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Trauma Nursing

1.5 Contact Hours
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Certified Nurse Practitioner, Certified Registered Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Nursing Student, Registered Nurse (RN)
This course will be updated or discontinued on or before Friday, February 20, 2026

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


≥ 92% of participants will have a better understanding of trauma and the different mechanisms of injury that result in trauma, know about primary and secondary surveys, and know how trauma impacts special populations.


After completing this continuing education course, the participant will be able to:

  1. Define trauma and the various mechanisms of injury.
  2. Outline the components of the primary and secondary survey.
  3. Appraise the vast impact that traumatic injuries can have on the healthcare system.
  4. Recall the essential components of the resuscitation efforts of the trauma team.
  5. Describe the critical factors of trauma within special populations of patients.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Trauma Nursing
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Krystle Maynard (DNP, RN, SANE-A)

Introduction to Trauma Nursing

Often used as an umbrella term to describe multiple potential injuries, trauma is quite complex. An accident of some type or act of violence resulting in tissue injury is a general definition of trauma. This tissue injury may produce a cascade of effects impacting the metabolic, immunologic, hormonal, and many other processes within the human body (Dumovich & Singh, 2022). The mechanisms of injury can be a lengthy list, but they generally fall into the following categories (Dumovich & Singh, 2022):

  • Blunt trauma
  • Penetrating trauma
  • Deceleration trauma
  • Thermal Injury
  • Blast trauma
  • Occlusive/Obstructive trauma

Blunt Trauma

A blunt trauma is something hitting or coming into contact with the body and the right speed and angle to cause some form of injury (Dumovich & Singh, 2022). The location(s) and speed of the force will often shed light on the seriousness of the injury.

The most common type of injury in motor vehicle accidents is blunt force trauma. Blunt force trauma injuries are most commonly to the trunk and abdomen, more specifically trauma to the abdominal organs, and can lead to substantial bleeding if left untreated. Blunt trauma may occur in any of the following (Emergency Nurses Association [ENA], 2007):

  • Falls
  • Motor vehicle accidents (MVAs)
  • Assaults
  • Pedestrian injuries

Penetrating Trauma

A penetrating trauma is fairly self-explanatory and is the result of something penetrating the body somewhere (Dumovich & Singh, 2022). Understanding the anatomy and physiology of the human body will help determine the level of injury and potential consequences once the location of the trauma is identified. Hypovolemic shock and, subsequently, death is the worst possible outcome of a penetrating trauma. Penetrating trauma may be classified as low or high velocity and may include (ENA, 2007):

  • Stab wounds
  • Gunshot wounds
  • Explosives

Deceleration Trauma

An injury occurring as a result of a sudden stop in motion is termed a deceleration trauma, with the brain and aorta being common areas of this type of injury (Dumovich & Singh, 2022). For example, in a motor vehicle accident, a passenger may strike their head against the dashboard, causing their brain to hit one side of the skull and may subsequently bounce back and hit the other side of their brain. This type of injury is what is often seen in shaken baby syndrome.


The integumentary system is the largest organ system in the human body. Its functions include temperature regulation, external environmental hazard protection, and sensory perception. Burns are a type of injury often caused by chemicals, heat, electricity, or friction, with more than 60% of burn injuries occurring at home (Weaver & Weavind, 2019). Cooking is a common factor in house fires, and substance use (primarily alcohol) is a primary factor in up to 40% of fire-related deaths (National Fire Protection Association [NFPA], 2023; ENA, 2007).

In the pediatric population, burns are commonly caused by fire, scalding injuries, or contact with hot surfaces or objects. Burns can be classified into the following primary categories (ENA, 2007):

  • Thermal
  • Electrical
  • Radiation
  • Chemical

Occlusive/Obstructive Injury

Occlusive or obstructive injuries are conditions that result in a deficiency in oxygen or gas exchange. Examples of these types of injuries include drowning and strangulation or hanging (ENA, 2007).

Scope of Trauma Nursing

Nursing features a variety of specialty areas; trauma is only one of them. Though different types of trauma can be seen in any area of healthcare and at any facility, the highest rates of traumatic injuries are often encountered within emergency room settings, more specifically, level I trauma centers. As a result, trauma nursing necessitates a specific skill set and knowledge base to deliver optimal nursing care and promote best-case outcomes (Society of Trauma Nurses [STN], 2016). All trauma nurses must have a baseline foundation in understanding injury mechanisms and patterns, patient safety, and evidence-based treatment methods.

