Role of nurse in treating injured persons with severe head injury

Uvod: V Sloveniji vsako leto 320 ljudi na 100.000 prebivalcev utrpi poškodbo glave, ki zahteva bolnišnično zdravljenjeizmed njih jih umre 15-30 na 100.000 prebivalcev ali več kot 300 ljudi na leto. Polovica tistih, ki umrejo zaradi hude poškodbe glave, jih umre v prvih dveh urah po poškodbi. Zunajbolnišnična ocena poškodovanca s poškodbo glave je zato izjemno pomembna pri zagotavljanju primerne oskrbe, pri kateri imajo zdravstveni delavci največjo vlogo. S poznavanjem pravilnih ukrepov lahko zdravstveni delavci omogočimo čim boljši izid oskrbe poškodovanca. Namen: Namen diplomskega dela je s pomočjo pregleda strokovne in znanstvene literature predstaviti vlogo medicinske sestre pri oskrbi poškodovanca s hudo poškodbo glave v zunajbolnišničnem obdobju po protokolu ITLS in s tem ugotoviti, kje imajo diplomirane medicinske sestre in zdravstveni reševalci največjo vlogo pri oskrbi poškodovanca s hudo poškodbo glave, in raziskati nekatere najpogostejše kontroverznosti, ki ostajajo pri oskrbi teh poškodovancev. Metode dela: V diplomskem delu je bila uporabljena metoda dela kritični pregled znanstvenih in strokovnih člankov, knjig in zbornikov v angleškem in slovenskem jeziku. Časovni okvir iskanja je bil od leta 2010 do leta 2020ključne besede so se navezovale na vsebino diplomskega dela. Rezultati: Vloga medicinskih sester v zunajbolnišničnem okolju je kompleksnadelo zahteva sposobnost samostojnega dela, načrtovanja in odločanja, saj delo poteka v okolju, kjer se velikokrat ne moremo posvetovati z drugimi zdravstvenimi delavci. Njihova prisotnost je ključnega pomena v neposredni pomoči poškodovancem, tehničnem izobraževanju ekip, pri izvedbi protokolov zdravstvene nege in poučnem materialu. Z njimi se zagotavlja hitrejša, bolj organizirana in varna oskrba poškodovancev. Vloga medicinskih sester pri oskrbi poškodovanca s hudo poškodbo glave je predvsem pri izvajanju življenjsko pomembnih intervencij, kot so oskrba dihalne poti, oksigenacija in ventilacija in vzdrževanje zadostnega krvnega tlaka. Razprava in zaključek: Ekipe nujne medicinske pomoči morajo zagotoviti najhitrejši možni odziv med nastankom poškodbe glave in sprejemom poškodovanca v ustrezni travma center, sicer se smrtnost teh poškodovancev hitro in drastično poveča. Prognoza poškodovancev s travmatsko poškodbo možganov in nizko vrednostjo GCS je zelo odvisna od zgodnje obravnave vitalnih funkcij, predvsem zunajbolnišnična preventiva hipoksije z ustrezno respiratorno podporo, kot so intubacija, normoventilacija in preventiva aspiracije. Za reševanje teh je potrebna pozornost za detajle in učinkovito upravljanje s časom. Ekipno delo je izrednega pomena, saj se mora veliko intervencij izvesti sočasno. Kljub nenehnem raziskovanju ostajajo negotovosti pri zunajbolnišnični in tudi urgentni obravnavi poškodovancev s HPG predvsem zaradi kompleksnosti takih poškodb.Introduction: Every year in Slovenia there are 320 per 100.000 people that suffer from a head injury that requires hospital treatment. Amongst them, 15-30 per 100.000 people or more than 300 people per year die. Half of those that die because of severe head injury, die in the first two hours after the injury occurred. Out-of-hospital evaluation of an injured person with head trauma is, therefore, incredibly important for assuring adequate care, which is where healthcare workers have the most important role. With knowing the right interventions, healthcare workers can provide the best possible outcome for the injured person. Purpose: The purpose of this bachelor’s thesis is, by reviewing professional and scientific literature, to present the role of nurses in the care of an injured person with a severe head injury in the out-of-hospital environment by following the ITLS protocol and thus find out where nurses have the most important role with treating injured persons with a severe head injury and to explore some of the most common controversies that remain in the care of these injured people. Methods: In this bachelor’s thesis, we used a critical review of professional and scientific articles, books, and collections of scientific papers in the English and Slovene languages. The time frame of the search was from the year 2010 to the year 2020 and the keywords were related to the topic of the bachelor’s thesis. Results: The role of nurses in an out-of-hospital environment is complex. The work demands the ability to work individually, planning, and decision-making because the work happens in an environment where we cannot often consult with other healthcare workers. Their presence is of the utmost importance with direct help to the injured person, technical education of teams, and in carrying out protocols of healthcare and learning materials. With the help of nurses, the care of injured persons is quicker, more organized, and safer. The role of nurses with the care of injured people with a severe head injury is mostly in carrying out vitally important interventions, such as the care of the airway, oxygenation and ventilation, and sustaining sufficient blood pressure. Discussion and conclusion: Emergency medical teams have to provide the quickest possible response from the time the injury occurred to the admission of the injured to the appropriate trauma center or the mortality of these injured people quickly and drastically increases. The prognosis of injured people with a traumatic brain injury and low GCS score relies heavily on the early treatment of vital functions, mainly the out-of-hospital prevention of hypoxia with the right respiratory support, such as intubation, normoventilation, and the prevention of aspiration. To solve these problems, attention to detail and effective time management are necessary. Teamwork is of utmost importance because a lot of interventions have to happen at the same time. Despite constant research, a lot of uncertainties remain in out-of-hospital and also urgent care of injured persons with a severe head injury, mostly because of the complexities of such injuries