Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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Trauma continues to be the leading cause of death among those younger than 40 years. A major cause of death within the first 24 hours is hemorrhage. Many of these patients present with severe coagulopathy and require massive transfusion. ⋯ To address coagulopathy sooner, changes in the way we identify and resuscitate the exsanguinating trauma patient have evolved. These changes include early identification of at-risk patients and early, aggressive transfusion of plasma and platelets. This article reviews the key massive transfusion triggers and resuscitation strategy of damage control resuscitation.
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A mass casualty event is a situation in which the need for medical care and resources, including personnel, exceeds that which is available. As the largest component of the health care workforce, nurses represent a significant resource that can be called on to act as first responders during a mass casualty. However, current education and national guidelines fail to provide specific instruction on pre-hospital nursing considerations and interventions. This article provides evidence-based guidelines designed for nurses to use when acting as first responders during a disaster and presents recommendations for future nursing practice related to mass casualty events.
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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. ⋯ 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.
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Multicenter Study
Utilization of low-molecular-weight heparin prophylaxis in pediatric and adolescent trauma patients.
The objective of this study was to use trauma registry data to describe the number and characteristics of patients 21 years or younger receiving thromboprophylaxis with low-molecular-weight heparin at 2 pediatric and 2 adult level 1 trauma centers. Among 706 patients, the average age was 18.5 years, and 94.6% were hospitalized at adult centers. ⋯ Despite a lack of scientific evidence, low-molecular-weight heparin prophylaxis is being used in young trauma patients (primarily those 14 years or older). Prospective multicenter studies are needed to accurately describe the risks and benefits of low-molecular-weight heparin prophylaxis in young trauma patients, thereby identifying those who truly benefit from this intervention.
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Predominantly, males have a higher risk of injury mortality and morbidity than females. However, less is known about gender differences for injury and trauma outcome at a regional level. The aim of this study was to examine the epidemiologic profile and trauma outcomes of males and females at a level 1 trauma center to inform local injury prevention efforts. ⋯ There are distinct differences between the sexes regarding the mechanism and severity of injury and trauma outcomes. Local injury prevention initiatives should be targeted to address gender differences. Future social research should examine the interplay of the construction of masculinities with male injury.