RESUMEN
Spinal injury can result in morbidity and mortality. Research suggests that only a small percentage of patients assessed for spinal fracture have sustained the injury, however, and even fewer have unstable fractures. Protection of the spine and spinal cord is critically important and although many trauma patients leave hospital having had no spinal trauma, despite their mechanism of injury, most arrive with spinal precautions in place. Such patients must be moved and it is common practice to do this using the log-roll procedure. This article examines the literature on spinal motion during the log-roll procedure and transfer devices, and asks if there is still a place for the manoeuvre in modern trauma practice.
Asunto(s)
Movimiento y Levantamiento de Pacientes , Fracturas de la Columna Vertebral/enfermería , Vértebras Cervicales , Humanos , Traumatismos VertebralesRESUMEN
STUDY DESIGN: Case report and literature review. OBJECTIVE: To discuss the diagnosis, limitations, and treatment of combined occipital-cervical and atlantoaxial disassociation with normal neurologic function. SUMMARY OF BACKGROUND DATA: Injuries to the craniocervical junction can lead to devastating neurologic deficits. Occipital-cervical disassociation is a well-documented injury pattern that can lead to pain, spinal cord injury, and death. Early diagnosis and treatment can preserve neurologic function. Combined injuries to both the occipital-cervical and atlantoaxial segments are less common and, to date, have only been described with severe neurologic injury. METHODS: Retrospective review of a case. Literature review was performed through Medline and Pubmed searches. RESULTS: This is the first case to present a combined occipital-cervical and atlantoaxial disassociation with a neurologically intact patient. Initial physical examination was limited, but early imaging revealed evidence of instability. Early diagnosis and early (< 24) surgical stabilization was performed with no complications and neurologic preservation. One-year follow-up visit revealed normal neurologic examination with neck pain VAS = 2/10 and neck disability index = 6. CONCLUSION: Combined injuries to the occipital-cervical and atlantoaxial can result in upper cervical instability. Despite previous reports, neurologic preservation remains a possibility in this injury pattern. Limitations in physical examination and radiographic imaging persist, but early diagnosis and surgical stabilization may improve neurologic outcomes.
Asunto(s)
Articulación Atlantoaxoidea/lesiones , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/cirugía , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/cirugía , Accidentes de Tránsito , Adolescente , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/patología , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/lesiones , Articulación Atlantooccipital/patología , Vértebra Cervical Axis/diagnóstico por imagen , Vértebra Cervical Axis/lesiones , Vértebra Cervical Axis/patología , Atlas Cervical/diagnóstico por imagen , Atlas Cervical/lesiones , Atlas Cervical/patología , Diagnóstico Precoz , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/normas , Femenino , Humanos , Fijadores Internos , Luxaciones Articulares/enfermería , Ligamentos/diagnóstico por imagen , Ligamentos/lesiones , Ligamentos/patología , Hueso Occipital/diagnóstico por imagen , Hueso Occipital/lesiones , Hueso Occipital/patología , Pelvis/lesiones , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Radiología/métodos , Radiología/normas , Estudios Retrospectivos , Fractura Craneal Basilar/diagnóstico , Fractura Craneal Basilar/enfermería , Fractura Craneal Basilar/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Compresión de la Médula Espinal/prevención & control , Fracturas de la Columna Vertebral/enfermería , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Bazo/lesiones , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas , Resultado del Tratamiento , Articulación Cigapofisaria/lesiones , Articulación Cigapofisaria/patologíaAsunto(s)
Enfermedad Crónica/enfermería , Anciano Frágil/psicología , Relaciones Enfermero-Paciente , Anciano , Anciano de 80 o más Años , Femenino , Hogares para Ancianos , Humanos , Masculino , Evaluación en Enfermería , Casas de Salud , Calidad de Vida/psicología , Fracturas de la Columna Vertebral/enfermería , Fracturas de la Columna Vertebral/psicología , SuizaAsunto(s)
Cementos para Huesos/uso terapéutico , Fracturas Espontáneas/enfermería , Procedimientos Quirúrgicos Mínimamente Invasivos/enfermería , Infarto del Miocardio/enfermería , Osteoporosis/enfermería , Fracturas de la Columna Vertebral/enfermería , Accidente Cerebrovascular/enfermería , Causas de Muerte , Terapia Combinada/enfermería , Comorbilidad , Humanos , Infarto del Miocardio/mortalidad , Osteoporosis/mortalidad , Factores de Riesgo , Accidente Cerebrovascular/mortalidadAsunto(s)
Bloqueadores de los Canales de Calcio/uso terapéutico , Ácido Etidrónico/análogos & derivados , Ácido Etidrónico/uso terapéutico , Fracturas Espontáneas/enfermería , Osteoporosis/enfermería , Fracturas de la Columna Vertebral/enfermería , Ensayos Clínicos como Asunto , Fracturas Espontáneas/prevención & control , Humanos , Ácido Risedrónico , Fracturas de la Columna Vertebral/prevención & control , Resultado del TratamientoRESUMEN
Percutaneous vertebroplasty is a minimally invasive procedure used to stabilise vertebral compression fractures caused by osteoporosis, haemangioma, myeloma, metastases and bone cysts. Acrylic bone cement is injected into the vertebral body to relieve pain and structurally reinforce the fracture. Interest in percutaneous vertebroplasty has grown as a result of technical procedural advances in radiology and the publication of an appraisal of, and guidelines for, the procedure by the National Institute for Clinical Excellence (2003). Nurses should be aware of the potential benefits of vertebroplasty and be involved in patient selection, and care of the patient before, during and after the procedure. Nurses should also be involved in audit analysis of the results of the procedure. More research into the effects of vertebroplasty is required and should involve nurses caring for this patient group.
