Trauma resuscitation record

Trauma nursing documentation has dramatically improved at our institution with the implementation of the trauma resuscitation record. As with previous records, the need for revision already has become apparent. It is important to keep this in mind when developing any new form; one must be flexible enough to change as the skill and efficiency of the nursing staff advance.     

Developing a personal health record self-efficacy tool

The purpose of this preliminary work was to develop a new short tool to assess personal health records (PHRs) self-efficacy. Prior work had found 4 distinct skills related to creating, updating, tracking symptoms, and sharing information with health care providers using PHR. Although PHRs have great promise, their uptake has been rather limited, especially in economically limited populations. A convenience sample of community-living persons with HIV/AIDS (N = 100) was asked to complete the new tool along with other self-efficacy measures. Preliminary work indicated more confidence about paper-based PHRs compared with computer-based PHRs. The paper-based subscale was significantly correlated to chronic illness and HIV treatment self-efficacy scales as expected, but there were no relationships for the computer-based subscale. This simple screening tool could identify interested clients and their preference either for a paper-based or computer-based PHR. Further research is needed with larger sample sizes and different chronically ill populations to further explore the psychometrics of the instrument.     

Fluid resuscitation following multiple trauma

The initial minutes and hours of nursing care of the trauma victim make a critical difference in the patient's chance for recovery. The critical care and ED nurse's ability to provide fluid resuscitation rapidly to augment the patient's flagging vascular volume is critical to the maintenance of circulation. By administering the most appropriate solution to meet the trauma patient's physiologic requirements, the nurse ensures that the patient will have an adequate circulating volume to meet the oxygenation and nutritional requirements of body tissues. Early, rapid fluid resuscitation is essential to stave off noncompensatory, irreversible shock. By implementing specific nursing care strategies to increase the flow of IV solutions to the patient, the nurse combats the nursing diagnosis appropriate for almost every multiple trauma victim: Fluid Volume Deficit.     

Cruciform position for trauma resuscitation

Multiply injured patients represent a particularly demanding subgroup of trauma patients as they require urgent simultaneous clinical assessments using physical examination, ultrasound and invasive monitoring together with critical management, including tracheal intubation, thoracostomies and central venous access. Concurrent access to multiple body regions is essential to facilitate the concept of ‘horizontal’ resuscitation. The current positioning of trauma patient, with arms adducted, restricts this approach. Instead, the therapeutic cruciform positioning, with arms abducted at 90°, allows planning and performing of multiple life‐saving interventions simultaneously. This positioning also provides a practical surgical field with improved sterility and procedural access.     

心肺复苏流程记录单的设计及应用

为进一步规范心肺复苏抢救的护理记录内容,提高护理病历质量,以心肺骤停患者抢救流程为基础,设计了心肺复苏流程记录单.经过2年的临床应用,效果明显.心肺复苏流程记录单可规范心肺复苏抢救的护理记录内容,提高护士心肺复苏抢救的能力和病历书写质量,改进心肺复苏抢救流程,并在提高心肺复苏成功率上具有一定的作用.     

Fluid resuscitation for the trauma patient

Attempts at prehospital fluid replacement should not delay the patient's transfer to hospital. Before bleeding has been stopped, a strategy of controlled fluid resuscitation should be adopted. Thus, the risk of organ ischaemia is balanced against the possibility of provoking more bleeding with fluids. Once haemorrhage is controlled, normovolaemia should be restored and fluid resuscitation targeted against conventional endpoints, the base deficit, and plasma lactate. Initially, the precise fluid used is probably not important, as long as an appropriate volume is given; anaemia is much better tolerated than hypovolaemia. Colloids vary substantially in their pharmacology and pharmacokinetics and the experimental findings from one cannot be extrapolated reliably to another. We still lack reliable data to prove that any of the colloids reduce mortality in trauma patients. In the presence of SIRS, hydroxyethyl starch may reduce capillary leak. Hypertonic saline solutions may have some benefit in patients with head injuries although this has yet to be proven beyond doubt. It is likely that one or more of the haemoglobin-based oxygen carriers currently under development will prove to be valuable in the treatment of the trauma patient.     

