Understanding the Role of Trauma Nurses in the ER: The Unsung Heroes of Emergency Departments
The role of the nurse and nurse practitioner in the care of trauma patient is critical. Moreover, ATLS nursing trauma assessment is important in the evaluation of critically injured trauma patients. Learn about the assessment that saves lives. Read more below…
NCLEX Pretest: Priority Questions
Question A 45-year-old female arrives in the emergency department following a motor vehicle accident. Upon assessment, the nurse notes decreased level of consciousness, irregular breathing, and visible chest trauma. Which assessment finding warrants immediate nursing intervention?
A) Decreased level of consciousness
B) Irregular breathing
C) Visible chest trauma
D) Decreased breath sounds on the right side
E) Bruising on the abdomen
Rationale: Assessing and managing airway patency and breathing are critical priorities in trauma care to ensure adequate oxygenation and ventilation, thereby supporting vital organ function and perfusion. Irregular breathing suggests potential compromise to the patient’s airway, breathing, or circulation, requiring immediate intervention to maintain oxygenation and prevent further deterioration.
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Question A 32-year-old male is brought to the trauma unit after a fall from a height. Upon assessment, the nurse notes paradoxical chest movement, decreased breath sounds on the left side, and respiratory distress. What action should the nurse prioritize?
A) Administering pain medication
B) Initiating intravenous fluid resuscitation
C) Applying a cervical collar
D) Placing the patient in a lateral position
E) Preparing for immediate intubation
Rationale: Paradoxical chest movement, decreased breath sounds, and respiratory distress indicate potential chest trauma, leading to compromised ventilation and respiratory failure. Immediate intubation is necessary to secure the airway, support ventilation, and prevent further respiratory deterioration, ensuring adequate oxygenation and ventilation until definitive management can be implemented.
Question A 50-year-old female presents to the emergency department after a stabbing incident. On examination, the nurse observes active bleeding from a wound to the left upper abdomen, a rapid thready pulse, and pale, cool extremities. What is the priority nursing intervention?
A) Applying pressure to the wound
B) Administering intravenous fluids
C) Assessing for additional injuries
D) Elevating the lower extremities
E) Obtaining a detailed medical history
Rationale: Active bleeding from a wound indicates significant hemorrhage, posing a threat to the patient’s hemodynamic stability and requiring immediate intervention to control bleeding. Applying direct pressure to the wound helps to minimize blood loss, stabilize the patient’s condition, and prevent further deterioration while awaiting definitive management, such as surgical intervention or blood product administration.
Question A 28-year-old male is brought to the emergency department after a motorcycle accident. Upon assessment, the nurse notes bruising over the abdomen, guarding, and rigidity upon palpation. Which action should the nurse prioritize?
A) Administering pain medication
B) Applying ice packs to the bruised area
C) Initiating intravenous fluid resuscitation
D) Assessing neurological status
E) Ordering a complete blood count (CBC)
Rationale: Bruising over the abdomen, along with guarding and rigidity, suggests potential intra-abdominal trauma, such as organ injury or hemorrhage. Initiating intravenous fluid resuscitation is crucial to maintain perfusion and prevent hypovolemic shock in patients with suspected internal bleeding. Adequate fluid resuscitation can help stabilize the patient’s condition and support vital organ perfusion while awaiting further diagnostic evaluation and definitive management.
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Question A 35-year-old female is involved in a high-speed car collision. On assessment, the nurse observes paradoxical chest movement, tachypnea, and cyanosis. Which intervention should the nurse implement first?
A) Administering oxygen therapy
B) Initiating cardiac monitoring
C) Placing the patient in a high Fowler’s position
D) Administering pain medication
E) Preparing for chest tube insertion
Rationale: Paradoxical chest movement, tachypnea, and cyanosis are indicative of impaired ventilation and potential respiratory compromise, requiring immediate intervention to improve oxygenation. Administering oxygen therapy is the priority to optimize oxygen delivery to tissues and alleviate hypoxia. Providing supplemental oxygen can stabilize the patient’s condition, improve respiratory function, and prevent further deterioration while awaiting definitive management.
