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SAMPLE.pptxNURS 6052
Student Name
4th August, 2020
ANSWERING THE PICOT QUESTION OF: In penetrating trauma patients, does spinal immobilization increase the risk of morbidity or mortality?
Conference presentation via podium/oral presentation with an engaging, informative powerpoint presentation in order to:
Reach a large audience
Gives the opportunity to disseminate research findings quickly
Attended by leaders in trauma that are more likely to be early adopters of research into practice (Edwards, 2015).
DISSEMINATION STRATEGY
There is a study that assesses patterns of error leading to trauma mortality citing 16% failure to secure an airway due to spinal immobilization (Velopulos, et al, 2018).
spinal immobilization in adults with penetrating trauma is associated with an increase in mortality and not only no benefit but also apparent actual harm in terms of neurologic deficit or potentially reversible neurologic deficits. Spinal immobilization is not recommended for routine use in penetrating trauma patients (Long, Koyfman, & Gottlieb, 2019)
Mortality was clearly associated with spinal immobilization due to the fact it impedes the ability of providers to care appropriately for the patient due to obscuring injuries, life saving procedures more difficult, and lastly delayed transportation (Velopulos, et al, 2018).
spinal immobilization is a time consuming intervention when the best intervention is getting our patients to the hospital quickly.
Spinal Immobilization, necessary or Not??? What does the research say?
decrease the burdens on the emergency departments by evaluating the need of spinal immobilization in all penetrating trauma patients. There is a need for a universal protocol for pre hospital assessment of trauma patients by EMS to evaluate the need for full spinal immobilization due to there being less than 1% of all trauma patients that suffer a spinal cord injury (Vaillancourt, et al, 2011).
develop a firm protocol for all trauma centers on the use of cervical spine radiograpy. There is a large number of normal cervical spine radiographs performed that adds to the cost of healthcare as well as the burden of time on emergency department staff and emergency medical services, who are expected to immobilize all patients before transport (Vaillancourt, et al, 2011).
What is my goal?
Selective Spinal Immobilization Protocol
End the use of spinal immobilization in penetrating trauma patients as studies have shown that the use of spinal immobilization in penetrating trauma patients increases risks of local pressure injury, increased intracranial pressure, covering of penetrating wounds therefore missed injuries, delaying lifesaving procedures including endotracheal intubation.
The use of the C-Spine rule was used and evaluated in Ontario, Canada had exceptional results with decrease in morbidity & mortality in penetrating trauma patients(Vaillancourt et al., 2011).
Proposal
Decrease in pressure injuries to the neck
Decreased incidences of increased intracranial pressure due to unnecessary spinal immobilization
Decrease in missed injuries
Decrease in delay of lifesaving procedures included but not limited to endotracheal intubation
Improved efficiency for EMS systems, therefore can be available to respond to other life threatening calls
Decrease in time spent in the field therefore they can receive upper level of care
Paramedics & other emergency medical services team participate in a two hour web-based training sessions followed by practical demonstration of the selective spinal immobilization protocol with check off and yearly follow-up educations sessions with check offs
Include risks vs benefits along with evidence based results from other hospital systems to explain the why in the change
The why & How
Questions, Comments or concerns??
Long, B., Koyfman, A., & Gottlieb, M. (2019). Utility of Spinal Immobilization in Patients With Penetrating Trauma. Academic Emergency Medicine, 27(1), 69-70. doi:10.1111/acem.13852
Vaillancourt, C., Charette, M., Kasaboski, A., Maloney, J., Wells, G. A., & Stiell, I. G. (2011). Evaluation of the safety of C-spine clearance by paramedics: Design and methodology. BMC Emergency Medicine, 11(1). doi:10.1186/1471-227x-11-1
Velopulos, C. G., Shihab, H. M., Lottenberg, L., Feinman, M., Raja, A., Salomone, J., & Haut, E. R. (2018). Prehospital spine immobilization/spinal motion restriction in penetrating trauma. Journal of Trauma and Acute Care Surgery, 84(5), 736-744. doi:10.1097/ta.0000000000001764
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