Hand injury: investigating the accuracy of referrals to a specialist trauma centre.

Hand injury is a common presentation in the emergency department (ED). The accurate assessment of hand injuries is essential to ensure optimal management, which may need to include referral to a tertiary trauma centre. However, hand injury assessment can be challenging, particularly in children. A better understanding of the accuracy of hand injury referrals to tertiary care can help improve clinical practice and clinician training. This article reports on a service improvement project that aimed to determine the accuracy of hand injury referrals from EDs and general practices to a tertiary trauma centre. The retrospective investigation found the accuracy of referrals to be high, but also identified areas where hand injury assessment required improvement, one of them being the training of clinicians referring complex cases to tertiary care.

Application and effect evaluation of nursing quality target management in free flap transplantation for hand injury.

To explore application and effect of nursing quality target management in free flap transplantation for hand injury. 140 patients with free skin flap transplantation for hand injury admitted to the hand and foot surgery ward of the hospital from January 2017 to December 2019 were selected as the research objects. They were randomly divided into observation group and control group. There were 70 patients in each group, and both groups of patients received microscopic free flap transplantation. The observation group adopted traditional nursing mode and nursing quality target management mode to carry out nursing, while the control group adopted traditional nursing mode to carry out nursing. The treatment compliance, skin flap survival, occurrence of vascular crisis, occurrence of complications, VAS and Barthel comparison score of the two groups were compared. The treatment compliance of patients in the observation group was significantly higher than that in the control group (P < 0.05). The survival rate of skin flap in the observation group was higher than that in the control group (P < 0.05). The incidence of vascular crisis in the observation group was lower than that in the control group (P < 0.05). The postoperative pain in the observation group was better than that in the control group (P < 0.05). There was no significant difference in Barthel score between the observation group and the control group at admission (P > 0.05), but the improvement range of Barthel score in the observation group was higher than that in the control group at discharge (P < 0.05), The satisfaction of patients in the observation group to nurses was higher than that in the control group (p < 0.05). The application of nursing quality target management can improve the treatment compliance of patients, improve the survival rate of free skin flap transplantation for hand injury, reduce the incidence of vascular crisis within 48 hours after operation, reduce the occurrence of postoperative complications, relieve the pain of patients, improve self-care ability and ensure the quality of life.

[Role of the nurse in the case of complex hand wounds]. / Rôle du soignant face à une plaie complexe de la main.

The initial assessment and care determine the quality of the secondary surgical treatment of complex hand wounds. The caregiver providing this initial care plays a critical role. The analysis of the management of these traumas in exceptional situations enables the key stages of the initial treatment to be identified: bleeding control, infection prevention and an accurate assessment of the injury. These measures thereby help to optimise the patient's transfer towards a specialised unit.

The effect of a rehabilitation nursing intervention model on improving the comprehensive health status of patients with hand burns.

AIMS AND OBJECTIVES: To observe the effect of a rehabilitation intervention on the comprehensive health status of patients with hand burns. BACKGROUND: Most studies of hand-burn patients have focused on functional recovery. There have been no studies involving a biological-psychological-social rehabilitation model of hand-burn patients. DESIGN: A randomized controlled design was used. METHODS: Patients with hand burns were recruited to the study, and sixty patients participated. Participants were separated into two groups: (1) The rehabilitation intervention model group (n=30) completed the rehabilitation intervention model, which included the following measures: enhanced social support, intensive health education, comprehensive psychological intervention, and graded exercise. (2) The control group (n=30) completed routine treatment. Intervention lasted 5 weeks. Analysis of variance (ANOVA) and Student's t test were conducted. RESULTS: The rehabilitation intervention group had significantly better scores than the control group for comprehensive health, physical function, psychological function, social function, and general health. The differences between the index scores of the two groups were statistically significant. CONCLUSIONS: The rehabilitation intervention improved the comprehensive health status of patients with hand burns and has favorable clinical application. RELEVANCE TO CLINICAL PRACTICE: The comprehensive rehabilitation intervention model used here provides scientific guidance for medical staff aiming to improve the integrated health status of hand-burn patients and accelerate their recovery. What does this paper contribute to the wider global clinical community?

Fight bite injury: emergency department assessment and management.

Human bite wounds to the hand are relatively common injuries and are associated with high infection rates. Given the unique anatomy of the hand, the bite mechanism and the organisms found in human saliva, even the smallest wound can result in an aggressive infection. Failure to recognise and treat human bite wounds appropriately, can therefore have negative outcomes for patients. This article outlines the diagnostic features of, and complications associated with, bite wounds and discusses the recommended treatment options.

Management of Hand Injuries: Part II.

Hand injuries are a frequent emergency department occurrence and account for most upper extremity injuries. Proper assessment and management of hand injuries can reduce morbidity and prevent long-term disability. "Assessment of Acute Hand Injuries" Part I was discussed in the Advanced Emergency Nursing Journal (). Part II herein discusses the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. Part III will discuss the management of tendon, ligamentous, neurovascular, and other special hand injuries along with the management of selected chronic hand conditions.

Implementing a tailored approach for the hand-injured patient: a prospective study on the evolution of the posttraumatic psychic distress.

Mutilating hand injuries are frequently associated with the development of psychic impairments such as posttraumatic stress disorder, depression, regression of the personality, and refusal of the disease. The psychic distress acts as a source of disability that outweighs the functional loss, causing impairments that may prevent a full recovery after the accident. The present study highlights the need for nurses to be familiar with the emotional response in the patients, to implement a specialized and comprehensive approach and detect stress points that may require early intervention.

Impact of hand injury on patients: psychosocially oriented nurse care.

