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Diagnósticos de enfermagem em vítimas de trauma nas primeiras seis horas após o evento
Sallum, Ana Maria Calil;Sousa, Regina Marcia Cardoso de;
Acta Paulista de Enfermagem , 2012, DOI: 10.1590/S0103-21002012000200016
Abstract: objective: to identify the frequency of nursing diagnoses in trauma victims in the first 6 hours, after the traumatic event, and to verify the relationship of these diagnoses with mortality. methods: a prospective, cross-sectional study using quantitative analysis, performed in a tertiary hospital, the trauma referral center in s?o paulo ( brazil). during six months, we evaluated 407 patients 18 years of age or older, treated at the emergency room of this hospital . results: the most frequent nursing diagnoses were: risk for infection (84.5%), impaired skin integrity (77.9%), acute pain (71.5%), impaired comfort (68.3%) and impaired tissue integrity (54.1%). the association between nursing diagnoses and mortality was observed in 28 (66.7%) of the diagnoses identified. conclusion: the data added information that may assist in education and performance of nurses in the setting of trauma emergency, and evidenced the potential of nursing diagnoses to evaluate the results and quality of care.
Violent and Fatal Youth Trauma: Is There a Missed Opportunity?  [cached]
Nicholas D. Caputo, MD, MSc,Christopher P. Shields, MD,Cesar Ochoa, MD,Jennifer Matarlo, RN
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2012,
Abstract: Introduction: Accidents and assaults (homicides) are the leading causes of death among the youth of the United States, accounting for 53.3% of deaths among children aged 1 to19 years. Victim recidivism,defined as repeated visits to the emergency department (ED) as a victim of violent trauma, is a significantly growing public health problem. As 5-year mortality rates for recidivism are as high as 20%,it is important to determine whether victims with a history of violent trauma are at increased risk for fatal outcome with their next trauma. We hypothesized that victims of violent trauma who have had 1 prior ED visit for violent trauma will have increased odds of fatal outcome.Methods: A retrospective chart review was conducted for patients presenting with penetrating trauma to the ED from January 1, 1999 to December 31, 2009. All patients between the ages of 15 to 25 years who presented to the ED for any penetrating trauma were included. Patients with prior presentations for penetrating trauma were compared to those patients who were first-time presenters to determine the odds ratio of fatal outcome.Results: Overall, 15,395 patients were treated for traumatic presentations. Of these, 1,044 met inclusion criteria. Demographically, 79.4% were Hispanic, 19.4% were African American, and 0.96% were Caucasian. The average age was 21 years, and 98% of the population was male. One hundred and forty-seven (14%) had prior presentations, and 897 (86%) did not. Forty of the 147 patients (27%)with prior presentations had a fatal outcome as compared to 29 patients of the 868 (3%) without prior presentations, with odds ratio of 10.8 (95% confidence interval, 6.4–18.1; Pearson v2, P , 0.001). The 5-year mortality rate for those patients with fatal outcomes was calculated at 16.5%.Conclusion: Patients who had prior ED visits for penetrating trauma were at greater risk for fatal outcomes compared to those with no prior visits. Therefore, trauma-related ED visits might offer an opportunity for education and intervention. This may help to prevent future fatalities.
Psychiatric diagnoses, trauma, and suicidiality
Silje K Floen, Ask Elklit
Annals of General Psychiatry , 2007, DOI: 10.1186/1744-859x-6-12
Abstract: During two months, all consecutive patients (n = 139) in a psychiatric hospital in Western Norway were interviewed (response rate 72%).Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas.Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment.Based on data from a large nationally representative sample of people participating in the National Comorbidity Survey (NCS) [1], 60% of men and 50% of women reported to have experienced a traumatic event at some point in their lives, with the majority of them having been exposed to two or more traumatic events. The prevalence of trauma exposure among psychiatric populations has been found to be higher than in the rest of the population. Five studies have reported childhood and sexual abuse in between 34% and 81% of patients with severe mental illness (SMI) [2]. In five other studies the exposure to physical and sexual violence varied between 43% and 81% in patients with SMI [2]. In addition, a significant rate (43%) of exposure to car and work accidents has also been reported in SMI patients [3]. A 90% lifetime trauma exposure has been reported among psychiatric patients [4]. Likewise, another study found that 61% of the patients in a psychiatric setting had experienced at least one traumatic event [5]. Thus, psychiatric patients appear to have been more exposed to traumatic events than the general population.While the NCS [1] found a 5% lifetime prevalence of PTSD among m
Skull fracture and hemorrhage pattern among fatal and nonfatal head injury assault victims - a critical analysis  [cached]
Saurabh Chattopadhyay,Chandrabhal Tripathi
Journal of Injury and Violence Research , 2010,
Abstract: BACKGROUND: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial hemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial hemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. METHODS: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. RESULTS: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. CONCLUSIONS: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases.
