The document summarizes the student's observation of the trauma center at Abilene Regional Hospital. It describes various medical cases seen including abdominal pain, chest pain, and injuries from an automobile accident. It discusses the goals of triage in the trauma center to prioritize patients based on need. It also outlines safety guidelines followed in the trauma center including security protocols and monitoring systems. Finally, it describes the critical role of trauma nurses in providing fast, knowledgeable care under stressful conditions to stabilize patients and prevent further health deterioration.

1. Running head: THE TRAUMA CENTER OBSERVATION Adegoju 1
The Trauma Center Observation
Patty Hanks Shelton School of Nursing
Brandi Rougeux. RN, MSN
Sijuwade Adegoju.
Nursing Process IV 4561A
February 4th, 2015

2. THE TRAUMA CENTER OBSERVATION Adegoju 2
On February 4th,2015 I had the privilege of observing different critical and acute health
cases in the emergency room of Abilene Regional Hospital. The trauma center team attends to
patients that are having episodes of pain or changes in level of consciousness due to their health
status or an accident. My experience varies from abdominal pain to chest pain, rectal bleeding,
cardiac problems, respiratory acidosis and automobile accident injuries. The goal of the trauma
center is to provide urgent lifesaving care during the rapid change in health status resulting from
the patient’s health problems... The components of the trauma center include triage, transfer and
injury prevention. Of course, these are important issues in the medical field. Green (2011)
followed a study by Considine and McGillvray (2010) showing that "improvements in stroke
patients’ care could be achieved through use of evidence-based guidelines focused on specific
nursing interventions" provided in a timely manner from the time the patient is admitted to the
time the patient is discharged (p.15). The treatment received in the first hour at the emergency
room determined the mortality rate. I studied electrocardiograph strips that are displayed on the
wall, showing interventions before and after treatment of several patients to show how crucial
emergent care is.
Triage Protocol
Triage protocol is an important separation of patients to decide which patient needs to be
attended to first. There are usually three categories. The most critical patients need medical
attention right away otherwise they will die. The other patients are stable but need minimum and
maximum medical intervention to improve their health conditions. The trauma nurse needs to do
thorough assessment to accurately determine who to treat first. Therefore accurate vital signs
such as blood pressure, respirations, pulse, and temperature are essential. This is followed by a
complete head to toe assessment and obtaining medication history and allergies. The mnemonic

3. THE TRAUMA CENTER OBSERVATION Adegoju 3
CSCATTT “stands for command, safety, communication, assessment, triage, treatment and
transport. On activation of a major incident plan, these elements must be in place to provide a
structured response and will be relevant in both the pre-hospital setting and various clinical areas
in the hospital” (Carter 2014).
Safety guideline and practices in Trauma center:
There are five main safety guideline in a trauma center that ensures a controlled and safe
area for the patient, visitor and hospital employee. The emergency unit has security that is
assigned to make rounds, monitor and intervene in case of any case with possible verbal and
physical abuse. The emergency center makes provision for prisoner by providing a prisoner
security area. Also, for patients with history of psychiatric diagnosis mental problems revealed
by an evaluation there is a special psychiatric room that have all suicidal precaution in place,
such as not plastic bag and cords are permitted in the room. All emergency room have
controlled entry and exits with number code and receptionist to control and provide a safe
environment to maintain therapeutic milieu. Another safety guideline that is followed by the
trauma center is the monitoring or security camera that records all activity in the hallway to
protect patients and caregivers from false accusations or harm. There are different types of
emergency center from level I to V. Level I center have all resources possible, surgeons for all
specialties surgeon, involve in education, research, quality assurance, proximity to community,
and meet annual requirements. Level II may have to refer to the level I for cardiac surgery,
hemodialysis, and micro vascular surgery. Level III has back up and referral agreements with the
level I and II for prompt availability of surgeons. Level IV, has trauma care team that gives
emergency care, and 24 hour laboratories. However, level IV may have to transfer patients that

4. THE TRAUMA CENTER OBSERVATION Adegoju 4
require surgery. Level V just has basic emergency resources but relies on activation of transfer
protocol to level I or II. During transfer, accurate and detailed handoff report must be given to
provider safe care for the patient in an emergency.
"The Critical Hour"
All trauma centers are open for critically ill or injured patients regardless of their age.
They are open 24 hours, 7 days a week and ready to save lives. A heart attack is an example of a
critical case requiring such emergency care. The trauma nurse will be able to recognize early
signs and symptoms of deterioration usually with unstable vital signs, oxygen saturation, and
Electrocardiogram rhythm. A study done and report show that “the mean door-to-EKG time of
11 minutes was dramatically decreased. A mean of 6.1 minutes was achieved during the first 7
months with more than 90% of EKGs completed within the 10 minutes in subsequent months”.
(Cline 2014)Proficient Cardiopulmonary resuscitation with good chest compression can save
lives. The trauma nurse is has a peculiar role because he or she serves as “a cardiac nurse, a
pediatric nurse, a psychiatric nurse, and a trauma nurse." (Workman, 2010 pg.127). Trauma
nurses are well trained and have continuing education in organizing emergency nursing skills
like starting Intravenous access, Basic Cardiac Life Support (BCLS), and Advanced Cardiac Life
Support (ACLS).
Within a little over first 60 minutes we took care of a 58-year-old man with diabetic
ketoacidosis. He came into the hospital because his "glucometer was reading 400 plus." I assisted
the nurse by obtaining vital signs, operating ECG machine, setting up continuous EKG monitor

