[Ballistic injury, decaying wounds: the nurse at the heart of the long rehabilitation process]. / Lésion balistique, plaies délabrantes : l'infirmier au cœur du long parcours de réhabilitation.

Ballistic injuries are disabling. Its functional impact is determined by its trajectory. Whether the injury affects a limb that could jeopardize its preservation, visceral lesions or craniocerebral and vertebro-medullary wounds, the nurse is at the heart of multidisciplinary care to limit and compensate for the after-effects. Directed healing, appropriate analgesia, settling in, technical training for this new, modified body (stoma, self-catheterization, appliances, etc.) and support in accepting the injury are all part of the nurse's role in helping the injured person rebuild his or her life.

School Nurses on the Front Lines of Medicine: The Approach to a Student With Severe Traumatic Bleeding.

With the continued threat of mass casualty incidents in schools and surrounding communities, it is essential for school nurses to be knowledgeable regarding the recognition of hemorrhagic shock due to massive bleeding and the acute management of these victims. In the past decade, increased interest and research in acute bleeding control have led to published evidence-based guidelines to reduce morbidity and mortality for victims of violent acts. It is essential that healthcare providers, including nurses who are the first responders in schools, are aware of methods to assess and control massive bleeding. This article summarizes the most up-to-date recommendations for the management of children with traumatic bleeding.

The incidence of fever in US Critical Care Air Transport Team combat trauma patients evacuated from the theater between March 2009 and March 2010.

INTRODUCTION: Most critically ill injured patients are transported out of the theater by Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are to identify the incidence of elevated temperature in patients managed in the CCATT environment and to describe the complications reported and the treatments used in these patients. METHODS: We performed a retrospective review of available records of trauma patients from the combat theater between March 1, 2009, and March 31, 2010, who were transported by the US Air Force CCATT and had an incidence of hyperthermia. We then divided the cohort into 2 groups, patients transported with an elevation in temperature greater than 100.4°F and patients with no documented elevation in temperature. We used a standardized, secure electronic data collection form to abstract the outcomes. Descriptive data collected included injury type, temperature, use of a mechanical ventilator, cooling treatment modalities, antipyretics, intravenous fluid administration, and use of blood products. We also evaluated the incidence of complications during the transport in patients who had a recorded elevation in temperature greater than 100.4°F. RESULTS: A total of 248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever. The mean age was 28 years, and 98% of patients were men. The mechanism of injury was an explosion in 156 patients (63%), blunt injury in 11 (4%), and penetrating injury in 45 (18%), whereas other trauma-related injuries accounted for 36 patients (15%). Of the patients, 209 (84%) had battle-related injuries and 39 (16%) had non-battle-related injuries. Traumatic brain injury was found in 24 patients (24%) with an incidence of elevated temperature. The mean temperature was 101.6°F (range, 100.5°F-103.9°F). After evaluation of therapies and treatments, 80 trauma patients (51%) were intubated on a mechanical ventilator (P < .001). Of the trauma patients with documented fever, 22 (22%) received administration of blood products. Nineteen patients received antipyretics during their flight (19%), 9 received intravenous fluids (9%), and 2 received nonpharmacologic cooling interventions, such as cooling blankets or icepacks. We identified 1 trauma patient with neurologic changes (1%), 6 with hypotension (6%), 48 with tachycardia (48%), 33 with decreased urinary output (33%), and 1 with an episode of shivering or sweating (1%). We did not detect any transfusion reactions or deaths during flight. CONCLUSION: Fever occurred in 41% of critically ill combat-injured patients evacuated out of the combat theater in Iraq and Afghanistan. Fewer than 20% of patients with a documented elevated temperature received treatments to reduce the temperature. Intubation of patients with ventilators in use during the transport was the only factor significantly associated with fever. Serious complications were rare, and there were no deaths during these transports.

Assessment of surgical wounds in the home health patient: definitions and accuracy with OASIS-C.

The number of surgical patients receiving home care continues to grow as hospitals discharge patients sooner. Home health clinicians must gain knowledge of the wound healing stages and surgical wound classification to collect accurate data in the Outcome and Assessment Information Set-C (OASIS-C). This article provides the information clinicians need to accurately assess surgical wounds and implement best practices for improving surgical wounds in the home health patient.

Overview of genitourinary trauma.

Genitourinary trauma is a common finding in the patient with multi-trauma, and includes injuries to the kidneys, bladder, ureters, urethra, penis, and scrotum. This article describes the care of the patient with genitourinary trauma focusing on assessments, diagnostic testing, and patient care. Nurses working with trauma patients need to monitor these patients carefully for genitourinary involvement because the signs and symptoms are not always clear.

Resuscitation of combat casualties: unique challenges and lessons learned.