Fluid resuscitation in the trauma patient

Trauma is responsible for 25% of all emergency department visits causing a healthcare burden of more than $400 billion a year. Timely and appropriate fluid resuscitation may mean the difference between survival and death. Controversy surrounds the best method of fluid resuscitation for optimum recovery. This article will evaluate current research regarding the various types of fluid resuscitation in the trauma population. Colloid and crystalloid fluid will be compared describing the risks and benefits of each.     

Efficacy of a massive transfusion protocol for hemorrhagic trauma resuscitation

Objectives

New paradigm shifts in trauma resuscitation recommend that early reconstitution of whole blood ratios with massive transfusion protocols (MTP) may be associated with improved survival. We performed a preliminary study on the efficacy of MTP at an urban, Level 1 trauma center and its impact on resuscitation goals.

Fluid resuscitation in the adult trauma patient

Successful fluid resuscitation of the trauma patient requires prompt assessment and initiation of fluid therapy. This article discusses the fluids and blood components that may be used in the resuscitation period for the adult trauma patient, as well as potential complications of fluid resuscitation therapy and nursing interventions.     

Advanced airway control in trauma resuscitation.

Definitive airway control which may require endotracheal intubation with or without an induction agent and muscle relaxant is an essential component of trauma resuscitation. We reviewed the delivery of advanced airway care in the resuscitation room of a regional trauma centre. This prospective survey suggests that in the absence of an experienced anaesthetist, A&E staff with a background of suitable training and experience may undertake the anaesthetic responsibility associated with securing a definitive airway when the situation demands.     

Developing trauma care systems: a nursing perspective

Emergency medical services (EMS)/trauma care systems offer unique opportunities for nurse administrators in community hospitals and medical centers to encourage a professional practice model for the department of nursing. The development of local and regional EMS/trauma services involves nurse administrators and their staffs in the legislative process; community networking; program planning, operation, and evaluation; and clinical research. This, the first in a series of articles, reviews the history of trauma care in America, explains the process of regionalization and designation as provided for in the proposed federal legislation, discusses appropriate roles and responsibilities for nurse leaders in trauma care systems, and outlines planning and operational functions for nursing departments in designated trauma care facilities.     

Effects of a novel antioxidant during resuscitation from severe blunt chest trauma

Previous work suggests that neutrophils (PMNs) and/or prostaglandins might mediate the progressive respiratory failure after severe pulmonary contusion. Since reactive oxygen metabolites are closely associated with both these factors, we examined the actions of a novel antioxidant after swine received a unilateral injury followed by 25% hemorrhage. An infusion (2mL/kg/h intravenously x 6 h) of either polynitroxylated 5% Dextran + Tempol (PND, n = 9), 5% Dextran (D, n = 6), or lactated Ringers (LR, n = 13) was begun 60 min post-injury to mimic 'pre-hospital resuscitation.' After 15 min, standard resuscitation was initiated (3x shed blood as LR in 30 min) plus further LR for 6 h to maintain hemodynamics. The total LR requirement was lower with PND (1,772+/-267 mL) versus D (3,040+/-689, P = 0.0563) or LR (4145+/-398, P = 0.0005). The ipsilateral bronchoalveolar lavage (BAL) PMN count with PND (8+/-2 x 10(5)/mL), was not different from its baseline (P = 0.131), but the counts with D (16+/-3) and LR (17+/-4) were both higher than their baselines (P = 0.0184 and 0.0431). Similarly, BAL protein with PND (1,560+/-350 mg %) was not elevated from its baseline (P = 0.0721), but the values with D (2,560+/-498) and LR (2,474+/-899) were both higher than their baselines (P = 0.0169 and 0.0325). In the contralateral (uninjured) lung, the effects were similar, but the increases were less for PMNs (8+/-2 versus 10+/-2 or 14+/-4 x 10(5)/mL) and for protein (609 +/-153 versus 1,955+/-671 or 1486+/-357 mg %). Despite these significant BAL changes, there was no obvious improvement in cardiopulmonary dysfunction. Thus oxidants probably have some role in the pathogenic mechanism of progressive secondary injury after thoracic trauma, but further work is needed to determine the therapeutic potential of antioxidants because no clinical improvement was detected.     