Epidemiology of Trauma

Let’s take a look at some national trauma statistics (American Association for the Surgery of Trauma, n.d.; National Highway Traffic Safety Administration [NHTSA], 2023a):

  • For people 45 years of age and younger, trauma is the leading cause of death, and ranks as #4 for all deaths, regardless of age.
  • There are upwards of 40,000 deaths annually as a result of homicide and suicide.
  • According to the National Highway Traffic Safety Administration (2023a), there were more than 42,000 fatalities in motor vehicle crashes in 2022. 

Now, let’s review some global trauma statistics (American Association for the Surgery of Trauma, n.d.):

  • Globally, more than 1 million people are killed annually in motor vehicle crashes, which comes to more than 3,000 people a day.

Common Causes of Trauma

Though trauma is a generalized term used to describe a variety of events and injuries, some of the most common causes may include:

  • Falls
  • Motor vehicle accidents
  • Gunshot wounds
  • Assault
  • Suicide
  • Recreational injuries
  • Pedestrian
  • Motorcycle or bicycle crashes
  • Intimate partner violence
  • Burns

Factors Related to Injury

When considering certain factors that may influence potential mechanisms of injury, age, gender, and substance abuse can be of impact.


The leading cause of injury in adults aged 65 and above is falls (Kakara, 2023). Motor vehicle accidents are named as the leading cause of death in people ages 5-24, whereas poisoning is responsible in ages 25-64 (National Safety Council, 2021; ENA, 2007).


Gender can impact death and injury rates, as it is believed to be a factor in risk-taking behaviors, occupations, and even cultural norms. For example, traumatic brain injuries (TBIs) are by far more common in males across all age groups (ENA, 2007).

According to evidence surrounding falls, males are at an increased risk of dying from a fall, whereas women are more likely to sustain fractures (World Health Organization [WHO], 2021). Hip fractures are three times as prevalent in women (Mayo Clinic, 2022). Men are at a higher risk of dying from accidental ingestion or poisoning. The injury and death rates of interpersonal violence are much higher in women (ENA, 2007).

Substance Abuse

Every single day, roughly about 37 people die in alcohol-related car crashes, just in the United States (National Highway Traffic Safety Administration [NHTSA], 2023b). The impact that tobacco/smoking has on traumatic events is two-fold. On the one hand, the leading cause of fire-related deaths is due to smoking (NFPA, 2019). On the other hand, patients who are smokers are at an increased risk of comorbid conditions that increase their mortality risk when involved in trauma (ENA, 2007). Other illicit substances (such as cocaine, marijuana, etc.) are said to be responsible for many motor vehicle driver deaths (ENA, 2007).


Though it may present itself in different forms, violence is a public health crisis. Violence may come in the form of interpersonal violence, abuse, homicide, and assault. In individuals aged 1-44, homicide is in the top five causes of death related to injuries (Centers for Disease Control and Prevention [CDC], 2023). Other startling statistics include (Okolo, 2024; National Children’s Alliance, 2021; ENA, 2007):

  • More than 500,000 older adults are neglected or victims of some form of abuse annually
  • More than 600,000 children are victims of some form of abuse or maltreatment annually

Trauma Assessment & Triage

Primary Survey

In trauma nursing, the primary survey is our initial assessment to quickly identify and treat life-threatening injuries (Planas et al., 2023).Due to the significant impact that traumatic injuries can cause, the most common causes of death are related to airway issues, hemorrhage, shock, brain injury, and respiratory failure (Planas et al., 2023).

ABCDE is the acronym often used to complete a primary survey, standing for each of the following (Planas et al., 2023):

Airway & Alertness

Healthcare professionals must go back to the basics of nursing and medicine when dealing with trauma: ABCs. Healthcare professionals must first establish if the patient has a patent airway and intervene quickly if it is determined they do not (Planas et al., 2023). Generally, if the patient can talk and seems oriented, they have a patent airway.