Asunto(s)
Procedimientos Ortopédicos/métodos , Fracturas de la Columna Vertebral/cirugía , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/enfermería , Procedimientos Ortopédicos/enfermería , Osteoporosis/complicaciones , Dimensión del Dolor/métodos , Selección de Paciente , Atención Perioperativa/enfermería , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/enfermeríaAsunto(s)
Enfermedad Crónica/enfermería , Promoción de la Salud , Estilo de Vida , Enfermería en Rehabilitación , Adaptación Psicológica , Adolescente , Enfermedad Crónica/psicología , Alemania , Humanos , Vértebras Lumbares/lesiones , Masculino , Grupo de Enfermería , Paraplejía/enfermería , Paraplejía/rehabilitación , Calidad de Vida/psicología , Rol del Enfermo , Fracturas de la Columna Vertebral/enfermería , Fracturas de la Columna Vertebral/rehabilitaciónRESUMEN
The prompt clearance of a patient's cervical spine is extremely beneficial both to the patients and the department however correct guidelines and education must be established before this can be undertaken safely. This paper examines whether nurses given the appropriate training and education using appropriate diagnostic and clinical criteria can safely, effectively clear cervical spines without consulting a medical practitioner. The paper explores the use of the Nexus Guidelines [J.R. Hoffman, W.R. Mower, A.B. Wolfson, New England Journal of Medicine 343 (2) (2000) 94-99] as a clinical prediction tool and presents evidence for its use.
Asunto(s)
Vértebras Cervicales/lesiones , Enfermería de Urgencia/métodos , Tratamiento de Urgencia/enfermería , Autonomía Profesional , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/enfermería , Algoritmos , Protocolos Clínicos , Árboles de Decisión , Enfermería de Urgencia/educación , Humanos , Inmovilización , Anamnesis/métodos , Rol de la Enfermera , Evaluación en Enfermería/métodos , Investigación en Evaluación de Enfermería , Examen Físico/enfermería , Guías de Práctica Clínica como Asunto , Fracturas de la Columna Vertebral/clasificación , Triaje/métodosAsunto(s)
Ácido Etidrónico/análogos & derivados , Osteoporosis/enfermería , Anciano , Anciano de 80 o más Años , Alendronato/administración & dosificación , Calcio de la Dieta/administración & dosificación , Estudios Transversales , Ácido Etidrónico/administración & dosificación , Femenino , Fracturas Espontáneas/epidemiología , Fracturas Espontáneas/enfermería , Fracturas Espontáneas/prevención & control , Alemania/epidemiología , Encuestas Epidemiológicas , Fracturas de Cadera/epidemiología , Fracturas de Cadera/enfermería , Fracturas de Cadera/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/tratamiento farmacológico , Osteoporosis/epidemiología , Guías de Práctica Clínica como Asunto , Clorhidrato de Raloxifeno/administración & dosificación , Ácido Risedrónico , Fracturas de la Columna Vertebral/epidemiología , Fracturas de la Columna Vertebral/enfermería , Fracturas de la Columna Vertebral/prevención & control , Vitamina D/administración & dosificaciónRESUMEN
OSTEOPOROSIS is a skeletal disorder that compromises bone strength, predisposing a person to an increased risk of fracture. An estimated 700,000 spinal fragility fractures, such as vertebral compression fractures, directly related to osteoporosis occur annually. KYPHOPLASTY, a minimally invasive fracture reduction procedure, has become a treatment option for osteoporotic fractures. A balloon is used in place of the conventional bone tamp to reduce the fracture and create a void in cancellous spinal bone. Polymethylmethacrylate, a cement-like material, is injected into the void to stabilize the fracture. EARLY DIAGNOSIS AND TREATMENT of vertebral compression fractures with kyphoplasty allows normal anatomy to be restored, ultimately decreasing the risk of patient morbidity.
Asunto(s)
Fijación de Fractura/métodos , Osteoporosis/complicaciones , Fracturas de la Columna Vertebral/cirugía , Cementos para Huesos/uso terapéutico , Cateterismo , Fijación de Fractura/enfermería , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Osteoporosis/fisiopatología , Enfermería Perioperatoria , Polimetil Metacrilato/uso terapéutico , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/enfermeríaRESUMEN
Quality of life issues remain at the forefront for individuals with life-threatening disease, such as metastatic cancer. The pain of metastatic bone cancer can severely hamper an individual's quality of life. Percutaneous vertebroplasty offers a minimally invasive way to reinforce bony elements, provide substantial improvement in pain control, allow for mobilization, and overall improve quality of life in these patients.