Resuscitation and trauma anesthesia of combat casualties is very similar to trauma care in any US hospital--except for the setting. Using case examples, this article describes the principles of trauma anesthesia and resuscitation and the lessons learned regarding the modifications required when caring for a combat casualty. Examples of a massive trauma resuscitation (>10 units of packed red blood cells in 24 hours) and burn resuscitation are presented.

A clinically relevant wound assessment method to monitor healing progression.

One of the most important principles of wound management is periodic assessment and documentation of wound healing. Documentation of healing progress over time allows providers to assess the effectiveness of care to maximize healing. Several methods to determine wound healing progress currently exist and include dimensional, visual, and physiological assessments. However, because existing tools often require correlation of subjective assessments, are time-consuming, and may not consider that wound healing occurs from the "bottom up," a more objective and quicker approach to monitor healing progression was pursued. The purpose of this case study is to describe a once pen-and-paper tool that has now been computerized (the Barber Measuring Tool) that builds a graphical representation of a patient's individual wound healing progress to facilitate clinical decisions regarding the patient's plan of care. The tool, which is currently used for all wound patients in the author's facility, calculates wound volume using a simple formula and tracks this measurement as a percent of baseline over time in the patient's chart. Although formal research to establish validity and reliability of this tool has yet to be conducted, the tool has been used with more than 400 patients and has provided an accurate representation of healing progress. Studies to support proliferating use of this tool are warranted.

A review of the effect of tap water versus normal saline on infection rates in acute traumatic wounds.

This review seeks to determine whether using tap water rather than normal saline to irrigate acute traumatic wounds in the community has any effect on the rate of infection. The evidence suggests there is no such association.

The effectiveness of using a lipido-colloid dressing for patients with traumatic digital wounds.

This study compares the effect of a daily gauze dressing with that of a lipido-colloid dressing on the time taken to make up the dressing and efficacy of the management of traumatic digital wounds. This is a randomized controlled trial of 28 patients (16 experimental and 12 control) with injuries to their fingers and loss of tissue. The patients in the experimental and control groups were given a lipido-colloid dressing and a daily gauze dressing, respectively. The patients'wounds were assessed in terms of the size of the wound and the time it took for the wound to heal. The findings showed that patients in the experimental group had a faster recovery time from the healing of their wound than the control group (p= .024). The findings can help to establish an evidence-based practice in the management of traumatic digital wounds in clinical settings.

Managing a traumatic wound in a geriatric patient.

Clinical management of a wound in a geriatric patient requires an understanding of age-related changes in the skin and the knowledge to make appropriate treatment choices. This case study describes clinical assessment and management of a traumatic hip wound in a 75-year-old patient. In addition to addressing his nutritional status by providing supplements, topical wound care preparations, including papain-urea and castor oil/balsam of Peru/trypsin, were used as a conservative approach to address debridement and periwound skin concerns. Extra vigilance is required to assess wounds in geriatric patients to determine proper wound treatment and achieve optimum results. Additional studies to evaluate optimal treatment strategies in the clinical management of traumatic wounds in the geriatric population are needed.

Ocular trauma under the shadow of terror.

OBJECTIVES: To determine the prevalence and severity of penetrating eye trauma (PET) in victims of terror attacks in Jerusalem and to determine their specific in-hospital needs; and to evaluate the role of the ophthalmic nurse in helping to treat these patients in wards other than the ophthalmology ward and to determine how the ophthalmic nurse can coordinate care of the patients with other hospital personnel. BACKGROUND: PET is a common cause of significant visual loss. Early treatment is mandatory if maximum vision is to be restored. From January 2000 through February 2003, 468 victims of terror were examined in one of two major hospitals in Jerusalem that treat ocular injuries; 40 (8.5%) of these patients suffered from PET. METHODS: We conducted in our hospital a retrospective chart review of 109 consecutive patients with PET from January 2000 to February 2003; 40 (36.7%) cases were caused by terrorism. Data were collected on demographic characteristics; type, cause and extent of injury; and visual acuity (VA) on admission and at discharge. The terror victims were hospitalized in intensive care, surgical, and ophthalmology wards. RESULTS: Of the patients admitted after terrorist attacks, 64% were male. Arab patients comprised 20% of those admitted. Ninety-five percent of the terror victims with PET required surgery (20% for enucleation, 30% for retinal detachment, and the remaining 45% for other causes). Eighty-two percent of these victims presented with a visual acuity > or = 20/200 in the injured eye (versus 63% in patients admitted with ocular trauma from other causes), and 44% remained blind at discharge (versus 28% from other causes). CONCLUSIONS: Terror victims have more severe ocular injuries than do other patients with PET Ophthalmic nurses must make a special effort to attend to these patients in wards other than the ophthalmology wards and to coordinate their in-hospital care and follow-up treatments with hospital personnel in intensive care and surgical wards.