Acute Care Management of a Patient with Multiple Trauma: Difference between revisions
No edit summary |
No edit summary |
||
Line 5: | Line 5: | ||
</div> | </div> | ||
== Introduction == | == Introduction == | ||
Patients with multiple traumas who require critical care are often exposed to interventions that "promote long periods of immobilization",<ref name=":0">Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127491/pdf/jpts-30-1193.pdf Rehabilitation and early mobilization in the critical patient: systematic review]. J Phys Ther Sci. 2018 Sep;30(9):1193-1201. </ref> such as mechanical ventilation, sedatives, analgesics, and | Patients with multiple traumas who require critical care are often exposed to interventions that "promote long periods of immobilization",<ref name=":0">Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127491/pdf/jpts-30-1193.pdf Rehabilitation and early mobilization in the critical patient: systematic review]. J Phys Ther Sci. 2018 Sep;30(9):1193-1201. </ref> such as mechanical ventilation, sedatives, analgesics, and medications to control anxiety and agitation.<ref name=":0" /> These patients are also at risk of [[ICU Acquired Weakness|intensive care unit-acquired weakness (ICU-AW)]], which is associated with a number of complications, including joint contractures, thromboembolism, pressure ulcers, atelectasis, pneumonia, an extended period weaning off mechanical ventilation, delirium, and the development of disabilities.<ref name=":0" /> In addition to the physical effects, prolonged hospitalisation can have a significant social impact, including increased days without income, an inability to provide for family and an inability to fulfil previously established social roles. | ||
Early acute care rehabilitation initiated in the Intensive Care Unit (ICU) can positively affect a patient's functional status, muscle strength, time spent on mechanical ventilation, walking ability at discharge, and health-related quality of life.<ref name=":0" /><ref>Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, Yu K, Chen X, Zhu L, Ma J, Qin Y. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776357/pdf/pone.0223185.pdf Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis.] PLoS One. 2019 Oct 3;14(10):e0223185.</ref> | Early acute care rehabilitation initiated in the Intensive Care Unit (ICU) can positively affect a patient's functional status, muscle strength, time spent on mechanical ventilation, walking ability at discharge, and health-related quality of life.<ref name=":0" /><ref>Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, Yu K, Chen X, Zhu L, Ma J, Qin Y. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776357/pdf/pone.0223185.pdf Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis.] PLoS One. 2019 Oct 3;14(10):e0223185.</ref> | ||
Line 15: | Line 15: | ||
== Multidisciplinary Team Approach == | == Multidisciplinary Team Approach == | ||
Patients with complex trauma admitted to ICU benefit from early rehabilitation interventions to prevent complications and promote recovery. The acute care trauma and rehabilitation teams form a multidisciplinary team, with team members working together to set goals and create care plans. Ideally, there will be clinical collaboration between members of the multidisciplinary team to ensure the successful integration of medical, rehabilitative, psychosocial, and financial resources available across various specialities. Patients with multiple injuries often require input from orthopaedic surgeons | Patients with complex trauma admitted to ICU benefit from early rehabilitation interventions to prevent complications and promote recovery. The acute care trauma and rehabilitation teams form a multidisciplinary team, with team members working together to set goals and create care plans. Ideally, there will be clinical collaboration between members of the multidisciplinary team to ensure the successful integration of medical, rehabilitative, psychosocial, and financial resources available across various specialities. Patients with multiple injuries often require input from physicians, orthopaedic surgeons, nursing staff, physiotherapists, occupational therapists, respiratory therapists, speech-language therapists (pathologists), and social workers. | ||
The following sections provide an overview of key considerations for physiotherapists treating patients with multi-trauma, including orthopaedic injuries, in an acute care setting. | The following sections provide an overview of key considerations for physiotherapists treating patients with multi-trauma, including orthopaedic injuries, in an acute care setting. | ||
== Patient Management in the Intensive Care Unit == | == Patient Management in the Intensive Care Unit == | ||
Before initiating | Before initiating an assessment, physiotherapists must obtain information that will help to determine if the patient is an appropriate candidate for physiotherapy. This is completed via a chart review and discussion with other members of the multidisciplinary team. | ||
=== Chart Review === | === Chart Review === | ||
Check the patient's chart for information on the following:<ref name=":2">Downey R. Case Discussion on the Continuum of Care for a Patient with Multiple Trauma. Plus Course 2024</ref> | Check the patient's chart for information on the following:<ref name=":2">Downey R. Case Discussion on the Continuum of Care for a Patient with Multiple Trauma. Plus Course 2024</ref> | ||
