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Optimising the Road Traffic Accident
L. Dodd
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Trauma patients most often following a road traffic accident are commonly seen in gen- eral practice. However the initial stabilisation of these patients is often difficult and can be associated with high morbidity and mortality rates. trauma patients can deteriorate rapidly and being able to recognize small but vital changes can be fundamental to ensuring a good patient outcome.
Be prepared!
An area should be ready for the patient’s arrival with a examination table and bedding and equipment for; intravenous catheterisation, intravenous fluids, oxygen, crash cart with equipment to deal with any life-threatening situation, monitoring equipment; preferably a multi-parameter monitoring, patient warming etc. ideally this area will be close to a prepared theatre in case emergency surgery is required. the area should be prepared with trained staff to assess and triage the patient on arrival.
Initial patient assessment
On arrival the patient should be promptly examined to prioritisation and triage each body system (aBC nursing). the aim of this initial assessment is to identify any emergent conditions that require immediate treatment so appropriate treatment can be initiated. the assessment is quick taking approximately a minute to assess;
Patient assessment- ABC nursing
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a = airway; note any sounds generated from the airway
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Does my patient have an airway?
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B = breathing; rate, pattern, auscultate the chest bilaterally (lung sounds should be auscultated before heart sounds) and bleeding (internal and external)
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is my patient breathing? Can my patient ventilate adequately?
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C = cardiovascular and level of consciousness
Does my patient have a pulse? What is my patient’s cardiovascular status? Life threatening injuries are identified and treatment is prioritised
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