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Biomedical subjects

L M Bernardo

Publications and source records attributed to L M Bernardo.

At least 19 recordsLinked to original sources
PubMed2000

Treatment of trauma-associated hypothermia in children: evidence-based practice.

BACKGROUND: Hypothermia is a serious immediate consequence of traumatic injury in children. Although numerous studies have addressed the treatment of hypothermia in adults after trauma or surgery, few have examined this issue in injured children. OBJECTIVES: To evaluate the research literature on when and how to treat hypothermia during emergency care of children with trauma and to apply these findings to clinical nursing practice. METHODS: Electronic literature searches conducted periodically for 3 years yielded more than 50 publications on hypothermia and its treatment in trauma and surgical patients. Publications were grouped by cause of hypothermia and by warming methods. Single case reports and publications related to submersion injuries were excluded. RESULTS: Three clinical trials of patients with head injuries included adolescents aged 15 years and older. One study compared peripheral and core warming methods used during operative management of infants and young children. Only one study evaluated core warming in children with trauma. DISCUSSION: The treatments examined in the few research-based studies on the treatment of hypothermia during emergency care of children with trauma were given low recommendations. Although the warming methods were successful in selected surgical and adult patients, the methods cannot be recommended for treating children with trauma because of the lack of evidence-based findings. CONCLUSIONS: Caution should be used when extrapolating published data on the treatment of hypothermia in injured adults to injured children. Ongoing clinical trials should evaluate in children with trauma those warming methods that have been used successfully in surgical patients.

Adolescent↗
PubMed1998

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

Emergency Service, Hospital↗
PubMed1998

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in emergency department record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product, Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

Emergency Service, Hospital↗
PubMed1998

Life events and injury in children: implications for schools.

Life events have been identified as a characteristic associated with injury in children and adolescents. Life events include moving to a new home or school and the death or hospitalization of a family member. The purpose of this study was to verify this relationship between life events and injuries in school-age children aged 6-11 years. A case-control design compared life events among 76 injured and 77 well school-age children. The school-age children with injuries were evaluated in a pediatric trauma unit and the well school-age children were evaluated in both a pediatric clinic and a private pediatrician's office. The parents of all the subjects completed the Life Event Scale-Children and a demographic data sheet. Severity of injury was measured with the Pediatric Trauma Score. There were no differences in the number or types of life events between the injured and well school-age children. There was no relationship between severity of injury and life events. However, children whose parents were not currently married, who came from non-Caucasian families, and who had lower socioeconomic status had higher life Event Scale-Children scores than children whose parents were currently married, were from Caucasian families, and had higher socioeconomic status. School nurses need to be aware of the influence of life events on the lives of their students. While this study did not find a statistically significant relationship between injury and life events, being alert to the family characteristics of children who experience high numbers and many types of life events may assist the school nurse in understanding and providing care for these students.

Case-Control Studies↗
PubMed1997

The effect of administered crystalloid fluid temperature on aural temperature of moderately and severely injured children.

OBJECTIVE: Warm intravenous fluid (W-IVF) administration is the standard of care to prevent hypothermia in injured adults. It is argued that such administration may not be helpful for treating injured children, because children often do not require as much intravenous fluid (i.v.f.) as adults. The purpose of this study was to compare the effects of W-i.v.f. to room temperature intravenous fluid (RT-i.v.f.) administration on aural temperature (Ta) in injured children during the first hour of trauma resuscitation. DESIGN: A randomized, controlled repeated-measures trial. SETTING: Emergency department, intensive care unit, and diagnostic areas in a level I pediatric trauma center. SAMPLE: Thirty moderately or severely injured children, ranging in age from 2 to 17 years (mean age = 8.9 years; SD = 4.4). METHODS: Eligible children were randomly assigned to receive either W-i.v.f. or RT-i.v.f. on ED arrival. Warmed IVF was administered with the Hotline fluid warmer (SIMS Level 1, Rockland, Mass). Aural temperatures were measured on arrival and every 10 minutes for 1 hour with a Core-Check Tympanic Thermometer (IVAC Medical Systems, San Diego, Calif). The level of significance for hypothesis testing was set at 0.05 (two-tailed). RESULTS: Groups were comparable in age, gender, weight, amount of infused i.v.f., Revised Trauma Score, room temperature, and baseline Ta. On average, Ta for the W-i.v.f. group increased by 0.25 degree C from baseline to final Ta, whereas Ta for the RT-i.v.f. group decreased by 0.32 degree C from baseline to final Ta. Repeated-measures analysis of covariance, treating baseline Ta as a covariate, demonstrated that Ta response profiles were similar (p = 0.06). CONCLUSIONS: When comparing the changes between baseline and final Ta for the W-i.v.f. and RT-i.v.f. groups, the standardized difference in temperature change was 0.62. Although results of the repeated measures analysis of covariance were not statistically significant, the standardized difference in temperature changes was large enough to warrant administration of W-i.v.f., even at slow flow rates, to prevent hypothermia in injured children.

