MGM NEW BOMBAY COLLEGE OF NURSING

RESEARCH APLLICATION AND EVIDANCE

BASED PRACTICE IN CRITICAL CARE

RESEARCH INSTRUMENT

SUBMITTED TO: SUBMITTED BY:

Mrs. Ponchitra Ma’am Ms. Rutuja Subhash Pol.
Professor 1st Year NPCC Student
MGM NBCON, Kamothe MGM NBCON, Kamothe

SUBMITTED ON:
PROBLEM STATEMENT:
Trauma resuscitation management and patient outcomes in critically ill patients: A prospective
correlational study.

INTRODUCTION:
Every year, 17th October is celebrated as World Trauma Day. This day highlights the
increasing rate of accidents and injuries causing death and disabilities across the world and the
need to prevents them.

Trauma means “any injury caused to the body”. The injury may be caused due to many
reasons like road accidents, fires, burns, falls, acts of violence and crimes against the vulnerable
population including women, children and elderly. Amongst all the causes, Road Traffic Accident
(RTA) is the leading cause of trauma across the world. Many injuries my lead to temporary or
permanent disability while others may even cause death.

The main steps in the early management of trauma are primary assessment; resuscitation: perform
primary assessment and resuscitation together; reassessment of airway, breathing, and circulation;
and secondary assessment. The primary assessment provides basic data essential for the patient’s
survival when life or limb is threatened. Resuscitation should be initiated simultaneously with the
primary assessment. It is performed when any component of the primary assessment appears
unstable. The secondary assessment is to be performed after the completion of primary assessment
and resuscitation. It provides comprehensive information about various organ systems .
BACKGROUND:

Injuries results from road traffic accident, falls, drowning, burns, poisoning and acts of
violence against oneself or others, among other causes 4.4 million injury-related deaths,
unintentional injuries take the lives of 3.16 million people every year and violence- related injuries
kill .25 million people every year. Roughly 1 in 3 of these deaths results from rod traffic accidents,
1 in 6 from suicides, 1 in 10 from homicide and 1 in 61 from war and conflict. For people age 5-
29 years, 3 of the top 5 causes of death are injury-related death, namely road traffic accident,
homicides are suicide.5

In India, 13-15 people die every hour due to an accident. In 2011, about 142,485 people
died in road traffic accident (RTA) in India, which is the highest ever in the world. Expected future
road traffic death suggest that the death toll will increase by approximately 66% over the next two
decades. It is low in high- income and developed countries of approximately 28%with an increase
in RTA- related death of almost 92% in china and 17% in India. A total of 4,67,044 road accident
have been reported by states of union Territories in the calendar year 2014.

NEED OF THE STUDY:

Addressing traumatic injuries is major components of Emergency Medicine (EM) practice.

Providers are asked to quickly evaluate these patients, address major life threats, and make a full
inventory of injuries. Having a systematic approach is essential to a rapid assessment that
minimizes the chance of missing injuries. This post will outline a step-by-step approach to
evaluation.

Implementation of the trauma resuscitation checklist would provide a clear and structured
understanding about the strategies that promote for a positive patient outcome and signifies the
importance of this study.
HYPOTHESIS:

H0: There is no association between trauma resuscitation management and patient outcomes in
critically ill patients.

H1: There is association between trauma resuscitation management and patient outcomes in
critically ill patients.

REVIEW OF LITERATURE:

Olivia Mair, Rolf Lefering (2022)11 conducted A retrospective, multicenter, match-pair

study was performed on 42,034 cases were identified. The study was conducted between 2009 to
2020. Gender specific differences in the clinical outcome of severely injured patient with leading
TBI could be detected. While women ae most likely to die within the first after trauma, the
mortality was significantly higher in men men.

Manoj Kashid (2020)12 conducted a observational study was performed on 2466 patients.
Who trauma victims over 1- year period in three center’s in India. The data collected from patient
recorded and its identified that road side accident is very common where as driving under effect
of alcohol was the second cause of death.

