Emergency medical services (EMS) brings a large number of clients to the emergency department following a mass casualty incident. The nurse identifies the clients with which injuries with yellow tags? (Select one, some or all that apply)

Rationale:

A. The primary survey in trauma begins with the ABCs (Airway, Breathing, Circulation). Securing the airway ensures the patient can oxygenate, assessing breathing ensures adequate ventilation, and evaluating circulation identifies shock or hemorrhage that requires immediate intervention. These steps are essential to stabilize life-threatening conditions before further evaluation.

B. Assessing neurological status is also part of the primary survey. This includes evaluating the patient’s level of consciousness, responsiveness, and pupillary reactions. Early detection of neurologic compromise, such as signs of increased intracranial pressure or spinal cord injury, is critical because it may require immediate life-saving interventions.

C. A key purpose of the primary survey is to rapidly identify injuries or conditions that could be fatal if not addressed immediately. This includes tension pneumothorax, massive hemorrhage, airway obstruction, or cardiac tamponade. Prioritizing life-threatening issues ensures the best chance of survival in trauma patients.

D. A comprehensive, systematic examination of all body systems is part of the secondary survey, not the primary survey. The secondary survey occurs after the patient has been stabilized and includes a head-to-toe assessment, obtaining a detailed history, and evaluating for non-life-threatening injuries. Focusing on all body systems during the primary survey would delay urgent interventions needed to save the patient’s life.

Rationale:

A. Mr. Snowden was submerged in icy water, which puts him at high risk for hypothermia. Hypothermia can worsen coagulopathy, impair cardiac function, and affect drug metabolism. Maintaining normothermia through warming blankets, warmed IV fluids, and environmental temperature control is essential for stabilization and to prevent secondary complications.

B. There is no indication of a urinary tract infection in the current assessment. Administering antibiotics for a UTI would be unnecessary and not a priority in the acute stabilization phase. Priority interventions should focus on immediate life-threatening issues and injuries sustained from the accident.

C. With a complete T10 spinal cord injury, frequent neurologic assessments are vital to monitor for changes in motor function, sensation, and reflexes above the level of injury. Hourly checks help detect complications such as autonomic dysreflexia, spinal shock, or evolving cord edema. Monitoring the Glasgow Coma Scale (even with intubation), voluntary movements in extremities, and sensory response is part of these assessments.

D. Spinal precautions are critical due to the complete T10 injury. The log-roll technique maintains spinal alignment and prevents further cord damage while turning, repositioning, or performing hygiene care. All staff must coordinate movements to prevent rotation or flexion of the spine.

E. The large abrasion/laceration on the scalp could lead to significant bleeding, infection, or indicate underlying skull fracture. Assessment includes checking for active bleeding, signs of hematoma or swelling, neuro changes, and proper wound care. This is important to prevent secondary complications and infection.

F. Mr. Snowden’s vital signs (heart rate 72 bpm, respiratory rate 16, oxygen saturation 99%) are currently stable. There is no evidence of hypovolemia or shock, so IV fluid bolus is not immediately indicated. Fluids may be considered later if hypotension develops or in response to lab values.

G. Collecting accurate information about the accident helps determine timing of submersion, duration of CPR, previous medical conditions, medications, allergies, and baseline neurologic function. This informs ongoing care decisions, prognostication, and potential complications such as hypoxic brain injury or organ damage.

H. Mr. Snowden is intubated and fully dependent on mechanical ventilation. Continuous monitoring of airway patency, ventilator settings, oxygenation, and tidal volumes is a life-saving priority. Ensuring suctioning is performed as needed and preventing ventilator-associated complications (e.g., pneumonia) are also part of stabilization.