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Journal scan Trauma from burns and scalds is more common and damaging in children than in adults, and may indicate abuse. The main goal of intensive care of an acute burn is to limit the extent of the systemic insult and, in this article, the authors explain that effective treatment of such acute physiological changes requires experienced monitoring by multidisciplinary teams, following appropriate emergency protocols at specialised burn centres in cases of major trauma. First aid involves maintaining a patent airway, supporting circulation and respiration, arresting the burning, managing pain and distress, reducing infection and considering transfer to specialist care. While advances in techniques and treatment have led to better survival rates and outcomes, there is still a need for education and prevention programmes at all levels to reduce the incidence of burns among children. The authors conclude that improvements in resuscitation and critical care are leading to fewer deaths from burn injuries, but add that initial assessment is crucial. Given the advances in knowledge and techniques, and appropriate training of multidisciplinary teams, patients whose injuries have been assessed properly and early have a good chance of recovery. Biasini A, Biasini M, Stella M (2014) Intensive care of children with burn injuries and the role of the multidisciplinary team. Nursing Children and Young People. 26, 9, 27-30.
Sexual assault Rape is the kind of trauma most commonly associated with post-traumatic stress disorder (PTSD) among women, which means it is vital to identify women at risk of developing PTSD. The aims of the authors of this study were to assess the prevalence of, and major risk factors for, PTSD six months after sexual assault. They cases involving 317 female victims of rape who sought help at the Emergency Clinic for Raped Women, at Stockholm South Hospital, Sweden. Baseline assessment of the women’s mental health was carried out at presentation and followed up after six months. EMERGENCY NURSE
Alamy
Burn injuries
Guidance and education programmes are needed to ensure that fewer children sustain burn injuries
The authors found that 39% of the women developed PTSD, and 47% experienced moderate or severe depression. The major risk factors for PTSD were having been sexually assaulted by more than one person, experiencing acute stress disorder shortly after the assault, having been exposed to several acts during the assault, having been injured, having co-morbid depression, and having a history of more than two earlier traumas. PTSD is common in the aftermath of sexual assault, and the risk of developing PTSD increases according to the vulnerability of the person concerned and the nature of the assault. The article emphasises that, by identifying women who are at the greatest risk of developing PTSD, services can ensure they receive the appropriate therapeutic resources. Tiihonen Möller A, Bäckström T, Söndergaard HP et al (2014) Identifying risk factors for PTSD in women seeking medical help after rape. PLoS One. 9, 10, e111136.
Cardiovascular care Ischaemic stroke is a devastating condition and the leading cause of disability in the United States. Over the past two decades, the focus of management has shifted from secondary stroke prevention to acute treatment. Co-ordinated care starts with paramedics in the field, continues in the ambulance and emergency department, and continues further in the intensive care unit. After diagnosis
and stabilisation, the major goal is reperfusion therapy with intravenous fibrinolytics to restore blood flow through blocked arteries. The authors of this article outline a practical approach to current and intensive-care management based on clinical guidelines and the best available evidence. The role of adjunctive intra-arterial and mechanical thrombectomy remains undefined, they say, and the use of sonolysis and fibrinolytics to improve reperfusion is under investigation. Treatment in the intensive care unit therefore involves prevention of secondary brain injury through optimisation of blood pressure, cerebral perfusion, glucose and temperature management, ventilation and oxygenation. The article also cites the most feared complications of ischaemic stroke, including malignant cerebral oedema and symptomatic haemorrhagic transformation. In these circumstances, decompressive craniectomy is life saving, but questions about patient selection and timing remain. The authors also touch on the use of hyperosmolar agents to mitigate cerebral oedema, but explain that newer agents are being sought to prevent excessive accumulation of fluid. Figueroa S, Zhao W, Aiyagari V (2014) Emergency and critical care management of acute ischaemic stroke. CNS Drugs. doi: 10.1007/s40263-014-0210-2 Journal scan is compiled by Jennifer Sprinks December 2014 | Volume 22 | Number 8 13
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Journal scan Trauma from burns and scalds is more common and damaging in children than in adults, and may indicate abuse. The main goal of intensive care of an acute burn is to limit the extent of the systemic insult and, in this article, the authors explain that effective treatment of such acute physiological changes requires experienced monitoring by multidisciplinary teams, following appropriate emergency protocols at specialised burn centres in cases of major trauma. First aid involves maintaining a patent airway, supporting circulation and respiration, arresting the burning, managing pain and distress, reducing infection and considering transfer to specialist care. While advances in techniques and treatment have led to better survival rates and outcomes, there is still a need for education and prevention programmes at all levels to reduce the incidence of burns among children. The authors conclude that improvements in resuscitation and critical care are leading to fewer deaths from burn injuries, but add that initial assessment is crucial. Given the advances in knowledge and techniques, and appropriate training of multidisciplinary teams, patients whose injuries have been assessed properly and early have a good chance of recovery. Biasini A, Biasini M, Stella M (2014) Intensive care of children with burn injuries and the role of the multidisciplinary team. Nursing Children and Young People. 26, 9, 27-30.
