Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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The purpose of this retrospective review was to determine the long-term consequences of retained bullet foreign bodies in children after gunshot injury. All children managed for gunshot wounds at an urban, level I pediatric trauma center were evaluated, identifying those discharged with retained bullet foreign bodies. ⋯ Complications occur in a significant subset of pediatric patients with retained bullets. Prophylactic bullet removal appears unnecessary, although close outpatient follow-up is warranted.
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Trauma nurse coordinators (TNCs) are essential to a successful trauma service. This study followed the 2003 Australian and 2007 binational TNC surveys and aimed to identify demographic information, common and differing role components, and professional development opportunities of TNCs. In September 2011, all TNCs in Australia and New Zealand were invited to participate in an electronic survey. ⋯ Nearly all respondents (92%) had attended a conference within the past year; however, one-quarter of them (24.5%) attended on their own time and more than half (53.1%) received no financial assistance for at least one of the conferences they attended. Nearly half of the respondents (46.0%) reported leading research, and two-thirds (66.7%) reported contributing to research projects. Trauma centers should provide TNCs with adequate resources for daily practice, including professional development to prevent burnout, and facilitate effective trauma services.
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Review Comparative Study
Trauma pain protocol: an interdisciplinary approach to process improvement.
The trauma pain protocol was developed in response to nursing staff concerns regarding pain management practices and hospital-wide goals. Data collected on pain management practices within the trauma patient population identified inconsistencies with the transition of patient-controlled analgesia (PCA) to oral (PO) and intravenous (IV) pain medications. Nursing staff cited concerns with the frequent need for calls to clinicians to obtain additional pain medication orders following discontinuation of PCA. ⋯ Data collected from a 4-month pilot of the protocol demonstrated a reduction in changes made to PO/IV medications following discontinuation of PCA. Nursing response to the protocol included increased satisfaction with pain management practices and a perception of time saved through reduced need for calls to clinicians for additional pain medication modifications. We conclude that this protocol results in a more individualized, evidence-based transition from PCA to PO/IV.
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Increased intracranial pressure (ICP) is a challenging complication to treat within a critical care setting. It is imperative that clinicians use a stepwise approach in developing a diagnosis, as to be comprehensive and decrease morbidity and mortality related to increased ICP. This article provides an algorithm that can be used as a clinical guideline when assessing a patient who has an ICP monitor in place and is presenting with increased ICP. The algorithm is inclusive and composed of a history of present illness, review of systems, physical assessment, labs, and further testing.