Mechanism of Injury - Charmaine Cunningham

Mechanism of injury In trauma, the most vital aspect of the paramedic handover is the mechanism of injury. The mechanism of injury provides vital clues for injuries to look out for and further tests and investigations required to rule out these injuries. A fundamental principle underlying the mechanism of injury is the law of thermodynamics also referred to the law of conservation of energy. This law states that energy is neither created of destroyed, it changes form. Thus if a motor vehicle collides with another vehicle, the energy that was created during the forward motion (driving) can’t simply disappear; it needs to change in some way. In other words for a moving object to lose speed its energy of motion must be transmitted to another object or it needs to change form. An easy way to think about it is that when two motor vehicles travelling at the same speed collide, there are three “accidents” or changes in energy: • The first is when the vehicles come to an abrupt stop due to the crash. The existing energy and the speed at which it was travelling are absorbed by damage to the vehicle. • The second accident or change in energy is when the occupants of the vehicle are brought to an abrupt stop by colliding or crashing into the vehicle’s structures. This could be the windscreen, the dash board, the steering wheel, the seatbelt, the side of the vehicle, the head rest in front of them if the patient is seated in the back. So the motion of the occupant will be seen as starring of the windscreen, damage to a steering wheel etc. • The third impact or collision is when the occupant’s internal organs collide or crash against the body structures (skin, bone, muscle). That is why the external and internal damage to the vehicle provides clues about injuries to the patient. As such damage to the steering wheel implies massive impact and injury to the chest, heart, lungs and major vessels. It is also likely to have resulted in an injury where these organs hit against the anterior chest wall, bounced back against the posterior chest wall and back against the anterior wall again (coup countercoup injuries). If other passengers travelling in the same vehicle died on impact, it suggests a serious mechanism of injury and you need to aggressively search for more injuries to your patient, even if the patient appears to be stable with minor injuries. It’s also important to note that paramedics can decide that based on the mechanism of injury to bypass a facility and transport the patient to a facility that could do CT scans, or has a surgeon on call. In summary, ensure continuity of comprehensive, holistic patient care by giving consideration to the mechanism of injury. Post note: Regarding mechanism of injury, there are many more factors to consider including mass, velocity etc. This blog only focused on one aspect.

Triage

Emergency nurses, we invite you to voice your opinion on the following statement: In South Africa we are currently mandated to triage patients in emergency departments using SATS (South African Triage Scale), a set of protocols which incorporates relevant vital signs and acuity discriminators to expedite the delivery of time critical treatment for patients with life-threatening conditions (The South African Triage Scale Training Manual 2012). Controversy exists on who should be triaging patients prior to entering the emergency departments. We all agree that nurses are predominantly responsible for triage. Based on ‘The South African Triage Scale Training Manual’ (2012:2) it is reported that adequately trained enrolled nursing assistants (ENAs) has been shown to be as adequate as international standard requirements of internal standards of nursing triage. Reference Republic of South Africa: Western Cape Government Health. 2012. The South African Triage Scale Training Manual. Access: 30 March 2015. Available from: http://emssa.org.za/wp-content/uploads/2011/04/SATS-Manual-A5-LR-spreads.pdf

E-Flyer Head Injury Prevention

March 2015

 

Head Injury Prevention

 

Anyone who decides to ride a bicycle or motorcycle must consider, that wearing a helmet is the most effective strategy for preventing head injuries from a crash or fall. 

Yearly, hundreds of people suffer head injuries and die from head injuries sustained following a fall from their bike. With the emergence of Quadbikes, which can be driven at higher speeds, the statistics for deaths and injuries has increased further. 

World Head Injury Awareness Day (yearly on 20 March) is there to remind us of how we can reduce accidents and brain injuries. It advocates the correct use of safety gadgets such as helmets and seat belts, which can prevent damage to the head when one is involved in an accident.

Globally every year more than 5% of people suffer serious brain injury after an accident or as a result of accidentally bumping their head.

An estimated 89 000 cases of new traumatic brain injuries are reported annually in South Africa.

Prevention of head injuries

 

·         Always wear a seat belt when in a motor vehicle

·         Use an appropriate child safety seat (Remember: rear-facing is safer than forward facing)

·         Never drive under the influence of alcohol or drugs

·         Always wear a helmet when on a bicycle, motorcycle or scooter

·         Use the rails on stairways

·         Provide adequate lighting on stairs for people with poor vision

·         Do not place obstacles on pathways

·         Provide the correct safety equipment for workers.

