1. Bergman Schieman, Karen PhD, RN, CNRN
  2. Pattison, Kelley PhD, RN
  3. Early, Conor BSN, RN, CCRN


The coexisting conditions of traumatic injury coupled with a comorbid condition such as heart failure create a complex scenario for the trauma nurse to manage. Initial care of the trauma patient includes following the Advanced Trauma Life Support guidelines and managing the airway, breathing, and circulation (ABC) of the patient. Once the airway is secure and breathing is managed, the team addresses circulation. At this point in the patient's care, the team typically does not know which, if any, comorbid conditions exist. Managing circulation for a hypotensive or hypoperfused patient will most likely include 1-2 L of crystalloid solution being given intravenously. Although most patients can tolerate this fluid volume challenge, excess volume can be difficult for a patient with heart failure. This article describes the monitoring and management techniques that are recommended for patients presenting with trauma and the comorbid condition of heart failure.