Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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Airway burns cause delayed collapse of airways due to airway edema. Transferring clinicians are trained to intubate at the first suspicion of airway collapse, which can lead to vague reasons for intubation such as "airway protection." Intubation, however, is not without risks, such as pneumonia and death. The objective of this research review is to compare pre-burn center intubations with those performed at burn centers and compare rates of pneumonia, mortality, and time to extubation. ⋯ There were mixed results on the correlation of pre-burn center intubation with pneumonia and death; however, pre-burn center patients were more likely to have earlier extubation times, which points to potentially unnecessary intubations. Clinicians should be aware of the increased mortality and morbidity associated with intubation. Providers should use objective evidence-based tools such as the ABA (American Burn Association) and Denver criteria to determine the need for intubation to avoid unnecessary intubations and their potential complications.
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Review Comparative Study
Analgesics Administered for Pain During Hospitalization Following Lower Extremity Fracture: A Review of the Literature.
Effective treatment of acute pain during hospitalization following lower extremity fracture is critical to improve short-term patient outcomes including wound healing, stress response, hospital length of stay, and cost as well as minimizing long-term negative patient outcomes such as delayed return to work, disability, and chronic pain. As many patients report moderate to severe pain during hospitalization, identifying the analgesics that most effectively reduces pain is a priority to improve patient outcomes. The purpose of this review was to examine published studies describing patient response to analgesics administered orally (PO) or intravenously (IV) in the immediate hospitalization following lower extremity fracture. ⋯ IV morphine provided faster and better pain relief compared with IV ibuprofen. Based on the limited data available, regional nerve blocks provided superior pain relief compared with opioids, and opioids provided superior pain relief compared with NSAIDs. Different NSAIDs provided similar pain relief.
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Review Comparative Study
Impacting Delirium in the Trauma ICU Utilizing the ICU Liberation Collaborative Benchmark Report.
Delirium is a frequent complication of intensive care unit (ICU) admissions, manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long-term disability and mortality. The Society of Critical Care Medicine published guidelines for the management of pain, agitation, and delirium (PAD) in the ICU in 2013. ⋯ An opportunity was identified to expand implementation of certain elements of the ABCDEF bundle in the trauma ICU. There is an opportunity for nurses to take the lead in improving patient outcomes. With improved education, evidence-based assessment tools, and best practice guidelines, nurses can help decrease the incidence of delirium by as much as 30%.
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Review
Determining the Education and Research Priorities in Pediatric Trauma Nursing: A Delphi Study.
Trauma has a greater impact on morbidity and mortality than all other disease processes in the pediatric population; yet, there is a gap in the literature related to the scientific basis for educating and researching future practice. The purpose of this research study was to utilize the Delphi technique to identify the current education and research priorities for pediatric trauma nursing as described by the members of the Society of Trauma Nurses. ⋯ The pediatric trauma nursing research priorities are the following: (1) impact of nursing care on outcomes; (2) initial resuscitation; and (3) critical care. Future efforts in educational program development and research study should focus on these priorities.
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Approximately 18,000 people are trafficked into the United States each year and forced into commercial sex work. Up to 80% of victims are seen by a health care provider. In the health care setting, they rarely identify themselves as victims of human trafficking (HT), making it difficult to recognize them. ⋯ To address the problem of identifying and assisting patients who are being trafficked, some hospitals developed their own protocols. However, the wide variation in what is included on these assessment protocols makes it difficult to hold up any particular protocol as a national model. The author concludes that until more effective standardized national protocols for the identification of the HT victim within the health care settings are developed, National Human Trafficking Resource Center's method of screening should be used to help increase the degree at which patient victims are identified within the health care setting.