If there is suspicion of an airway obstruction, perform a jaw thrust or chin lift to assess. If there is a suspicion of a cervical spinal injury, the jaw thrust is the more appropriate choice. A cervical spinal injury is suspected in any multisystem trauma patient until the patient is determined to be alert and properly assessed or if the cervical spine has been cleared by an x-ray or CT scan (ENA, 2007). If the patient does not have a patent airway, a secure airway will need to be established while keeping the cervical spine immobilized until it has been cleared (Planas et al., 2023).

AVPU is a mnemonic taught in the Trauma Nursing Core Course by the Emergency Nurses Association to help nurses and other healthcare professionals assess for alertness in trauma (ENA, 2007). AVPU stands for (ENA, 2007):

  • A ⇒ Alert ⇒ This patient will be able to manage their airway, most likely.
  • V ⇒ Verbal stimuli responsiveness ⇒ This may require an airway intervention.
  • P ⇒ Painful stimuli response ⇒ This may require an airway intervention.
  • U ⇒ Unresponsive ⇒ This will need to be announced to the team, so healthcare professionals can determine if the patient has a pulse, assess for a cause, and secure an airway and intervene appropriately.

While assessing the patient's alertness and airway, the nurse must also inspect and assess for potential airway-related complications, such as blood in the mouth, obstructions, loose or missing teeth, edema, visible burns, or evidence of a potential inhalation injury (ENA, 2007). When any of these are present, it is best to assume that while the patient may have a patent airway initially, close monitoring will be needed, as that can change at any time (ENA, 2007).

If any of the following occur, consider intubation (ENA, 2007):

  • Periods of gasping or apnea
  • Glascow Coma Scale (GSC) score of less than 8
  • Severe facial fractures
  • Inhalation injuries (this may not signal a concern immediately, but healthcare providers should anticipate the likelihood of edema and loss of airway)
  • Injury to the trachea or larynx, causing a neck hematoma
  • Ineffective oxygenation


Healthcare professionals should first inspect the patient for equal chest rise and fall and assess for signs of tracheal deviation (Planas et al., 2023). Auscultating lung sounds should follow this to assess for abnormalities, such as asymmetric, decreased, or absent lung sounds. Until patients are deemed stable, all trauma patients should be on some form of supplemental oxygen.

Visible or palpable injuries such as flail chest, rib fractures, open chest wounds, and obvious deformities may signify decreased ventilation (ENA, 2007).


Just as all humans require adequate circulation of all vital organs to live, this should be assessed in trauma patients, as something may be compromised. Hemorrhage and, subsequently, shock is the most common cause of death in trauma patients (Planas et al., 2023). Nurses should assess for obvious signs of bleeding and assess pulses, skin color, and patient responsiveness. Always assess for alertness, response to verbal and painful stimuli, or if the patient is unresponsive to any form of stimuli (Planas et al., 2023). Consider a Focused Assessment with Sonography for Trauma (FAST) exam early in the primary survey if bleeding is suspected (ENA, 2007).

If, at any point, pulses become absent, further assess and, if indicated, initiate life-supporting measures, such as Advanced Cardiovascular Life Support (ACLS).

If bleeding is suspected or confirmed, the nurse should insert two large-bore IVs (if unsuccessful, consider a central line or an intraosseous (IO) vascular access), collect a type and screen, and begin resuscitation efforts with intravenous (IV) fluids and blood products. Red blood cells, platelets, and plasma are often utilized together to optimize oxygen delivery within the cells, correct a potential acidosis, prevent coagulopathy, and begin damage control prior to surgery if indicated (ENA, 2007).

Fact: It may take the human body to lose up to 30% of its blood volume before abnormalities are noticed with their vital signs, especially in children(Planas et al., 2023).


Disability is another word for assessing a person's neurological status (Planas et al., 2023). The Glasgow Coma Scale (GCS) is most commonly used to assess neurological status, with airway compromise being highly suspected, with a score of less than 8.

Image 1: Glascow Coma Scale

graphic showing glascow coma scale

The healthcare team should assess for potential causes of an alteration in the level of consciousness (if there is no obvious reason). Until proven otherwise, most traumatic reasons for a decreased level of consciousness are suspected to be due to a head injury, so obtaining a CT scan of the head is often warranted. Other interventions that can be utilized are collecting arterial blood gases (ABGs), checking blood glucose levels, or a toxicology screen. An acid-base imbalance, hypoventilation, hypoglycemia, or substance use can all contribute to a decreased level of consciousness (ENA, 2007).