5. THE TRAUMA CENTER OBSERVATION Adegoju 5
and testing his blood sugar levels. We performed a complete head- to- toe assessment performed.
The patient was alert and oriented to person, places and time. A focused neurological assessment
and diabetic ketoacidosis was performed. The patient complained of a throbbing headache,
which he rated a 7 on a scale of 0 to 10, and nausea and vomiting. The nursing diagnosis was a
fluid volume deficit related to osmotic diuresis resulting from hyperglycemia as evidence by
excessive diluted urination and patient’s complains of nausea and vomiting. Our nursing
priorities were to maintained blood sugar at a normal range and restore fluid and electrolyte
balance. The nurses' intervention was as follows: initiate intravenous access on the right hand
and draw blood to send to a laboratory as soon as possible. I administer insulin subcutaneously
and oral analgesia. The patient was re -evaluation after 30 minutes, and relieved from
medication, but his blood sugar still read "high." The laboratory result stated blood sugar of 694
mm/hg. The emergency room physician notified and ordered the nurse to start of Insulin drip
infusion continued with close monitoring of the patient conditions. Patient was transferred to the
intensive care unit for further assessment and titration of Intravenous Insulin. The outcome of
the evaluation was unobtainable since patient was transferred. The desired outcome was for the
patient to maintain normal blood sugar range, and deny pain and nausea, and find a balance
between fluid intake and output within 24 hours.
The Autonomy of Trauma Nurses.
The trauma nurses are unique because of their ability to be fast, knowledgeable and
able to work under stressful and fast- changing conditions. “They assess, treat and manage every
type of condition in patients of any age, and seek specialist support when they need it, just as
medical staff does. They are provided with indemnity and vicarious liability by their employing

6. THE TRAUMA CENTER OBSERVATION Adegoju 6
trust.” (Swann 2013).The trauma nurse should be self-directed and engaged in patient care and
assessment and conducting diagnostic test in a timely manner. There is a certain doctors’
standing order for care that is to be implemented as soon as possible, such as IV access,
laboratory testing, EKG, ECG, and portable X-rays. The trauma nurse explained, updated and
reassured the patient and family member about the care given. The prioritizing skill of trauma
nurses is important; Maslow’s hierarchy of need should be a guide. The patient with airway,
breathing, circulation problems and other basic needs and should be addressed first. The trauma
nurse and physician will be guided by their assessments. The change in level of consciousness,
infection, shock, sepsis, critical lab report and active bleeding, may call for emergency surgery.
The emergency room has a special room called the trauma room that is well equipped with
lighting and crash cart for adult and pediatric patients, in case intubation is warranted. The
trauma nurse checks the five crash carts at the beginning of the shift so that she does not have to
waiting for one when it is needed, and documents before and after each use. The nurse also
follows up with a supervisor, pharmacist, and central supply department to ensure accurate
replacement of used medication and supplies. The trauma nurse collaborates with the physician’s
orders after a complete assessment. The nurse plan cares and implements it in a timely manner. It
is important to keep close monitor of patient change in condition and re-evaluate the results of
treatment given. The nurse independently documents all care given and maintains patient’s
privacy and confidentiality as safe care is provided.
In conclusion, the trauma nurse plays a great part in preventing deteriorating medical
condition and saving lives. The patient with diabetic ketoacidosis was not in a coma due to high
blood sugar partially because of the incredibly fast nursing intervention received. I was amazed
and felt good about the level of care and knowledge that was provided to the variety of patients’

7. THE TRAUMA CENTER OBSERVATION Adegoju 7
medical conditions. It all required extraordinary organization skills and knowledge. The nurses
there were a great asset for the hospital and they had wonderful skills and were great for
allowing me to practice various skills with different patients.

8. THE TRAUMA CENTER OBSERVATION Adegoju 8
References
Carter, C.. (2014), Managing a major incident in the critical care unit. Nursing Standard. 28, 39 -
44.
Cline, K., Huber, M., Schelhaas, R., Vogelsang, P., Huether, R., & Batterman, T. (2014) Saving
Hearts 1 Minute at a Time: Reducing Emergency Department Door-to-
Electrocardiography Times. Critical Care Nurse, 34, 3-4.
Doenges M. Mary Frances Moorhouse, Alice C .Murr.F.A Davis company . (2013)
Nursing care plans. Guidelines for individuating client care across the life span. 10th ed.
Philadelphia.
Green, T., Kelloway, L., davies-Schinkel. (2011), Nurses’ accountability for stroke quality of
care: Part one: Review of literature on nursing-sensitive patient outcomes. Canadian
Journal of Neuroscience Nursing. 33 (3), 13-21.
Jarvis C. (2014). Physical Examination & Health Assessment (14 th. ed.).
Missouri: Saunders Inc.
Swann, Garry; Chessum, Peter; Fisher, Joanne; Cooke, Matthew.An Autonomous Role in
Emergency Departments.(2013). Emergency Nurse, Vol. 21 Issue 3, p12-15. 4p.
Workman, I., (2012). Medical-Surgical Nursing (8th ed.). Missouri: Saunders Elsevier