Pre-Hospital Setting Nursing Management

This report analyzes the pre-hospital nursing management of three trauma victims using the ABCDE approach. It examines the assessment and treatment strategies for each casualty, including airway, breathing, circulation, disability, and exposure. The report highlights the importance of evidence-based practice and multidisciplinary teamwork in providing optimal care to trauma patients.

PRE-HOSPITAL SETTING-
NURSING MANAGEMENT

TABLE OF CONTENTS
DISCUSSION..................................................................................................................................1
CASUALTY 3 ................................................................................................................................1
CASUALTY 1.................................................................................................................................3
CASUALTY 2 ................................................................................................................................4
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................8

DISCUSSION
CASUALTY 3
The third casualty on accident site is an old man who is aged 60. This casualty is
discussed at first because due to penetration of metallic piece he has been experiencing active
bleeding in the region. His condition need to be managed to control the severity of the situation.
For his assessment nurses make following analysis:
Airway:
This assessment is the first and prior in the ABCDE approach. Nurses monitor that the
man is sobbing and his breathing sounds can be heard so airways of victim are not obstructed.
However, with increasing pain if swelling is and vomiting occurs then nurses provides first aid
treatment for airway obstruction.
Airway treatment: If nurses observe that breathing sounds are not proper along with
asymmetrical expansion of abdomen and chest then they ensure to give proper supply of oxygen.
Suction can also be provided. And gradually and carefully he is shifted into lateral position. The
delay in airway treatment can lead to organ damage and cardiac arrest.
Breathing:
The accident and bleeding has caused the increased heart rate of the patient. He is highly
sweating thus is suffering from diaphoretic condition. The panic situation is making it difficult
for him to breathe. The respiratory rate of the victim is 28 which is very high. It indicates that his
condition is deteriorating. Nurses use pulse oximeter for measuring the peripheral saturation of
oxygen. It must be in the range 94-98 percent. The various gases such as oxygen, carbon dioxide
and PH are also measured so that breathing issues can be controlled.
Treatment for breathing: The patient must be provided emotional condolence so that his anxiety
can be regulated and he can breathe easily. Usually upright position can help patient but for the
given casualty due to metallic penetration it may be difficult.
Circulation:
The shocking stage of the old man can cause difficulties in circulation. Nurses measures
heart rate and blood pressure for the assessment. The heart rate is very high. The metallic
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penetration in groin is causing blood flow. The urine output is also reduced so it is also
monitored. For preventing the blood loss nurses immediately cover it with bandage. On the basis
of blood flow, it can be changed. To give more relief to the patient cold compress can also be
effective approach used by the nurses. For measuring circulation capillary refill time and the
temperature of patient is also used.
Circulation treatments: Due to active blood flow fluid replacement is preferred by the nurses.
For efficient administration of emergency fluids, the victim must have intravenous cannula. For
maintaining the continuous circulation tissue perfusion is also restored and blood pressure, heart
rate as well as haemorrhage are maintained.
Disability:
This assessment is used by the nurses to analyse the neurological functionality of the
patient. The consciousness, pain level is used as critical criteria. The man is sobbing with the
pain and trauma. For managing such situations, the nurses first try to give emotional support to
the patient so that its anxiety and stress can be minimised (Mellor & et.al., 2016). The man is
awake and is crying in pain which means that he is conscious and responsive. Blood glucose
level, size of pupil and Glasgow coma scale can also be used to analyse the consciousness if the
man does not remain awake.
Treatment strategies after disability assessment: After the assessment of aiways, breathing
patterns and circulation nurses regularly check and ensure that hypotension and hypoxia are not
introduced and are eliminated. Lateral position will avoid the risk of airway if patient become
unconscious.
Exposure: The metallic piece has been penetrated in groin region. It can lead to severe damage
to the genitals (McIntosh & Mok, 2017). Depending on the depth of penetration there is
possibility that urethra can also be damaged. The pelvis bones are also analysed by the nurses in
such situations because the sharp objects like metal piece may have injured the region between
perineum and genitals. The damaged urethra can make it difficult to pass urine and blood traces
can also be observed at the genitals opening.
Treatment for exposure: It is essential to remove metallic piece from the body thus health care
providers may also perform immediate surgery to avoid excessive blood loss and infections. The
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nurses remove the clothes covering wound carefully and precautions are also taken in order to
avoid cross infections (Giannoudis & Pape, 2017).
CASUALTY 1
ASSESSMENT
Mechanism
The age of the lady was said to be 35. It has been analysed that the female was travelling
in car on NSW main road at an unknown speed. She was seating in front of the car and was
wearing seat belt. After, sometime the vehicle became unhandled and collided with the concrete
wall. Three person were travelling in the car and has suffered various injuries.
