...................... 7 Plan of care development for thoracic injury ................................. 12 Populations of patients requiring trauma rehabilitation ................... 3 Post traumatic stress syndrome...................................................... 8 Postrenal failure pathophysiology ................................................. 14 Pregnant Trauma Patients ............................................................ 17 Prerenal failure pathophysiology................................................... 14 Prevention, Injury ............................................................................ 2 Prioritization of care, facial injuries................................................ 10 Program development, injury prevention ........................................ 2 Psychosocial support, maxillofacial injuries .................................. 10 Rehabilitation nurse role ................................................................. 3 Rehabilitation populations............................................................... 3 Rehabilitation potential factors........................................................ 3 Rehabilitation settings..................................................................... 3 Rehabilitation team ......................................................................... 3


Rehabilitation, current issues.......................................................... 3 Rehabilitation, trauma..................................................................... 3 Resuscitation primary survey and associated interventions............ 6 Resuscitation, Clinical indicators for endpoints............................... 6 Risk of injury .................................................................................. 4 Risk reduction of secondary injury to the brain following TBI.......... 9 Sedation assessment and considerations....................................... 7 Sedation indications........................................................................ 7 Shock categories and presentations .............................................. 5 Shock interventions ........................................................................ 5 Shock, classes & associated ......................................................... 6 Shock, clinical signs and symptoms................................................ 6 Shock, definition.............................................................................. 6 Shock, types ................................................................................... 6 Soft tissue anatomical structures .................................................. 16 Soft tissue injuries......................................................................... 16 Spinal cord injury, medical and nursing management modalities 11 Spinal cord injury, systemic sequelae .......................................... 11 Spinal cord injury, types................................................................ 11 Spinal injuries, incidence ................................................................ 4 Substance abuse and injury, epidemiology................................... 21 Substance abuse, clinical issues and management ..................... 21 Thoracic injuries treatment............................................................ 12 Thoracic injuries, nursing management ........................................ 12 Thoracic injury, plan of care development .................................... 12 Thoracic trauma, mechanism of injury ......................................... 12 Trauma rehabilitation ...................................................................... 3 Trauma system development.......................................................... 1 Traumatic brain injuries, incidence.................................................. 4 Traumatic brain injury (TBI), affect on brain functional anatomy..... 9 Victims of intimate partner violence .............................................. 21 Violence between intimate partners ............................................. 21 Volume deficit treatment in the resuscitation phase, fluid options... 6 Wound assessment and management ......................................... 16


Bibliography Chapter 2 - Injury Prevention Bonnie, R., Fulco, C., & Liverman, C. (Eds.). (1999). Reducing the Burden of Injury: Advancing Prevention and Treatment. Washington DC: National Academy Press. Christoffel, T., & Gallagher, S. (1999). Injury Prevention and Public Health: Practical Knowledge, Skills, and Strategies. New York: Aspen Publishers. Rivara, F., Cummings, P., Koepsekk, T., Grossman, D., & Maier, R. (Eds.). (2002). Injury Control: Research and Program Evaluation. Cambridge, United Kingdom: The Cambridge University Press. Chapter 5 - Shock and MODS Cheever, K. (1999). Early enteral feeding of patients with multiple trauma. Critical Care Nurse, 19(6), 40-53. Galban, C., Montejo, J., Mesejo, A., Marco, P., Celaya, S., Sanchez-Segura, J., Farre, M., & Bryg, D. (2000). An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Critical Care Medicine, 28(3), 643-8. Morris, P. (2003). Meeting unmet needs in patients with sepsis: the role of drotrecogin alfa (activated. American Journal of Critical Care, 12(2), 94-7. Chapter 6 – Initial Management of Shock Mikhail, J. (1999). Resuscitation endpoints in trauma. AACN Clinical Issues, 10(1), 10-21. Mikhail, J. (1999). The trauma triad of death: Hypothermia, acidosis, coagulopathy. AACN Clinical Issues, 10(1), 85-94. Rosenberg, A. (1999). Blood transfusions. In C. Smith, A. Rosenburg, & C. Grande (Eds.). Massive Transfusion and Control of Hemorrhage in the Trauma Patient [CME curriculum] (pp.27). Baltimore: International Trauma Anesthesia and Critical Care Society.


Smith, C. (1999). Principles of fluid warming. In C. Smith, A. Rosenburg, & C. Grande (Eds.). Massive Transfusion and Control of Hemorrhage in the Trauma Patient [CME curriculum] (pp.30-33). Baltimore: International Trauma Anesthesia and Critical Care Society. Robb, W. (1999). Massive transfusion in trauma. AACN Clinical Issues, 10(1), 69-84. Ziglar, M. (2000). Application of base deficit in resuscitation of trauma patients. International Journal of Trauma Nursing, 6(3):81-84. Chapter 10- Maxillofacial and Ocular injuries Holler, L., Thorton, J., Pazmino, P., & Stal, S. (2003). The management of orbitozygomatic fractures. Plastic and Reconstructive Surgery, 111(7), 2386-2393. Holmes, S., Carter, J., & Metefa, A. (2000). Blunt orbital trauma. British Medical Journal, 321(7263), 750-751. Kim, D., Tawfilis, A., Brne, P., & Moe, K. (2003). Facial trauma, maxillary and LeFort fractures. EMedicine. Retrieved March 29, 2004 from http://www.emedicine.com Morris, W., Osborn, F., & Fleming, J. (2002). Traumatic evulsion of the globe. Ophthalmic Plastic and Reconstructive Surgery, 18(4), 261-267. Richardson, M. (2000). Approaches to Diagnosis in Musculoskeletal Imaging: Facial and Mandibular Fractures. University of Washington School of Medicine. Retrieved March 29, 2004 from http://www.rad.washington.edu/mskbook/facialfx.html Sankar, P., Chen, T., Grosskreutz, C., & Pasquale, L. (2002). Traumatic hyphema. International Ophthalmology Clinics, 42(3), 57-68. Walton, W., Von Hagen, S., Grigorian, R., & Zarbin, M. (2002). Management of traumatic hyphema. Survey of Ophthalmology. 47(4), 297-234. Chapter 16 - Soft Tissue Injuries and Wound Healing American College of Surgeons. (1997). Advanced trauma life support for doctors – Student course manual. Chicago, IL: American College of Surgeons. Bledsoe, B., Porter, R., & Cherry, R. (2003). Essentials of paramedic care. Upper Saddle River, NJ: Prentice Hall.


