ABSTRACT
SCIWORA is a syndrome occurring when the spinal cord sustains neural damage during a traumatic event without positive radiographic findings. Anatomic characteristics of the pediatric spine place children at risk for this injury. The injury occurs through extreme flexion, hyperextension, longitudinal distraction or ischemic damage to the spinal cord. Diagnosis is based on MRI findings. Timely diagnosis and stabilization is key to optimizing the child's recovery. Nursing care and evaluation of these children goes beyond the ABCs of resuscitation focusing on astute neurological examination.
Subject(s)
Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/therapy , Age Factors , Arnold-Chiari Malformation/complications , Arnold-Chiari Malformation/diagnosis , Biomechanical Phenomena , Braces , Critical Care/methods , Disease Progression , Emergency Treatment/methods , Emergency Treatment/nursing , Female , Humans , Infant , Magnetic Resonance Imaging , Medical History Taking , Neurologic Examination/methods , Neurologic Examination/nursing , Nurse's Role , Nursing Assessment , Patient Care Planning , Recovery of Function , Recurrence , Risk Factors , Spinal Cord Injuries/etiology , Time Factors , Tomography, X-Ray ComputedABSTRACT
A case report is presented that describes the initial care of a severely injured patient who was hemodynamically unstable. The discussion highlights the process used to recognize life-threatening injuries, to differentiate internal sources of hemorrhage, to provide damage-control surgery, and to stop further bleeding with an interventional radiologic examination. The emergency nursing care of a patient with unstable pelvic trauma is included.
Subject(s)
Emergency Nursing/methods , Fractures, Bone/nursing , Pelvis/injuries , Accidents, Traffic , Adult , Fractures, Bone/diagnostic imaging , Hemorrhage/diagnostic imaging , Hemorrhage/nursing , Humans , Male , RadiographySubject(s)
Bicycling/injuries , Pancreas/injuries , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapy , Biomechanical Phenomena , Child , Emergency Nursing/methods , Emergency Treatment/methods , Emergency Treatment/nursing , Female , Humans , Injury Severity Score , Wounds, Nonpenetrating/classificationABSTRACT
OBJECTIVE: To characterize the use of the esophageal tracheal combitube (ETC) in trauma patients who fail orotracheal rapid sequence intubation (RSI). DESIGN: Prospective protocol design and retrospective chart review. MATERIALS AND METHODS: Flight nurses were trained in the use of the ETC by mannequin simulation, videotape review, and didactic sessions. ETC insertion was attempted after failure of two or more attempts at orotracheal RSI. Over a 12-month period, 12 patients had ETC insertion, and 10 cases qualified for review. Injuries, number of failed orotracheal RSI attempts, definitive airway, initial arterial blood gas results, and outcome were recorded. RESULTS: ETC insertion was successful in all 10 patients in whom it was attempted. Definitive airway control was achieved by conversion to orotracheal intubation in seven patients, emergency department cricothyroidotomy in one patient, and operative room tracheostomy in two patients. No patient died because of failure to control the airway. Seven patients requiring ETC had mandible fractures. CONCLUSION: ETC insertion is an effective method of airway control in trauma patients who fail orotracheal RSI. It may be particularly useful in the patient with maxillofacial trauma and offers a practical alternative to surgical cricothyroidotomy in difficult airway situations.
Subject(s)
Airway Obstruction/therapy , Emergency Treatment/instrumentation , Intubation, Intratracheal/instrumentation , Multiple Trauma/complications , Adolescent , Adult , Air Ambulances , Airway Obstruction/etiology , Emergency Nursing/education , Emergency Treatment/adverse effects , Equipment Design , Equipment Failure , Humans , Intubation, Intratracheal/adverse effects , Middle Aged , Prospective Studies , Retrospective StudiesABSTRACT
The Combitube is currently being used in some prehospital cardiac arrest situations and in flight programs for management of airways in trauma patients, as well as in inpatient departments with limited availability to personnel experienced in intubation. The Combitube allows for quick intubation and for continuing airway access while the patient is in the emergency department.
