Archive for the ‘Trauma’ Category

Trauma Patients at Risk for Hypothermia

February 4, 2015

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by Charles Bankhead
Staff Writer, MedPage Today

 

French investigators reported trauma-associated hypothermia evolves from a combination of injury severity and potentially modifiable environmental and treatment-related factors.

Higher Revised Trauma Score (RTS) increased the odds of hypothermia by almost 70%. Intubation, lower temperature inside the transport vehicle, and lower infusion fluid temperature also increased the risk.

The risk declined significantly if patients were clothed and did not have a head injury, as reported online in Critical Care.

“Optimal patient management could contribute to limit heat loss or even to increase patient temperature when required,” Frederic Lapostolle, MD, of Hopital Avicenne in Bobigny, France, and co-authors wrote. “Undressing patients should be avoided. Mobile unit temperature and fluid infusion temperature were independently associated with hypothermia. They should be routinely measured.”

In addition, the group pointed out that mobile intensive care units should be equipped with “a warming system “to allow ‘body temperature’ fluid infusion, especially in severely injured patients.”

Trauma patients often have hypothermia on arrival to a hospital, and even moderate hypothermia can adversely affect prognosis. Causes of hypothermia remain unclear, and available data have come largely from hospital registries and retrospective studies.

To identify potential causes of hypothermia in trauma patients, Lapostolle and colleagues performed a prospective, multicenter, observational study involving  eight French hospitals and a regional emergency medical service (EMS).

EMS units in France are equipped for intensive care requirements, including anesthetics, catecholamines, laboratory facilities, and ultrasound, the authors noted. An EMS team consists of an emergency physician, critical care nurse, and a driver who has training in basic life support.

The study included all trauma patients older than 18 who received prehospital care from an EMS team and who were transported to a hospital by an EMS mobile unit.

Investigators recorded the following:

  • Patients’ demographic and morphologic information
  • Nature and circumstances of the trauma incident
  • Patient’s condition upon arrival of the EMS team
  • Environmental conditions (wind, rain, ground temperature)
  • Clinical characteristics (wound features, vital signs, RTS, oxygen saturation, tympanic temperature)

Investigators also recorded pertinent aspects of each patient’s care until arrival at the hospital.

The primary endpoint was hypothermia upon arrival at the hospital and the authors defined hypothermia as a body temperature of less than 95°F (35°C).

Data analysis comprised 448 patients, of whom 64 (14%) had a body temperature less than 35°C when they arrived at the hospital. Patients with and without hypothermia did not differ significantly with respect to demographic or morphologic traits.

In a univariate analysis, numerous clinical, environmental, and treatment-related factors were associated with the odds of hypothermia. Multivariate analysis revealed six factors that independently predicted lack of hypothermia on arrival at the hospital:

  • No intubation: odds ratio 4.23, 95% CI 1.61 to 11.02 (P=0.003)
  • Revised Trauma Score: OR 1.68, 95% CI 1.29 to 2.20 (P=0.0001)
  • EMS unit temperature on arrival at site of trauma: OR 1.20, 95% CI 1.04 to 1.38 (P=0.01)
  • Infusion fluid temperature (>21°C or 69.8°F): OR 1.17, 95% 1.05 to 1.30 (P=0.003)
  • Patient remaining clothed: OR 0.40, 95% CI 0.18 to 0.90 (P=0.03)
  • Absence of head injury: OR 0.36, 95% CI 0.16 to 0.83, (P=0.01)

“Routine temperature measurements should help improve the care of trauma victims,” the authors concluded. “When providing early care, EMS should always look for hypothermia. The severity of injury, mobile unit temperature, and medical interventions were risk factors associated with hypothermia on the victim’s arrival at hospital. Mobile unit and infusion fluid temperature should be measured and increased if necessary. Unclothing of patients [often done to examine the patient] should be avoided.”

The authors noted several limitations, including the fact that the results cannot be generalized to all trauma victims because the most severe cases (failure of onsite resuscitation) and least severe cases were not transported in the medically equipped mobile unit.

Also, they did not include outcomes in this study but pointed out that “the relationship between hypothermia and death is now well established.”

They called for a prospective study to assess the effect of warming on patient morbidity and mortality.

 

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What is Mechanism of Injury in regards to the Trauma patient?

May 20, 2013

This refers to the mechanisms whereby the energy is transferred from the environment to the person. Mechanism of injury assists the health care provider in triaging casualties and determining the probability of various types of injury.

Obtaining information related to Mechanism of injury is crucial in understanding what the patient’s body went through during the traumatic event. It may also be a very good predictor for associated injuries in which the patient may have sustained. Such things that may be of great importance: What did the vehicle look like: Mild/Moderate/Severe damage? Was there a Death in the same vehicle? Was the passenger restraint device used? Was there intrusion into the frame of the vehicle? Was the steering wheel bent? Did EMS notice any starring of the windshield? This information can be of great help when trying to prevent secondary injury in the trauma patient.