Injuries suffered
After, meeting with accident lady was found to be semi-conscious and has suffered
wound which are deep to bone. Slow ooze of blood was also flown from her body but she was
alert to the voice of other people. It was noted that the female was suffering from shortness in
breath because of pain and bruising in chest.
Sign and symptom
Patient is facing shortness in breath and pain, bruising in chest plus abdomen. Medical
history of service user has interpreted her ECG findings on 115 breathe per minute. This means
that the lady is suffering from problem of fast heart rate. It means that her body is trying to
balance cardiac output and the reduction is pre-loaded. Blood pressure of service user has been
analysed at 100/67 mm that reveals the patient has low BP.
This can be because of the reason that bleeding has reduced pre-load resulting in loosing
intravascular volume. Respiratory rate of lady is being noted at 30 bpm which is considered as
quite low. It has analysed that after accident, she has been suffering from shortness in breath.
Pain or bruising to chest can be because of forceful blow to cheat during car injury (Fleisher &
et.al., (2014). It can hurt heart, blood vessel, airway, liver or the spleen. Common signs which
can be seen after this includes high fever, shortness in breath, and mucus from lungs. For curing
this nurses can also make use of evidence based practice in order to improve the patient outcome
as well as their quality of service.
Treatment
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Health-care professionals can assess the condition of patient by using ABCDE approach.
It is based on mainly five stages which are airway, breathing, circulation, disability, exposure to
treat service users (Nishimura & et.al., (2014).
Airway
Airway includes looking at the vital signs of patients which are the reason behind obstruction in
breath as symptoms like this can damage kidney, heart and brain. Untreated airway emergency
can lead to hypoxaemia which may also result into death. For improving service user condition at
this stage health-care professional can provide lady with high concentration oxygen mask.
Breathing
Breathing includes assessing vital signs of change like 30 bpm is very high. It is a
symptom of severe illness which shows that patient may deteriorate suddenly.
Circulation
Circulation can be measured by nurses by looking at the hands of service user. Medical
chart shows that the lady has lost blood while meeting through accident. If the flow remains
continuous it can lead to making service user conditions severe and also cardiac related problem
can arise in her. This can also result in heart failure. Low blood pressure in lady can raise issues
like hypoxia which can make female extremely weak and unconscious. Health-care providers
can treat it by providing her with proper medications.
Disability
After, suffering from these chronic problems patient may suffer from various disability
problems like permanent or temporary impairment, stress, depression or ongoing grief.
Exposure
Exposure of service user includes analysing the patient condition after ABCDE approach.
It also consists of evaluating whether outcome is positive or negative. Treatment can be also
provided by keenly observing the vital signs of changes in patients. Health-care professionals can
better understand the service user by monitoring and listening to her needs and requirements.
They can also make use of evidence based practice which involves multidisciplinary team like
physicians, psychiatrist, dietician, physicians who can support in improving condition of lady.
CASUALTY 2
The 55-year man has been ejected from the car and is laying in ditch. For the second casualty the
evaluation and treatment approaches are as follows:
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Airway:
The movement of abdomen and paradoxical chest is normal so the man is not having
airway obstruction. He is also lying in an open area and breathing sounds are clear so he does not
have signs of airway obstruction.
Treatment after airways assessment: Though there are no signs of obstruction of air passage
path but for precaution nurses put the patient into lateral position. But as his knees and upper
thighs are swollen the movement is made carefully. On requirement of providing clear airway
suction can be given.
Breathing: The respiratory rate is regularly monitored. It is also possible that he may find
difficulty in breathing. In such instances cardiopulmonary resuscitation (CPR) is also provided to
the patient. The patient is not sweating and his respiratory rate is also higher. It can be due to the
shock and pain. Nurses regularly monitor the breathing rhythm so that if patient feel difficulty in
breathing immediate treatment can be provided to him. Air entry is also assessed to ensure that
wheezing, crackles and other abnormal sounds during breathing are not present.
Treatment: Although during inspection breathing difficulties are not observed. But if required
oxygen supply can be given to the victim.
Circulation: It is essential to monitor that victim is not having blood losses. The ditch area can
cause severe infection by interacting with blood. It is also evaluated that if person is not
bleeding (Simpson, 2018). The immobilisation of the injured area is also considered essential by
the nurses. This approach is useful to prevent the movement of sharp bone edges into other
muscles and blood vessels. It will hinder the blood circulation. The forceful attempts of make
dislocations back into the position are not made.