Exposure & Environmental Control

As you perform the primary assessment, it is normal protocol to undress the patient to assess for injuries fully, but use caution, as there could be sharps, foreign objects, etc.

It is relatively common for trauma patients to experience hypothermia; if this is the case, efforts to warm them should be made (Planas et al., 2023). Nurses can cover the patient in warm blankets, use warming lights or forced warm air warmers (ex. Bair Hugger™), or administer warm IV fluids (ENA, 2007).

Primary Survey Additions

Not all trauma scenarios are created equal, so there may be situations where additional examinations or diagnostics are necessary to complete an initial assessment (Planas et al., 2023). For example (ENA, 2007):

  • Vital signs and family presence: Most trauma centers and emergency departments have someone act as a family liaison (usually a chaplain).
  • Laboratory values: Most protocols have a standard list of labs they order, including ABGs, Complete Blood Count (CBC), Complete Metabolic Profile (CMP), lactic acid, etc.
  • Pain assessment and intervention.
  • Electrocardiogram (EKG): An EKG is often performed to assess for any cardiac abnormalities.
  • Chest X-Ray: A chest x-ray is performed to assess for injuries or abnormalities to the chest, heart, and lungs, such as a pneumothorax.
  • Pelvic X-Ray: A pelvic x-ray may be done to assess for pelvic fractures.
  • Focused Assessment with Sonography in Trauma (FAST): A FAST exam is performed to assess for free fluid in the abdomen to assess for potential bleeding.
  • CT Scan: CT scans are often performed to scan for all potential injuries based on the mechanism of the trauma.

Secondary Survey

Once the patient has been stabilized, the trauma nurse can perform a secondary assessment, a more thorough head-to-toe examination. The secondary survey allows nursing staff to gather additional information regarding the accident (or traumatic event) and identify other injuries to help prioritize continued resuscitation and patient care (Zemaitis et al., 2023). This examination includes additional vital sign monitoring and trends, as well as collecting and resulting laboratory findings that can help drive the patient's care moving forward.

The secondary survey should only be performed once the primary survey is complete, resuscitation has begun, the patient is hemodynamically stable, and all life-threatening injuries have been addressed (Zemaitis et al., 2023). The more thoroughly that history is gathered, the better the chances for optimal outcomes. By asking detailed questions about the mechanism of injury, the nurse can identify potential complications that the team should assess and monitor for. For example, in gunshot wounds, it is essential to learn the type of firearm, how many gunshots, where, and whether or not there were exit wounds. For blunt trauma patients, understanding whether they were restrained vs. unrestrained, if they were ejected from a vehicle, if they experienced a loss of consciousness, etc, are all vital pieces of information to assess for. A good mnemonic to help ensure nurses get as much of a history as possible is SAMPLE, which includes (ENA, 2007):

  • S ⇒ Injury symptoms
  • A ⇒ Allergies
  • M ⇒ Current medications
  • P ⇒ Past medical and surgical history
  • L ⇒ Last oral intake
  • E ⇒ Events leading up to the injury

*Pro Tip: During a head-to-toe assessment if the nurse notices clear drainage from the patient's nose or ears, alert a physician immediately and be sure not to insert an NG tube or pack the nares (ENA, 2007).

Triage Systems and Prioritization

Any information obtained from the pre-hospital report of incoming trauma will lead the team with clues of potential injuries and severity. Getting advanced insight on the mechanism of injury, specific types of trauma, inhalation or chemical burns, altered mental status, substance use, and breathing difficulties can all assist the trauma team with prioritization of their interventions and potential collaborating services that may be needed (ENA, 2007).

Trauma Systems & Levels of Care

Trauma Centers & Their Designations

Though traumas can land anywhere, they often need to be transferred to a higher level of care, depending on the severity of the injury. Trauma centers earn their designations. Designations are solely due to the type and amount of resources of care they can provide, with levels I and II being equipped to manage the higher acuity trauma cases (Lundy et al., 2023).

