Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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The optimal degree of resuscitation in the initial control and resuscitative phase of trauma care remains unclear. Many attempts have been made with animal studies to determine the optimal degree and method of resuscitation. Human studies were first conducted in 1994 and the results were inconclusive and have not been replicated. The question of the volume, rate, and type of fluid to be infused for initial control and adequate resuscitation of the trauma patient remains to be answered.
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Review
Cervical spine clearance in the blunt trauma patient: a review of current management strategies.
The risks of overlooking a cervical spine injury in a polytrauma patient still remain substantial even with the development of recent advanced radiologic imaging and practice management guidelines. Cervical spine clearance continues to pose a diagnostic dilemma to the trauma team providing care for these patients. There are several issues with legal, medical, and economic implications: which patient populations require cervical spine radiographs; which views should be obtained; is there efficacy in flexion/extension radiographs, CT scan, or MRI scans; in the obtunded patient can the absence of significant ligamentous injury be demonstrated; who should perform clearance methods and be ultimately responsible for valid clearance. The purpose of this article is to revisit current management strategies for clearance of the cervical spine and explore new findings if any, which have been accepted as standard of care by providers, faced with this challenging responsibility.
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The care of a critically ill trauma patient is complex and requires the expertise and skill of many healthcare providers. Delays in injury identification and the development of a treatment plan without considering comorbid conditions impede the patient's resuscitation and recovery from the acute injury, delay the rehabilitative phase, and increase the costs. This article will discuss a strategy using an advanced practice nurse as a case manager to assist in prompt identification of the patients' pathologic and physiologic changes and psychosocial and rehabilitative needs and to orchestrate a comprehensive and consistent plan through the continuum of care.
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Pediatric cardiopulmonary arrest is frequently a terminal event of an unrecognized progressive shock state. This article describes predisposing factors and classifications of shock as they relate to pediatric patients. It assists the experienced pediatric nurse as well as the nurse who is less experienced in caring for children in identifying early shock in this population and provides practical advice on the assessment of children. In addition, management and intervention techniques are addressed.