ABSTRACT
Blunt mechanism chest wall injury (CWI) is commonly seen in the emergency department (ED), since it is present in around 15% of trauma patients. The thoracic cage protects the heart, lungs and trachea, thereby supporting respiration and circulation, so injury to the thorax can induce potentially life-threatening complications. Systematic care pathways have been shown to improve outcomes for patients presenting with blunt mechanism CWI, but care is not consistent across the UK. Emergency nurses have a crucial role in assessing and treating patients who present to the ED with blunt mechanism CWI. This article discusses the initial assessment and acute care priorities for this patient group. It also presents a prognostic model for predicting the probability of in-hospital complications following blunt mechanism CWI.
Subject(s)
Thoracic Injuries , Wounds, Nonpenetrating , Humans , Wounds, Nonpenetrating/nursing , Thoracic Injuries/nursing , Thoracic Injuries/therapy , Thoracic Wall/injuries , Emergency Nursing , United Kingdom , Emergency Service, Hospital , Nursing AssessmentABSTRACT
El trabajo de enfermería se basa en un método científico, el Proceso de Atención de Enfermería (PAE), que puede aplicarse en cualquier situación y medio. En este artículo, describimos la elaboración e implementación de un Plan de Cuidados de Enfermería para una niña afgana de aproximadamente 2 años, que fue remitida al hospital español desplegado en Herat, Afganistán (Role 2E), en Abril de 2015, para valoración y tratamiento por quemaduras en brazo derecho y región anterior del tórax, tras haberle caído agua hirviendo. Se practicaron curas con sedación (por su corta edad) cada 48 horas. Siguiendo el PAE, se estandarizaron los cuidados a aplicar y se fijaron unas líneas de acción encaminadas a la continuidad de los mismos tras el relevo del personal sanitario español, así como la prevención de futuros problemas derivados de las secuelas de las lesiones
The nurse work is based on a scientific method; the Nursing Process (Proceso de Atención de Enfermería -PAE- in Spanish) which can be applied in every situation and milieu. In this article, we describe the design and implementation of a Nursing Care Plan for a two-year-old Afghan girl who had been sent to the Spanish hospital deployed in Herat, Afghanistan (Role 2E) in April 2015 to be checked and treated of burns on her right arm and anterior chest after hot water had fallen upon her. Due to her short age, dressings with sedation were performed every 48 hours. Acording to the NP, both the care to be applied was established together with the course of action to be followed after the replacement of the Spanish staff in order to prevent future problems directly derived from the consequences of the injuries
Subject(s)
Humans , Female , Child, Preschool , Nursing Process , Patient Care Planning , Nursing Care , Burns/nursing , Burns/therapy , Military Facilities , Arm Injuries/nursing , Thoracic Injuries/nursing , AfghanistanABSTRACT
BACKGROUND: Blunt chest injuries not treated in a timely manner with sufficient analgesia, physiotherapy and respiratory support are associated with increased morbidity and mortality. The aim of the study was to determine the impact of a blunt chest injury early activation protocol (ChIP) on patient and hospital outcomes. METHODS: In this pre-post cohort study, the outcomes of patients with blunt chest injury who received ChIP were compared against those who did not. Data including injury severity, patient outcomes, hospital treatments and comorbidites were extracted from medical records. The primary outcome was pneumonia. Secondary outcomes evaluated health service delivery. Logistic and multiple regressions were used to adjust for potential confounding variables. RESULTS: 546 patients were included, 273 in the before-ChIP cohort and 273 in the after-ChIP cohort. The incidence of pneumonia following the introduction of ChIP was reduced by 4.8% (95% CI 0.5-9.2, p=0.03). In the after-ChIP cohort, more patients received a pain team review (32% vs. 13%, p<0.001), physiotherapy (93% vs. 86%, p=0.005) and trauma team review (95% vs. 39%, p<0.001). There was no difference in length of stay (p=0.50). CONCLUSIONS: ChIP improved the delivery of healthcare services and reduced the rate of pneumonia among patients with isolated chest trauma.
Subject(s)
Rib Fractures/nursing , Wounds, Nonpenetrating/nursing , Aged , Aged, 80 and over , Clinical Protocols , Controlled Before-After Studies , Delivery of Health Care , Emergency Nursing/methods , Female , Humans , Length of Stay , Male , New South Wales , Patient Care Team , Pneumonia/etiology , Pneumonia/nursing , Retrospective Studies , Thoracic Injuries/etiology , Thoracic Injuries/nursing , Treatment Outcome , Wounds, Nonpenetrating/etiologyABSTRACT
Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.
Subject(s)
Accidents, Traffic , Aorta, Thoracic/injuries , Cardiopulmonary Resuscitation/methods , Thoracic Injuries/therapy , Wounds, Nonpenetrating/therapy , Advanced Practice Nursing/methods , Aorta, Thoracic/diagnostic imaging , Glasgow Coma Scale , Humans , Injury Severity Score , Male , Middle Aged , Multiple Trauma/diagnosis , Multiple Trauma/nursing , Multiple Trauma/therapy , Nurse's Role , Pneumothorax/diagnostic imaging , Pneumothorax/nursing , Pneumothorax/therapy , Rib Fractures/diagnostic imaging , Rib Fractures/nursing , Rib Fractures/therapy , Thoracic Injuries/diagnosis , Thoracic Injuries/nursing , Trauma Centers , Treatment Outcome , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/nursingABSTRACT
Multi-trauma patients need specific care provided by medical teams and hospitals with a technical platform that optimises emergency care.They also require a special 'shock management' unit with staff members available to welcome these patients and maintain their vital functions.