Adam R Aluisio et al, (Dec.2015)13 conducted a retrospective cross sectional study on 410
patients admitted at an urban trauma hospital in Hauti, who underwent traumatic injuries. The
study aimed to identify the burden of traumatic injuries in the selected hospital. The data were
extracted from the patients records and its was identified that Road traffic accident were the
primary reason for traumatic injury and the study emphasize on prevention initiatives and trauma
care improvement for substantial public health benefits.

Karan Hoffman Elaine cole (2014)14 conducted The ICF may provides a useful framework
for the development of a comprehensive health outcome measures for trauma care. Outcome
measures used in major trauma captured only a small proportion of health impact. Only 6% of all
possible health impact were captured. Measures performed very poorly in capturing concept
related to body function(5%), functional activity (11%) and environmental factors (2%).
OBJECTIVES:
Primary Objectives:

 To assess the trauma resuscitation management in critically ill patients.

Secondary Objective:

 To examine the association between the trauma resuscitation management and patient
outcomes in critically ill patients.

Methodology:

Research Approach:

In this study, Quantitative approach is used.

Research Design:

The research design used in this study is Correlational research design.

Setting:

The study will be conducted in Casualty and critical care units of the tertiary care hospital.

Population:

 Target population: In this study, the target population consists of all trauma patients
admitted in tertiary care hospital.

 Accessible population: In this study the accessible population consists of all trauma
patients admitted in critical care units of tertiary care hospital.

Sample size: Cochrane formula is used to calculate the sample size for the study with reference
to a study performed by ( Al-Mawali M, Al Rawahi S), the sample size calculated followed,

N = Z2 pq/e2

N = (1.96)2 * (0.19*0.81)/0.0025

N ≅ 236
Sampling technique:

In this study, Non probability convenient sampling technique is used.

Sampling criteria:

 Inclusion criteria: 1) All patients admitted with traumatic injuries.

2) Patient / relatives who gives assent for participation in the study.

3) Who are willing to participate in the study.

Operational Definition:

Trauma:

According to Oxford dictionary15, trauma refers to a mental condition caused by severe

shock, stress or fear, especially when the harmful effect last for a long time.

In this study, trauma refers to any injury such as head injury, abdomen injury, penetrating
injury, caused due to a harmful source such as accidents, assaults etc.

Resuscitation:

According to Oxford dictionary15, resuscitation means an act of making somebody start

breathing again or become conscious again after they have almost die.

In this study resuscitation refers to the implementation of strategies for avoiding the
complications of trauma injuries.

Management:

According to Oxford dictionary15, management refers to the act or skill of dealing with
people or situation in a successful way.

In this study, management refers to skills of taking care of the patients with traumatic
injuries at the emergent phase.

Patient:

According to Oxford dictionary15, patient refers to a person who is receiving medical treatment,
especially in a hospital.
Outcomes:

According to Oxford dictionary15, outcomes refers to the result or effect of an action or

event.

In this study patient outcomes refers to prognosis of the patient in terms of Physical,
Physiological, and Biochemical Parameters, that results from the intervention of the health care
team in casualties and critical care units.

Critical:

According to Oxford dictionary15, critical refers to saying what you think is bad about
somebody /sometimes.

Ill: According to Oxford dictionary15, ill refers to someone who is sick

In this study critically ill refers to a person whose physiological parameters are altered as
an effect of trauma and is being hospitalised for the same.

Methods of measurement of variables:

Dependant variable: Patient outcomes

Independent variable: Trauma resuscitation management.

Data collection tool:

 Section 1: Socio demographic characteristics of the trauma patients admitted in critical

care units.

 Section 2:

TOOL1: Trauma resuscitation checklist to assess the resuscitation management of trauma

patients in critical care units.

TOOL2: Structured tool to assess the patient outcomes among critically ill patients.
Methods / techniques for data collection:

Objective 1: The data will be extracted from patient data records.