 

 

 

 

 

Ebola Virus Disease and Emergency Nurses

Ebola Virus Disease and Emergency Nurses

On 26 August 1976 a patient arrived at the small mission hospital at Yambuku, along the Ebola river in the now Democratic Republic of the Congo. He was received and treated by the nurses at the emergency room of this small hospital – and within days, 11 of these nurses contracted what is now known as Ebola Virus Disease and died.

Today, nearly 40 year later, nurses are again involved in managing an outbreak, now with approximately 24000 cases, in a different part of Africa, in which nearly 800 health care practitioners contracted the disease and more than 500 died - many of them nurses.

In view of this threat, emergency nurses rose to the challenge in South Africa to ensure that the Emergency Departments of all hospitals are prepared and ready to manage a suspected case of EVD with adequate protection for all health care practitioners.

Emergency Nurses are now, unlike our predecessors in Yambuku, aware that the disease presents with very general symptoms such as fever, headache, nausea and vomiting, but that good patient history recording can identify a suspected patient who was in contact with a sick person or with a travel history to or from affected areas. We are now prepared to protect the health care practitioners in the Emergency Department against body fluid transmission of EVD, which include blood, urine, saliva, sweat, faeces, vomitus, breast milk and semen, by donning personal protective equipment protecting broken skin and mucus membranes from contact with body fluids. For this purpose sets of PPE are kept ready in most Emergency Departments.

Currently, in most hospitals, the Emergency Nurses are fulfilling a lead role in identifying an appropriate area in the department where isolation areas can be established in the form of a red isolation area, separated by an effective yellow transit area from a green support area.

Specialised short courses on establishing high security bio-safety isolation in the Emergency Departments are now also available for emergency nurses and the details are available from ENSSA.

Through their actions; emergency nurses had not only contributed extensively to the readiness levels of hospitals, but had also demonstrated their commitment to patient care by volunteering to participate in the care teams managing and transporting suspected Ebola Virus Disease patients, with a commitment to care and compassion. Currently emergency nurses all over South Africa stand ready to identify, isolate, manage, but most importantly, provide care for patients with suspected Ebola Virus Disease.

Theo Ligthelm, RN

(Only Nurse on the Ministerial Advisory Committee on Ebola Virus Disease)

MONTHLY E-FLYER

 

January 2015

 Injury Prevention & Health Promotion

 Prevention is the ultimate goal for injuries and violence around the world. Much can be done to minimize the negative health consequences among those affected by the events that do occur.

You will receive monthly e-flyers with important information on injury prevention and health promotion. Please do not hesitate to contact us should you require more information on any of these topics. The injury prevention programmes are linked to specific health days. You are welcome to print and distribute the monthly e-flyer to your clients and patients.

 

Upcoming E-flyers:

Road Safety

Helmet Safety

Lightning Strike

Unrestrained Driving

Burns

Drowning

Texting & Driving

Animals

Concussion

Falls

Firework Injuries

Sun Smart

 

We look forward to sharing an exciting year filled with injury prevention and health promotions ideas with you. 

Nurses the unsung heroes of the ED

Hello all Emergency Nurses

I have just finished reading an article posted 07/04/2014 where a doctor writes about the “6 reasons why nurses are the unsung heroes of the ED”.

It really touch my hart and I would like to share a couple of his thoughts with all of you:

 1. “Nurses regularly save us doctors when the going gets tough”

“…I have learned nurses know their stuff, and that their enormous experience is an incredible asset to have by my side when faced with the most challenging patients.”

 2. “Nurses take abuse and maintain their professionalism”

“Emergency Rooms, due to the high-pressure, life and death nature of the work we perform, are very stressful places to be. Patients and their family members, are frequently on edge. When tempers flare in the ER, nurses, as the workers in the ER who spend most time with patients, frequently serve as proverbial, and too often literal, punching bags.”

 3. “Nurses do all the dirty work that doctors don’t”

“There is nothing pretty or glamorous about much of the work performed in a typical emergency room. From diaper changes on elderly patients, to administering enemas, to cleaning of bed bugs and maggots of our homeless and less fortunate guests, the nurses I work with do it all, and it is a testament to their dedication that they rarely protest about it.”

 4. “Nurses work grueling hours”

“Most nurses work staggered schedule of several day shifts, then several night shifts, followed by several days off. As a results their bodies are perpetually in a state of shifting time zones and sleep schedules. Additionally, nursing schedules have little regard for social lives, family obligations and holidays. Wonderfully, instead of complaining, the nurses in my department throw potluck meals during holidays and adorn the ER with impressive festive decorations, transforming a place nobody want to be during these special days into a celebratory place for patients and staff.”

  Let us salute the unsung hero in all of us – the Emergency Nurse. Believe in yourself!

Have a great 2015!

Emergency Nurses Society of South Africa