Cerebral injuries and intracranial hemorrhages as a result of trauma

Cerebral injuries refer to an actual injury to the brain matter. Injuries seen are concussion, contusion, or diffuse axonal injury. Bleeding into any of the meningeal spaces, brain, or ventricles is known as intracranial hemorrhage. Seldom do cerebral injuries appear as distinct entities but rather as a combination of injuries. The neurologic dysfunction is the sum total of the injury. The significance of the initial injury lies in the development of secondary events, such as edema, hemorrhage, and swelling. These events may lead to further deterioration and neurologic dysfunction. Treatment is directed at preservation of brain homeostasis and prevention of secondary injury. Controlled hyperventilation is the mainstay in the treatment of increased ICP. Other therapies include barbiturate coma and the use of corticosteroids to reduce ICP. Nursing interventions focus on methods to promote cerebral perfusion and support other body systems affected by immobility and altered level of consciousness. Planning nursing care and activities to the patient's ICP and CPP responses is indicated.     

Endovascular therapy of traumatic injuries of the intracranial cerebral arteries

Traumatic intracranial arterial injuries represent uncommon complications of both closed-head injury and penetrating head trauma. These injuries include arterial dissections, pseudoaneurysms, and fistulas, both direct and indirect. Although these lesions may be identified while still asymptomatic, they usually present in a delayed fashion with intracranial hemorrhage, focal cerebral ischemia, or, occasionally, severe epistaxis. Endovascular therapy has assumed a major role in the management of this diverse group of lesions. Embolization of pseudoaneurysms with balloons or detachable coils, the use of embolic particles for small arterial injuries, and large vessel occlusion with detachable balloons represent current treatment strategies that have evolved over the past three decades. Angioplasty and stent deployment may have a future role to play in the management of arterial dissection. Principles of neurologic critical care that minimize secondary brain injury are essential adjuncts in the management of these patients before, during, and after endovascular treatment.     

Reducing assaults against nursing home caregivers

BACKGROUND: Nursing assistants (NAs) working in long-term care have the highest incidence of workplace assault among all workers in the United States. OBJECTIVES: The objective of this study was to test the effectiveness of a violence-prevention intervention, on the basis of Social Cognitive Theory to increase knowledge, self-efficacy, and skills, and to decrease assaults. METHODS: Investigators conducted a quasi-experimental study with 138 NAs in 3 intervention and 3 comparison homes. A baseline questionnaire was used to obtain information on demographics, employment, and violence experience. At pre-, post- and 6 months after the intervention, all participants completed the State Trait Anger Inventory and the Knowledge and Self-Efficacy Survey, carried an Assault log for 80 hr of work, and participated in a simulation exercise to assess violence-prevention skills. Tabulations, analysis of variance, and Poisson regression were used to analyze the data. RESULTS: The intervention participants showed significant increases in knowledge, self-efficacy, and violence-prevention skills. Although the intervention had no significant main effect on the incidence of assaults, there was an interaction effect between the intervention and the number of preintervention assaults. The intervention had a significant effect on those NAs who had fewer than 6 assaults preintervention (p < .001) and no significant effect on those who had more than 7 assaults on preintervention. There were significant relationships between assaults and the following covariates: age, state anger, and the number of residents assigned. DISCUSSION: Although the incidence of violence cannot be eliminated, it can be decreased and it should never be tolerated or accepted as "part of the job" because to do so devalues the NA.     

Educate your staff to prevent assaults

Research shows that appropriate training of ED staff can significantly reduce assaults by patients. Ensure all staff know how to de-escalate an agitated patient. Provide annual training for staff. Educate staff in appropriate use of restraints.     

Toxicological investigation of drug-facilitated sexual assaults

Drug-facilitated sexual assaults have drawn a lot of attention during the last years. The role of the non-forensic doctors in the early recognition and management of such cases is crucial. Diagnosis assisted by samplings must be ascertained without delay, in victims initially brought to the emergency room for a sleepy state, a suspected abuse of drug or a pseudo-alcoholic clinical state. Further, where amnesia is present, it may be prudent to assume that sexual activity has occurred and offer pregnancy and sexually transmitted disease prophylaxis. Forensic doctors should entertain the possibility of poisoning in any presentation involving amnesia. Forensic toxicological laboratories should develop sensitive and specific methods to assure a low threshold of detection of the drugs. The awareness of a delinquent or criminal use of alcohol and/or drugs could permit a better medical recognition, so that proper and timely forensic examination is achieved, and adequate evidence is collected for the establishment of an effective investigation and prosecution.     

Nurses' attitudes toward physical assaults by patients

This article reports the survey findings of 184 psychiatric nurses' attitudes toward patient physical assault. Attitudes related to staff competence and performance, legal aspects, patient responsibility and safety were measured on a self-report questionnaire. Data were interpreted based on the scant literature related to patient assaults. Findings indicated that attitudes related to legal aspects of patient assault varied considerably among nursing staff. Discussion highlighted the influence of attitudes on both assaulted staff as well as the victim's colleagues.     

