Fingertip injuries in children: a review of the literature.

Fingertip injuries in children are a common presentation in emergency settings. These injuries result from a variety of mechanisms with most occurring at home by crushing fingers in a door and are distressing for the child and parent or carer. It is essential that emergency clinicians respond competently and confidently. This article reviews the literature on the management of fingertip crush injuries to establish, where possible, best evidence. The article also describes the anatomy and assessment of the finger in relation to fractures of the distal phalanx, nail bed injury and subungual haematoma, and considers the use of antibiotics in the treatment of a subungual haematoma with a distal phalanx fracture.

Emergent Bilateral Face-lift Hematoma: A Case Report.

The face-lift, or rhytidectomy, is a common surgical procedure in the United States. Facial hematoma is the most frequent complication after face-lift. Sometimes an emergent expanding hematoma may require general anesthesia and can present difficulty in securing the airway. This article reviews the frequency and causes of an expanding hematoma and how it affects anesthesia care. The case summary describes an emergent bilateral hematoma after a face-lift in a 50-year-old woman, the emergency treatment, and her subsequent recovery. Details of the procedure are provided. The purpose of examining this case is to inform and educate anesthesia providers about the possibility of a common face-lift complication and how to prepare for securing the difficult airway in this situation.

Biopsia renal en receptores de transplante renal: cuidados de enfermería y complicaciones / Renal biopsy in renal transplant recipients: nursing care and complications

Introducción: La biopsia renal percutánea es una herramienta fundamental para el manejo del paciente trasplantado renal. La prueba es primordial para detectar y/o prevenir cualquier disfunción en el injerto, siendo un procedimiento tanto diagnóstico como preconizador. Objetivo: Describir los cuidados de enfermería e identificar las complicaciones derivadas de la biopsia renal en los receptores de Trasplante Renal. Material y métodos: Estudio cuantitativo, descriptivo y transversal realizado en la Unidad de Trasplante Renal, Servicio de Nefrología, del 2008 al 2014. La población objeto de estudio son los receptores de Trasplante Renal (TR). La muestra está compuesta por 368 biopsias renales de seguimiento que ingresan para someterse a una biopsia renal. Los criterios de inclusión son ser mayores de 18 años, trasplantados y que han firmado el consentimiento informado. Se recogen datos sociodemográficos, clínico-asistenciales y complicaciones post-biopsia renal. Resultados: Desde 1980 hasta el 2014 se han llevado a cabo 1868 TR, de 2008 a 2014 se estudiaron 368 biopsias de seguimiento. Se monitoriza la Tensión Arterial y la coagulación pre biopsia. Tras el procedimiento, se controla la presencia de sangrado por micción y constantes vitales. Inicialmente el reposo absoluto era de 24 h, a partir de 2014 se reduce a 6 horas, recomendando reposo relativo al alta, las complicaciones fueron mínimas. Conclusiones: Los resultados indican que la biopsia renal es un procedimiento eficaz, con escasas complicaciones. Destacar el papel de enfermería en la detección precoz de complicaciones (AU)

Introduction: Percutaneous Renal Biopsy is an essential tool for the management of renal transplant patients. The test is essential to detect and / or prevent any graft dysfunction, being both a diagnostic and preconizador procedure. Objective is to describe nursing care and identify complications of renal biopsy in renal transplant recipients. Methods: A quantitative, descriptive and transversal study was carried out in the Renal Transplantation Unit, Nephrology Department of Puigvert Foundation, from 2008 to 2014. The study population is kidney transplant recipients (TR). The sample consists of 368 kidney biopsies follow-up. Inclusion criteria are being over 18 years, transplanted, and signed informed consent. Sociodemographic data, clinical care and complications after renal biopsy are collected. Results: From 1980 to 2014 were carried out 1868 TR of 2008-2014 368 follow-up biopsies were studied. Blood Pressure and pre biopsy coagulation were monitored. After the procedure, the presence of bleeding urination and vital signs monitored. Initially absolute rest was 24 h, since 2014 was reduced to 6 hours, recommending rest relative to high, complications were minimal. Conclusions: The results indicate that renal biopsy is an effective procedure with few complications. The nursing role in the early detection of complications is important (AU)

Complicaciones en pacientes sometidos a Angioplastia Coronaria Transluminal Percutánea / Complications in patients undergoing Percutaneous Transluminal Coronary Angioplasty