* movement precautions and weight-bearing precautions / restrictions | * movement precautions and weight-bearing precautions / restrictions | ||
* fracture management plan | * fracture management plan | ||
**when patients are going to have surgery, the timeline and anticipated surgical interventions can influence their functional mobility progression | **when patients are going to have surgery, the timeline and anticipated surgical interventions can influence their functional mobility progression | ||
**patients with a high risk of complications may be managed with early temporary stabilisation, followed by delayed definitive fixation when their risk of systemic complications decreases<ref name=":1">Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SP. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364767/?report=printable The right team at the right time - Multidisciplinary approach to multi-trauma patient with orthopedic injuries]. Int J Crit Illn Inj Sci. 2017 Jan-Mar;7(1):32-37.</ref> | **patients with a high risk of complications may be managed with early temporary stabilisation, followed by delayed definitive fixation when their risk of systemic complications decreases<ref name=":1">Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SP. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364767/?report=printable The right team at the right time - Multidisciplinary approach to multi-trauma patient with orthopedic injuries]. Int J Crit Illn Inj Sci. 2017 Jan-Mar;7(1):32-37.</ref> | ||
Line 31: | Line 31: | ||
**ventilator settings and plans for extubation | **ventilator settings and plans for extubation | ||
***for more information, please see: [[Ventilation and Weaning]] and [[Non Invasive Ventilation]] | ***for more information, please see: [[Ventilation and Weaning]] and [[Non Invasive Ventilation]] | ||
**additional complications (e.g. placement of [[Chest Drains|chest tubes/drains]]) | **additional complications (e.g. placement of [[Chest Drains|chest tubes / drains]]) | ||
**[[Lab Value Interpretation|lab values]] | **[[Lab Value Interpretation|lab values]] | ||
***haematocrit | ***haematocrit | ||
Line 41: | Line 41: | ||
***temperature | ***temperature | ||
***respiratory rate | ***respiratory rate | ||
**trends in arterial blood gases ( | **trends in arterial blood gases (ABGs) | ||
***pH | ***pH | ||
***PaCO2 | ***PaCO2 | ||
Line 49: | Line 49: | ||
*level of sedation / alertness | *level of sedation / alertness | ||
**[[Richmond Agitation-Sedation Scale (RASS)|Richmond Agitation Sedation Scale]] (RASS) | **[[Richmond Agitation-Sedation Scale (RASS)|Richmond Agitation Sedation Scale]] (RASS) | ||
***allows | ***allows clinicians to track the level of sedation | ||
*** | ***scores range from +4 to -5 | ||
***0 = awake and calm | ***0 = awake and calm | ||
If you would like to learn more, please watch the following optional video | ***moving up in a positive direction indicates increasing agitation | ||
***moving down through the negative numbers indicates increasing sedation | |||
If you would like to learn more about the RASS, please please watch the following optional video:{{#ev:youtube|v=-jnUsQIzSUs|300}}<ref>ICU REACH. Richmond Agitation-Sedation Scale (RASS). Available from: https://www.youtube.com/watch?v=-jnUsQIzSUs [last accessed 26/4/2024]</ref> | |||
=== Multidisciplinary Team Discussions === | === Multidisciplinary Team Discussions === | ||
Line 68: | Line 70: | ||
To increase the accuracy of the assessment, clinicians should: (1) determine the patient's level of confusion and (2) assess the patient's ability to follow basic commands and establish consistent and reliable communication.<ref name=":2" /> | To increase the accuracy of the assessment, clinicians should: (1) determine the patient's level of confusion and (2) assess the patient's ability to follow basic commands and establish consistent and reliable communication.<ref name=":2" /> | ||
The following tools can help | The following tools can be used to help determine the patient's level of confusion: | ||
* Confusion Assessment Method for the ICU (CAM-ICU)<ref>Miranda F, Arevalo‐Rodriguez I, Díaz G, Gonzalez F, Plana MN, Zamora J, Quinn TJ, Seron P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513664/pdf/CD013126.pdf Confusion Assessment Method for the intensive care unit (CAM‐ICU) for the diagnosis of delirium in adults in critical care settings.] Cochrane Database Syst Rev. 2018 Sep 10;2018(9):CD013126.</ref> | * Confusion Assessment Method for the ICU (CAM-ICU)<ref>Miranda F, Arevalo‐Rodriguez I, Díaz G, Gonzalez F, Plana MN, Zamora J, Quinn TJ, Seron P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513664/pdf/CD013126.pdf Confusion Assessment Method for the intensive care unit (CAM‐ICU) for the diagnosis of delirium in adults in critical care settings.] Cochrane Database Syst Rev. 2018 Sep 10;2018(9):CD013126.</ref> | ||
* Alert, Voice, Pain, Unresponsive scale (AVPU)<ref>Romanelli D, Farrell MW. AVPU Scale. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538431/ [last access 26.4.2024]</ref> | * Alert, Voice, Pain, Unresponsive scale (AVPU)<ref>Romanelli D, Farrell MW. AVPU Scale. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538431/ [last access 26.4.2024]</ref> | ||
Please watch this optional video if you would like to see a demonstration of | Please watch this optional video if you would like to see a demonstration of the Confusion Assessment Method for the ICU (CAM-ICU):{{#ev:youtube|v=slCX_6iV0fg|300}}<ref>Critical Care Nursing 101. Confusion Assessment Method (CAM-ICU). Available from: https://www.youtube.com/watch?v=slCX_6iV0fg [last accessed 26/4/2024]</ref> | ||