Level I trauma centers have specific requirements they must meet (Lundy et al., 2023):

  • Serve at least 1200 traumas annually or have 240 admissions with a severity score of more than 15
  • Must maintain a critical care service managed by a trained surgeon
  • A hospital must participate in community outreach, perform trauma research, train residents, and lead in trauma education

Level II trauma centers are typically found in smaller areas and have the resources to stabilize critical traumas before transfer, if necessary (Lundy et al., 2023). Surgeons in both level I and II trauma centers must assess trauma patients within 15 minutes of their arrival.

Level III trauma centers are limited by the resources available to them (Lundy et al., 2023). However, they are capable of stabilizing patients and transferring them to a higher level of care if/when necessary.

Hospitals that become recognized as designated trauma centers come with multiple benefits, both financial and recognition.

Roles & Responsibilities

The roles and responsibilities will vary based on the hospital, trauma center designation, and available staffing and resources. In general, the primary trauma nurse’s main priority is the patient. There is usually a team leader, which is often a physician, an advanced practice provider, or a nurse. Their roles may include:

  • Keeping the team organized
  • Assigning clear roles
  • Have the ability to make clear and concise decisions based upon assessment findings
  • Allow fellow team members to ask questions and voice concerns
  • Be a team player
  • Maintain situational awareness

Next, there may be a core trauma team. These are the healthcare providers who will be working together to stabilize and treat the patient. Roles and responsibilities may include securing an airway, securing IV access, primary survey, diagnostics, labs, and developing a plan of care from the moment the patient arrives until they are stable and a level of care and disposition is determined (ENA, 2007).

Other support services also play a role in trauma management. These individuals may be charge nurses, chaplains, anesthesiologists, fellow consulting services, pharmacists, etc. All emergency departments should develop trauma policies and protocols based on their ability and resources (ENA, 2007).

Damage Control Resuscitation

Initial Management in the Emergency Department

Damage control resuscitation (DCR) prioritizes prevention over intervention in patients at risk for presenting in shock or developing shock (ENA, 2007). Administering intravenous fluids, blood products, calcium chloride, mass transfusion protocol, tranexamic acid (TXA), and stabilization surgery are ways the trauma team works together to establish damage control in the initial management stages (ENA, 2007).

Use of Resuscitation Fluids

The standard of care in a trauma patient is for nursing staff to establish two large-bore intravenous catheters and a bolus of 1-2 liters of isotonic fluids (including pre-hospital volume), followed by a reassessment and blood products, if indicated (ENA, 2007). Administering too much fluid has been shown to contribute to hemodilution and, potentially, poorer outcomes, according to experts (ENA, 2007).

Blood Transfusion Strategies

In traumatic injuries where a large volume of blood loss is suspected, a mass transfusion protocol (MTP) may be ordered. The ratio is a 1:1:1 of red blood cells, plasma, and platelets. Calcium chloride infusions are often incorporated to prevent hypocalcemia following the mass transfusion protocol (ENA, 2007).

Tranexamic Acid (TXA)

Tranexamic Acid (TXA) is an antifibrinolytic that is a synthetic variation of lysine, an amino acid. TXA is often used to decrease intraoperative bleeding (ENA, 2007).

Emergent Stabilization Surgery

Otherwise known as damage control surgery, is often utilized in major trauma centers. Surgeons will take the patient to the operating room to repair immediate, life-threatening injuries, and is best not to last more than 90 minutes. Surgeons will then ensure the patient is stabilized and send the patient to the intensive care unit for close monitoring and stabilization until they return to surgery to address the next operation or injury, often the next day. There may be a process of multiple preplanned, staged operations throughout the patients' recovery period. This method has been shown to increase survival rates, rather than have an unstable patient under anesthesia on an operating room table for an extended period (ENA, 2007).

Trauma Nursing Skills

As one of the most vital trauma team members, nurses are pivotal in effectively assessing and managing trauma patients in emergent settings (Haghighat et al., 2023). As a result, hospitals must set forth specific educational requirements for nurses to ensure they are competent in patient trauma and emergency management. Though nursing school provides nurses with a mass quantity of education, trauma is a specific area of nursing in which most education and training occurs once nurses enter the workforce (Haghighat et al., 2023). Often, nurses employed in the emergency room are required to obtain particular credentials to ensure their competency; trauma nurses are no different.

