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- Management of bleeding in trauma victims by Portuguese nurses in prehospital settingPublication . Mota, Mauro; Reis Santos, Margarida; Santos, Eduardo JF; Figueiredo, Andrea; Melo, Filipe; Albuquerque, Sara; Cunha, MadalenaIntroduction: External bleeding is the leading preventable cause of death from traumatic injuries. Implementation of guidelines for its control have been associated with a significant reduction in mortality. The objectives of this study were to provide a characterisation of trauma patients with external bleeding and to compare the outcomes from specific autonomous interventions applied by nurses in prehospital care.Methods: A non-randomised prospective study was conducted in the Immediate Life Support Ambulances in Portugal, from 1 March 2019 to 30 April 2020. Patients were divided into two groups according to whether external bleeding was controlled or not on their arrival at the emergency room.Results: A total of 189 patients were included in this study (73.0% men; mean age of 53.6 years). Among these patients, 140 (74.1%) had their external bleeding controlled by prehospital nurse’s intervention. The average time of assistance at the incident site was 31.5 min. Patients with uncontrolled bleeding had a higher average rescue time (30.8 ±15.2 vs 33.7 ±13.0). Cryotherapy was administered to 15.9% of all patients and 93.3% of these patients arrived at the emergency room with controlled bleeding (p=0.01).Discussion: Despite the substantial reduction in the number of patients who keep bleeding after prehospital care, it was observed that one fifth of patients have external bleeding on arrival at the emergency room. Cryotherapy has been shown to be effective in controlling external bleeding. Failure to use haemostatic agents may explain the ineffective control of more complex external bleeding.Contribution to Emergency Nursing Practice: The current literature on management of bleeding in trauma patients is scarce and contradictory, especially in terms of interventions provided by AUTHORSMAURO AL MOTA PhD, RN1,2,3,4,5MARGARIDA REIS SANTOS PhD, RN6,7EDUARDO JF SANTOS PhD, RN2,3ANDREA FIGUEIREDO MSN, RN5FILIPE MELO MSN, RN5,8,9SARA ALBUQUERQUE MSc, MD10MADALENA CUNHA PhD, RN2,31. Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal2. Health School of the Polytechnic Institute of Viseu, Portugal3. Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal4. Hospital Nossa Senhora da Assunção, Local Health Unit of Guarda, Seia, Portugal5. INEM – National Institute of Medical Emergency. Portugal6. Nursing School of Porto, Porto, Portugal7. CINTESIS – Center for Health Technology and Services Research, University of Porto, Porto, Portugal8. Hospital de Faro. University Hospital Center of Algarve. Faro, Portugal9. ABC – Algarve Biomedical Centre. Faro, Portugal10. Group of Health Centers – Greater Porto VII – Gaia, USF Nova Salus, Gaia, PortugalRESEARCH ARTICLESManagement of bleeding in trauma victims by Portuguese nurses in prehospital setting rehospital teams led by a registered nurse. In addition, interventions vary from country to country.This article increases awareness of autonomous interventions implemented by prehospital nurses to manage external bleeding.Key implications for emergency nursing practice identified in this study suggest greater fluid therapy appears harmful while cryotherapy achieved the best results (control of the bleeding on emergency room arrival). This may contribute to the review of institutional algorithms and training in this area.
- Prehospital interventions to prevent hypothermia in trauma patients: a scoping reviewPublication . Mota, Mauro; Cunha, Madalena; Reis Santos, Margarida; Santos, Eduardo; Melo, Filipe; Abrantes, Tito; Santa, AnaObjective: The aim of this review is to map the prehospital rewarming measures used to prevent hypothermia among trauma victims. Background: Hypothermia is responsible for an increase of the mortality and morbidity in trauma victims and its recognition and early treatment are crucial for the victim’s haemodynamic stabilisation. Prehospital interventions are particularly important, especially those that target bleeding control, haemodynamic stability, and safe body temperature. Registered nurses may be pivotal to prevention and minimisation of the dangerous effects of hypothermia. Study design and methods: A scoping review was used to identify articles from several online databases from 2010 to 2018. Studies in English, Spanish, and Portuguese were included. Two reviewers performed data extractions independently. Results: Seven studies were considered eligible for this review: two quantitative research studies, one qualitative research study, and four literature reviews. Rewarming measures can be divided into two main groups: passive rewarming, which includes the use of blankets, positioning the response unit to act as a windbreak, removing the patients’ wet clothes, drying the patient’s body, and increasing the ambient temperature; and active rewarming which includes the use of heating pads, heated oxygen, warmed intravenous fluids, peritoneal irrigation, arteriovenous rewarming, and haemodialysis. Discussion: Active measures reported by the included studies were always used as a complement to the passive measures. Active rewarming produced an increase in core temperature, and passive rewarming was responsible for intrinsic heat-generating mechanisms that will counteract heat loss. Patients receiving passive warming in addition to active warming measures presented a statistically significant increase in body core temperature as well as an improvement in the discomfort caused by cold. Conclusion: Rewarming measures seem to be essential for the prevention of hypothermia and to minimise the discomfort felt by the patient. In many countries registered nurses can play important roles in the prehospital context of trauma victim’s assistance. Greater understanding of these roles is necessary to the development of better practice.