Scand J Trauma Resus
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Scand J Trauma Resus · Jan 2012
The Prehospital assessment of severe trauma patients` performed by the specialist ambulance nurse in Sweden - a phenomenographic study.
A common feature of prehospital emergency care is the short and fragmentary patient encounters with increased demands for efficient and rapid treatment. Crucial decisions are often made and the premise is the specialist ambulance nurse's ability to capture the situation instantaneously. The assessment is therefore a pre-requisite for decisions about appropriate actions. However, the low exposure to severe trauma cases in Sweden leads to vulnerability for the specialist ambulance nurse, which makes the assessment more difficult. Our objective was to describe specialist ambulance nurses' perceptions of assessing patients exposed to severe trauma. ⋯ This study reveals that the specialist ambulance nurse, on the scene of accident, finds the task of assessment of severe trauma patients difficult and complicated. In some cases, even exceeding what they feel competent to accomplish. The specialist ambulance nurses feel that no trauma scenarios are alike and that more practical skills, more training, exercise and feedback are needed.
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Scand J Trauma Resus · Jan 2012
Case ReportsResuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery.
Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. ⋯ The courses of events indicate that bubbles had persisted in the circulation for a prolonged period. We speculate whether insufficient CO2 flushing of the laparoscopic tubing, causing air to enter the peritoneal cavity, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient.
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Scand J Trauma Resus · Jan 2012
Comparative StudyA comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams.
Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR) in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. ⋯ We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team-training of nursing students.
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Scand J Trauma Resus · Jan 2012
Early do-not-resuscitate orders in intracerebral haemorrhage; frequency and predictive value for death and functional outcome. A retrospective cohort study.
In former studies from North America early Do-Not-Resuscitate orders (DNR orders) in patients with intracerebral haemorrhage (ICH) had negative prognostic impact on mortality. The influence of DNR orders on functional outcome and whether DNR orders are grounded on relevant patient characteristics is unknown. We aimed to determine the frequency and predictive factors of DNR-orders and its association to prognosis, in ICH patients, in Scandinavia. ⋯ Well known prognostic factors are determinants for DNR orders, however DNR orders are independently related to one-month case fatality. In addition to improvements of the local routines, we welcome a change of attitude with an enhanced awareness of the definition of, and a more careful approach with respect to DNR orders.
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Scand J Trauma Resus · Jan 2012
Negative catheter angiography after vascular contrast extravasations on computed tomography in blunt torso trauma: an experience review of a clinical dilemma.
Catheter angiography is often arranged when vascular contrast extravasations on computed tomography (VCEC) presents after blunt torso trauma. However, catheter angiograph can be negative for bleeding and further management about this condition is not well discussed. The purpose of this study was a review of our experience of this discrepancy and to propose management principle. ⋯ A negative catheter angiography after VCEC is possible in blunt torso trauma, and this occurs most in kidney. Embolization or not under this discrepancy requires an integrated consideration of injury site, clinical presentations, and the risk of rebleeding. Liver and kidney in blunt torso trauma can be managed successfully without embolization when catheter angiography is negative for bleeding after VCEC.