Causes and Severity of Fatal Injuries in Autopsies of Victims of Fatal Traffic Accidents
HR Taghipour,F Panahi,H Khoshmohabat,N Hojati Firoozabadi
Journal of Shahid Sadoughi University of Medical Sciences , 2010,
Abstract: Introduction: In this retrospective study, we decided to determine the death causes and severity of injuries in traffic accidents according to reports of the forensic medical center of Yazd. Methods: A total of 251 fatalities due to traffic accidents that had undergone autopsy examinations at the Yazd forensic medicine center from2006 till 2008 were included in the study by census method. Data regarding gender, road user type, type of vehicle (car, motorcycle, autobus or minibus), consciousness level, and intensive care unit (ICU) admission was gathered. For evaluation of injury severity, we used Injury Severity Score (ISS). Results: The population under study consisted of 202 men (80.5%) and 49 women (19.5%) with an average age of 34.1 years (range: 1-89 years). Motorcycle-pedestrian accidents were the most common type of injury (100, 39.8%). Head (220, 87.6%) and face (169, 67.3%) were the two most common sites of injuries. Mean (±SD) of ISS was 23.2 (±10.4). According to autopsy records, the main cause of death was head trauma (146, 58.1%). Conclusion: Public awareness in terms of primary prevention of road accidents should be considered important. Also, regarding the high prevalence of brain injuries and complications associated with skull fractures, accessibility to neurosurgeons and availability of imaging devices have an important role in decreasing the mortality rate of traffic accidents.
Injury Pattern Among Non-fatal Road Traffic Crash Victims
K Gichuhi
East African Orthopaedic Journal , 2007,
Abstract: Objective: To study and analyse the pattern of injuries among non-fatal road traffic crash victims. Design: Retrospective analytical study. Setting: Kenyatta National Hospital, Nairobi over a six-month period from February to July 2004. Subjects: Road traffic crashes victims treated at Kenyatta National Hospital, Nairobi during the period under study. Results: One thousand four hundred and twenty four victims of road traffic crashes were treated over a sixmonth period. The male: female ratio was 3:1 and the pedestrians were the majority (69.7%). The commonest injuries were fractures (69.0%) and the tibia/fibula being the most fractured bones (30.3%). Age group 15-44 years was the most affected (81.9%). There was one incidence of a ruptured eye in a passenger. Conclusion: Road traffic injuries are a major cause of death and disability globally with disproportionate number occurring in the developing countries. The most affected age group 15-44 years lead to double tragedy to these countries with loss of productive man-hours and expenditure incurred to treat them.
Penetrating trauma victims in three Tehran hospitals, Sina, Shohada, Fayazbakhsh: Epidemiology and management errors
"Zargar M,Saeed Modaghegh MH,Rezaishiraz H,Moez Ardalan K "
Acta Medica Iranica , 2001,
Abstract: This is an observational case series study on penetrating trauma admissions in three teaching hospitals in Tehran from 1996 to 1997. in order to describe the epidemiology and determine the ways of improving treatment of penetrating injuries, we selected 410 patients with penetrating injuries and injury severity scores (ISS) of more than 7 (the maximum ISS is 75) out of 3580 trauma patients, hospitalized in the three hospitals (Sina, Shohada, Fayzbakhsh) since may 1 st 1996 during a period of approximately one year. These hospitals were among the ones with the highest load of trauma patients in Tehran. The in- hospital mortality rate was 2% and the rate of permanent disability was 6%. The most frequent injuries were in the extremities; while the most fatal ones occurred in the head and neck region.The mean ± SE injury severity score was 10.9±0.23 . Cutting was the most prevalent mechanism of injury while gunshot was the ratest. The most fatal mechanism of injury was gunshot followed by stab can cutting injuries. Industrial workers comprised the population at the highest risk for other cutting injuries, which can be avoided by utilizting better protection facilities at work.Our findings show that the improvement of preventive measures in industrial occupations should be considered to be of utmost importance. It seems that faster and direct transporation of patients to appropriate and well- equipped centers, improvement of the technical skills of the emergency staff, appropriate tiage of trauma victims and decreasing the time spent in the emergency room can decrase the mortality rate substantially
Predetermining value analysis of the prehospital phase procedures in trauma victims survival
Malvestio, Marisa Aparecida Amaro;Sousa, Regina Marcia Cardoso de;
Revista Latino-Americana de Enfermagem , 2008, DOI: 10.1590/S0104-11692008000300016
Abstract: the aim of this study was to analyze the determining value of the procedures carried out during prehospital care in the survival time of traffic accident victims. data of 175 victims with revised trauma score £ 11, cared for and transported by advanced life support to tertiary referral hospitals, were submitted to kaplan-meier survival analysis and to cox proportional hazards model. four procedure groups associated with survival were identified: basic circulatory; advanced respiratory; volume replaced and medication. until hospital discharge, the victims who underwent orotracheal intubation and chest compressions showed 3.6 and 6.4 times higher death hazards, respectively. the need for definitive airway and cardiopulmonary resuscitation in the prehospital phase was predetermining with higher death hazard. the less than 1000ml intravenous fluid replacement was the only predetermining factor with protective power against death hazard.