Airway Management in Trauma

Registered nurses are not typically trained in airway management, though advanced practice registered nurses (APRNs) may be (Avva et al., 2023). Despite not being the team member who will secure the airway in a trauma patient, nurses must still have advanced knowledge in the anatomy and physiology of airway management and understand contraindications and potential complications.

Though intubation is often performed by a physician, an advanced practice provider, or a respiratory therapist, some nurses are trained in this skill (Avva et al., 2023). Nurses are commonly responsible for retrieving and administering sedation medications to assist in the airway management process, monitoring the patient's vital signs, assessing lung sounds, and more.

Advanced Cardiac Life Support (ACLS) in Trauma

All trauma and emergency nurses must become trained and competent in advanced cardiac life support (ACLS). As an evidence-based algorithm, ACLS allows trained providers to enact specific responses and interventions in response to a person experiencing a life-threatening event, such as cardiac arrest. The protocols learned in ACLS were developed based on real evidence, research findings, and expertise, and they are designed to help healthcare team members save lives.

In certain circumstances, trauma patients may require ACLS protocols to be utilized for them to survive. There are also incidences when people suffer catastrophic traumatic injuries that are not sustainable with life. When these situations occur, difficult decisions may be made by the trauma team to provide the most supportive outcome possible. As a general rule, trauma surgeons and the trauma team will make every attempt physically possible to stabilize and save as many lives as possible.

Trauma Nursing Procedures

The procedures that may need to be performed by the nurse or other trauma team members will vary based on the patient and the mechanism of injuries. As a general rule, members of the trauma team will be expected to know and understand their scope of practice and be able to act accordingly.

The ABCDE algorithm mentioned above can be slightly altered, adding a “C” to the front of the mnemonic for catastrophic bleeding.

Suppose a trauma patient presents with a life-threatening hemorrhage. In that case, the nurse may assist with interventions, such as:

  • Initiating a mass transfusion protocol
  • Applying a tourniquet
  • Applying pressure
  • Administering IV fluids
  • Dressing wounds

In a compromised airway, the nurse will need to monitor the patient, assess vital signs, administer oxygen, and may even need to administer rescue breaths or use a bag valve mask/Ambu ® bag to provide breaths while awaiting impending intubation.

If a patient presents with an increased breathing difficulty, the nurse may administer medications or supplemental oxygen. If a patient has injuries such as rib fractures, they may also have a pneumothorax, which could require chest tube insertion.

Circulation issues go along with catastrophic bleeding but can occur separately. There could be obvious or no obvious signs of hemorrhage, but the nurse may notice signs during their assessment, such as color or temperature changes, tachycardia, hypotension, etc. The nurse may:

  • Perform venipunctures to draw labs
  • Apply a pelvic binder in those with pelvic fractures
  • Administer fluids and blood products

In a disability (or head injury), the nurse is vital in performing an adequate assessment to determine the level of consciousness, the need for further imaging and possible intubation, and additional consults (Lucena-Amaro & Zolfaghari, 2022). Additionally, there is a large quantity of trauma patients who arrive in emergency room settings with hypothermia (Lucena-Amaro & Zolfaghari, 2022). In these circumstances, the nurse may administer warm fluids (or blood products, if indicated), utilize a warming device, such as a Bair Hugger™, use warming blankets, or other interventions to provide optimal outcomes.

Table 1: C-ABCDE Assessment
 Assess For ⇒ Treatment/Management
C ⇒ Catastrophic bleedingLife-threatening hemorrhage ⇒ Apply direct pressure/tourniquet
A ⇒ Airway compromisePatency/position ⇒ Airway protection/jaw thrust to open while maintaining cervical spine
B ⇒ Breathing difficultyPoor respiratory effort ⇒ Provide oxygen supplementation
Pneumothorax ⇒ Chest tube (lung decompression)  
C ⇒ Circulation (hemorrhagic shock)Cool skin, tachycardia, bleeding sites ⇒ Apply compression bandage, administer tranexamic acid, transfuse blood
D ⇒ Disability (head injury)Reduced level of consciousness ⇒ Protect airway, transfer ASAP
E ⇒ ExposureHypoglycemia, hypothermia ⇒ Work to maintain normothermia

(Mercer, 2018)

Psychological Aspects of Trauma Care

Impact of Trauma on Patients & Families

There is a wide variety of potential responses that can occur following a traumatic event, which can be categorized as scary, dangerous, unpredictable, and even life-threatening. Understanding the potential impact that traumatic events can have on patients, their families, and even staff is vital in developing a trauma-informed care (TIC) approach (ENA, 2007; Mohta, 2003).

