Condition	Assessment: Signs and Symptoms	Prehospitalization Nursing Care	In-hospital Nursing Care
	Sensorium: alert; disoriented, stuporous, comatose Respirations: increased rate, depth; shallow; asymmetrical; parodoxical breathing; mediastinal shift; gasping, blowing C/V: signs of shock Abdomen: contusions; pain; abrasions; open wounds; rigidity; increasing distention Skeletal system: pain; swelling; deformity; inappropriate or no movement Neurological: pupils round, equal, react to light; ipsilateral dilation and unresponsive; fixed and dilated bilaterally Bilateral movement and sensation in all extremities Progressive contralateral weakness Loss of voluntary motor function See Sensorium above for level of consciousness	Do not move patient unless you must, to prevent further injury; send for help Check breathing - give mouth-to-mouth resuscitation if indicated Check for bleeding Control bleeding by applying pressure on wound or on pressure points (artery proximal to wound) Use tourniquet only if above pressure techniques fail to stop severe bleeding Check for shock (pulse, pupils, skin color) and other injuries Fractures; keep open-fracture area clean Do not try to set bone If patient must be moved - splint broken bones with splints that extend past the limb joints; tie splints on snugly but not so tight as to cut off circulation Check peripheral pulses If head or hack injury suspected - keep body straight; move only with help Reassure patient that help is on the way	Assess vital functions Establish airway; ventilate with Ambu-bag, volume cycled ventilator Draw arterial blood gases Control bleeding Support circulation by closed chest massage Prepare infusions of dextran, blood, crystalloids Assess for other injuries: head injuries - suspect cervical neck injury with all head injuries Place sandbags to immobilize head and neck Do mini-neurological exam:level of consciousness, pupils, bilateral movement. and sensation Get history - time of injury; any loss of consciousness; any drug ingestion Stop bleeding on or abouthead Apply ice to contusions andhematomas Check for bleeding fromnose, pharynx, ears Check for cerebrospinal fluid from ears or nose Assist with spinal tap if ordered Keep accurate I&O Protect from injury if restless, seizures; orient to time, place, person Administer steroids, diuretics, as ordered Check for signs of increasing intracranial pressure: slowing pulse and respiration, widened pulse pressure, decreasing mentation
Spinal Injuries			Assess and support vital functions as above Immobilize no flexion or extension allowed If in respiratory distress - nasotracheal intubation or tracheostomy to avoid hyperextending neck

Condition

Assessment: Signs and Symptoms

Prehospitalization Nursing Care

In-hospital Nursing Care

Sensorium: alert; disoriented, stuporous, comatose

Respirations: increased rate, depth; shallow; asymmetrical; parodoxical breathing; mediastinal shift; gasping, blowing

C/V: signs of shock

Abdomen: contusions; pain; abrasions; open wounds; rigidity; increasing distention

Skeletal system: pain; swelling; deformity; inappropriate or no movement

Neurological: pupils round, equal, react to light; ipsilateral dilation and unresponsive; fixed and dilated bilaterally

Bilateral movement and sensation in all extremities

Progressive contralateral weakness

Loss of voluntary motor function

See Sensorium above for level of consciousness

Do not move patient unless you must, to prevent further injury; send for help
Check breathing - give mouth-to-mouth resuscitation if indicated
Check for bleeding
Control bleeding by applying pressure on wound or on pressure points (artery proximal to wound)
Use tourniquet only if above pressure techniques fail to stop severe bleeding
Check for shock (pulse, pupils, skin color) and other injuries
Fractures; keep open-fracture area clean
Do not try to set bone
If patient must be moved - splint broken bones with splints that extend past the limb joints; tie splints on snugly but not so tight as to cut off circulation
Check peripheral pulses
If head or hack injury suspected - keep body straight; move only with help
Reassure patient that help is on the way

Assess vital functions
Establish airway; ventilate with Ambu-bag, volume cycled ventilator
Draw arterial blood gases
Control bleeding
Support circulation by closed chest massage
Prepare infusions of dextran, blood, crystalloids
Assess for other injuries: head injuries - suspect cervical neck injury with all head injuries
Place sandbags to immobilize head and neck
Do mini-neurological exam:level of consciousness, pupils, bilateral movement. and sensation
Get history - time of injury; any loss of consciousness; any drug ingestion
Stop bleeding on or abouthead
Apply ice to contusions andhematomas
Check for bleeding fromnose, pharynx, ears
Check for cerebrospinal fluid from ears or nose
Assist with spinal tap if ordered
Keep accurate I&O
Protect from injury if restless, seizures; orient to time, place, person
Administer steroids, diuretics, as ordered
Check for signs of increasing intracranial pressure: slowing pulse and respiration, widened pulse pressure, decreasing mentation

Spinal Injuries

Assess and support vital functions as above
Immobilize no flexion or extension allowed
If in respiratory distress - nasotracheal intubation or tracheostomy to avoid hyperextending neck