Did the car accident occur in Miami, FL (the location of our office)? Was chiropractic, massage, physical therapy, or another type of mechanical therapy instituted? Was there a surgical or mechanical procedure performed at the hospital? This information can be of help in identifying the progress in the accident patient.
References: American College of Surgeons (2008). ATLS

Abdominal trauma in forensic nursing, comment

August 20, 2009

This article speaks a lot of truth for the field in which I currently work in. As a Critical Care Nurse in a Trauma 1 hospital I see a lot of abdominal issues that may or may not be trauma related. However the assessments and sequence of assessments tend to be the same (if indicated.) We see a lot of GI bleeds which may or may not be extremely painful. Auscultation of bowel sounds, palpation etc are all part of our core assessment. Using forensic assessment is almost 100% of the assessment process as well. Its funny how we do things out of instinct and training now, then read an article that reminds us of where we learned it from previously, as part of our education.

Original Post:
July 31, 2009
ABDOMINAL TRAUMA IN FORENSIC NURSING

  The primary components of health assessment are the health history and the physical examination. Since forensic nurses may need to perform specific exams related to each individual case, abdominal assessments may be indicated where there is some nature of trauma involved. Subjective and objective data are utilized in order to obtain data required for the specific case involved. Just as nursing assessment are used in hospitals, the same assessment is utilized in forensic nursing assessments.

  Forensic nursing assessment as with general nursing assessment is initiated by observing the client’s general behavior and position. The nurse assesses the client for any marked restlessness, rigid posture or knees drawn up. Facial grimacing and rapid, uneven or grunting respirations are also noted.

  The abdomen is observed to detect any erythema or bruises. The nurse also documents any signs of abdominal distention, tautness, scars, lacerations or open wounds. Auscultation is then performed to assess if bowel sounds are present or absent. Percussion of the abdomen, liver and spleen are indicated in order to assess the level of trauma sustained. Palpation of the abdomen, umbilicus, liver, gallbladder, spleen and kidneys are noted to assess any tenderness, hypersensitivity or rigidity. The client may respond to pain by using muscle guarding, facial grimaces or pulling away from the nurse. Spleen and kidney tenderness may indicate trauma.

  The nurse should use a pain scale in order to assess the degree of pain the client exhibits. Examples of pain scales can include descriptive or numeric pain intensity scale. The McGill Pain Questionnaire is another resource to indicate pain quality descriptors using 4 major groups ie: descriptive, affective, evaluative and miscellaneous which aids clients in describing their pain.  These groups are then totaled in order to indicate the description of pain the client is experiencing.

  Although all assessments of abdominal trauma are useful in determining the degree of trauma sustained, the nurse should be aware that findings detected during an exam may warrant the use of additional tests. The client may need to be transported to the nearest hospital for further evaluation.

  Abdominal assessments regardless of injury should be performed in a setting that is conducive to the client’s safety, privacy and dignity.

  Abdominal assessment techniques utilized in Chapter 20 of Health Assessment for Nursing Practice, Wilson & Giddens is an excellent resource for any nurse to familiarize themselves with the proper sequence of assessments.

Forensic Nursing Certificate Program that includes Health Assessment

Tags: , , , ,

ABDOMINAL TRAUMA IN FORENSIC NURSING

July 31, 2009

  The primary components of health assessment are the health history and the physical examination. Since forensic nurses may need to perform specific exams related to each individual case, abdominal assessments may be indicated where there is some nature of trauma involved. Subjective and objective data are utilized in order to obtain data required for the specific case involved. Just as nursing assessment are used in hospitals, the same assessment is utilized in forensic nursing assessments.

  Forensic nursing assessment as with general nursing assessment is initiated by observing the client’s general behavior and position. The nurse assesses the client for any marked restlessness, rigid posture or knees drawn up. Facial grimacing and rapid, uneven or grunting respirations are also noted.

  The abdomen is observed to detect any erythema or bruises. The nurse also documents any signs of abdominal distention, tautness, scars, lacerations or open wounds. Auscultation is then performed to assess if bowel sounds are present or absent. Percussion of the abdomen, liver and spleen are indicated in order to assess the level of trauma sustained. Palpation of the abdomen, umbilicus, liver, gallbladder, spleen and kidneys are noted to assess any tenderness, hypersensitivity or rigidity. The client may respond to pain by using muscle guarding, facial grimaces or pulling away from the nurse. Spleen and kidney tenderness may indicate trauma.

  The nurse should use a pain scale in order to assess the degree of pain the client exhibits. Examples of pain scales can include descriptive or numeric pain intensity scale. The McGill Pain Questionnaire is another resource to indicate pain quality descriptors using 4 major groups ie: descriptive, affective, evaluative and miscellaneous which aids clients in describing their pain.  These groups are then totaled in order to indicate the description of pain the client is experiencing.

  Although all assessments of abdominal trauma are useful in determining the degree of trauma sustained, the nurse should be aware that findings detected during an exam may warrant the use of additional tests. The client may need to be transported to the nearest hospital for further evaluation.

  Abdominal assessments regardless of injury should be performed in a setting that is conducive to the client’s safety, privacy and dignity.

  Abdominal assessment techniques utilized in Chapter 20 of Health Assessment for Nursing Practice, Wilson & Giddens is an excellent resource for any nurse to familiarize themselves with the proper sequence of assessments.

Forensic Nursing Certificate Program that includes Health Assessment

Tags: , , , ,

 

 

 


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