Trauma management involves a multidisciplinary approach, prioritizing stabilizing the patient but not forgetting the psychosocial and psychological impact it can have on the patient and others. Psychological stress is bound to be associated with any form of trauma or injury. Some of the causes and feelings related to psychological stress may include (ENA, 2007; Mohta, 2003):

  • Feelings of helplessness
  • Feelings of humiliation
  • Impaired coping mechanisms
  • Fear
  • Guilt
  • Grief

Nursing Interventions

The RESPOND mnemonic is a helpful tool to help both staff and family members assist patients after a traumatic event (ENA, 2007):

  • R ⇒ Reassurance that the patient is safe and is getting the best care is essential after a traumatic event.
  • E Establishing a good rapport is vital for both the patient and family; they need to know they can trust their healthcare team.
  • S ⇒ Supportive care is necessary after a trauma. If available, nurses can contact the chaplain, social worker, or other supportive care staff to assist.
  • P ⇒ Plan; Allow the patient and family the opportunity to know their plan of care and ask questions as needed.
  • O ⇒ It is always helpful to offer hope to patients and family members, using caution not to provide false hope.
  • N ⇒ Never attempt to deliver a poor prognosis or bad news to a patient or family member alone. Healthcare providers can never anticipate how a family or loved one may react upon receiving bad or scary news.
  • D ⇒ Determine the patient's and family's needs and encourage them to express themselves as needed.

Special Populations in Trauma

Pediatric Trauma

Trauma continues to be the leading cause of death in the pediatric population despite all efforts of injury prevention and education. More than 9 million children nationwide receive medical care annually for unintentional injuries (ENA, 2007). Nationally, a large number of emergency departments lack pediatric-specific trauma education, training, or equipment, leading to an increased need for trauma preparedness in pediatric patients (ENA, 2007).

Geriatric Trauma

Trauma is one of the top 10 causes of mortality in the geriatric population (Lalwani et al., 2020). Aside from being over the age of 65, most older adults have multiple comorbid conditions that increase their risk for complications, longer hospitalizations, and even death. The most common mechanisms of injury in this population are falls and motor vehicle collisions (this includes pedestrian accidents).

Additional factors to consider in this population include comorbid conditions and medications, as members of the trauma team may easily predict potential complications that may occur. It is known that 60% of falls occur in the home, with most being a fall from a standing position (National Council on Aging, 2023). This can sometimes result in improper triage, therefore prolonging adequate treatment (ENA, 2007).

Pregnant Trauma Patients

Trauma is said to be the leading cause of death and disability for pregnant women (that is non-obstetric) (Mayo Clinic, 2017). The majority of injuries occur during the third trimester, with up to 7% of traumatic injuries being fatal (Mayo Clinic, 2017).

Hemorrhage and head injuries are the most fatal of traumatic injuries during pregnancy, according to evidence. Preterm delivery and placental abruption are the most common causes of death in the fetus, with the highest risk factor for fetal death being maternal death (ENA, 2007).

Ethical and Legal Issues in Trauma Nursing

Consent and Decision-Making in Trauma Cases

Informed consent should be addressed in any healthcare situation (Lin et al., 2019). Only competent individuals can make decisions regarding their healthcare wishes. Some people opt to establish a legal document, such as a living will, or establish a power of attorney, highlighting their wishes and who they elect to make decisions on their behalf, should they be deemed unable to do so.

Unfortunately, this process is not always clear-cut. For starters, determining competence means that a patient can understand the information being told to them by the healthcare providers and make reasonable decisions based on risk factors, potential consequences, etc. Suppose a person is deemed unable to make decisions and they have a documented power of attorney (or healthcare surrogate). In that case, healthcare providers may have the delegated party as the decision maker. Depending on your state, the laws can be different if individuals do not have any legal documents or especially in cases in which individuals are unmarried and do not have adult children.