Esta investigación tuvo como objetivo identificar las complicaciones locales y sistémicas en pacientes sometidos a Angioplastia Coronaria Transluminal Percutánea y los factores de riesgo que pueden influir en la aparición de estas complicaciones. Estudio prospectivo, transversal, con análisis cuantitativo de los datos que fueron recolectados de 127 pacientes en la Unidad de Hemodinámica y en la Unidad de Cuidados Intensivos del hospital campo de estudio. Los datos fueron analizados mediante estadística descriptiva. Para investigar la asociación entre los factores de riesgo y las complicaciones después de la Angioplastia Coronaria Transluminal Percutánea se utilizó prueba de Chi cuadrado. Se observó que 79 (62,2%) pacientes presentaron complicaciones. De éstos, 39 (49,4%) tuvieron complicaciones locales, 25 (31,7%), complicaciones sistémicas y 15 (18,9%) habían asociado las complicaciones locales y sistémicas. Hubo una asociación estadísticamente significativa (p<0,05) entre el uso continuo de los anticoagulantes después de la Angioplastia Coronaria Transluminal Percutánea y la presencia de complicaciones. Se encontró que la mayoría de los pacientes tuvo complicaciones y el uso de anticoagulante después del procedimiento está asociado con estas complicaciones(AU)

This research aimed to identify the local and systemic complications in patients undergoing Percutaneous Transluminal Coronary Angioplasty and risk factors that may influence the occurrence of these complications. It is a prospective cross-sectional study with a quantitative approach of the data that were collected from 127 patients in the Unit of Hemodynamic and in the Unit of Intensive Terapy of the hospital field of study. Data were analyzed using descriptive statistics. To investigate the association between risk factors and complications after Percutaneous Transluminal Coronary Angioplasty was used Chi-square test. It was observed that 79 (62.2%) patients had complications. Of these, 39 (49.4%) had local complications, 25 (31.7%) systemic complications and 15 (18.9%) had associated local and systemic complications. There was a statistically significant association (p<0,05) between the continuous use of anticoagulants after Percutaneous Transluminal Coronary Angioplasty and presence of complications. It was evident that most of the patients had complications and use of anticoagulant after the procedure is associated with these complications(AU)

Outcomes of buttonhole and rope-ladder cannulation techniques in a tropical renal service.

BACKGROUND: Buttonhole cannulation was introduced into this Queensland Renal Service in 2005. Contrary to published literature, a local review of cannulation outcomes found no greater likelihood of infections with the buttonhole technique. OBJECTIVES: To compare the outcomes of buttonhole and rope-ladder cannulation techniques. DESIGN: Prospective cohort. PARTICIPANTS: Consenting patients attending for haemodialysis via an existing arteriovenous fistula (n = 104). MEASUREMENTS: Cannulation sites were assessed at every dialysis session for 12 weeks; fear and pain were scored by participants weekly. RESULTS: No statistically significant differences in infection, haematoma formation, pain or fear between the techniques. Occurrence of aneurysm was higher (p < 0.05) in the rope-ladder group. More patients in buttonhole group required multiple cannulation attempts (p < 0.05). More of the rope-ladder group failed to attend their scheduled dialysis sessions (p < 0.05). CONCLUSIONS AND APPLICATIONS TO PRACTICE: This study confirms that in this setting there are few negative outcomes of either technique of fistula cannulation. Specifically, buttonhole cannulation appears to be a safe alternative means of fistula access to the gold-standard cannulation technique. The Service is examining strategies to improve attendance.

Hematoma renal en paciente monorreno / Haematoma of the kidney in patient with one kidney

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Duodenal hematoma from a fall down the stairs.

Blunt abdominal trauma is not a common finding in abused children. However, there is a high rate of mortality associated with this type of injury. Recognizing the presentation of a child with abusive abdominal injuries is crucial for healthcare providers. Often these children are too young to provide a history of the injury, the caretaker accompanying the child may provide you with a misleading history or a history of minor trauma, and the child's symptoms may range from abdominal pain to vomiting to septic shock, making the diagnosis difficult. The child's anatomy puts him/her at risk for intra-abdominal injury from blunt force. They have less musculature and fat than adults and their rib cage is horizontally oriented, allowing organs to extend beyond the costal margin. Duodenal injuries are extremely uncommon in children because of the retroperitoneal location and a substantial amount of force is necessary to injure this area of abdomen. Understanding the different injury patterns and various mechanisms required to cause abdominal injury is important in determining accidental injury from nonaccidental injury.

