trauma nurse Archives - Off the Charts

Success Being Relative

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

blood bags/ by montuno, via flickr

We trouped in from the parking garage through the fading starlight of early dawn to find most of night shift gathered in one room. Portable surgical lights added to the overhead fluorescence, casting a striking glare on the scene. The patient was ominously flat: his positioning and pallor an instant indicator of his perfusion status, which was confirmed by a quick glance at the monitor. His blood pressure, we said among ourselves, was “in the toilet.”

He’d been in a motor vehicle accident and had suffered a prolonged extrication. There’d been a fatality at the scene. He wasn’t my patient (although he was everyone’s patient, really), so I’m not the one who got the long report. I didn’t know each and every one of his injuries, but I knew the only one that was relevant at the time—his liver was badly fractured and he was bleeding out. His abdomen was hugely distended and firm. He was cold to the touch, and his skin bore the expected pallor of a man in shock.

We […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:09:30-05:00August 8th, 2012|nursing perspective, nursing stories|2 Comments

Air Force Trauma Nurse: Teacher, Winner of Bronze Star

Air Force nurse Major Kari A. Miller is currently the director of the nurse trauma program and the chief of the critical care nurse program for the U.S. Air Force Center for Sustainment of Trauma and Readiness Skills (C-STARS) in Baltimore, where she helps train military medical personnel who are preparing to deploy, with a focus on teaching trauma assessment, treatment, and skills.

Says Miller: “My C-STARS colleagues and I work directly with the staff of R Adams Cowley Shock Trauma Center [at the University of Maryland], where we see over 8,000 patients per year. The center has an excellent survival rate of 97% and our nurses and physicians are fully integrated with the civilian staff here.”

The photos here show Major Miller and her team during deployment in Ghazni, Afghanistan, in September 2010, when she earned a bronze star for leadership and performance and courage under fire. The team members earned an Army Combat Action Badge for care under fire. The photos on this page show the team treating American casualties received after an improvised explosive device detonated and the vehicle rolled over. Says Miller: “I believe we had three or four casualties with that incident and all had minor injuries. We did fly a couple of them to Bagram for further evaluation and treatment but no fatalities.”—Jacob Molyneux, […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:41-05:00October 20th, 2011|Nursing|1 Comment

Blind Spot – At the Intersection of Mother and Nurse

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By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

Being a nurse has changed my reactions to situations at home. For one thing, I don’t get overexcited about non-life-threatening medical problems. I can hardly stand the thought of going to an emergency room (Steri-Strips and ice are my usual “go-to” treatment plans). I’d like to blame this on working in a trauma center—it makes sense that seeing catastrophic injuries every day tends to make less severe injuries look insignificant—but I’m not sure that completely excuses my recent diagnostic error.

My son, who’s 12, came home from school last week complaining that his hand was sore. He’d hit a wall in gym, he said, but it was a padded wall, and he hadn’t hit it very hard. Still, he was absolutely certain that, at the very least, he’d dislocated something, and that, most likely, he’d broken his hand.

To my defense, he has a history of overdramatizing situations, and I took his self-assessment with a grain of salt. Although the side of his hand was slightly swollen, nothing was bruised, and everything seemed to be moving all right.

We iced it, of course, and although hand pain didn’t seem to interfere with his usual activities, he proceeded to tell anyone who would listen that he’d broken his hand.

“Stop saying that!” I told him. […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:11:48-05:00October 6th, 2011|career, Nursing, nursing perspective|7 Comments

Stillness and Violence: The Dog Days

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer for this blog.

If I had a crystal ball, I might have called in sick. Or at least gotten more sleep.

They brought the patient up at the start of our shift, and he was a ‘train wreck.’ He’d been shot many times and he was bleeding out before our eyes. I don’t know how much blood we gave him—I can only say it seemed endless . . . blood and fresh frozen plasma and platelets, volume expanders and fluids. The room was packed with trauma surgeons and nurses and jammed with equipment: the rapid transfuser, ventilator, Bair Hugger, pressure bags, pumps and coolers.

Our tech must have covered miles, running to the blood bank for one cooler after another full of blood products.

From the outside, the melee must have looked like chaos. But it was actually a calculated and very effective frenzy, for a while. Amidst the rushing and crowding, the shouting and alarms, amongst people and equipment, spills and blood splatters, we were staying ahead of the game. He was perfusing and his blood pressure was adequate. But it wasn’t long before his pressure was barely adequate, and he was just barely maintaining, and then, despite our urgency and expertise, despite science and wings and prayers, we were losing. His blood pressure was dropping, no matter what we did. […]