You might also be interested in this optional video on how to use the Alert, Voice, Pain, Unresponsive scale (AVPU): | You might also be interested in this optional video on how to use the Alert, Voice, Pain, Unresponsive scale (AVPU): | ||
Line 77: | Line 79: | ||
{{#ev: youtube|v=olToUEk0Ayo|300}}<ref>Top Hat Tutorials. The AVPU Scale. Available from: https://www.youtube.com/watch?v=olToUEk0Ayo[last accessed 26/4/2024]</ref> | {{#ev: youtube|v=olToUEk0Ayo|300}}<ref>Top Hat Tutorials. The AVPU Scale. Available from: https://www.youtube.com/watch?v=olToUEk0Ayo[last accessed 26/4/2024]</ref> | ||
The following strategies can help | The following strategies can be used to help establish consistent and reliable communication with a patient: | ||
* check if | * check if the patient can consistently nod / shake their head, blink for yes or no, etc. | ||
* picture communication boards | * use picture communication boards or letter spelling boards | ||
=== Body Systems Assessment === | === Body Systems Assessment === | ||
Line 92: | Line 93: | ||
system | system | ||
| | | | ||
* Monitor blood pressure and heart rate response in response to | * Monitor blood pressure and heart rate response in response to activities, such as: | ||
** transiting from a supine to a sitting position | ** transiting from a supine to a sitting position | ||
** transitioning from a sitting to a standing position | ** transitioning from a sitting to a standing position | ||
Line 110: | Line 111: | ||
* A general range of motion and strength assessment, if appropriate: | * A general range of motion and strength assessment, if appropriate: | ||
** may be hypothesised based on the patient's social history (type of work) | ** may be hypothesised based on the patient's social history (type of work) | ||
** may be | ** may be assessed based on a general observation of the patient's movements | ||
|} | |} | ||
Line 126: | Line 127: | ||
* use alternative approaches to decrease agitation and increase a patient's participation | * use alternative approaches to decrease agitation and increase a patient's participation | ||
* incorporate positioning strategies for pressure sore prevention and pain and oedema reduction | * incorporate positioning strategies for pressure sore prevention and pain and oedema reduction | ||
* | * educate family and friends on delirium prevention strategies:<ref>Low Stimulation Environment Guideline. Available from https://craighospital.org/wp-content/uploads/sites/Educational-PDFs/852.LowStimulationGuidlines.pdf [last access 26.4.2024]</ref> | ||
** perform frequent reorientation | ** perform frequent reorientation | ||
** keep the lights on and the windows open during the day | ** keep the lights on and the windows open during the day | ||
Line 137: | Line 138: | ||
After a patient transfers from ICU to a general ward, physiotherapists should: | After a patient transfers from ICU to a general ward, physiotherapists should: | ||
* reasses the patient | * reasses the patient (this includes obtaining a more specific social history) | ||
* establish specific goals with the patient | * establish specific goals with the patient | ||
* complete a systems review | * complete a systems review | ||
* increase the patient's independence with functional mobility | * work to increase the patient's independence with functional mobility | ||
*assess the patient's need for an assistive device | *assess the patient's need for an assistive device | ||
Line 165: | Line 166: | ||
=== Interventions === | === Interventions === | ||
Rehabilitation interventions may focus on the following: | Rehabilitation interventions at this stage of care may focus on the following: | ||
* improving the patient's functional mobility | * improving the patient's functional mobility | ||
Line 172: | Line 173: | ||
* progressing activity tolerance and endurance (i.e. increase duration of ambulation and then speed of ambulation) | * progressing activity tolerance and endurance (i.e. increase duration of ambulation and then speed of ambulation) | ||
* pulmonary education as needed; topics may include: | * pulmonary education as needed; topics may include: | ||
** coughing with cough pillow / towel roll to | ** coughing with cough pillow / towel roll to help manage pain when coughing | ||
** active cycle of breathing | ** active cycle of breathing | ||
** huff coughing | ** huff coughing |
Revision as of 12:08, 6 May 2024
Original Editor - Rebecca Downey
Top Contributors - Ewa Jaraczewska and Jess Bell
Introduction[edit | edit source]
Patients with multiple traumas who require critical care are often exposed to interventions that "promote long periods of immobilization",[1] such as mechanical ventilation, sedatives, analgesics, and medications to control anxiety and agitation.[1] These patients are also at risk of intensive care unit-acquired weakness (ICU-AW), which is associated with a number of complications, including joint contractures, thromboembolism, pressure ulcers, atelectasis, pneumonia, an extended period weaning off mechanical ventilation, delirium, and the development of disabilities.[1] In addition to the physical effects, prolonged hospitalisation can have a significant social impact, including increased days without income, an inability to provide for family and an inability to fulfil previously established social roles.