Asunto(s)
Fracturas Espontáneas/cirugía , Dolor/cirugía , Fracturas de la Columna Vertebral/cirugía , Anciano , Educación Continua en Enfermería , Femenino , Fracturas Espontáneas/complicaciones , Fracturas Espontáneas/enfermería , Humanos , Neoplasias/complicaciones , Dolor/etiología , Dolor/enfermería , Enfermería Perioperatoria/métodos , Complicaciones Posoperatorias , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/enfermeríaRESUMEN
Osteoporosis is a chronic and potentially debilitating disease. A painful consequence of osteoporosis is a compression fracture of a vertebral body of the spine. These fractures can lead to physical deformities and emotional trauma. Treatment options for these fractures are limited and occasionally ineffective. New surgical advances in treating vertebro-compression fractures are evolving. Kyphoplasty is a new surgical procedure now being used to treat the painful compression fracture.
Asunto(s)
Educación del Paciente como Asunto , Fracturas de la Columna Vertebral/enfermería , Fracturas de la Columna Vertebral/cirugía , Humanos , Procedimientos Ortopédicos , Osteoporosis/complicaciones , Calidad de Vida , Fracturas de la Columna Vertebral/etiologíaRESUMEN
A case report is used to discuss common problems and complications of hospitalized elders. The report also illustrates the need for proactive hospital staff who are knowledgeable about the special needs of the aging population if this group is to be cared for successfully. The geriatric resource nurse model involves informal unit-based education aimed at expanding staff nurses' geriatric knowledge and is one of several models sponsored by the Hartford Foundation to improve care of the hospitalized elderly. Teaching rounds between geriatric resource nurses and advanced practice nurses are a primary feature of this model.
Asunto(s)
Enfermedad de Alzheimer/enfermería , Enfermería Geriátrica/métodos , Hospitalización , Evaluación de Necesidades , Fracturas de la Columna Vertebral/enfermería , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica , Humanos , Modelos de Enfermería , Evaluación en EnfermeríaRESUMEN
Halo skeletal traction may be used to immobilize a patient's head and neck following a cervical fracture. Prevention of infectious reactions around the pin sites of halo traction is a priority in rehabilitation nursing practice. Although prophylactic treatment of skeletal pin sites is a generally accepted practice, there is great diversity of opinion and very limited systematic investigation as to how the sites should be treated. In this article, the author reviews the literature on pin site care and suggests a protocol based on the current literature.
Asunto(s)
Clavos Ortopédicos , Vértebras Cervicales/lesiones , Planificación de Atención al Paciente , Cuidados de la Piel/métodos , Fracturas de la Columna Vertebral/enfermería , Tracción/enfermería , Humanos , Control de Infecciones , Enfermería Ortopédica/métodos , Rehabilitación/enfermeríaRESUMEN
This study sought to document the experience of women who suffer postmenopausal vertebral fractures. As the women described it, the essential structure of the experience of postmenopausal spinal fractures was an abrupt descent into disease, disability, and deformity. Each informant described significant challenges to her ability to continue to function as a whole, independent person. Constant pain, loss of independent function, changes in physical appearance, feelings of isolation, a sense of vulnerability, and an uncertain future were the hallmarks of the experience. This study identified specific areas of concern and suggests new focuses for nursing intervention with women with spinal fractures. An intervention program that incorporates education, programs to regain or maintain function, pain management, techniques to reduce stress and isolation, and promotion of self-care ability has the potential to enhance the quality of life for women with postmenopausal spinal fractures.
Asunto(s)
Adaptación Psicológica , Osteoporosis Posmenopáusica/complicaciones , Dolor/psicología , Fracturas de la Columna Vertebral/psicología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Imagen Corporal , Femenino , Humanos , Estilo de Vida , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Dolor/etiología , Educación del Paciente como Asunto , Aislamiento Social , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/enfermeríaRESUMEN
Back pain is a significant cause of functional impairment in elderly women with vertebral fractures. To determine the degree of functional impairment due to painful osteoporotic vertebral fractures, investigators compared 75 white women with a mean age of 77 (+/- 7.2) years who had a mean number of 2.8 (+/- 0.87) vertebral fractures with 83 white women with a mean age of 74 (+/- 6.5) years who had no vertebral fractures. These patients were seen within a 2-year period. The Katz Activities of Daily Living scale was used to assess the patients' functional status. All patients underwent a comprehensive evaluation that included a detailed history and a physical examination. Bone density was evaluated in most of the patients and the evaluation revealed osteoporosis in all of the patients with vertebral fractures. The women with vertebral fractures were found to be more significantly dependent in the following activities of daily living: bathing, toileting, dressing, transfer, and continence. These findings have important nursing implications for rehabilitation of the elderly with this condition.