Circulation Treatment: If bleeding instances are observed then, bleeding is controlled by the
nurses via sterile bandage. The skin temperature, blood pressure, CRT and heart rate are
continuously monitored by the nurses. It may also require medicines to control these parameters.
Disability:
The higher level of pain is and strain is also causing the heart rate to increased. The most
important method for this type of incidents is that nurses try to ensure that due to pain and panic
attacks the victim does not make movement of legs. It could create more pain. There are
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possibilities that the victim may have heard about the bone snapping. So on finding the victim in
conscious state nurses ask them questions to provide better medication. The deformation of leg
may also be the result of thigh-bone break. The deformation can also cause damage to nerves or
muscles.
Treatment of disabilities: In order to analyse the severity of the leg injury nurses also feel the
affected area gradually. It provides them idea regarding the length of bone. To treat the swelling
ice packs nurses can also use ice packs. It will relieve patient and will help him to stay stable
(Dauwe & et.al., 2017).
Exposure:
The sudden collision of the car with the wall caused the man to hit out of the car. It has
led to muscular tear or damage to tendons. The jumping event established strain over thigh
muscles (Liu & et.al.2016). Due to this reason the thighs are swollen and deformation of leg has
occurred. Thigh bruise also make it difficult to move the legs and to lift the knees of victim.
Treatment: The nurses wrap legs of patient in the position of bent-knee. Nurses use this
approach to minimise the stiffness in the muscles. It will enable quick recovery during treatment.
It is important that during this time the patient does not make movement until primary nursing
care is not provided to him. The forceful movement may expand the bruise and calcium deposits
in the muscles can lead to hard lump. The pain relief medicine can provide comfort to the patient
but nurses try to avoid anti-inflammatory nonsteroidal medicines. The patient is above 50-year-
old and these medicines can cause stomach bleeding and other health effects in this age.
CONCLUSION
From the entire assignment it has been interpreted that health-care professionals are
firstly required to take a 360 degree walk, as there are so many cases of trauma. Then, they
should assess those patients who are severely injured. They can make use of ABCDE method in
order to diagnose the service users after accident. Report consists of pathophysiology related to
the casualties which has been occurred. It shows how airway can support carers in analysing the
vital signs of changes after accident. To overcome this health-care provider can impart them with
operational mask to breathe properly. It also shows that how these conditions can lead to further
problems which includes cardiac arrest, hypotension, liver and brain damage. In future death can
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also be occurred due to these problems. This method supports carers in providing the best care to
patients in order to improve their condition.
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REFERENCES
Books and Journals
Dauwe, J., Verhulst, K., Metsemakers, W. J., & Nijs, S. (2017). Conservative treatment of a
chronic Morel-Lavallée lesion: a case report. BioMedicine and Surgery. 1(3). 144-147.
Fleisher, L. A. & et.al., (2014). ACC/AHA guideline on perioperative cardiovascular evaluation
and management of patients undergoing noncardiac surgery: a report of the American
College of Cardiology/American Heart Association Task Force on Practice
Guidelines. Journal of the American College of Cardiology, 64(22).
Giannoudis, P.V. & Pape, H.C., (2017). Principles of Damage Control for Pelvic Ring Injuries.
In Damage Control Management in the Polytrauma Patient (pp. 219-232). Springer,
Cham.
Liu, S., Yin, Z., & et.al., (2016). Underbelly injury based identification of the driver in a three-
rider motorcycle accident. Legal Medicine. 18. pp.20-24.
McIntosh, N. & Mok, J.Y., (2017). A Comparison of Accidental & Abusive Ano‐Genital Injury
in Children. Child abuse review.26(3).pp.230-244.
Mellor, R., Grimaldi, A., & et.al., (2016). Exercise & load modification versus corticosteroid
injection versus ‘wait & see’for persistent gluteus medius/minimus tendinopathy (the
LEAP trial): a protocol for a r&omised clinical trial. BMC musculoskeletal
disorders. 17(1). p.196.
Nishimura, R. A. & et.al., (2014). 2014 AHA/ACC guideline for the management of patients
with valvular heart disease: a report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines. Journal of the American College of
Cardiology.63(22). e57-e185.
Piepoli, M. F. & et.al., (2014). Secondary prevention in the clinical management of patients with
cardiovascular diseases. Core components, standards and outcome measures for referral
and delivery: a policy statement from the cardiac rehabilitation section of the European
Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee
for Practice Guidelines of the European Society of Cardiology. European journal of
preventive cardiology.21(6). 664-681.
Simpson, C., 2018. Non-accidental injury and neglect.Essential Human Development, p.271.
Online
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The ABCDE approach. (2017). [ONLINE] Available through:
<https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/>
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