Subject(s)
Cooperative Behavior , Interdisciplinary Communication , Multiple Trauma/nursing , Shock, Traumatic/nursing , Allied Health Personnel , Brain Injuries/diagnosis , Brain Injuries/nursing , Brain Injuries/therapy , Emergency Medical Services , France , Humans , Multiple Trauma/diagnosis , Multiple Trauma/therapy , Nursing Diagnosis , Prognosis , Resuscitation/methods , Resuscitation/nursing , Shock, Hemorrhagic/diagnosis , Shock, Hemorrhagic/nursing , Shock, Hemorrhagic/therapy , Shock, Traumatic/diagnosis , Shock, Traumatic/therapy , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/nursing , Spinal Cord Injuries/therapy , Thoracic Injuries/diagnosis , Thoracic Injuries/nursing , Thoracic Injuries/therapy , Vital SignsABSTRACT
Management of blunt injury to the boney thorax centers on the hospital; yet, these injuries continue to impact patients long after hospitalization. The purpose of this literature review was to identify long-term outcomes associated with this injury. A literature search found 616 studies and, after screening, yielded 6 articles for review. Patient and injury characteristics and postinjury assessment findings were explored. The impact of this injury can be prolonged and life altering, prompting the need for further investigation. A greater understanding of injury-specific posthospitalization outcomes could elucidate the impact of these injuries on patients, families, and society.
Subject(s)
Fractures, Bone/complications , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications , Education, Nursing, Continuing , Emergency Nursing , Fractures, Bone/nursing , Fractures, Bone/therapy , Humans , Thoracic Injuries/nursing , Thoracic Injuries/therapy , Treatment Outcome , Wounds, Nonpenetrating/nursing , Wounds, Nonpenetrating/therapyABSTRACT
Dyspnea is one of the most common presenting symptoms in thoracic trauma patients; therefore, trauma nurses require extensive knowledge of this symptom. The Human Response to Illness model provides an organizing framework to establish a comprehensive understanding of the human response of dyspnea following thoracic trauma. The model is used to describe the physiological, pathophysiological, behavioral, and experiential perspectives of dyspnea in thoracic trauma, while considering personal and environmental factors. This comprehensive overview will provide the trauma nurse with appropriate evidence-based rationale for interventions in the management of acute dyspnea in the thoracic trauma population.
Subject(s)
Dyspnea/nursing , Dyspnea/physiopathology , Emergency Nursing/methods , Thoracic Injuries/nursing , Thoracic Injuries/physiopathology , Dyspnea/psychology , Education, Nursing, Continuing , Evidence-Based Nursing , Humans , Thoracic Injuries/psychologySubject(s)
General Surgery/standards , Guideline Adherence , Hemothorax/nursing , Intensive Care Units/standards , Multiple Trauma/nursing , Nurse's Role , Thoracic Injuries/nursing , Aged , Decision Making , Evidence-Based Medicine/education , Fatal Outcome , Female , Hemothorax/surgery , Hemothorax/therapy , Humans , Interdisciplinary Communication , Medical Errors/prevention & control , Multiple Trauma/surgery , Multiple Trauma/therapy , Patient Care Team/standards , Professional-Family Relations , Quality of Health Care/standards , Thoracic Injuries/complications , Thoracic Injuries/surgery , Thoracic Injuries/therapyABSTRACT
Critically-ill patients who have sustained multiple traumatic injuries have complex, and often conflicting, physiological needs. These have profound implications on the way in which nursing staff approach the physical positioning of these patients to minimize the risks of further physiological injury and damage, maintain homeostasis and promote optimum recovery. This article reviews and discusses the evidence base underpinning therapeutic positioning of the multiply-injured trauma patient within the intensive-care unit (ICU), focusing on patients with a known or suspected unstable spinal injury, pelvic injury, traumatic brain injury, chest injury, or multiple limb fractures. Included are guidelines on the therapeutic positioning of the multiply-injured trauma patient within the ICU, based on the current available evidence and also drawn from practical experience within the author's own place of work. There is also a brief discussion of how such guidelines may be introduced into clinical practice.
Subject(s)
Bed Rest/methods , Bed Rest/nursing , Critical Care/methods , Multiple Trauma/nursing , Posture , Bed Rest/adverse effects , Brain Injuries/nursing , Critical Illness/nursing , Evidence-Based Medicine , Fractures, Bone/nursing , Humans , Immobilization , Lung Injury , Nursing Evaluation Research , Orthotic Devices , Patient Care Planning , Pelvic Bones/injuries , Practice Guidelines as Topic , Spinal Injuries/therapy , Thoracic Injuries/nursingABSTRACT
Cardiac trauma fatalities occur in 22% of victims of motor vehicle crash. Blunt cardiac trauma may result in myocardial rupture. Mechanisms of injury include compression, deceleration, laceration, and "hydraulic ram" effect. Diagnosis is difficult because of coexisting injuries and the lack of evidence-based protocols. Physiological changes in the elderly and the presence of comorbid illness result in poor survival rates when myocardial rupture occurs. Trauma nurses must be prepared to provide end-of-life care related to the poor outcome associated with myocardial rupture. This case study reports a right ventricular rupture in an elderly patient involved in a frontal motor vehicle crash.
