School Nurses on the Front Lines of Medicine: Emergencies Associated With Sport and Physical Activities: Part 1.

Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life- and limb-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus, catastrophic brain or cervical spine injuries, hypoglycemia, blunt chest/abdominal injuries, or extremity fractures requiring surgery. It is important for the school nurse to recognize potential life- and limb-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life- and limb-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of three common emergencies associated with sport and physical activities.

Sideline Management of Joint Dislocations.

Athletes can sustain a large variety of injuries from simple soft tissue sprains to complex fractures and joint dislocations. This article reviews and provides the most recent information for sports medicine professionals on the management of simple and complex joint dislocations, i.e., irreducible and/or associated with a fracture, from the sidelines without the benefit of imaging. For each joint, the relevant anatomy, common mechanisms, sideline assessment, reduction techniques, initial treatment, and potential complications will be discussed, which allow for the safe and prompt return of athletes to the field of play.

Reduction of radial-head subluxation in children by triage nurses in the emergency department: a cluster-randomized controlled trial.

BACKGROUND: Radial-head subluxation is an easily identified and treated injury. We investigated whether triage nurses in the emergency department can safely reduce radial-head subluxation at rates that are not substantially lower than those of emergency department physicians. METHODS: We performed an open, noninferiority, cluster-randomized control trial. Children aged 6 years and younger who presented to the emergency department with a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous 12 hours were assigned to either nurse-initiated or physician-initiated treatment, depending on the day. The primary outcome was the proportion of children who had a successful reduction (return to normal arm usage). We used a noninferiority margin of 10%. RESULTS: In total, 268 children were eligible for inclusion and 245 were included in the final analysis. Of the children assigned to receive physician-initiated care, 96.7% (117/121) had a successful reduction performed by a physician. Of the children assigned to receive nurse-treatment care, 84.7% (105/124) had a successful reduction performed by a nurse. The difference in the proportion of successful radial head subluxations between the groups was 12.0% (95% confidence interval [CI] 4.8% to 19.7%). Noninferiority of nurse-initiated radial head subluxation was not shown. INTERPRETATION: In this trial, the rate of successful radial-head subluxation performed by nurses was inferior to the physician success rate. Although the success rate in the nurse-initiated care group did not meet the non-inferiority margin, nurses were able to reduce radial head subluxation for almost 85% of children who presented with probable radial-head subluxation. TRIAL REGISTRATION: Clinical Trials.gov, no. NCT00993954.

Managing 'pulled elbow' in the paediatric emergency department.

Nurses are bound by the Nursing and Midwifery Council code of conduct (2008) to deliver care based on the best available evidence, which involves a combination of clinical expertise and incorporating research into practice (Thompson et al 2004). This article critically evaluates the evidence base of methods available to reduce radial head subluxation in children. The author is a senior staff nurse at an inner-city paediatric emergency department in which about 30,000 children are treated each year.

Combined occipital-cervical and atlantoaxial disassociation without neurologic injury: case report and review of the literature.

STUDY DESIGN: Case report and literature review. OBJECTIVE: To discuss the diagnosis, limitations, and treatment of combined occipital-cervical and atlantoaxial disassociation with normal neurologic function. SUMMARY OF BACKGROUND DATA: Injuries to the craniocervical junction can lead to devastating neurologic deficits. Occipital-cervical disassociation is a well-documented injury pattern that can lead to pain, spinal cord injury, and death. Early diagnosis and treatment can preserve neurologic function. Combined injuries to both the occipital-cervical and atlantoaxial segments are less common and, to date, have only been described with severe neurologic injury. METHODS: Retrospective review of a case. Literature review was performed through Medline and Pubmed searches. RESULTS: This is the first case to present a combined occipital-cervical and atlantoaxial disassociation with a neurologically intact patient. Initial physical examination was limited, but early imaging revealed evidence of instability. Early diagnosis and early (< 24) surgical stabilization was performed with no complications and neurologic preservation. One-year follow-up visit revealed normal neurologic examination with neck pain VAS = 2/10 and neck disability index = 6. CONCLUSION: Combined injuries to the occipital-cervical and atlantoaxial can result in upper cervical instability. Despite previous reports, neurologic preservation remains a possibility in this injury pattern. Limitations in physical examination and radiographic imaging persist, but early diagnosis and surgical stabilization may improve neurologic outcomes.

