Ongoing assessment is vital for motor vehicle accidents
Your patient could die otherwise
A patient involved in a motor vehicle accident was alert with stable vital signs when he arrived at an ED. Three hours later, a nurse from the step-down unit came to transfer the patient for continued monitoring. She saw that he no longer was opening his eyes and didn't respond to verbal commands. The patient was transferred anyway because no one realized that his condition had changed. About 90 minutes later, his heart failed and he died.
The hospital was cited by the state department of health because emergency nurses failed to monitor the patient's deteriorating neurological condition.
"Trauma patients can deteriorate quickly, which is why it is so important for the ED nurse to assess the patient thoroughly and frequently," says Sanna K. Henzi, RN, MSN, trauma injury prevention coordinator at the University of California — Irvine (UCI) Medical Center.
UCI's ED nurses monitor the neurologic status of a patient involved in a motor vehicle accident upon arrival and at least hourly for a minimum of three hours, or as needed based on the stability of the patient's mental status, she says. The neurologic assessment includes the patient's general appearance, behavior, speech, and language; orientation to time, place, person, and situation; a Glasgow Coma Score; pupil reaction and symmetry; and movement, strength, and symmetry of extremities. "Neurologic status should always be checked and documented if there is a change in the patient's condition," says Henzi. "Prior to transporting a patient to any unit, a full neurological assessment should be done and documented."
When assessing the patient's condition, also consider the age and general health of the patient. Henzi gives these signs of deteriorating neurologic status: confusion, agitation, combativeness, somnolence, difficult to arouse, pupil reaction, hypotension, hypoxia, tachycardia, and/or respiratory difficulty. Also watch for increased headache, nausea/vomiting, and irritability, which could lead to a future change in neurologic status.
"These signs and symptoms can also be warnings of increased intracranial pressure and impending herniation," says Henzi. "These should all be documented and monitored appropriately."
If there are mental status changes, do these four things, she says:
1. Make sure the patient's airway is open.
2. Verify that vital signs are stable.
3. Notify the ED physician of the change.
The patient might need to be upgraded to a different unit for closer monitoring or might need to repeat a CT scan, laboratory tests, or medication administration, Henzi explains.
"The patient should not be transferred from the ED until this change in status is reported, appropriate interventions are initiated and properly documented, and the patient is cleared to move to the appropriate unit," says Henzi.
4. For trauma patients with possible head injuries, elevate the head of bed 30 degrees or in reverse Trendelenberg to avoid increased intracranial pressure and aspiration.
A patient involved in a motor vehicle accident was alert with stable vital signs when he arrived at an ED. Three hours later, a nurse from the step-down unit came to transfer the patient for continued monitoring. She saw that he no longer was opening his eyes and didn't respond to verbal commands.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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