Facilitators Manual - Emergency Care Institute

FACILITATORs’ Manual Transition to Emergency Nursing3.9 TRAUMAACTIVITY 43Discuss with participant.Complete the table below by discussing how blood loss in each body area may be identifiedand what interventions/definitive care would be required to STOP the bleeding.Region ofblood loss How to identify bleeding Intervention/management24ThoraxClinical assessment:Decreased symmetryIncreased work of breathingDecreased air entrySigns of shock:• tachycardia,• hypotension,• cool,• diaphoretic,• prolonged capillary refillCXR:Blood will pool posteriorly in the supine patient, leading toa ‘white out’ or water density within the affected lung. Thelung and cardiac border will merge together, obscuring thecardiac border.In the erect-positioned patient, the affected haemothoraxwill demonstrate a ‘fluid level’ and blunting of thecostophrenic angle as fluid will pool at the base of the lung.CT scan can be performed• Oxygen• IV access• Bloods including X-match, Group & hold• Chest drain• Fluid replacement and treatment ofshock• Ongoing clinical assessmentAbdomenClinical assessment:HypotensionTachycardiaAbdominal distentionBruisingPainRigidityGuardingInvestigations:FAST scan positiveDiagnostic Peritoneal LavageCT scan• IV access• Bloods including X-match, Group & hold• Fluid replacement as required• +/- surgical interventionRetroperitoneumHypotensionTachycardia# pelvis and haemodynamic instability – consider bloodin retroperitoneum• IV access• Bloods including X-match, Group & hold• Fluid replacement as required• Splinting of pelvis with sheet if pelvic # issuspected• Embolisation +/fixation if unstablepelvic #Table continued next page