Are You Ready for Some Football?

Football has become the most popular spectator sport in the United States today and attracts millions of players, both professional and amateur. This article discusses the risks of playing football. It is a contact sport and can result in a wide variety of injuries to the players. The rules of the game are based on adult participation; however, 2.8 million children participate in recreational tackle football every year. An understanding of the game and the risks associated with playing football is presented. The risks of the game are discussed with a focus on the prevention of injury. The most common injuries are presented, which include concussion and the major risk of traumatic brain injury. The importance of wearing appropriate protective gear and developing strategies to avoid head and neck injuries is presented. The role of parents and coaches is described, with tips on how to identify injuries and how to prevent them to guarantee the safety of players. Finally, the role of the nurse and other health care providers is discussed. This article presents an overview of the complexity of tackle football and strategies to keep the players safe.

Pediatric Femur Fractures.

Trauma is the leading cause of death and disability in children. Orthopaedic trauma has led to more than 84,000 hospital admissions annually and costs nearly a billion dollars. Femoral diaphyseal fractures account for nearly 2% of all bony injuries in children and are the most common orthopaedic injury requiring hospitalization. These injuries occur at an annual rate of 19 per 100,000, with an associated cost of millions of dollars. Emergency department (ED) visits for musculoskeletal injuries account for 10%-15% of the 100 million annual visits to U.S. pediatric EDs. Treatment of femur fractures in children vary on the basis of the mechanism of injury, the patient's age, weight, the fracture pattern, family circumstances, and cost. Treatment ranges from noninvasive to invasive and includes traction, casting, internal fixation, and external fixation. Complications can include infection, delayed or malunion, leg length discrepancy, ossification, and refracture. Attention to pain control and anxiety management becomes a major focus for nursing. Pediatric femur fracture can have a devastating impact on the child and the family and requires monitoring for 12-24 months. This injury is significant and can be a life-changing event for the child and the entire family. A case study is used as an example of the extent of the problem with pediatric patients and highlights the long-term effect of this injury.

Pediatric Emergence Delirium: A Case Study.

The pathophysiology of emergence delirium (ED) remains a mystery. Using a case study approach, ED is discussed from a clinical perspective. The case is a 4-year-old male who had myringotomy tube placement while anesthetized with sevoflurane. The negative outcome for this child is presented. The epidemiology of the phenomena is reviewed and definitions are examined. Several methods to assess ED are presented, accompanied by a discussion of the development of assessment tools. Research findings are included that address the possible causes of ED including preoperative anxiety, rapid awakening, pain, and a predisposition for this phenomenon in certain children. Various interventions, both pharmacologic and nonpharmacologic are considered. The impact of anesthesia on pediatric brain development is discussed and finally some possible solutions are hypothesized.

Perioperative Delirium Protocol for the Older Patient.

PURPOSE: Delirium is an acute change in cognition and attention. It may affect any age group. It is most common in older patients and is associated with a significant increase in mortality. The purpose of this project was to implement an assessment protocol to identify patients at risk for postoperative delirium. DESIGN: A case study approach was used. METHODS: The Confusion Assessment Method (CAM) tool for screening and diagnostic purposes was used to train surgeons, anesthesia providers, and nurses. A standardized delirium assessment and management protocol was developed and implemented. FINDINGS: The CAM and geriatric preoperative assessment was used with the patient discussed in the case study. The patient did not experience postoperative delirium and was discharged from perioperative services on the same day. CONCLUSION: Evidence informs us that early recognition and multifaceted interventions can prevent postoperative delirium in the elderly.

Disorders of the hand: a case study approach.

Using a case study approach, 2 disorders of the hands are presented. Dupuytren's contractures and bilateral trigger finger are described with a discussion of the interventions, including injection and surgical repair. Dupuytren's disease is a contracture of the connective tissue in the hand. It is also known as palmar fibromatosis and can occur bilaterally. This is a progressive disorder and causes deformity of the hands and eventually results in a decrease of functionality. Trigger finger is a common finger ailment that also causes deformity of the hand. This disorder is often referred to as stenosing tenosynovitis and can occur in several fingers bilaterally. The inflammation and hypertrophy of the sheath restricts the motion of the flexor tendon that results in triggering of the affected finger. It is painful and disabling. The etiology, prevalence, incidence, diagnosis, treatment, and nursing care of these disorders are discussed.

Barriers and perceived needs for understanding and using research among emergency nurses.

INTRODUCTION: Nurses are involved in conducting research and incorporating evidence into their practice. However, barriers exist at the individual, unit, and organizational level related to understanding, conducting, and evaluating the evidence. The Emergency Nurses Association (ENA) conducted a study to understand levels of education in research, the extent of experience, and needs and barriers to research at the individual and organizational levels in emergency nursing. METHODS: A cross-sectional survey design was used to poll members of the ENA. A 62-item survey instrument was designed to assess five areas: 1) nurses' research values, skills, experience, and awareness; 2) organizational settings' opportunities, barriers, and limitations to research; 3) nurses' understanding and comprehension of research and evidence; 4) presentation and accessibility of research; and 5) continuing educational topics to improve knowledge of the research process. RESULTS: Respondents (n = 948) identified barriers at the individual level that included lack of knowledge about critiquing research studies and familiarity with the research process. Barriers at the unit level included obtaining help from administrators and other staff in starting a project or having the authority to change practice. Barriers at the institution level included lack of support systems such as protected time to conduct research or implement changes in practice. DISCUSSION: Emergency nurses are highly motivated and interested in learning more about conducting and utilizing research to improve practice. Perceived personal, unit-based, and organizational barriers were identified through this research in an effort to highlight areas for improvement at the local and national levels.