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Question A 50-year-old male is admitted to the emergency department after a fall from a height. Upon assessment, the nurse notes swelling, deformity, and limited range of motion in the left lower extremity. What is the priority action for the nurse?
A) Administering analgesics
B) Applying ice packs to the affected area
C) Immobilizing the left lower extremity
D) Ordering a lower extremity Doppler ultrasound
E) Assessing pedal pulses bilaterally
Rationale: Swelling, deformity, and limited range of motion in the left lower extremity are indicative of a potential fracture or musculoskeletal injury. Immobilizing the extremity is crucial to prevent further injury, reduce pain, and minimize the risk of complications such as neurovascular compromise or additional tissue damage. By immobilizing the extremity promptly, the nurse can help maintain alignment, reduce movement-related pain, and facilitate safe transfer and transport for further evaluation and treatment.
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Question A 40-year-old female is brought to the emergency department after a skiing accident. Upon assessment, the nurse notes swelling, ecchymosis, and crepitus in the right lower leg. The patient reports severe pain and inability to bear weight. Which intervention should the nurse prioritize?
A) Applying a warm compress to the affected leg
B) Administering pain medication intravenously
C) Ordering a computed tomography (CT) scan of the leg
D) Assisting the patient to ambulate with crutches
E) Elevating the affected leg on pillows
Rationale: Swelling, ecchymosis, crepitus, severe pain, and inability to bear weight suggest a significant lower extremity injury, such as a fracture. Administering pain medication intravenously is the priority to alleviate pain and improve comfort for the patient. Pain management is essential not only for patient comfort but also for facilitating assessment and management of the injury, ensuring optimal outcomes and patient satisfaction.
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Question A 25-year-old male is involved in a motorcycle collision and presents to the emergency department with blunt trauma to the chest. On assessment, the nurse notes asymmetrical chest expansion, decreased breath sounds on the left side, and respiratory distress. What intervention should the nurse perform first?
A) Administering oxygen therapy
B) Placing the patient in a lateral position
C) Initiating cardiac monitoring
D) Preparing for chest tube insertion
E) Assessing blood pressure and heart rate
Rationale: Asymmetrical chest expansion, decreased breath sounds, and respiratory distress suggest a pneumothorax or hemothorax, which can lead to respiratory compromise and respiratory failure. Preparing for chest tube insertion is the priority intervention to evacuate air or blood from the pleural space, restore negative pressure, and re-expand the lung, thereby improving ventilation and oxygenation. Prompt intervention can prevent further respiratory deterioration and improve outcomes for the patient.
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Question A 30-year-old male is brought to the emergency department after a fall from a height. Upon assessment, the nurse observes tenderness, swelling, and deformity in the right forearm. The patient is unable to move his fingers and reports numbness and tingling in the hand. What is the priority action for the nurse?
A) Applying ice packs to the affected forearm
B) Administering nonsteroidal anti-inflammatory drugs (NSAIDs)
C) Immobilizing the right forearm with a splint
D) Ordering a magnetic resonance imaging (MRI) of the forearm
E) Assessing capillary refill in the fingers
Rationale: Tenderness, swelling, deformity, loss of movement, and neurovascular symptoms suggest a potential fracture or dislocation of the forearm with associated nerve injury. Immobilizing the forearm with a splint is the priority action to prevent further injury, reduce pain, and stabilize the affected limb. By immobilizing the forearm promptly, the nurse can help prevent additional tissue damage, maintain alignment, and facilitate safe transfer for further evaluation and treatment.
Question A 55-year-old female is admitted to the emergency department after a motor vehicle accident. Upon assessment, the nurse notes bruising and swelling over the left side of the abdomen, tenderness upon palpation, and distended abdomen. The patient complains of severe abdominal pain. What is the priority nursing intervention?
A) Administering intravenous fluids
B) Notifying the healthcare provider
C) Placing the patient in a semi-Fowler’s position
D) Obtaining a focused abdominal ultrasound
E) Assessing bowel sounds in all quadrants
Rationale: Bruising, swelling, tenderness, distention, and severe pain in the abdomen raise concern for internal organ injury or hemorrhage. Obtaining a focused abdominal ultrasound is the priority intervention to assess for free fluid or organ injury, guiding further management and interventions. Prompt ultrasound evaluation can facilitate timely diagnosis and appropriate treatment, helping to prevent complications and optimize outcomes for the patient.