Psychosocially oriented nurse care Psychological and social post-traumatic adjustments consequent to hand injury deeply affect patients' needs. Nurses are the professional figures who, within the surgery, work more closely in terms of frequency and time with patients: a targeted nurse training must be implemented. A systematic review was conducted to assess hand-injured patients nurse care. In total, 335 articles were identified, of which 20 met inclusion criteria. Issues identified included psychological response to hand injury, social implications, nurse's recognition and assessment of psychosocial needs, appropriate intervention. The results show how important it is to train nurses who are well prepared to deal with the psychological status when caring for hand-injured patients, in order to set the most correct psychosocial assistance.

The impact of emergency nurse practitioners on referrals to a tertiary hand trauma service: a pilot of referral quality scoring system.

Hand injuries account for 2000 referrals to the Northern Ireland plastic surgery trauma service each year. Emergency nurse practitioners are increasingly utilised to assess and manage minor injuries and independently refer patients to the hand trauma service. This paper uses a newly developed scoring system to assess the impact of varying grades of referring practitioner on the quality and appropriateness of referral.

Actuación de enfermería en paciente con mano catastrófica por explosión de petardos / Nursing care plan of a patient with traumatic hand injuries caused by firecracker explosion

Se presenta el caso clínico de un adolescente que presenta amputación traumática de la mano derecha y otras heridas más leves provocadas por la explosión de petardos y cohetes tras su incorrecta manipulación. Al llegar a la Unidad de Urgencias del Hospital de Traumatología y Rehabilitación Virgen del Rocío (Sevilla) se trataron de manera inmediata sus lesiones. La prevención del shock y el tratamiento del dolor fueron aspectos prioritarios en su asistencia. Tras una exhaustiva valoración del paciente, se seleccionaron 6 diagnósticos de enfermería, y se planificaron las intervenciones más apropiadas para cada uno de ellos, utilizando la taxonomía NANDA, NIC y NOC. Con esta actuación se contribuyó, en gran medida, a mejorar el estado de salud del paciente, tanto física como psicológicamente. Para disminuir el número de lesionados por manipulación inapropiada de material pirotécnico, sería conveniente realizar en colegios e institutos, y en coordinación con atención primaria, programas de prevención de accidentes pirotécnicos

We report the case of a teenager with traumatic amputation of the right hand and other less severe wounds caused by explosion of firecrackers and rockets after faulty handling by the boy. On arrival at the Emergency Unit of the Virgen del Rocío Orthopedic and Traumatology Hospital (Sevilla, Spain), the boy's injuries were immediately treated. Priorities were to prevent shock and alleviate pain. After an exhaustive assessment of the patient, six nursing diagnoses were selected. The most appropriate interventions for each of these diagnoses were planned, using NANDA, NIC and NOC taxonomy. This approach greatly contributed to improving the patient's physical and psychological status. To decrease the number of injuries caused by faulty handling of fireworks, programs for accident prevention should be carried out in schools in conjunction with primary care

Emergency nurse practitioner care and emergency department patient flow: case-control study.

OBJECTIVE: The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. METHODS: A case-control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. RESULTS: There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. CONCLUSION: Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.

Cuidados enfermeros en la mano traumática / Nursing care of traumatic hand injury

La mano con lesiones traumáticas después de un accidente es una lesión de gran incidencia en nuestro hospital. Los pacientes más graves necesitan ingreso; con estos casos nos encontramos en nuestra unidad de hospitalización. Los pacientes llegan a la unidad procedentes del quirófano; los cuidados enfermeros que debemos ofrecer son postoperatorios, centrados principalmente en el tratamiento de la herida quirúrgica, los vendajes y la reeducación funcional, sin olvidar el aspecto psicológico del paciente y la atención a la familia (AU)

The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture.

INTRODUCTION: Fracture care often represents the first opportunity for clinical management of osteoporosis; however, many patients do not receive any evaluation after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients underwent bone mineral density (BMD) testing. In an effort to better meet the needs of fracture patients by providing routine assessment and, where necessary, treatment for osteoporosis after their fracture, a novel service (The Fracture Liaison Service) was designed and implemented in two separate National Health Service trusts in Glasgow. METHODS: An agreed-upon standard of care for men and women 50+ years of age with fractures was established in collaboration with orthopedic surgeons and primary care physicians. The Fracture Liaison Service assumes responsibility for fracture case-finding and for assessing and performing diagnostic evaluations (including axial DXA), and making specific treatment recommendations for the secondary prevention of osteoporotic fractures. RESULTS: During the first 18 months of operation, more than 4,600 patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and other sites were seen by the Fracture Liaison Service's osteoporosis specialist nurses. Nearly three quarters of these patients were considered for BMD testing; treatment was recommended for approximately 20% of the patients without need for BMD testing. Overall, 82.3% of patients who had BMD testing were found to be osteopenic or osteoporotic at the hip or spine. CONCLUSIONS: The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.

Neurovascular assessment.

The outcome of an injured extremity is affected primarily by initial assessment and immediate treatment of the extremity. Delaying the recognition of neurovascular compromise can cause the amputation of an extremity, or even the death of the patient. However, having the foundation of knowledge regarding total neurovascular function can equip the nurse with accurate assessment skills and the knowledge of the need for immediate action. This essential orthopaedic knowledge is used daily by the orthopaedic nurse to provide the best patient care possible with the best possible outcome.

Assessment and management of hand and wrist fractures.

Injuries to the hand and wrist are common, and incorrect diagnosis and management can have catastrophic consequences for patients. This article discusses the causes, assessment, treatment and psychosocial needs of patients with hand or wrist fractures.