Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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Comparative Study
Implementation of a Massive Transfusion Protocol: Evaluation of Its Use and Efficacy.
Massive transfusion protocols (MTPs) allow practitioners to follow a prescribed algorithm for the rapid replacement of blood products during a massive hemorrhage. They function as an established protocol to provide consistent treatment. Once implemented, the MTP must be evaluated to ensure best practice. ⋯ While 58 patients experienced massive bleeding, only 16 (28%) were managed using the MTP. Although the non-MTP group received fewer transfused blood products due to higher initial and 24-hr hemoglobin levels, more deaths occurred in this group than in the MTP group. The recommendations were to (1) establish well-defined criteria for MTP activation based on the 4 indicators of massive bleeding and (2) regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes.
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Head strikes can be fatal for patients taking blood thinners (anticoagulants or antiplatelets). Our trauma center instituted the "head strike protocol" to provide uniform and expedited care for adult trauma patients taking preinjury anticoagulants and antiplatelet medications with suspected head injury. The purpose of this article is to describe the development and implementation of the head strike protocol and compare time metrics and outcomes before and after implementing the protocol. ⋯ There were no differences in mortality for patients taking antiplatelet agents. This comprehensive nurse-driven reversal protocol presents an algorithm for managing patients with suspected tICH taking any preinjury blood thinners, allowing "ownership" by the nursing staff to ensure there are no delays in initiating blood products. This protocol may be particularly salient with the aging of the trauma population and parallel increase in the use of blood thinners.
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Traditionally, resuscitative efforts for uncontrolled noncompressible torso hemorrhage are achieved by cross-clamping the proximal aorta via thoracotomy to deliver temporary hemodynamic stability during injury repair. A less commonly used method of promoting early resuscitation and hemorrhagic control in trauma patients is resuscitative endovascular balloon occlusion of the aorta (REBOA). The focus of this literature review is to examine the effectiveness of REBOA in the management of noncompressible pelvic hemorrhage when compared with traditional methods of hemorrhage control in trauma patients. ⋯ Studies encompassed in the review included 3 experimental studies utilizing swine, 2 retrospective studies that reviewed data collected from procedures performed in empirical situations, and a case series that described the implementation of REBOA. Trauma patients with noncompressible torso hemorrhage that is intervened with REBOA have higher mean arterial pressures and systolic blood pressures, require fewer boluses of intravenous fluids and vasopressors, avoid severe acidosis and ischemia, and have significantly lower rates of mortality, thus ensuring enhanced long-term outcomes. Evidence suggests that hemodynamic stability, physiological effects, and mortality rates are improved in patients who receive REBOA for torso hemorrhage control when compared with traditional methods.
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Nurses are at the forefront of our health care delivery system and have been reported to exhibit a high level of burnout. Burnout and stress in trauma nurses at a safety-net hospital can negatively impact patient care. Safety-net hospitals are confronted with unique social, financial, as well as resource problems that can potentially make the work environment frustrating. ⋯ In addition, the study revealed that significant relationships exist among perceived stress, burnout, and job satisfaction. Work environment significantly impacts burnout, job satisfaction, and perceived stress experienced by trauma nurses in a safety-net hospital. Nursing administration can make an effort to understand the levels of burnout and strategically improve work environment for trauma nurses in order to minimize stressors leading to attrition and enhance job satisfaction.
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The incidence of burnout syndrome is increasing among all health care disciplines. The core members of the trauma team in high-performing trauma centers are the greatest risk. It is the responsibility of trauma leadership to raise awareness of risk factors, implement standardized assessment tools, and develop strategies to mitigate burnout in employees. ⋯ The development of burnout in team members can negatively impact patient safety. It can increase the risk of medical errors, health care-acquired infections, and declining patient satisfaction scores. It is essential that professional organizations raise awareness of this health care epidemic and provide resources to leaders to impact change.