What does a trauma nurse do in the ER?
Trauma nurses play a crucial role in emergency departments, especially in managing critically injured patients. Let’s delve deeper into their responsibilities and the crucial distinctions between trauma nurses and their ER counterparts.
Trauma Nurse Responsibilities: Immediate Care for Critical Patients
Trauma nurses are integral members of the trauma team, tasked with assessing and treating patients with severe injuries. They operate within the high-stakes environment of the emergency department, where swift and efficient action can be a matter of life and death.
The Emergency Department: A Hub for Critical Care
In the chaotic setting of the emergency department, trauma teams, comprising emergency nurses among others, spring into action to provide specialized care to trauma victims. Their primary objective is to stabilize patients and facilitate their transfer to facilities equipped for further treatment.
Emergency medical services often rely on trauma teams, which include emergency nurses, to provide immediate and specialized care to patients with severe injuries. These trauma teams must work quickly and efficiently to stabilize the trauma patient and transport them to a hospital where they can receive further treatment. Emergency department nurses are trained to handle a variety of situations, from minor injuries to life-threatening emergencies, and they play a critical role in the overall success of trauma care. The Emergency Nurses Association is the professional organization that plays a vital role in the trauma system and helps ensure that trauma patients receive the highest level of care possible.
Differentiating Trauma Nurses from ER Nurses
While both trauma nurses and ER nurses operate in high-pressure environments, the former specializes in the immediate management of critically injured patients. From securing airways to administering life-saving medications, trauma nurses play a vital role in the initial phases of trauma care.
Becoming a Trauma Nurse: Pathways and Requirements
Embarking on a career as a trauma nurse requires a blend of education, licensure, experience, and certifications. Prospective trauma nurses undergo rigorous training and examinations to equip themselves for the demanding role.
Mastering Nursing Trauma Assessment
Efficient trauma assessment is fundamental to effective patient management. Using tools like the Glasgow Coma Scale, trauma teams gauge patients’ conditions swiftly and accurately, laying the groundwork for appropriate interventions.
Trauma nurses are nurses who specialize in caring for critically injured trauma patients. They are part of the trauma team and are responsible for assessing and treating patients in the emergency department. The goal of treatment in the emergency department is to provide immediate assessment and treatment to patients who have suffered from traumatic injuries such as motor vehicle accidents, assaults, falls, explosions, fires, and other types of incidents.
Trauma Nurse vs ER Nurse
Nursing duties in the care of trauma patients are to provide assessment, and initial interventions to secure and stabilize the airway, breathing, circulation, in addition to giving life-support measures. Nurses will monitor vital signs, including temperature, heart rate, blood pressure, and respiratory rate, to ensure that the patient remains stable and does not deteriorate. The nursing staff will communicate with the other members of the trauma and healthcare team, including support staff. The subsequent plan of care is coordinated to ensure that the patient is admitted or transferred. Nurses often have a role in communicating updates to the family. The nurse will administer medications such as analgesics and antibiotics. If blood products are needed, this will be administered by the nurse. Documenting patient care is critical and includes the medical history, the assessment, gathering laboratory results, and treatment.
The Role of Emergency Nurses Association (ENA)
Facilitating excellence in trauma care, the Emergency Nurses Association stands as a beacon of professionalism in the field. Through its advocacy and standards, ENA ensures that trauma patients receive optimal care and support.
Our free NCLEX practice questions provide an excellent resource. Questions cover all NCLEX exam topics.
How To Become A Trauma Nurse
To become a trauma nurse, you need to complete 1) Educational requirements, a nursing degree such as an associate degree in nursing (ADN), or a bachelor of science in nursing (BSN). 2) Licensure, after completion of your nursing education, you need to pass the National Council Licensure Examination for Registered Nurses, NCLEX-RN. 3) Experience, most trauma nurses have had several years of experience, and some opt to participate in a nursing internship for trauma. 4. Certifications, professional organizations offer certification in emergency nursing and trauma. In addition, states may have additional requirements.