Ferguson, A. (2002). Traumatic wounds. Trauma.org. Retrieved March 29, 2004 from http://www.trauma.org/nurse/wound.html McCaig, L., & Ly, N. (2002). National hospital ambulatory medical care survey: 2000 emergency department summary: Advanced data from vital and health statistics; no. 326. National Center for Health Statistics. Retrieved March 29, 2004 from http://www.cdc.gov/nchs/data/ad/ad326.pdf US National Library of Medicine, & National Institutes of Health. (2001). Skin graft. Medlineplus Health Information. Retrieved March 29, 2004 from http://www.nlm.nih.gov/medlineplus/ency/article/002982.htm Sadler, D. (1999). Forensic medicine course lecture notes. University of Dundee. Retrieved March 29, 2004 from http://www.dundee.ac.uk/forensicmedicine/llb/woundsdws.htm Chapter 19 - Trauma in the Elderly Battistell, F., Din, A., & Perez, L. (1998). Trauma patients 75 years and older: long-term follow-up results justify aggressive management. The Journal of Trauma, 44(4), 618-624.

Bird, P., Harrington, D., Barillo, D., McSweeney, A., Shirani, K., & Goodwin, C. (1998). Elder abuse: a call to action. Journal of Burn Care & Rehabilitation, 19(6), 522-527. Chakravarty, M., & Sorman, A. (2001). Guidelines for prevention of falls in people over 65. Health improvement plans must incorporate falls and osteoporosis strategies. British Medical Journal, 322(7285), 554-555.

Davis, J., & Kaups, K.. (1998). Base deficit in the elderly: a marker of severe injury and death. Journal of Trauma-Injury, Infection & Critical Care, 45(5), 873-877. Epstein, S. (2000). Postmenopausal osteoporosis: fracture consequences and treatment efficacy vary by skeletal site. Aging, 12(5), 330-341. Ferrera, P., & Bartfield, J. (1999). Outcomes of anticoagulated trauma patients. American Journal of Emergency Medicine, 17(2), 154-156. Gregg, E., Cauley, J., Seeley, D., Ensrud, K., & Bauer, D. (1998). Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Annals of Internal Medicine, 129(2), 81-88.


Heruti, R., Lusky, A., Barell, V., Ohry, A., & Adunsky, A. (1999). Cognitive status at admission: Does it affect the rehabilitation outcome of elderly patients with hip fracture? Archives of Physical Medicine and Rehabilitation, 80(4), 432-436. Horan, M., & Clague, J. (1999). Injury in the aging: Recovery and rehabilitation. British Medical Bulletin, 55(4), 895-909. McGwin, G., May, A., Melton, S., Reiff, D., & Rue, L. (2001). Recurrent trauma in elderly patients. Archives of Surgery, 136(2), 197-203.

McGwin, G., Melton, S., May, A., & Rue, L. (2000). Long-term survival in the elderly after trauma. Journal of Trauma-Injury, Infection & Critical Care, 49, 470-476.

Nagy, K., Smith, R., Roberts, R., Joseph, K., An, G., Bokhari, F., & Barrett, J. (2000). Prognosis of penetrating trauma in elderly patients: A comparison with younger patients. Journal of Trauma-Injury, Infection & Critical Care, 49, 190-194.

Pickering, S., Esberger, D., & Moran, C. (1999). The outcome following major trauma in the elderly. Predictors of survival. Injury, 30(10), 703-706.

Ritchie, P., Cameron, P., Ugoni, A., & Kaye, A. (2000). A study of the functional outcome and mortality in elderly patients with head injuries. Journal of Clinical Neuroscience, 74(4), 301-304.

Rzepka, S., Malangoni, M., & Rimm, A. (2001). Geriatric trauma hospitalization in the United States: A population-based study. Journal of Clinical Epidemiology, 54(6), 627-633. Tornetta, P., Mostafavi, H., Riina, J, Turen, C., Reimer, B., Levine, R., Behrens, F., Geller, J., Ritter, C., & Homel, M. (1999). Morbidity and mortality in elderly trauma patients. The Journal of Trauma-Injury Infection and Critical Care, 46(4), 702-706.

Trunkey, D., Cahn, R., Lenfesty, B., & Mullins, R. (2000). Management of the geriatric trauma patient at risk of death: Therapy withdrawal decision making. Archives of Surgery,135(1), 34-38.

Wardle, T. (1999). Co-morbid factors in trauma patients. British Medical Bulletin, 5(4), 744-56.

table of contents - trauma nurses · donna has spent all 21 years of her nursing career in trauma...

Documents