Bed-rest post-femoral arterial sheath removal--what is safe practice? A clinical audit.

Numbers of patients undergoing coronary angiography and angioplasty procedures have increased in England due to targets within the National Service Framework for Coronary Heart Disease. Little evidence is available regarding optimal bed-rest duration for patients post-femoral arterial sheath removal following these procedures. Through literature review and clinical benchmarking, we aimed to identify what best practice was in the UK and whether bed rest times at our centre could be reduced without increasing complications to enable increased day case procedures. An audit tool was designed to collect data regarding method of obtaining haemostasis, length of bed-rest post-sheath removal and any post-procedural complications experienced by the patient. From a convenience sample of consecutive patients, 195 complete sets of baseline data revealed an average (median) period of 6-h bed rest. This was reduced to 3h and audit repeated yielding 176 complete data sets using the same audit tool. Femoral wound site complication rates were not significantly affected by reducing bed-rest time for diagnostic or interventional procedures. These findings contributed to an important change in practice, reducing length of stay post-procedure and should be re-explored due to increased use of femoral arterial closure devices.

The effect of cold on the occurrence of bruising, haematoma and pain at the injection site in subcutaneous low molecular weight heparin.

The purpose of this study was to investigate the effect of local dry cold application on the occurrence of bruising, haematoma and pain at the injection site in subcutaneous low molecular weight heparin injections. The research involved 63 patients who had received 2 x 20 mg enoxaparine and who were divided into four treatment groups. In the first group, cold was not applied. Cold was applied to the injection site for 5 min before the injection in the second group, and for 5 min after the injection in the third group. In the fourth group, it was applied to the injection site for 5 min pre and post injection. Following each injection, the patients' pain intensity and duration were measured, and the presence of bruise and haematoma were measured at 48 and 72 h after the injection. Results showed that a haematoma did not occur at the injection site of any subject, and there was no significant difference in the incidence or size of bruise among the groups; however, the subjects' perception of pain was significantly less with ice application.

Local complications of nursing interventions on peripheral veins.

The authors analyze the causes of complications after nursing interventions on peripheral veins. Twenty-one percent of all venipunctures involve complications, mainly subcutaneous hematomas (62% of all complications), paravasal injection of drugs (28%), spontaneous rupture of the vein (6%), obliteration of the vessel (2%), superficial phlebitis (2%), external bleeding from the vein (0.5%), and local allergic reactions (0.5%). The complications are cause mainly by incorrect technique. Recommendations are offered for preventing complications associated with peripheral infusion treatments.

Using pressure dressings after femoral artery sheath removal.

Only one previous study has been performed to assess the efficacy of pressure dressings after removal of a femoral artery sheath. The results of a 739-patient randomised study show there is no benefit in the routine application of pressure dressings after arterial sheath removal. This practice can be abolished with no negative impact on patient safety.

Development of a hematoma classification tool for assessment and documentation post femoral arterial puncture.

Hematoma development following procedures involving femoral arterial puncture is a potentially serious complication, estimated to occur in 0.6% to 17% of the population undergoing these procedures. (Karfonta, 1994). A review of the current literature indicates there is a lack of consistent recording mechanisms and a lack of descriptors to document femoral site observations. Our purpose is to demonstrate the utility of a Hematoma Classification Tool (developed and piloted at the University of Ottawa Heart Institute) for post operative care management of patients following femoral arterial puncture.

Surgical management of patients with severe head injuries.

Minutes can make the difference between life and death when patients with severe head injuries require surgery. Subdural, epidural, and intracerebral hematomas and cerebral contusions and gunshot wounds are the pathologic entities encountered most frequently during emergency surgery in patients with severe head injuries. Neurosurgical team members frequently use hyperventilation, mannitol and barbiturates, and sophisticated monitoring modalities to manage patients with severe head injuries during and after surgery. Although monitoring a patient's intracranial pressure (ICP) through a ventriculostomy catheter remains the most widely used gauge of cerebral metabolism, neurosurgical teams also are using fiber-optic ICP monitoring catheters, cerebral blood flow measurement probes, microdialysis catheters, jugular venous oxygen saturation catheters, and brain oxygen content measurement electrodes. Coordinated teamwork by perioperative nurses, neurosurgeons, anesthesia care providers, and emergency department staff members helps ensure the best possible outcomes for patients who require surgery for management of severe head injuries.