Risk factors for onset of hypothermia in trauma victims: The HypoTraum study
Frédéric Lapostolle, Jean Sebbah, James Couvreur, Fran?ois Koch, Dominique Savary, Karim Tazarourte, Gerald Egman, Lynda Mzabi, Michel Galinski, Frédéric Adnet
Critical Care , 2012, DOI: 10.1186/cc11449
Abstract: This was a multicenter, prospective, open, observational study in a pre-hospital setting.The subjects were trauma victims, over 18 years old, receiving care from emergency medical services (EMS) and transported to hospital in a medically staffed mobile unit.Study variables included: demographics and morphological traits, nature and circumstances of the accident, victim's presentation (trapped, seated or lying down, on the ground, unclothed, wet or covered by a blanket), environmental conditions (wind, rain, ground temperature and air temperature on site and in the mobile unit), clinical factors, Revised Trauma Score (RTS), tympanic temperature, care provided (including warming, drugs administered, infusion fluid temperature and volume), and EMS and hospital arrival times.A total of 448 patients were included. Hypothermia (<35°C) on hospital arrival was present in 64/448 patients (14%). Significant factors associated with the absence of hypothermia in a multivariate analysis were no intubation: Odds Ratio: 4.23 (95% confidence interval 1.62 to 1.02); RTS: 1.68 (1.29 to 2.20); mobile unit temperature: 1.20 (1.04 to 1.38); infusion fluid temperature: 1.17 (1.05 to 1.30); patient not unclothed: 0.40 (0.18 to 0.90); and no head injury: 0.36 (0.16 to 0.83).The key risk factor for the onset of hypothermia was the severity of injury but environmental conditions and the medical care provided by EMS were also significant factors. Changes in practice could help reduce the impact of factors such as infusion fluid temperature and mobile unit temperature.Trauma victims often suffer from hypothermia on arrival at hospital and, even when the hypothermia is moderate, it can be associated with a poorer prognosis and an increase in mortality rate [1-8]. Early diagnosis of hypothermia is thus essential [3]. However, although the mechanisms of the deleterious effects of hypothermia are well known, its causes are not clear. Most published data on hypothermia victims are hospital registry
Nursing intervention in deficit fluid volume situation’s in trauma’s victims
Regilene Molina Zacareli Cyrillo, Anamaria Alves Napole?o, Ana Emilia Pace, Tania Couto Chianca, Emília Campos de Carvalho, Maria Célia Barcellos Dalri
Revista de Enfermagem UFPE On Line , 2009,
Abstract: Objective: to identify the nursing interventions in the Nursing Intervention Classification (NIC) related to the real and risk situation for fluid volume deficit in trauma patients attended in a pre-hospital advanced unit. Methods: descriptive crossed mapping study, based on nurses’ description of the interventions and further refining. Approval was obtained from the Research Ethics Committee of the University of S o Paulo (0949/2008). Of the 39 nurses in the sector, 11 complied with the inclusion criteria: two years of work in pre-hospital advanced units and agreement to participate in the study. The data collection instrument comprised the subjects’ identification and space to include the activities performed in the real and risk situation for fluid volume deficit in trauma patients. The collected data were mapped comparatively and the adopted interventions were classified. This mapping was validated by experts. Results: 16 interventions and 59 activities were identified for the real situation, against 11 interventions and 37 activities for the risk situation. Conclusion: the activities of the adopted NIC interventions are performed in this context; we suggest adding the interventions "emergency care, emergency care and routing protocol for diagnosis” for the real and risk diagnosis, and the intervention "Supply management" for the fluid volume deficit diagnosis only.
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