There is no recipe for trauma.
Sometimes questionable decision-making is a key ingredient. Other times, happenstance is the star of the dish.
Regardless of the mechanism of injury, University of Chicago Medicine Aeromedical Network flight nurse Teri Campbell cautions against becoming distracted by its novelty.
“You’re always going to start with your primary survey, and you don’t move on until you secure your primary survey,” she said. “So, he could have legs that are on backwards. He could have legs coming out of his ear. He could have all kinds of really cool, distracting stuff. Airway, breathing, circulation, disability, exposure — we take care of that first and then we move on.”
During her session yesterday, The Mixology of Traumatology, Campbell walked through the decision-making process for cases handled by UCAN with “mixology differentials” that made it challenging to pinpoint all the injuries they faced.
In the case of a 54-year-old man hit by a vehicle while he was walking in the dark, the flight nurses involved in his air transport considered the possibilities of a spinal cord injury, neurogenic shock, hypovolemic shock and a closed head injury before a key symptom manifested as they offloaded the patient and began chest compressions.
Multiple viewers commented in the live chat that it must be a spinal cord injury.
Indeed, the injured pedestrian had an internal decapitation, which involves either a separation or stretching of the ligaments that keep the head on top of the spinal column.
“Anyone who survives that should buy a lotto ticket!” wrote Lissa Perez in the chat.
Campbell responded: “Anyone that survives an internal decapitation, already won the lottery.”
Between 75 and 85 percent of patients with internal decapitation die at the scene, she noted.
“There are some patients that survive this and have zero neuro deficits, but if you look at the literature, there’s usually a variable amount of severe neurologic deficits, the worst of course being para- or tetraplegia,” she said.
Campbell also used cases involving geriatric and pediatric patients to outline unique considerations for these subgroups.
In one case, a 14-year-old boy was ejected from a motorcycle he was driving while intoxicated during a high-speed chase with the police. Based on age, he was a child, but at 75 kg, his frame was comparable to an adult. Ultimately, he was treated as a pediatric patient.
“Keep in mind your specialty population considerations — your pediatric patients, their compensatory mechanisms; your elderly patients, their limited compensatory mechanisms,” Campbell said. “Keep that all in mind.”
For example, in younger patients, systolic blood pressure should be at least 90, while older patients should have a systolic blood pressure of close to 110 to continue to perfuse their vital organs, Campbell said.
The inverse applies to heart rate.
“There was a large study that was done in 2010 on traumatic injuries for senior citizens, and what we found is that patients that had a significant increase in heart rate of greater than 90 for a significant period of time had a huge slope, a huge increase in mortality,” Campbell explained. “This does not hold up for our younger patients until younger patients have that same sustained increase of heart rate over 130.”
EN21 session recordings will be available for on-demand viewing on the Emergency Nursing 2021 meeting platform through Jan. 31.