Tuesday, December 10, 2024
Today, Keri Bryant, an ER Nurse for 10 years now working at USA freestanding now.
We found out today that the patient was discovered 15 feet from an ATV crash site with a possible spinal cord injury, evidenced by decreased sensation and numbness below the umbilicus. Lung sounds were diminished on the left, and initial oxygen saturation was 89% on room air, with a midline trachea. While en route via life flight, the patient was sedated with succinylcholine and fentanyl pushes. Vital signs upon arrival were blood pressure 110/65, heart rate 120, respiratory rate 24, and oxygen saturation 98% on supplemental oxygen. The patient was following some commands but was alert and oriented only to person (AAOx1).
Upon activation of an Alpha Trauma page, the trauma bay was prepared with a multidisciplinary team, including trauma/surgical attending physicians, trauma residents, ER nurses, respiratory therapists, radiology technicians, and specialists in neurosurgery and orthopedics. The OR reserved a suite in anticipation of further intervention. Upon the patient’s arrival, the South Flight RN provided a comprehensive handoff report, detailing findings from the scene, medications administered, changes in condition during transport, and updated vital signs. The patient was carefully transferred from the carrier to the trauma stretcher to ensure spinal precautions were maintained.
The trauma team initiated a full assessment, led by the attending physician at the head of the bed. A rectal exam confirmed signs of spinal cord injury, and the patient’s airway was secured with a 7.5 ET tube, supported by mechanical ventilation. A needle decompression had been performed in the field due to diminished left lung sounds and signs of a potential pneumothorax. A chest X-ray confirmed left hemothorax, pneumothorax, and rib fractures from the 3rd to 7th ribs. Spinal imaging revealed fractures at T2-T5 and an L1 burst fracture. The patient was log-rolled, maintaining cervical spine precautions, to examine posterior injuries, where step-offs were noted along the thoracic and lumbar spine.
After addressing immediate life-threatening conditions, including placing a chest tube using a 10-blade incision and Kelly clamps to drain the hemothorax, the team worked to stabilize the patient. Consulting services, including neurosurgery and orthopedics, were brought in to establish a plan of care for the spinal injuries. Ideally, the patient would be transferred to the STICU for ongoing management. If no bed was available, the ED nurse would continue care until transfer to the OR or a suitable inpatient unit could occur. This meticulous coordination ensures the best outcomes for critically injured trauma patients.
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