Distracting Injuries

In trauma resuscitation, we learn not to get sidetracked by "distracting injuries." When we assess the priorities in a trauma patient - securing the airway, maintaining breathing, and supporting the circulation - we are told not to be distracted by other things the patient may have. When we practice this in simulation scenarios, it's not a big deal. But in real life, it happens to be a lot easier said than done.

A drunk motorcyclist hits a parked car and lands face-first into the pavement. When he arrives, he has profuse bleeding from his facial fractures, to the point that he needs to be transfused multiple units of blood. The gurgling noises he makes suggest he's not able to breathe independently; the blood pooling in the back of his throat is starting to be a problem. The emergency physician, however, wants to get CT scans of his face to look at the extent of the fractures. In doing so, he loses his window; the patient has a cardiac arrest. An emergent breathing tube needs to be placed, and this is not easy; the blood in his airway and the ongoing chest compressions complicate matters. The patient subsequently has a prolonged stay in the surgical ICU.

A victim of a car accident has a mangled extremity; he has over a dozen fractures in his leg. During the trauma resuscitation, though, the leader methodically goes through the priorities for resuscitation, ensuring that the patient's breathing, blood pressure, heart, and lungs are uninjured before leaving the vital organs.

In the chaos of the trauma bay, it is easy to get flustered, lose track of things, and put the patient in danger. When you learn things by the book, they sound so simple, but in the heat of the excitement and emergency, it is easy to be distracted by nonimportant injuries.