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.

Does nurse-led initiation of Ottawa ankle rules reduce ED length of stay?

INTRODUCTION: Ankle injuries can account for up to 3.8% of UK Emergency Department (ED) presentations per annum and this figure is comparative to the 4.4% in North America. Growing ED attendance impacts on crowding, waiting times, patient satisfaction and service provision. One way to streamline service would be widespread use of the Ottawa Ankle Rules (OAR), which reduces the need to wait for radiography. AIM: To examine the best available evidence on the impact of OAR on ED length of stay (LoS) following standard systematic review methodology. METHODS: A systematic search was undertaken in the CINAHL, EMBASE, MEDLINE, SCOPUS, and BNI databases. Studies that examined OAR use in the ED adult population were considered. Four studies met the inclusion criteria and were included in the narrative synthesis. RESULTS: All four studies point towards a reduction in LoS following OAR introduction. The quality of the body of evidence is considered to be low due to moderate risk of bias and indirectness between the studies. DISCUSSION: A strong body of evidence supports OAR use in reducing radiography but further research is needed to explore impact on LoS. This would inform clinical practice and potentially combat current pressures faced within EDs worldwide.

Treatment options for ankle ligament sprain.

There is a wealth of literature on the management of ankle sprains, but the quality of evidence is variable and conclusions diverge. Practice in emergency departments (EDs) also varies and in some cases does not reflect the evidence base. This article reviews some of the most recent research on the subject and suggests air-stirrup ankle braces can be used in EDs for management of moderate and severe ankle sprains.

Actuación enfermera en pacientes con esguince de tobillo grado I y II en Atención Primaria de Salud / Nursing intervention in patients with a grade I-II ankle sprain in Primary Health Care

El esguince es una de las patologías más frecuentes del sistema músculoesquelético; su incidencia diaria es aproximadamente de 1 por cada 10.000 habitantes. Desde la Atención Primaria de Salud (APS) pueden ser tratados los esguinces grado I y II (según los protocolos de actuación) siendo los de grado III los que deberán ser remitidos al servicio hospitalario. La actuación requiere un trabajo en equipo en el que el profesional de Enfermería es una pieza clave para establecer el plan de cuidados cuyo objetivo será la resolución o mejora del problema. El objetivo de este artículo es definir los pasos a seguir desde que el paciente acude al centro de salud hasta que se recupera de su lesión, mostrandolas diferentes técnicas de actuación, es decir, un seguimiento global,cercano y accesible, los tres puntos estrella de los servicios de APS (AU)

A sprain is one of the most frequent pathologies of the musculoskeletalsystem; with a daily incidence of approximately 1 per each 10,000 people. Grade I and II sprain (according to practice guidelines) can betreated at Primary Care settings. Grade III sprains should be referred to hospital settings.The intervention is team work where the nursing professional is a key elementto establish the care plan to resolve or improve the condition.The aim of this paper is to define the steps to be taken from the moment the patient presents to the health care centre until he or she recovers from his or her injury, implementing the different intervention techniques, which are based on the three key landmarks of primary care centres: overall follow-up, closeness to the patient and accessible care (AU)

Ankle sprains and fractures in adults.

The orthopaedic nurse will undoubtedly care for patients with ankle injuries. Ankle sprains and fractures are common injuries seen in orthopaedic practices in the United States. To provide comprehensive nursing care of these injuries, nurses should understand ankle biomechanics as well as anatomy. Knowledge of fracture classification schemes, pathology of injury, and treatment modalities is also important. Fracture classification schemes vary as do treatment modalities. Ankle sprains and fractures can be treated operatively or nonoperatively, and orthopaedic nurses play an important role in the care of patients with such ankle injuries.

Atención enfermera al paciente con esguince de tobillo / Nursing care for the patient with a sprained ankle

Debido a su frecuencia en la vida diaria, son múltiples los esguinces de tobillos que tendremos que tratar a lo largo de nuestra carrera profesional. La figura de la enfermera y su rol, desarrollan un papel fundamental a lahora de la valoración, tratamiento y evolución del esguince de tobillo. Por todo, este trabajo tiene como propósito describir las principales característicasdel esguince de tobillo (aspectos anatómicos, mecanismos de producción, tipos de lesión, cuadro clínico), su exploración, diagnóstico y tratamiento; y finalmente proponer cuál es el papel enfermero en este problemade salud, tanto desde el punto de vista de los problemas de colaboración como de los diagnósticos enfermeros que pueden darse más frecuentemente en las personas que sufren un esguince de tobillo

Due to their frequency in daily life, it will be many sprained ankles that we will have to treat in our professional career. The nurse’s figure androle are of utmost importance in the assessment, treatment and progression of a sprained ankle.The aim of this article is therefore to describe the main characteristics of a sprained ankle (anatomical aspects, production mechanisms, types of lesions, clinical picture), its examination, diagnosis and treatment, and finally to suggest what the nursing role is in this health problem, from the point of view of collaboration problems and the nursing diagnosesthat may more frequently occur in people who have sustained a sprained ankle

Diagnostic accuracy and reproducibility in the interpretation of Ottawa ankle and foot rules by specialized emergency nurses.

OBJECTIVES: The ED is often confronted with long waiting periods. Because of the progressive shortage in general practitioners, further growth is expected in the number of patients visiting the ED without consulting a general practitioner first. These patients mainly present with minor injuries suitable for a standardized diagnostic protocol. The question was raised whether these injuries can be treated by trained ED nurses (specialized emergency nurses [SENs]). The aim of this study was to evaluate the diagnostic accuracy and reproducibility of SENs in assessing ankle sprains by applying the Ottawa Ankle Rules (OAR) and Ottawa Foot Rules (OFR). METHODS: In a prospective study, all ankle sprains presented in the ED from April to July 2004 were assessed by both a SEN and a junior doctor (house officer [HO]) randomized for first observer. Before the study, SENs were trained in applying OAR and OFR. In all patients, radiography was performed (gold standard). The diagnostic accuracy for the application of OAR and OFR was calculated for both groups and was compared using z statistics. Furthermore, from the paired results, reproducibility was calculated using kappa statistics. RESULTS: In total, 106 injuries were assessed in pairs, of which 14 were ultimately found to concern acute fractures (prevalence, 13%). The sensitivity for the SEN group was 0.93 (95% confidence interval [CI], 0.64-1.00) compared with 0.93 (95% CI, 0.64-1.00) for the HO group (no significance [ns]). The specificity of the nurses was 0.49 (95% CI, 0.38-0.60) compared with 0.39 (95% CI, 0.29-0.50) for the doctors (ns). The positive predictive value for the SEN group was 0.22 (95% CI, 0.13-0.35) compared with 0.19 (95% CI, 0.11-0.31) for the HO group (ns). The negative predictive value for the nurses was 0.98 (95% CI, 0.87-1.00) compared with 0.97 (95% CI, 0.84-1.00) for the doctors (ns). The interobserver agreement for the OAR and OFR subsets was kappa = 0.38 for the lateral malleolus; kappa = 0.30, medial malleolus; kappa = 0.50, navicular; kappa = 0.45, metatarsal V base; and kappa = 0.43, weight-bearing. The overall interobserver agreement for the OAR was kappa = 0.41 and kappa = 0.77 for the OFR. CONCLUSION: Specialized emergency nurses are able to assess ankle and foot injuries in an accurate manner with regard to the detection of acute fractures after a short, inexpensive course.

Patient education series. Sprains and strains.

SUMMARY: Offer your patient this educational tool when you teach him how to care for his injury.

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.