Trauma Week Day Two

December 10, 2024 with ER Nurse

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Today, we continued working on the case of the ATV accident from yesterday. The 17-year-old girl was brought to the hospital by EMS, who provided the following report to the ER team: There were no outward signs of bleeding. The patient’s airway was secured with a 7.5 ET tube, and needle decompression was performed on the left side due to decreased breath sounds and a midline trachea. The patient was placed on a ventilator, and a chest X-ray (CXR) was obtained. A C-collar was in place, and her abdomen was soft with no contusions or abrasions. Her pelvis was stable, and there were no long bone deformities. The patient was log-rolled, maintaining cervical spine precautions, and her posterior surfaces were evaluated. A step-off was noted at T2, T3, T4, T5, and L1. The patient had poor rectal tone and bruising to the left scapula and posterior ribs. After log-rolling the patient to a supine position, the CXR was completed, the ET tube was confirmed, and the patient was prepared for chest tube insertion.

ER Nurse, Keri Bryant, helped teach us and show us about chest tubes. In order to start a chest tube you must first secure the patient's arm with tape or soft restraints above their head, you then palpate to the 4th or 5th space in between a rib, take the Kelly clamp and clamp the hole then take another Kelly clamp and do it to the opposite side, cut with a scapula a small incision then inserting the tub into the patient's chest until you feel the gush of air from the patient. After the tube is placed the doctor will suture the chest tube to the patient's skin to stabilize the tube and to keep it in place. This tube will stay inside the patient until the patient starts breathing on their own.

I also learned about the terms "Alpha" and "Bravo" Trauma Alerts today. These are pages sent out to summon the necessary team members to the trauma bay. For an Alpha Trauma Alert, the following professionals are called in: the Trauma/Surgical Attending MD, Trauma Residents, Trauma/ER Nurses, Respiratory Therapy, Radiology Techs, CT, Neuro Surgery MD, Ortho Resident, and an OR suite is reserved in case surgery is needed. In the case of the 17-year-old girl, this would be considered an Alpha Trauma Alert. This ensures that all the right people are available and ready to assist as needed in an urgent situation.