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Nurse is a person that strong enough to tolerate anything and kindly able to understand everyone. We are always there for you but, are we really prepared. In emergency preparedness, always expect the worst.
A 30-year-old man presented with hypovolemic shock following motor vehicle accident (MVA). The charge nurse (CN) calmly verbalizes the need for trauma team activation, bleeding control prioritization, stabilize the life-threatening condition and prepare equipment for definitive airway. His blood pressure was 60/30 mmHg and heart rate 120 beats per minute. Resuscitation team consist of an emergency resident and two experienced emergency nurses (EN). First EN on the patient's right side responsible to remove patient’s attire and obtain vital signs while the second EN placed cervical collar and insert two large intravenous access. Primary survey done by EN revealed a laceration to the left upper arm with pulsatile bleeding, controlled with direct pressure and tourniquet placed which stops the arterial bleeding. Hemostatic resuscitation consists of emergency 'O' blood and intravenous tranexamic acid initiated by CN. Shock index improved with rapid blood products transfusion managed by EN through the Level-1 infuser. First pass success intubation done by emergency resident. The initial e-FAST was negative remainder of the primary survey and secondary survey performed. Warm blanket was placed to prevent hypothermia. Primary survey chest x-ray reveals endotracheal tube in appropriate position and no significant thoracic injuries. Then a good patient care report and followed by passed over by EN to Trauma OT. Finally, we conducted team debriefing as reflection.
There is a huge shortage of nurses specialize in Emergency and Acute Care because being denied specialty recognition, poor awareness, inadequate future career plan and lack of highly vision leadership. It would take an extraordinary leadership quality to steer Malaysian Nursing in tandem with other medical professions. It clearly shows that with sufficient personnel with adequate competency, resourceful equipment and optimizing respective role in a team leads to smooth execution and better outcome.
We need highly motivated people to change hearts and minds. The importance of continuous training, education based on evidence-based medicine and the necessity of research and development.
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