Lisfranc's or tarsometatarsal fracture-dislocation.

Lisfranc's injuries are one of the most commonly missed fractures in a multitrauma patient. Failure to recognize and treat such an injury can lead to acute (e.g., compartment syndrome of the foot) and chronic problems (e.g., arthritis). A list of reminders is included to help with the recognition and treatment of Lisfranc's injuries (Table 1).

Did you check your nursemaid's elbow?

Imagine a parent innocently swinging around a toddler ... a yank on an outstretched arm to keep a preschooler from falling ... a caregiver attempting to move a reluctant child by dragging the child by the hand ... a helping hand to lift a young child up over the curb or a high step. None of these activities is ever intended to hurt a child, yet the result of these specific activities send many children with anxious parents and caregivers to emergency departments and unscheduled pediatrician appointments each year. Nursemaid's elbow, also known as a pulled elbow or a subluxated radial head, may result from the specific activities described above and is the most common dislocation injury handled by pediatricians. Most commonly occurring in the 1-year to 4-year old age group, nursemaid's elbow is easily treated and generally has no long-term sequelae.

Spinal cord injury without radiographic abnormality (SCIWORA).

Spinal cord injury without radiographic abnormality (SCIWORA) is associated with self-reducing transient subluxation or distraction of the juvenile spine. It accounts for about 40% of spinal injuries in children under sixteen. Children's anatomical features increase their susceptibility to hyperflexion, hyperextension and distraction mechanisms. Nursing management includes an awareness of two of its greatest dangers: a delay in onset of symptoms and a possible recurrence. If these dangers are identified early, the child's potential for recovery is maximized.

[Systematization of nursing care for a patient with luxation of the cervical spine: case study]. / Sistematização da assistência de enfermagem a paciente com luxação de coluna cervical: estudo de caso.

It deals with a study of patient case of cervical spine luxation with no marrow commitment, in which the authors conducted nursing process according to Horta's Conceptual Model, adapting to Taxonomy I of the Nursing Diagnosis proposed by the North American Nursing Diagnosis Association (NANDA). The results showed that the proposed intervention contributed to the patient rehabilitation preventing complication, as well as, helped the patient to reassume his autonomy coming back to his social environment.

Traumatic atlantooccipital dislocation injury in children.

The tragedy of trauma turns into triumph when the surgery team members' efforts result in victory for the patient. Nowhere is this more true than in successful pediatric trauma care. Giving a child a second chance at life and the family an opportunity for a new beginning is the highest reward for the trauma team's years of professional training and practice. Traumatic atlantoocipital dislocation injury usually results in death, but recent neurosurgery trauma advances are increasing pediatric survival rates.

C1-C2 fractures and dislocations.

The management of patients with bony or ligamental injury of C1 or C2 depends on the nature of the fracture or subluxation. Other factors which must be taken into consideration are mechanism of injury, presence of neurological deficit and demonstration of stability. It is the intention of this article to examine bony anatomy of the upper two cervical vertebrae and their relationship to each other. The management of this injury and the role of the nurse in caring for and educating the patient with this type of injury, as well as a case study will be presented.

Nursing assessment of injuries to the lower extremity.

When assessing injuries to the lower extremity, they can best be discussed if divided into two groups: (1) vehicular or crushing injuries; and (2) nonvehicular, torsion, or overuse injuries. Vehicular injuries require speedy, accurate assessment as they are often complex and frequently involve other systems. The patient is initially stabilized, then assessment of orthopedic problems is begun. The nurse's role is an assistive one. If the patient is admitted to the hospital, orthopedic care involves prevention of complications, reduction of pain, and assisting the patient in daily activities. Nonvehicular injuries are more chronic in nature. The patient may have unsuccessfully ignored the problem, tried home remedies, or attempted to work with it. At this point, they are seen in the physician's office, hoping for a cure. After diagnosis, proper instruction for a rehabilitation program is begun. Treatment for a sprain, strain, or overuse syndrome can often be done at home. An active program should be encouraged and the patient should be taught why the problem occurred initially and how it can be prevented in the future.