If in an emergency, healthcare providers will attempt to gain consent from a family member or other support person as a surrogate. However, sometimes, healthcare providers may have to provide life-saving treatment in an emergency without specific consent (Lin et al., 2019).

Certification and Professional Development in Trauma Nursing

Trauma Nursing Certification

The Board of Certification for Emergency Nursing (BCEN) offers a Trauma Certified Registered Nurse (TCRN) examination (Board of Certification for Emergency Nursing [BCEN], 2023). It is recommended that nurses have at least two years of experience before sitting for the exam, but it does not appear to be required. Topics covered on the exam include head and neck trauma, thoracic and abdominal trauma, wounds, injuries, compartment syndrome, fractures, burns, and more. The exam cost is $380 for non-members and $285 for members (Board of Certification for Emergency Nursing [BCEN], 2023).

The Emergency Nurses Association (ENA) offers a Trauma Nursing Core Course (TNCC), including instructor-led courses and skill stations (Emergency Nurses Association University [ENA University], n.d.). Topics include trauma overview, roles, and responsibilities, primary survey, secondary survey, and more. The skill stations require that nurses be “checked off” before gaining their certification.

Case Study

Patient Description

The charge nurse at a level I trauma center emergency department received notification of an incoming motor vehicle accident that was 10 minutes out. The report given by EMS included:

  • Name: Charlie
  • Age: 52
  • Gender: Male
  • Chief Complaint: Motor vehicle accident (MVA) driving an estimated 45 MPH, patient was a restrained driver
  • Past medical history: Hypertension, High cholesterol, diabetes, no known allergies

Upon arrival to the ER, the patient was drowsy, but arousable, with no reports of loss of consciousness (LOC). His presenting Glasgow Coma Scale (GCS) score was assessed as a 13. The patient had a visible seatbelt sign across his chest, various abrasions on his face, and an obvious deformity of the right shoulder and arm. He had decreased lung sounds on the right side.

Primary Survey

Airway: Nurse provided supplemental oxygen via a non-rebreather mask.

Breathing: Nurse visualized the patient had a rapid, but shallow breathing pattern. Auscultation revealed diminished lung sounds on the right side. The nurse communicated to the team and a chest X-ray was ordered to assess for possible pneumothorax.

Circulation: Vital signs were taken, telemetry was applied, and the patient was monitored closely. The nurse established IV access and began fluid resuscitation.

Disability: The nurse conducted a neurological exam, and determined the GCS was still around a 13. Because the patient had a decreased level of consciousness, cervical spine precautions were initiated, and a head CT was requested.

Exposure: Full-body assessment revealed the obvious seatbelt sign across the abdomen and upper chest. Other injuries appeared to be scattered abrasions and superficial.

Secondary Survey

Head-to-Toe Assessment: A team of nurses collaborated with the medical team to perform a thorough examination to search for and identify potential additional injuries or areas of concern.

Diagnostic Tests: In addition to the chest X-ray and head CT, scans of the pelvis, abdomen, and cervical spine were ordered. A FAST exam was performed and showed no signs of internal bleeding.

Pain Management: The patient verbalized some mild discomfort in his chest and face, so a low-dose analgesic was administered (given his current mental status).

Comprehensive Care

Multidisciplinary approach: The trauma team includes nurses, physicians, surgeons, respiratory therapists, and radiology technicians, who ensure timely and comprehensive care.

Communication: Clear and concise communication was necessary to prioritize interventions and address emergent issues promptly.

Emotional support: Recognizing the traumatic nature of the event, the primary nurse made sure to connect the hospital chaplain to the patient and his family to help provide additional support.

After stabilization and image results, it was determined that Charlie had a few rib fractures, a small pneumothorax, a dislocated shoulder, and a small subdural hematoma. He was transferred to the trauma ICU for closer monitoring, serial respiratory and neurological exams, and continued inpatient management.


Trauma patients present varying degrees of complexity, meaning that their injuries can range from mild to catastrophic. The trauma team must work together to perform a rapid assessment, intervene quickly and efficiently, and continue ongoing patient care management.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


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