Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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Comparative Study
Evaluation and treatment of depression in adult trauma patients.
A retrospective study examined in-hospital antidepressant medication (ADM) use in adult trauma patients with an intensive care unit stay of 5 or more days. One fourth of patients received an ADM, with only 33% of those patients having a documented history of depression. Of patients who received their first ADM from a trauma or critical care physician, only 5% were discharged with a documented plan for psychiatric follow-up. The study identified a need for standardized identification and management of depressive symptoms among trauma patients in the inpatient setting.
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Tracheal injury from blunt trauma is a rare, life-threatening condition in pediatric patients. Rapid assessment and identification of the severity of the injury will increase the likelihood of survival. Subcutaneous emphysema, pneumomediastinum, and persistent pneumothoraces after chest tube placement should be considered in the index of suspicion for tracheal injury. Treatment for a complete tracheal transection includes rapid airway securement via endotracheal tube or tracheostomy and careful surgical repair in the operating room in conjunction with bronchoscopy.
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Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.
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Postresuscitation debriefings allow team members to reflect on performance and discuss areas for improvement. Pre-/postsurveys of trauma team members (physicians, mid-level practitioners, technicians, pharmacists, and nurses) were administered to evaluate the acceptability of debriefings and self-perceptions after multidisciplinary trauma resuscitations. After a 3-month trial period, improvements were observed in perceptions of psychological and patient safety, role on team, team communication, and acceptability of the debriefing initiative. Regrouping for a debriefing requires organizational change, which may be more easily assimilated if team members recognize the potential for process improvement and feel confident about success.
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There are inherent difficulties in assessing and managing pain in elderly trauma patients, especially those with chronic health conditions or diminished capacities for self-reporting pain. This retrospective study identifies and describes patterns of pain assessment for a trauma population of older adults (age ≥65 years). ⋯ In addition, assessment methods were not always appropriate for the patient population. We conclude that older patients were not assessed for pain frequently enough, and that more regular and routine pain assessments may improve patient outcomes.