TCRN key terms

The period immediately after traumatic injury, commonly framed as the first 60 minutes, during which rapid assessment and early definitive or damage-control intervention most strongly influence the patient's chance of survival.

A rapid, structured ABCDE assessment (airway, breathing, circulation, disability, exposure) done on arrival to find and immediately treat life-threatening problems before any detailed examination is attempted.

A systematic head-to-toe examination with a complete history, performed once the primary survey is finished and the patient is stabilizing, to identify injuries not found during initial resuscitation.

A repeat, methodical full-body examination usually completed within the first 24 hours of admission to detect injuries missed on the initial primary and secondary surveys, especially in intoxicated or unresponsive patients.

The physical forces and events that produced the trauma, such as blunt, penetrating, blast, or thermal energy, used to predict likely injury patterns and guide triage and assessment.

The deliberate practice of anticipating occult or hidden injuries based on mechanism, patient age, medications, and comorbidities rather than relying only on obvious physical findings.

The self-reinforcing combination of hypothermia, metabolic acidosis, and coagulopathy in severely injured patients, which worsens bleeding and dramatically increases the risk of death.

A strategy prioritizing rapid hemorrhage control, limited crystalloid, balanced blood component transfusion, and prevention of hypothermia and acidosis until surgical or procedural bleeding control can be accomplished.

Deliberately accepting a lower-than-normal blood pressure in selected patients with active hemorrhage, avoiding large crystalloid volumes that can raise pressure, dislodge clot, and dilute clotting factors.

A preplanned, system-wide process for rapidly delivering large volumes of balanced blood components with defined activation triggers, laboratory monitoring, and deactivation criteria for patients with severe hemorrhage.

Heart rate divided by systolic blood pressure; a value above roughly 0.9 suggests occult hypoperfusion and can reveal compensated shock before conventional vital signs appear abnormal.

A value calculated from arterial blood gas reflecting the amount of base needed to restore normal pH; a rising base deficit signals worsening metabolic acidosis and inadequate tissue perfusion.

Focused Assessment with Sonography for Trauma: a rapid bedside ultrasound that checks pericardial and dependent abdominal and pelvic windows for free fluid in an unstable injured patient.

Air trapped in the pleural space that cannot escape, progressively raising intrathoracic pressure, collapsing the lung, shifting mediastinal structures, and obstructing venous return; it requires immediate decompression.

The classic combination of hypotension, distended neck veins, and muffled heart sounds suggesting cardiac tamponade, although all three findings occur together in only a minority of patients.

The combination of hypertension with widened pulse pressure, bradycardia, and irregular respirations that signals rising intracranial pressure and impending brain herniation.

The principle that the skull is a fixed container holding brain tissue, blood, and cerebrospinal fluid, so an increase in one component must be offset by a decrease in another or intracranial pressure rises.

The pressure gradient that drives blood flow to the brain, calculated as mean arterial pressure minus intracranial pressure; it must be maintained to prevent ischemic secondary brain injury.

Progressive neuronal damage occurring after the initial impact from causes such as hypoxia, hypotension, hyperthermia, seizures, or elevated intracranial pressure, much of which nursing care can prevent.

Distributive shock after high spinal cord injury caused by sudden loss of sympathetic tone, producing hypotension with bradycardia and warm, dry skin rather than the usual tachycardia and vasoconstriction.

A temporary loss of all cord function below the level of acute spinal cord injury, including absent reflexes and flaccid paralysis; it is distinct from neurogenic shock and gradually resolves over days to weeks.

Dangerously increased pressure within a closed fascial space that compromises perfusion to muscles and nerves, marked by pain out of proportion, pain on passive stretch, and late findings such as pulselessness.

Sustained intra-abdominal pressure above 20 mmHg accompanied by new organ dysfunction, impairing ventilation, venous return, and renal perfusion, and potentially requiring decompressive laparotomy.

Resuscitative Endovascular Balloon Occlusion of the Aorta: temporary inflation of an endovascular balloon in the aorta to slow subdiaphragmatic hemorrhage in selected non-compressible torso injuries while definitive hemorrhage control is arranged.

The prehospital process of using physiology, anatomy of injury, mechanism, and patient factors to decide the transport destination, such as a trauma center versus a closer non-trauma hospital.

A coordinated regional network of prehospital providers, hospitals of differing capability, and rehabilitation services that aims to get the right injured patient to the right facility at the right time.

Formal verification by a state authority or accrediting body that a hospital meets defined resource, staffing, and performance standards for a specific level of trauma care.

A structured database of injured-patient demographics, injuries, treatments, and outcomes used for benchmarking, research, quality improvement, and injury prevention planning.

An ongoing, data-driven cycle in which trauma programs identify care deviations through filters and review, implement corrective changes, and re-measure outcomes to improve care.

A confidential multidisciplinary case review meeting where trauma deaths and complications are examined for preventability, systems failures, and opportunities to change practice.

An injury prevention framework that organizes contributing factors by host, agent or vehicle, and environment across pre-event, event, and post-event phases to design targeted interventions.

Population-level strategies such as legislation, product engineering, education, and enforcement aimed at reducing how often traumatic injuries occur and how severe they are.

An approach that recognizes the widespread impact of trauma, builds physical and emotional safety and trust, and avoids re-traumatizing patients during assessment, procedures, and daily interactions.

New or worsening physical, cognitive, or mental health impairments that persist after critical illness and intensive care, including weakness, memory difficulty, anxiety, and depression.

The coordinated process of restoring function, independence, and participation after injury through physical, occupational, speech, and psychosocial therapies across the continuum of care.

The return of an injured person to work, school, family roles, and community life, supported by vocational services, psychosocial resources, and adaptive equipment after rehabilitation.

Targeted administration of agents such as vitamin K, prothrombin complex concentrate, or specific antidotes to restore clotting in an injured patient who is bleeding while anticoagulated.

Injury in older adults, in whom frailty, polypharmacy, anticoagulation, and reduced physiologic reserve mean that lower-energy mechanisms can cause severe injury and worse outcomes.

The documented, unbroken record of who collected, handled, and transferred forensic evidence so that it remains admissible; trauma nurses often initiate it when preserving evidence from injured patients.

A clinician's legal obligation to notify designated authorities about specified events, such as suspected abuse, neglect, or particular injuries, in accordance with state law and facility policy.