Subject(s)
Accidents, Traffic , Heart Rupture/nursing , Nursing Care , Terminal Care , Thoracic Injuries/nursing , Advanced Cardiac Life Support , Aged, 80 and over , Cardiac Tamponade/etiology , Cardiac Tamponade/nursing , Family Nursing , Fatal Outcome , Heart Rupture/etiology , Humans , Male , Thoracic Injuries/complicationsABSTRACT
Deadly Dozen ... Lethal Six ... Hidden Six ... Major thoracic injuries are known as the Deadly Dozen. The Lethal Six (airway obstruction, tension pneumothorax, cardiac tamponade, open pneumothorax, massive hemothorax, and flail chest) are immediate, life-threatening injuries that require evaluation and treatment during primary survey. The Hidden Six (thoracic aortic disruption, tracheobronchial disruption, myocardial contusion, traumatic diaphragmatic tear, esophageal disruption, and pulmonary contusion) are potentially life-threatening injuries that should be detected during secondary survey. Each of these may present as immediately life-threatening or potentially life-threatening events. This article provides an overview of these 12 injuries and appropriate management for each. Case studies are included.
Subject(s)
Emergency Nursing , Thoracic Injuries/diagnosis , Thoracic Injuries/therapy , Combined Modality Therapy , Contusions/diagnosis , Contusions/therapy , Critical Illness , Female , Flail Chest/diagnosis , Flail Chest/therapy , Follow-Up Studies , Heart Injuries/diagnosis , Heart Injuries/mortality , Heart Injuries/therapy , Hemothorax/diagnosis , Hemothorax/therapy , Humans , Injury Severity Score , Male , Multiple Trauma/diagnosis , Multiple Trauma/therapy , Pneumothorax/diagnosis , Pneumothorax/therapy , Risk Assessment , Survival Rate , Thoracic Injuries/mortality , Thoracic Injuries/nursing , Trauma CentersABSTRACT
La autora describe la etiología y tratamientos que reciben los pacientes que sufren algún tipo de trauma. Se detallan los cuidados de enfermería brindados a este tipo de pacientes (AU)
Subject(s)
Humans , Multiple Trauma/nursing , Wounds and Injuries/nursing , Accidents , Peritoneal Lavage/nursing , Abdominal Injuries/nursing , Thoracic Injuries/nursing , Nursing Diagnosis , First Aid/nursing , Terminology , Craniocerebral Trauma/nursingABSTRACT
La autora describe la etiología y tratamientos que reciben los pacientes que sufren algún tipo de trauma. Se detallan los cuidados de enfermería brindados a este tipo de pacientes
Subject(s)
Humans , Wounds and Injuries , Multiple Trauma/nursing , Peritoneal Lavage , Accidents , Terminology , First Aid , Craniocerebral Trauma , Abdominal Injuries , Nursing Diagnosis , Thoracic Injuries/nursingSubject(s)
Emergency Nursing/methods , Nursing Assessment/methods , Thoracic Injuries/nursing , Wounds, Penetrating/nursing , Cardiac Tamponade/etiology , Cardiac Tamponade/therapy , Emergency Treatment/methods , Emergency Treatment/nursing , Hemothorax/etiology , Humans , Pericardiocentesis , Thoracic Injuries/complications , Thoracic Injuries/diagnosis , Wounds, Penetrating/complications , Wounds, Penetrating/diagnosisABSTRACT
El aumento en las altas velocidades y la falla mecanica de los vehiculos, y el aumento de la violencia en los medios urbanos,son las cuasas mas importantes que incrementan progresivamente el numero de politraumatismo en nuestro medio,entre ellos ,el traumatismo de torax.Las lesiones toracicas,son la causa,de cada cuatro muertes producidas por trauma,y muchos deestos pacientes mueren despues de llegar al hospital.(au)
Subject(s)
Humans , Male , Female , Thoracic Injuries/diagnosis , Thoracic Injuries/nursing , Thoracic Injuries/prevention & control , Thoracic Injuries/therapy , BoliviaABSTRACT
The incidence of myocardial contusion as a result of blunt chest trauma remains difficult to assess. As such the potentially lethal consequences are often difficult to mitigate against. The true incidence of myocardial contusion is not known and various authors have ascribed percentages in the very broad range of 8-71% of those having suffered blunt chest trauma. The extremely wide variation in presenting signs and symptoms further complicates the clinical picture creating a complicated and complex challenge for the assessing team. In the absence of clear guidelines to date a number of potential options are discussed exploring their efficacy and appropriateness in the management of those patients suffering from blunt chest trauma.