Objective 2: The data will be extracted from patient data record and observation of vital and
clinical parameters.

Objective 3: The data will be extracted from patient data records.

Plan for data collection:

Select the sample as per inclusion criteria

Identify the trauma resuscitation management

implementation on the patient.

Assess the patient outcomes

(day wise)

Plan for data analysis:

Objective 1:

 Descriptive statistics which include Frequency distribution and percentage to examine

trauma resuscitation management among patients with traumatic injuries.

Objective 2:

 Karl Pearson correlation coefficient to associate trauma resuscitation management and

patient outcomes.
 DRAFT OF RESEARCH TOOL
SECTION A

SECTION 1: Socio demographic characteristics of the trauma patients admitted in critical care
units of tertiary care hospital.

1. Sample No:

2. Patient ID:

3. Age:

4. Gender: 1) Male 2) Female

5. Address:

6. Contact no:

7. Education:

8. Occupation:

9. Marital status:

10. Allergy: 1)No 2)Yes: if yes then specify

11. Diagnosis:
SECTION B: TOOL 1: Trauma resuscitation checklist to assess the resuscitation management of
trauma patients in critical care units.
PRE – ARRIVAL PREPARATION:
□ Oxygen
□ Suction
□ Bag and mask
□ Intubation trolley
□ Intubation medicine
□ Defibrillator
PRIMARY SURVEY:
□Confirm C- Spine is immobilized. (manually or with collar)

□Confirm is airway is protected If intubation: □ N/A

A □ GCS assessed before giving RSI medication.

□ Report ET tube size, depth, and color change.

□ Confirm ETCO2 reading on monitor.

□ Order chest x-ray for placement confirmation.

Place oxygen mask or connect existing mask to oxygen.

B
Breathing pattern

□Check pulses
C □Establish IV/IO access

□ Give fluid bolus (NS/RL) OR ordering blood. □ N/A

□State GCS (Eyes, Verbal, Motor)

D □States pupil size and response.

□Completely remove patients clothing.

□Cover patients with warm blanket.
E □Take temperature.
SECONDARY SURVEY:
Evaluate the state findings: PLAN OF CARE
□ Head Determine need of:
□ Ears  Lab test: yes□ No□
□ Eyes  x-ray: yes□ No□
□ Facial bones
 CT Scan: yes□ No□
□ Nose
 operation notification: yes□ No□
□ Mouth
 ICU Notification: yes□ No□
□ Neck/ c- spine

□ chest

□ abdomen

□ pelvis

□ Upper Extremities

□ Lower Extremities

□ Log Roll and Back Examination

DEPARTURE TIME: AMPLE HISTORY

□ State patient destination Allergy:

Prepare patient for travel: Medication:

□ Equipment Past history:

□ Medication Last meal:

□ Identify who travel with the patient Event:

 TOOL 2: Structured tool to assess the patient outcomes among critically ill patients.
Patient information Day 0 Day 1 Day 2 Day 3

1.PHYSIOLOGICAL
PARAMETERS
Temperature

Pulse

Respiration

Blood pressure

Oxygen saturation

2.ARTERIAL BLOOD GAS

PARAMETERS
PH

PCO2

PO2

HCO3

Lactate

3. GLASGOW COMA SCALE

4. PAIN SCORE
5. INTAKE / OUTPUT (ml) I= I= I= I=
O= O= O= O=

6. BIOCHEMICAL PARAMETERS
Hemoglobin

TLC Count

Platelet Count
Sodium

Potassium

Chloride

Creatinine

Urea

PT /INR

PRBC

FFP

CPD

7. MEDICATIONS
Antibiotics

Analgesics

IV Fluids

Inotropic supports

Sedatives

8. NUTRITION

RT Feeds

Soft Diet

Full Diet

Nil by Mouth

Fluid Restriction
9. ACTIVITY AND MOBILITY

Bed Rest

Chest Physiotherapy

Spirometry

Range of Motion Exercises

10. WOUND CONDITION