RESUMEN
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.
Asunto(s)
Fracturas de las Costillas/enfermería , Heridas no Penetrantes/enfermería , Anciano , Anciano de 80 o más Años , Protocolos Clínicos , Estudios Controlados Antes y Después , Atención a la Salud , Enfermería de Urgencia/métodos , Femenino , Humanos , Tiempo de Internación , Masculino , Nueva Gales del Sur , Grupo de Atención al Paciente , Neumonía/etiología , Neumonía/enfermería , Estudios Retrospectivos , Traumatismos Torácicos/etiología , Traumatismos Torácicos/enfermería , Resultado del Tratamiento , Heridas no Penetrantes/etiologíaRESUMEN
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.
Asunto(s)
Accidentes de Tránsito , Aorta Torácica/lesiones , Reanimación Cardiopulmonar/métodos , Traumatismos Torácicos/terapia , Heridas no Penetrantes/terapia , Enfermería de Práctica Avanzada/métodos , Aorta Torácica/diagnóstico por imagen , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/enfermería , Traumatismo Múltiple/terapia , Rol de la Enfermera , Neumotórax/diagnóstico por imagen , Neumotórax/enfermería , Neumotórax/terapia , Fracturas de las Costillas/diagnóstico por imagen , Fracturas de las Costillas/enfermería , Fracturas de las Costillas/terapia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/enfermería , Centros Traumatológicos , Resultado del Tratamiento , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/enfermeríaRESUMEN
Rib fractures pose significant risk to trauma patients. Effective pain control and the ability to take deep breaths are crucial for optimal recovery, and these are key elements in current clinical guidelines. These guidelines use incentive spirometry volumes along with other assessment values to guide patient care. However, despite current guidelines, nurses do not routinely document inspired respiratory volumes. This article provides trauma nurses with the rationale for documenting and tracking incentive spirometry volumes to improve outcomes for patients with rib fractures. This promotes early detection of respiratory decline and early interventions to improve pain control and pulmonary function.
Asunto(s)
Terapia Respiratoria/enfermería , Fracturas de las Costillas/enfermería , Fracturas de las Costillas/terapia , Espirometría/métodos , Espirometría/enfermería , Educación Continua en Enfermería , Humanos , Mecánica Respiratoria/fisiología , Terapia Respiratoria/métodos , Fracturas de las Costillas/fisiopatologíaAsunto(s)
Bombas de Infusión , Manejo del Dolor/métodos , Dolor/tratamiento farmacológico , Fracturas de las Costillas/complicaciones , Ensayos Clínicos como Asunto , Diseño de Equipo , Humanos , Investigación Metodológica en Enfermería , Dolor/etiología , Manejo del Dolor/enfermería , Ensayos Clínicos Controlados Aleatorios como Asunto , Fracturas de las Costillas/enfermeríaRESUMEN
The importance of the respiratory system to total body functioning cannot be overemphasized. It is imperative that the nurse realize that the first priority in trauma care is to maintain and support the respiratory system. The nurse must be able to rapidly and effectively perform a primary survey, recognize the clinical manifestations of life-threatening thoracic injuries, and intervene in the care of the patient to help stabilize and maintain the patient's respiratory function. The nurse must not only be able to asses, but must also be able to technically intervene rapidly and effectively. Other potential life-threatening injuries must remain uppermost in the nurse's mind. Continual, ongoing monitoring of the patient's status must be an integral part of the nurse's actions. If these activities are judiciously employed, perhaps the mortality rate will decrease and the thoracic trauma victim will survive, capable of leading a full and productive life in our society. This is quality patient care.