Here's how to prevent assaults on staff

ED personnel experience the majority of all hospital assaults, and these attacks can have long-term effects on morale and productivity. OSHA regulations require you to provide staff with a safe working environment. You should have a plan to address security personnel issues, responses to specific scenarios, restraint techniques, and violence prevention. Strategies include flagging violence-prone individuals, using patient liaisons in the waiting areas, and ensuring that ED security officers have been trained to work in hospitals.     

Attitudes of emergency nurses regarding patient assaults.

INTRODUCTION: The purpose of this study was to investigate the frequency of patient assaults on emergency nurses and to explore nurses' attitudes about patient assaults. METHOD: A convenience sample of ED nurses (N = 55) from 2 hospitals in the mid-south region of the United States was used. All subjects completed a 31-item questionnaire that assessed frequency of assaults and attitudes about patient assaults. RESULTS: Eighty-two percent of nurses surveyed had been assaulted during their careers. In the preceding year, 56% of nurses had been assaulted; 29% of these assaults were unreported. The majority of nurses (73%) believed that being assaulted "goes with the job." Only 2 nurses (3.6%) felt safe from the possibility of patient assault at work "all of the time." DISCUSSION: The high rate of patient assault and the subsequent underreporting of patient assault identified in our study are consistent with rates reported by other researchers. It is alarming that, although many of these other studies were conducted 10 or more years ago, the assault rates are nearly the same. Of the 45 nurses in this study who had been the victim of patient assaults, only 9 believed that reporting their assaults had been beneficial. Lack of support for nursing, whether it be from other nurses, management, the institution, or society, appears to be responsible for the vast underreporting of patient assaults. Nurses themselves are also unsure of how to proceed. Whereas 91% of the surveyed nurses stated that they believed they had a right to take legal action against an assaultive patient, only 65% stated that it was ethically appropriate and even less (33%) stated that they would actually press charges against an assaultive patient.     

Preventive effects of motorcycle helmets on intracranial injury and mortality from severe road traffic injuries

Introduction

Road traffic injuries caused by motorcycle crashes are one of the major public health burdens leading to high mortality, functional disability, and high medical costs. The helmet is crucial protective equipment for motorcyclists. This study aimed to measure the protective effect of motorcycle helmets on clinical outcomes and to compare the effects of high- and low-speed motorcycle crashes.

Women attending an accident and emergency department after assaults.

Assaults on women are a distressing aspect of A&E work. In a combined prospective and retrospective study, covering a 6-month period, 282 female victims were identified (0.75% of attendances). Although most of the injuries were relatively minor the recording of historical and social factors was poor. Attempted follow up for counselling and support proved ineffective. Better education of the doctors regarding the documentation for such patients, assessment of the social dimensions of their needs and requirement for improving both their immediate care and long term follow-up are discussed.     

An internet training to reduce assaults in long-term care

Physical and verbal assaults by residents on care staff are not uncommon in long-term residential care facilities (LTCs). This research evaluated an Internet training designed to teach nurse aides (NAs) strategies to work with aggressive resident behaviors. Six LTCs were randomized in an immediate treatment (IT) and delayed treatment (DT) design, and NAs were recruited in each (IT: n = 58; DT; n = 45). The treatment involved 2 weekly visits to the online training. Hard copy assessments collected participant responses at baseline (T1), 8 weeks (T2), and at 16 weeks (T3). The DT group viewed the program after T2. Hierarchical linear models showed significant group differences at T2 in knowledge, and these levels were maintained at T3. The number of aggressive incidents reported per day by the IT group were nonsignificant at T2 but decreased significantly from T1 to T3 with a large effect size. The program was well received by users. These results suggest that the Internet training was an effective tool to reduce assaults in LTCs, and training effects may improve over time as NAs gain experience using the techniques.     

Relationships of stressors, strain, and anger to caregiver assaults

Nursing assistants (NAs) working in nursing homes are at risk for nonfatal workplace violence. The aims of this study were to describe the context in which assaults occur and to identify characteristics of the NAs related to the incidence of assaults. One hundred and thirty eight subjects participated. NAs completed a demographic and employment survey, the Occupational Stress Inventory and the State Trait Anger Expression Inventory-2, and recorded information on an Assault Log for 80 hours of work. The mean number of assaults per NA was 4.69 (range 0-67). Significant relationships were found among incidence of assaults and staffing ratios, age, occupational strain, occupational role stressors, and anger. Results provide new and useful information when planning violence prevention programs for caregivers in nursing homes.     

Work related assaults. The impact on victims.

This pilot project employed a case study design consistent with that of Rice to describe the impact of violence on individuals who incurred a work related assault in 1992. Ten randomly selected subjects were interviewed from a population of 429 individuals reporting a work related assault that resulted in a wage loss claim. Half of the subjects had received permanency ratings, thought to be a measure of injury severity. The study hypothesis, stating the impact of the assault (e.g., pain and suffering, decrease in functioning) years after a work related assault was associated with the severity of the injury (i.e., permanency rating), was not supported by the data. However, individuals' health and quality of life 4 years after the assault were affected significantly and resulted in job changes, chronic pain, changes in functional status, and depression. The new hypothesis resulting from this study is employer support and mental health intervention immediately after an assault may prevent employee job changes and decrease mental health sequelae.