Adolescent↗
PubMed1996

A comparison of aural and rectal temperature measurements in children with moderate and severe injuries.

OBJECTIVE: The purpose of this study was to compare initial rectal and aural (i.e., ear-based) temperature measurements in children with moderate and severe injuries during their trauma care in the emergency department. DESIGN: A cross-sectional, prospective design was used to compare aural temperature and rectal temperatures in injured children. SAMPLE/SETTING: A convenience sample of 40 children who met the study inclusion criteria were enrolled at the level I pediatric regional resource trauma center in western Pennsylvania. METHODS: Aural temperature was measured by infrared technology (IVAC Corporation, San Diego, Calif.), and rectal temperatures were measured with a thermistor (IVAC Corporation). RESULTS: The subjects (N = 40) ranged in age from 1 to 14 years (mean 6.9 years; SD = 4.4 years). The mean difference between rectal and aural temperature measurements (mean = -0.3 degree C; SD = 0.76 degree C) was statistically significant when compared with a paired t test (p < 0.05). The Pearson product-moment correlation coefficient between aural and rectal temperature measurements was moderate to high (r = 0.85). CONCLUSION: The moderate to high correlation between the two methods shows promise for use of aural infrared temperature measurements as a screening measure for children with moderate and severe injuries.

Adolescent↗
PubMed1996

Parent-reported injury-associated behaviors and life events among injured, ill, and well preschool children.

Injury and illness pose significant morbidity problems for preschool children and are the primary reasons for emergency department visits. Parents' reports about their children's behaviors and life events were studied within Rogers' Science of Unitary Human Beings. Injury, illness, and wellness served as measures of change. This correlational study sought to determine differences in the numbers and types of parent-reported injury-associated behaviors and life events among injured, ill, and well preschool children. Consenting parents of 151 preschool children who presented to a pediatric emergency service for treatment of injuries, illnesses, and well child care completed the Injury Behavior Checklist, the Life Event Scale-Children, and a demographic data sheet. Data were analyzed with descriptive and inferential statistical tests. Significant differences were found with respect to age, sex, ethnicity, parents' socioeconomic and marital status, and attendance at daycare or preschool. There were no differences in the numbers and types of behaviors or in the numbers of life events. However, there were differences in the types of life events. The absence of differences was attributed to the lack of conceptual congruence between the instruments and the Rogerian model. Future studies should use instruments derived from this model.

Accident Proneness↗
PubMed1995

Evaluation of four methods of warming intravenous fluids.

OBJECTIVE: The purpose of this in vitro study was to compare four methods of warming intravenous fluid (IVF) with a control of unwarmed IVF at flow rates of 200, 400, 600, 800, and 1000 ml/hr. DESIGN: A 5 x 5 factorial experimental design was used to evaluate the methods of warming IVF and the control at varied flow rates. METHODS: The methods of warming IVF in this study included the following: (1) the Level 1 System 250 fluid warmer with D-60HL tubing (Level 1 Technologies, Inc., Rockland, Mass.); (2) the Level 1 System 250 fluid warmer with D-50 tubing (Level 1 Technologies, Inc.); (3) the Hotline fluid warmer with L-70 tubing (Level 1 Technologies, Inc.); and (4) the Baxter DW 1000 D blood fluid warmer with blood cuff set tubing (Baxter Healthcare Corporation, Valencia, Calif.). The IVF temperatures were measured with thermocouples at three points: (1) in the intravenous solution bag, (2) in the tubing after the infusion pump, and (3) 2 cm proximal to the end of the tubing. Ambient temperature and the temperature at the three measurement points were recorded when the temperature at the point 2 cm proximal to the end of the tubing was stable for 3 minutes. RESULTS: With single-lumen tubing, fluids flowing at low rates (e.g., 200 ml/hr) were barely warm at the end of the tubing. In contrast, fluid warmed with triple-lumen technology was consistently kept warm throughout the tubing.