Sexual assault Rape is the kind of trauma most commonly associated with post-traumatic stress disorder (PTSD) among women, which means it is vital to identify women at risk of developing PTSD. The aims of the authors of this study were to assess the prevalence of, and major risk factors for, PTSD six months after sexual assault. They cases involving 317 female victims of rape who sought help at the Emergency Clinic for Raped Women, at Stockholm South Hospital, Sweden. Baseline assessment of the women’s mental health was carried out at presentation and followed up after six months. EMERGENCY NURSE
Alamy
Burn injuries
Guidance and education programmes are needed to ensure that fewer children sustain burn injuries
The authors found that 39% of the women developed PTSD, and 47% experienced moderate or severe depression. The major risk factors for PTSD were having been sexually assaulted by more than one person, experiencing acute stress disorder shortly after the assault, having been exposed to several acts during the assault, having been injured, having co-morbid depression, and having a history of more than two earlier traumas. PTSD is common in the aftermath of sexual assault, and the risk of developing PTSD increases according to the vulnerability of the person concerned and the nature of the assault. The article emphasises that, by identifying women who are at the greatest risk of developing PTSD, services can ensure they receive the appropriate therapeutic resources. Tiihonen Möller A, Bäckström T, Söndergaard HP et al (2014) Identifying risk factors for PTSD in women seeking medical help after rape. PLoS One. 9, 10, e111136.
Cardiovascular care Ischaemic stroke is a devastating condition and the leading cause of disability in the United States. Over the past two decades, the focus of management has shifted from secondary stroke prevention to acute treatment. Co-ordinated care starts with paramedics in the field, continues in the ambulance and emergency department, and continues further in the intensive care unit. After diagnosis
and stabilisation, the major goal is reperfusion therapy with intravenous fibrinolytics to restore blood flow through blocked arteries. The authors of this article outline a practical approach to current and intensive-care management based on clinical guidelines and the best available evidence. The role of adjunctive intra-arterial and mechanical thrombectomy remains undefined, they say, and the use of sonolysis and fibrinolytics to improve reperfusion is under investigation. Treatment in the intensive care unit therefore involves prevention of secondary brain injury through optimisation of blood pressure, cerebral perfusion, glucose and temperature management, ventilation and oxygenation. The article also cites the most feared complications of ischaemic stroke, including malignant cerebral oedema and symptomatic haemorrhagic transformation. In these circumstances, decompressive craniectomy is life saving, but questions about patient selection and timing remain. The authors also touch on the use of hyperosmolar agents to mitigate cerebral oedema, but explain that newer agents are being sought to prevent excessive accumulation of fluid. Figueroa S, Zhao W, Aiyagari V (2014) Emergency and critical care management of acute ischaemic stroke. CNS Drugs. doi: 10.1007/s40263-014-0210-2 Journal scan is compiled by Jennifer Sprinks December 2014 | Volume 22 | Number 8 13
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
