Quemaduras profundas en extremidades inferiores. La importancia del factor humano: caso clínico / Deep burns in lower extremities. The importance of the human factor: clinical case

El objetivo de este artículo es exponer el abordaje terapéutico y la importancia del factor humano en la aparición de eventos adversos en lesiones producidas por quemaduras. Para ello presentamos el caso de una mujer de 48 años que sufrió quemaduras dérmicas profundas por exposición a aceite hirviendo en ambas extremidades inferiores con una superficie corporal total quemada del 10%. En atención primaria se estableció un plan de actuación de enfermería con visión holística para evitar la aparición de eventos adversos. Los resultados muestran que, pese a las instrucciones dadas sobre la importancia del reposo, el factor humano de la paciente impidió, a partir de los 15 días, que guardase el reposo necesario. Este hecho produjo la profundización de algunas de las lesiones. Se puede concluir que la aparición de los eventos adversos debidos al factor humano retrasó la curación de las heridas y profundizó las lesiones en ambas extremidades (AU)

The objective is to expose the therapeutic approach and importance of the human factor in the appearance of adverse events in injuries caused by burns. To do this, we present the case of a 48-year-old woman who suffered deep skin burns from exposure to boiling oil in lower extreme embassies with a burned total body surface area of 10%. In Primary Care, a nursing action plan with a holistic vision was established to avoid the appearance of adverse events. The results indicated, despite the instructions given on the importance of rest, that the human factor of the patient prevented, from 15 days, keeping the necessary rest. This fact caused the deepening of some of the injuries. It can be concluded that the appearance of adverse events due to the human factor delayed wound healing and deepened the injuries to both extremities (AU)

Protecting vulnerable skin from moisture-associated skin damage.

The skin, the body's largest organ, has several functions. Its barrier role can be undermined if it is in contact with urine, faeces and other sources of excess moisture; overhydration can also increase the likelihood of injury from friction through contact with clothing, incontinence pads or bed linen. If skin has been damaged by moisture or is at risk of this, its health can be supported through cleansing to maintain its acid mantle followed by protection with barrier products. Barrier preparations are available in different forms, and their effectiveness varies. A new product, Medline Remedy Moisturising Barrier Cream, has been trialled in adults, children and neonates in a variety of healthcare settings.

Acute to chronic pain transition in extremity trauma: A narrative review for future preventive interventions (part 1).

BACKGROUND: Several studies have been conducted over the last decade that describe the issue of pain and prognostic factors of acute to chronic pain transition post extremity trauma (ET). However, no thorough interventions to prevent chronic pain development in ET patients have yet been proposed. OBJECTIVES: This first part of a series of two articles aimed to provide a comprehensive analysis of literature on the epidemiology of pain post-ET, the impact of persistent pain on ET patients and the relevant biological transformations involved in acute to chronic pain transition. The second article will focus on risk and protective factors relating to chronic pain that could potentially assist in the development of preventive interventions. METHODS: A narrative review of the literature was undertaken. Databases were searched to identify relevant studies and seminal works on the topics of interest. RESULTS: The review revealed that acute pain converts to chronic pain in up to 86% of ET patients. Analysis of study findings also indicated that chronic pain interferes with activities of daily living and capacity to work. Weak associations between chronic pain and anxiety as well as depression have been demonstrated. Anxiety and depression have been identified as important predictors of chronic pain post-ET. Neuro-immunological transformations, genetics and an emotional shift in the brain circuitry involved in nociception have been shown to contribute to the transition towards chronic pain. CONCLUSIONS: This narrative review supports the view that acute to chronic pain transition is a prevalent and significant issue post-ET. It also provides information about patients who present a higher risk of chronic pain and features that should be integrated in preventive interventions as well as methodological considerations pertaining to the evaluation of such interventions.

Effect of nurse initiated X-rays of the lower limb on patient transit time through the emergency department.