Mastering Nursing Trauma Assessment
Trauma patients require rapid and effective care, and a systematic approach to evaluation is critical for successful management. The Glasgow Coma Scale is a widely used tool that helps trauma teams assess a patient’s level of consciousness. In the emergency medicine setting, the trauma room or “suite” serves as the primary site for trauma care, and the team leader is responsible for ensuring that the team is following the proper protocol.
Navigating Trauma Assessment Techniques
Emergency medical services provide some preliminary information about the patient, but the team leader must conduct a head-to-toe examination to identify major and minor injuries and any hidden injuries. The consciousness assessment is a key component of this process and can provide valuable information about the patient’s condition. With the use of the Glasgow Coma Scale, trauma teams can quickly evaluate a patient’s mental status and get an indication of head trauma.
Motor vehicle accident, explosion, fall or penetrating trauma?
Loss of consciousness?
Are injuries compatible with the story?
Was the casualty burned inside or outside?
Abuse?
Radiation exposure?
Chemical involved?
Voltage exposure?
Scald burns?
Flame burns?
Allergies?
Other medical problems and comorbidities?
Medications?
Drug abuse?
Last meal?
Remember, the history and mechanism of injury will help direct the trauma work-up.
nursing assessment for burn patients
A complete physical examination will be done. This should include an examination of the entire body and all of the organ systems. When trauma teams treat major trauma, a thorough assessment is key to ensuring the best possible outcomes for trauma victims. The mechanism of injury can provide valuable information to the medical team, allowing them to quickly determine the severity of the patient’s injuries. Once a patient arrives at a trauma center, the team performs a head-to-toe assessment to identify any injuries.
Physical Examination
This process includes evaluating vital signs such as O2 saturation and blood pressure, which can provide critical information about the patient’s condition. Advanced Trauma Life Support (ATLS) protocols are used to guide the primary assessment, which can help identify life-threatening injuries such as gunshot wounds, head injuries, spinal cord injuries, cervical spine injuries, and flail chest. Following the primary assessment, the team moves on to a secondary assessment, which provides a thorough physical assessment to identify additional injuries. By utilizing a comprehensive approach, medical teams can quickly and accurately assess major trauma and provide appropriate care to trauma victims. Don’t forget to consider the following in the physical exam of the injured trauma victim:
Trauma Assessment Techniques
Eyes
Fluorescein is used to look for corneal abrasions (have a high index of suspicion if there is a history of splash, explosion, flash, or chemicals. If a corneal abrasion is present, ophthalmic antibiotics are essential and consult ophthalmology early. Avoid steroids.
Ears
Examine the canal and drum before swelling and significant pain is present Look for tympanic membrane (TM) perforation, have a high index of suspicion in explosions occlusion of auditory canal
Avoid further trauma and pressure (no pillows)
Sulfamylon cream BID (has better penetration) for auricular burns and penetrates cartilage. It may help prevent chondromalacia.
Abdomen
Perform a careful abdominal exam,
Consider visceral perforation if there is a history of blast.
Consider placing a feeding tube (burns > 30%),
Transduodenal tubes may allow early feeding with of gastric ileus
Extremities
Assess vascular and neurological function
Keep reassessing vascular status in patients with circumferential or near circumferential burns
Elevate burned extremities
Encourage active range of motion (ROM) and provide passive ROM to reduce edema.
No constrictive bandages, avoid ace wraps
Splint to position of function
Document pulses
Perform sensorimotor examination every shift or hourly if at risk.
Early intervention: ESCHAROTOMY may be limb saving.
Genitourinary
Penile and scrotal burns – place a foley catheter if not already present to keep the urethra patent
Consider scrotal elevation
Assess the burn: Determine the burn depth and the extent of the burn.
What happened?
Was the victim previously healthy or chronically ill?
Honoring the Vital Role of Trauma Nurses
In the fast-paced realm of emergency medicine, trauma nurses stand as guardians of life and hope. Their unwavering dedication and expertise form the backbone of trauma care, ensuring that patients receive the urgent attention they need to survive and thrive.