Hemodynamic responses to fluid resuscitation after blunt trauma

OBJECTIVES: To determine the acute circulatory effects of an open fracture and the circulatory effects of different fluid resuscitation strategies after such a fracture. DESIGN: Randomized controlled laboratory study. SETTING: Medical Research Council laboratory, university medical school. SUBJECTS: Four groups of ten immature female Large-White pigs (16.5-27.0 kg): those receiving limited resuscitation, moderate resuscitation, and normal resuscitation, as well as surgical controls. INTERVENTIONS: After induction and intubation with 3% halothane, anesthesia was maintained with intravenous Saffan. Cannulae were placed in the left external jugular vein and both axillary arteries. A pulmonary artery flotation catheter was introduced through the jugular cannula. The left femur was exposed for fracture with a captive bolt. Resuscitation was with 0.9% saline; the moderate resuscitation group received less than the normal resuscitation group (840 +/- 67 mL vs. 1873 +/- 96 mL), whereas the surgical control and limited resuscitation groups received the lowest volumes (466 +/- 10 mL and 452 +/- 19 mL, respectively). MEASUREMENTS AND MAIN RESULTS: Measurements/calculations of global hemodynamics (intravascular pressures, e.g., mean arterial pressure, heart rate, stroke volume index, cardiac output/index, left ventricular stroke work index, and systemic vascular resistance index), metabolism (oxygen delivery index and consumption index, oxygen extraction ratio, plasma lactate, hemoglobin), blood gases, pH, and hematocrit were made before fracture, immediately and 30 mins after fracture, and at 30-min intervals for the next 4 hrs. Hind-limb muscle water content was determined by dessication. Femur fracture led to acute reductions in cardiac output/index, stroke volume index, and oxygen delivery index and increases in systemic vascular resistance index and oxygen extraction ratio. In the absence of fluid resuscitation, these changes persisted and were accompanied by hypotension. Normal resuscitation attenuated the fracture-induced changes such that the only differences during resuscitation between limited resuscitation and normal resuscitation were a reduction in hematocrit in the latter and an increase in oxygen extraction ratio in the former. Water content increased in both injured and uninjured muscle. CONCLUSIONS: The cardiovascular and metabolic changes associated with femur fracture in the anesthetized pig can be reversed or prevented by crystalloids given in a volume equivalent to Advanced Trauma Life Support guidelines.     

Initial management and resuscitation of severe chest trauma

Severe chest trauma, blunt or penetrating, is responsible for up to 25% of traumatic deaths in North America. Respiratory compromise is the most frequent dramatic presentation in blunt trauma, while injuries to the heart and great vessels pose the greatest risk of immediate death following penetrating trauma. More than 80% of patients will be managed with interventions that can be performed in the emergency department. This article reviews the presentation, diagnosis, and management of the most important thoracic injuries. A structured approach to the acutely unstable patient is proposed to guide resuscitation decisions.     

Pediatric trauma resuscitation: initial fluid management.

Fluid management is a vital component in the resuscitative care of the injured child. The goal of fluid resuscitation is to restore tissue perfusion without compromising the body's natural compensatory mechanism. Recent literature has questioned the timing, type, and amount of fluid administration during the resuscitative phase. When managing a pediatric resuscitation, it is imperative to use a variety of age-appropriate physiologic parameters because reliance on blood pressure alone will lead to delayed recognition of shock. Establishing vascular access, via peripheral intravenous, central venous, or intraosseous catheter, should be a high nursing priority. Hemorrhage control and fluid resuscitation of an injured child remains a top priority of trauma care. Early intravenous access with appropriate fluid administration continues to be a universal treatment for the hypotensive trauma patient. Fluid resuscitation in the early phase of care, whether in the field, emergency department, or operating room, should be targeted toward perfusing critical organs, such as the brain and heart. Once obvious bleeding is controlled, the overall goal for fluid management centers on maintaining oxygen delivery to perfuse vital structures with enough oxygen and energy substrates to maintain cellular function, thus avoiding tissue ischemia. However, specific issues around timing and type of fluid administration, once thought to be straightforward, have triggered increasing investigation of current beliefs.