OBJECTIVE: To compare outcomes of nurse initiated X-rays (NIX) with emergency physician (EP) initiated X-rays (EPIX) of isolated lower limb injuries in patient transit time (from triage to discharge) through the emergency department (ED). METHOD: A prospective, interventional study using a historical control group. Data were collected at each contact point from triage (including time of EP's initial assessment of patient, X-ray request and review, patient disposition decision and discharge time). Initially, data were collected as patients proceeded through the ED having X-rays requested after EP assessment. Following nurse education on use of pre-validated foot, ankle and knee X-ray decision instruments, similar data were collected following nurse X-ray request. Time differences between the two groups were compared. RESULTS: A total of 206 patients were enrolled, with 105 having EPIX and 101 NIX. Group characteristics were not significantly different. Fractures were identified in 26.7% of EPIX compared to 34.7% of NIX (p=0.300). Despite an observed reduction in the mean transit time (172.9minutes (min) for EPIX to 158.6min for NIX) this did not achieve statistical significance (p=0.230). There were significant differences in times from triage to initial assessment by EP (mean 57.6min EPIX, 93.4min NIX, p<0.001) (median 45.0min in EPIX, 78.0min in NIX group, p<0.001) which delayed transit time in the NIX group. CONCLUSION: Although NIX reduced patient transit times, this did not reach statistical significance. In an ED with substantial access block, this suggests that corresponding systems changes are required to improve ED flow.

Reducing the cost of lower limb wound management through industry partnership and staff education.

Following an audit of practice in North East London Foundation Trust (NELFT), obstacles in the management of lower limb conditions were identified. An appraisal of needs in terms of skills and theory updates for staff led to a fixed-term 'honorary contract' between the trust and a wound-care company to facilitate a rolling programme of education, to upskill staff in terms of assessment and treatment, and develop standardised care pathways. After 3 months, a repeated practice audit revealed a reduction in nurse contact hours of 1156 hours. The partnership with industry proved to be beneficial and did not compromise care, and trust staff were not obligated to use their product.

[Catastrophic left leg V.A.C. Therapy First Prize in 2008. Second convocation]. / Pierna catastrófica izquierda. Primer Premio Terapia V.A.C. Segunda convocatoria.

This report received the V.A.C. Therapy Prize, second convocation, in the clinical case category of note is the spectacular nature of its results.

Pierna catastrófica izquierda / Catastrophic left leg

Trabajo que ha recibido el Premio Terapia V.A.C.® en su segunda convocatoria, en la modalidad de: «Exposición de un caso clínico». A destacar la espectacularidad de los resultados(AU)

This report received the V.A.C.® Therapy Prize, second convocation, in the clinical case category. Of note is the spectacular nature of its results(AU)

Classifying and managing pretibial lacerations in older people.

As the population of older people increases it is likely there will be an associated increase in the numbers of patients presenting with pretibial lacerations to GP surgeries, accident and emergency departments and referred to community nurses. This will be due, in part, to the increasing frailty of the skin of the older person, as well as comorbidities, the number of which are also likely to increase with ageing. It is important that the older person with a pretibial laceration is treated promptly and appropriately to prevent complications and optimize healthcare resources.

Evoking the essence of caring: experiences from a Peruvian adventure relevant for leaders in healthcare today.

There are times when an experience is so powerful that it evokes caring in its purest form. This is what happened when a group of healthcare providers traveled together on a trip to Peru. This article recounts a harrowing experience that called each person to give caring and receive learning regarding his or her own journey. It is about how caring can simply happen with ease and purpose. Communication and collaboration occurred effortlessly. In this experience, there was a remembering of the passion and purpose that exists when we are called to serve in healthcare settings. The learning gained included 4 key elements of caring: intent, presence, action, and surrender. This learning offers insight, direction for healthcare environments today. Healthcare leaders must be responsive to creating cultures and providing opportunities to support those serving patients to intentionally think about their caring approaches. It is possible to evoke caring through providing opportunities that help healthcare providers transcend the daily barriers to being present and be more effective in their caring. It is imperative that they experience ways to examine their ability to care for themselves and others and to reconnect to the passion of choosing the healthcare profession.