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- Eficácia da intervenção da enfermagem pré-hospitalar na estabilização das vítimas de traumaPublication . Mota, Mauro; Cunha, Madalena; Santos, Eduardo; Figueiredo, Ândrea; Silva, Márcio; Campos, Rui; Reis Santos, MargaridaAbstract Background: Trauma is a public health issue with a significant social and economic impact. However, national data on its characterization and the role of nursing in its management is still scarce. Objective: To assess the effectiveness of prehospital nursing interventions in stabilizing trauma victims provided by nurses of Immediate Life Support Ambulances in Portugal. Methodology: Observational, prospective, and descriptive-correlational study. Data were collected by nurses of the Immediate Life Support Ambulances in mainland Portugal, from 01/03/2019 to 30/04/2020, and the Azores, from 01/10/2019 to 30/04/2020. Trauma severity indices were assessed before and after the nursing interventions. Results: This study included 606 cases (79.4% blunt trauma; 40.8% road accidents) reported by 171 nurses. Nurses performed mostly interventions for hemodynamic support (88.9%) and non-pharmacological pain control (90.6%) of trauma victims. The nursing interventions improved the Revised Trauma Score and the Shock Index (p<0.001). Conclusion: Prehospital nursing interventions improve trauma victims’ clinical status.
- O enfermeiro no pré-hospitalar: cuidar para a curaPublication . Mota, Mauro; Cunha, Madalena; Reis Santos, MargaridaIntrodução: A presença de enfermeiros no contexto pré-hospitalar português remonta ao ano de 1981. Em 2007, constituíram-se as Ambulâncias Suporte Imediato de Vida do Instituto Nacional de Emergência Médica, onde os enfermeiros assumem a função de team leaders. Esta reflexão tem como objetivo analisar o papel dos enfermeiros no socorro pré-hospitalar. Desenvolvimento: O contexto pré-hospitalar imprime fortes desafios à Enfermagem e à sua identidade profissional. Os enfermeiros conduzem as suas intervenções e tomam as suas decisões de acordo com a melhor evidência científica, seguindo protocolos terapêuticos predefinidos. Enquanto lideres da equipa de socorro, são responsáveis pela gestão dos diferentes intervenientes que prestam assistência no pré-hospitalar, garantindo a segurança dos cuidados de saúde. As pessoas socorridas no pré-hospitalar depositam no enfermeiro as esperanças não só de garantir a sua sobrevivência, como também, de que no decorrer do socorro, o cuidar, intimamente ligado à génese da Enfermagem, seja também salvaguardado. A produção e disseminação de conhecimento científico contribuirá para a otimização de todas as práticas autónomas e interdependentes. Conclusões: O papel do enfermeiro do pré-hospitalar assenta em três pontos fundamentais: administração de cuidados de Enfermagem no processo de cura/saúde; implementação de metodologias de gestão do risco e desenvolvimento de estratégias de gestão para a segurança do socorro; promoção de investigação no âmbito da prestação de cuidados de emergência que contribuam para a melhoria dos cuidados de Enfermagem prestados. A disseminação do conhecimento que corrobora as práticas vigentes no contexto pré-hospitalar contribuirá para que se perceba a importância da participação de enfermeiros no quadro da emergência e para a afirmação da imprescindibilidade e insubstituibilidade da sua intervenção no pré-hospitalar.
- Consensus must be found on intravenous fluid therapy management in trauma patientsPublication . Mota, Mauro; Reis Santos, Margarida; Cunha, Madalena; Melo, Filipe; Neves, Hugo; Abrantes, TitoIntroduction: Trauma is an important cause of death among young people and 30-40% of this mortality rate is due to hypovolemic shock, intensified by trauma’s lethal triad: Hypothermia, Acidosis, and Coagulopathy. Nurses are responsible for managing fluid therapy administration in trauma victims. The purpose of this study is to analyse the reasons why intravenous fluid therapy is recommended for trauma patients’ hemodynamic stabilization. Methods: This narrative literature review included published and unpublished studies in English, Spanish or Portuguese between 1994 and January 2019. The search results were analyzed by two independent reviewers. Inclusion criteria encompasses quantitative studies involving trauma victims aged over 18 who underwent fluid therapy in a prehospital assessment context. Results& Discussion: 11 quantitative studies were included. 9 involved the use of fluid therapy for hypotension treatment and 2 of the studies analyzed involved the use of warmed fluid therapy for hypothermia treatment. The analysis performed reveals that the administration of aggressive fluid therapy seems to be responsible for the worsening of the lethal triad. In the presence of traumatic brain injury, permissive hypotension is not allowed due to the negative impact on cerebral perfusion pressure. Used as warming measure, warmed fluid therapy does not seem to have a significant impact on body temperature. Conclusions: There is no consensus regarding the administration of fluid therapy to trauma patients. This conclusion clearly supports the need to develop more randomized controlled trials in order to understand the effectiveness of such measure when it comes to control hypovolemia and hypothermia.
