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When Trauma Strikes: The Importance of the Trauma Bundle

By caringsurgeon | Published 6 June 2022 | No Comments

Trauma happens all the time, but it’s rare that people get the opportunity to properly manage it. A trauma bundle—a collection of interventions and treatments that constitute the immediate management of trauma—can improve patient outcomes and save lives by treating life-threatening conditions in addition to injuries at the same time. In this article, we’ll explain what a trauma bundle is, why it’s so important, and how to implement one when the need arises.

ABCDE

Primary Survey – A for Airway, B for Breathing, C for Circulation, D for Disability and E for Exposure. If you’re administering care to someone with significant trauma.

Airway and cervical spine restriction

A primary survey means looking at your scene, and quickly assessing and treating limb and life-threatening injuries first. Airway and cervical spine restrictions apply here. A threatened airway is a condition where there is no room for air to flow into or out of someone’s lungs. This can result in severe hypoxia (lack of oxygen) and rapid death. To correct an open airway, you should perform a chin lift (avoid head tilt) manoeuvre to improve the alignment of the trachea. If that doesn’t work, try a jaw thrust or modified jaw thrust technique. If all else fails, consider using an oropharyngeal airway. The cervical spine should be protected in all trauma patients. clear cut signs are if they have any spinal injury symptoms like numbness or tingling down their arms, they could be at risk for paralysis from further injury. In these cases, it’s important to immobilize their head and neck by placing them on a long backboard or c-collar. You may also want to use some type of collar—like a Philadelphia collar —to help stabilize their spine while transporting them.

Breathing and Ventilation

Conscious airway management is an essential first step in any trauma assessment. In order to breathe and oxygenate your patient, you need to be able to open up his or her airway using basic maneuvers like jaw thrust, chin lift and head tilt/chin lift. Once your patient’s airway is established, respiratory assistance via bag-valve mask can help with breathing. This will ensure adequate oxygenation while you work on other aspects of your patient’s primary survey. It is important to note that it is always preferable to use a supraglottic airway device (SAD) such as a Combitube or King LT when providing ventilatory support. However, if none are available, an endotracheal tube may be used for advanced airway management; once again placing emphasis on establishing a patent upper airway before initiating ventilation with an ETT.

Circulation and Hemorrhage control

It is vital to control hemorrhage in trauma patients. If they suffer a significant blood loss they could go into shock, which could lead to death. Life-saving techniques include packing any open wound with gauze, tourniquets and hemostatic agents like QuikClot or Celox (specially designed powder or granules that can be packed into wounds). Packing a wound with gauze reduces bleeding while surgical clamps can be used on larger wounds. Tourniquets are effective for controlling bleeding from limbs but must not be left on for more than 2 hours as they can cause tissue damage. These methods should only be used when all other methods have failed. For example, if someone has been shot in an arm and you cannot stop their bleeding using pressure dressings then it may be necessary to apply a tourniquet. As soon as possible you should get them to medical help where they will receive surgery to remove bullets and fix any damaged arteries.
A tourniquet may need to be applied if there is severe bleeding from an extremity such as an arm or leg.

Neurological Disability

Up to 70% of trauma deaths are related to traumatic brain injury (TBI). Along with proper medical management, it is crucial that first responders and medical providers have a systematic approach for identifying and treating TBI. A three-step approach—called the trauma bundle—is designed to ensure proper care is administered in a timely manner. When used correctly, these steps can help save lives and improve outcomes for those suffering from TBI. Here’s how they work:
The primary survey must be performed immediately after injury occurs and before any other intervention takes place. This step involves an assessment of ABCs (airway, breathing, circulation) as well as head-to-toe assessment looking for other injuries or medical problems such as bleeding or shock. If a spinal cord injury is suspected, immobilization with a cervical collar should occur at this time. If there are no life-threatening injuries present—such as severe bleeding—the secondary survey can take place at a later time. During the secondary survey, it is important to determine if there are any serious medical issues that need immediate attention—such as internal bleeding or damage to vital organs. At that point in time, more advanced procedures can be used to treat these conditions.

Exposure – Prevention of hypothermia

It’s important to keep your patient covered with warm blankets, as hypothermia can occur in as little as 20 minutes in a cold environment. Consider head-to-toe exposure (the bundle) if your patient is hypothermic and you suspect that core temperature has dropped below 95 F (35 C). This step—which includes adding insulation between the patient and ground, removing wet clothing and applying dry blankets—can improve core temperature control by up to 6 degrees. And while not all trauma patients will require it, when they do it can be a life saver.
The next time you or someone around you experiences trauma, remember these five steps: STOP THE BLEEDING; CALL 108; CHECK FOR BREATHING AND CIRCULATION; EXPOSE THE TRAUMA PATIENT; and START YOUR BUNDLE. By following these simple steps, you can improve your chances of surviving a traumatic injury.
Because with every second that passes after an injury occurs, your chances of survival decrease by 7 percent. So don’t wait for help to arrive—STOP THE BLEEDING NOW!

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