Clinical Nursing Research↗
PubMed1993

Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient.

OBJECTIVE: To assess the prevalence of laboratory abnormalities (complete blood cell count, electrolytes, blood urea nitrogen, creatinine, glucose, aspartate aminotransferase, alanine aminotransferase, amylase, lipase, urinalysis [U/A]) and the sensitivity and specificity of the physical examination (PE) and screening laboratory tests for identifying intra-abdominal injury (IAI) in moderately injured pediatric patients. DESIGN, PARTICIPANTS, AND SETTING: Phase I: Retrospective chart review of 285 consecutive level II (moderately injured) trauma patients seen at a children's hospital emergency department/pediatric trauma center. All patients were received directly from the scene and had the following data recorded: mechanism of injury, Glasgow coma score, trauma score, pediatric trauma score, systematically recorded PE findings, laboratory results, and injuries detected during hospitalization. Phase II: To confirm the sensitivity of the PE and U/A found in phase I, the model was applied to 91 additional trauma patients identified by International Classification of Diseases, 9th revision (ICD-9) codes as having IAI. INTERVENTION: None. RESULTS: Phase I: A total of 3939 tests were ordered for the 285 patients entered in phase I. Aspartate aminotransferase and alanine aminotransferase values were obtained in 59% of patients; glucose level was obtained in 78% of patients; complete blood cell count, U/A, and levels of electrolytes, blood urea nitrogen, creatinine, amylase, and lipase were obtained in more than 85% of patients. The overall prevalence of laboratory abnormalities was 5.7%. Fourteen patients (4.8%) were identified who had a total of 23 significant IAIs (9 pancreatic, 6 splenic, 5 renal, 3 hepatic). The PE combined with U/A showing more than five red blood cells per high-power field had a sensitivity of 100%, specificity of 64%, positive predictive value of 13%, and negative predictive value of 100% for the detection of IAI. The presence of laboratory abnormalities suggesting injury did not increase the sensitivity of the model and significantly decreased both specificity and positive predictive value. Phase II: The PE combined with U/A identified an abnormality in 89 (97.8%) of 91 cases (95% confidence interval = 94.8% to 100%). CONCLUSIONS: In the moderately injured pediatric trauma patient, (1) there is a low prevalence of laboratory abnormalities; (2) the PE combined with U/A is a highly sensitive screen for IAI; and (3) in patients with a normal PE of the abdomen and a normal U/A, laboratory testing seldom identifies unsuspected IAI.

Abdominal Injuries↗
PubMedDate not supplied

Lawn mower injuries to children in Pennsylvania, 1989 to 1993.

Lawn mowers pose a significant risk of morbidity and mortality to children. The purpose of this study was to identify the characteristics of children injured by lawn mowers admitted to accredited trauma centers in Pennsylvania from 1989 to 1993. Data were available on 177 children who sustained 504 injuries. The majority of children were less than 5 years old, male, injured by a power mower, during the summer, at home, and with an injury to an extremity. Four cases that represent patients with a low injury Severity Score but a long hospitalization are discussed.

Adolescent↗
PubMedDate not supplied

Dog bites in children admitted to Pennsylvania trauma centers.

Dog bites are a major public health problem in the pediatric population, requiring emergency treatment for wound repair and possible hospitalization in a trauma center. Data from the Pennsylvania Trauma Outcome Study were analyzed, and the records of 183 pediatric dog bite patients from 1990 to 1995 were evaluated. Dog bites were found to constitute a very small proportion of the total pediatric admissions to Pennsylvania trauma centers; however, the findings were similar to other reported studies.

Animals↗