- Non-pharmacological interventions for pain management in adult victims of traumaPublication . Mota, Mauro; Cunha, Madalena; Reis Santos, Margarida; Silva, Dulce; Santos, EduardoThis scoping review aims to map non-pharmacological interventions for reducing acute pain for adult victims of trauma. Introduction: Acute pain, as a consequence of either a pathological or traumatic event or even due to invasive and non-invasive healthcare procedures, is highly prevalent in critically ill patients. However, specific acute pain as a direct consequence of trauma is one of the least studied areas of acute pain. Inclusion criteria: This scoping review will consider studies on adult victims of trauma, aged 18 years or over, in prehospital emergency care, emergency departments and trauma centers. All studies that focus on non-pharmacological interventions designed to reduce acute pain, implemented and evaluated by health professionals in any form, duration, frequency and intensity, will be considered. Methods: An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies from 2000 to the present in major healthcare related electronic databases. Studies in English, French, Spanish and Portuguese will be included. Data extraction will be performed independently by two reviewers in tabular form and include details about the interventions, populations, study methods and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives
- Intervenções de enfermagem pré-hospitalar : revisão narrativaPublication . Mota, Mauro; Cunha, Madalena; Reis Santos, Margarida; Cunha, Isabel Cristina; Alves, Mónica; Marques, NunoConstruir algoritmos de intervenção de enfermagem pré-hospitalar para vítimas de trauma. Metodologia: Revisão Narrativa da Literatura, entre 2008 e 2019, nas principais bases de dados. Dois revisores independentes realizaram a avaliação crítica, extração e síntese dos dados. A construção dos algoritmos resultou do processo interpretativo da revisão narrativa por três peritos na área. Utilizou-se o modelo teórico de Virgínia Henderson. Resultados: Obtiveram-se 17 documentos, seis foram incluídos no desenvolvimento dos metaparadigmas Saúde, Pessoa e Ambiente e 16 na elaboração e construção de Algoritmos de avaliação, diagnóstico e intervenções de enfermagem às vítimas de trauma. Conclusões: A revisão possibilitou a operacionalização do modelo teórico de Henderson para a assistência pré-hospitalar permitindo a criação de algoritmos orientadores da prática de enfermagem.
- 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.
- Pre-hospital treatment of acute trauma pain: an observational studyPublication . Mota, Mauro; Reis Santos, Margarida; Santos, Eduardo; Henriques, Carla; Matos, Ana; Cunha, MadalenaObjective: To describe and analyze the effectiveness of nurses’ interventions in pain reduction among patients with traumatic injury. Methods: Prospective cohort study conducted in the Immediate Life Support Ambulances in Portugal from March 1, 2019 to April 30, 2020. We have collected data on the kind of interventions implemented and the time elapsed during rescue procedures. To investigate the course of acute trauma pain, a 11-point Numeric Rating Scale was used. Changes in the level of pain registered throughout the three assessment moments were studied using linear mixed-effects models with random intercepts to account for the repeated measurements conducted on the same patient. These changes were assessed before and after the administration of the pain relief interventions. Results: 596 patients were included in this study. Most of them were male (65.9%) and had a mean age of 53.05±19.72 years. There was a reduction in the average pain intensity of 2.44 points (p<0.005), between the beginning and end of the assessment, and a reduction of 39.62% among the patients who were experiencing a level of pain equal to or greater than 7 (46.7% vs 7.08%, p<0.05). Measures involving the use of morphine, cryotherapy and relationship-based measures have proven to be effective. Comfort measures as a whole do not seem to have a significant impact on pain relief. Conclusion: Pre-hospital pharmacological and non-pharmacological nurses’ interventions have proven to be effective in reducing pain. Comfort measures have not been proved to be effective, so their potential must be rethought and enhanced.
- Prehospital interventions to reduce discomfort caused by immobilization in adult trauma victims: a scoping review protocolPublication . Mota, Mauro; Cunha, Madalena; Santos, Eduardo; Abrantes, Tito; Melo, Filipe; Monteiro, Mariana; Reis Santos, MargaridaObjective: The objective of this review is to identify the level of discomfort caused by immobilization as reported by trauma victims, and to map all the interventions in the prehospital context where they have been implemented and evaluated in order to reduce discomfort in adult victims of trauma. Introduction: Immobilization is a cause of discomfort for trauma victims, which has important implications for the deterioration of vital signs and quality of life. However, discomfort caused by immobilization remains an underexplored topic by the scientific community. Inclusion criteria: This scoping review will consider studies of adult victims of trauma, aged 18 years or over, in prehospital emergency care. Studies that focus on interventions designed to reduce immobilization discomfort, implemented and evaluated by health professionals, of any form, duration, frequency, and dose will be considered. Methods: An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies without time restrictions, in major health care–related electronic databases. Studies in English, French, Spanish, and Portuguese will be included. Data extraction will be performed independently by 2 reviewers in a tabular format and will include details about the level of discomfort, interventions, populations, study methods, and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives.
- Gestão do desconforto causado pela imobilização em vítimas de trauma - mitigar um "mal necessário"Publication . Mota, Mauro; Cunha, Madalena; Reis Santos, Margarida