Early acute care rehabilitation initiated in the Intensive Care Unit (ICU) can positively affect a patient's functional status, muscle strength, time spent on mechanical ventilation, walking ability at discharge, and health-related quality of life.[1][2]
Multiple Trauma[edit | edit source]
"Major trauma refers to physical injury or a combination of injuries where there is a strong possibility of death or disability and is commonly defined using an Injury Severity Score."[3]
The Injury Severity Score allows clinicians to describe the severity of injury in a trauma patient.[4] The body is divided into six anatomical areas, and each injury is rated using the Abbreviated Injury Scale (AIS). Only the most severe injury in each region is considered in the final ISS calculation. The final ISS is calculated by adding the squares of the three highest AIS scores. A score greater than 15 = major trauma.[4]
For more information, please see: Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients.[4]
Multidisciplinary Team Approach[edit | edit source]
Patients with complex trauma admitted to ICU benefit from early rehabilitation interventions to prevent complications and promote recovery. The acute care trauma and rehabilitation teams form a multidisciplinary team, with team members working together to set goals and create care plans. Ideally, there will be clinical collaboration between members of the multidisciplinary team to ensure the successful integration of medical, rehabilitative, psychosocial, and financial resources available across various specialities. Patients with multiple injuries often require input from physicians, orthopaedic surgeons, nursing staff, physiotherapists, occupational therapists, respiratory therapists, speech-language therapists (pathologists), and social workers.
The following sections provide an overview of key considerations for physiotherapists treating patients with multi-trauma, including orthopaedic injuries, in an acute care setting.
Patient Management in the Intensive Care Unit[edit | edit source]
Before initiating an assessment, physiotherapists must obtain information that will help to determine if the patient is an appropriate candidate for physiotherapy. This is completed via a chart review and discussion with other members of the multidisciplinary team.
Chart Review[edit | edit source]
Check the patient's chart for information on the following:[5]
- movement precautions and weight-bearing precautions / restrictions
- fracture management plan
- when patients are going to have surgery, the timeline and anticipated surgical interventions can influence their functional mobility progression
- patients with a high risk of complications may be managed with early temporary stabilisation, followed by delayed definitive fixation when their risk of systemic complications decreases[6]
- information on medical status / stability, including:
- ventilator settings and plans for extubation
- for more information, please see: Ventilation and Weaning and Non Invasive Ventilation
- additional complications (e.g. placement of chest tubes / drains)
- lab values
- haematocrit
- haemoglobin
- markers for acute infection: C-reactive protein (CRP) and procalcitonin (PCT)[7]
- vitals (consider trends)
- blood pressure
- heart rate and rhythm
- temperature
- respiratory rate
- trends in arterial blood gases (ABGs)
- pH
- PaCO2
- PaO2
- bicarbonate (HCO3)
- base excess (BE)[8]
- ventilator settings and plans for extubation
- level of sedation / alertness
- Richmond Agitation Sedation Scale (RASS)
- allows clinicians to track the level of sedation
- scores range from +4 to -5
- 0 = awake and calm
- moving up in a positive direction indicates increasing agitation
- moving down through the negative numbers indicates increasing sedation
- Richmond Agitation Sedation Scale (RASS)
If you would like to learn more about the RASS, please please watch the following optional video:
Multidisciplinary Team Discussions[edit | edit source]
Members of the multidisciplinary team may include physicians, surgeons, neurologists, pulmonologists, physiotherapists, occupational therapists, nursing staff, social workers, case managers, and speech language therapists.
Frequent discussions between multidisciplinary team members help the team establish a communication plan. Working with the multidisciplinary team helps physiotherapists to:[5]
- increase their understanding of social factors that will impact discharge planning
- obtain information on a patient's access to resources
- coordinate the timing of therapy sessions with nursing staff to ensure optimal engagement in treatment
- gather additional information on a patient's cognition, agitation, and ability to follow commands
- obtain information on a patient's ability to participate, their haemodynamic response to activity, and the plan for ongoing medical interventions
Assessment[edit | edit source]
To increase the accuracy of the assessment, clinicians should: (1) determine the patient's level of confusion and (2) assess the patient's ability to follow basic commands and establish consistent and reliable communication.[5]
The following tools can be used to help determine the patient's level of confusion:
- Confusion Assessment Method for the ICU (CAM-ICU)[10]
- Alert, Voice, Pain, Unresponsive scale (AVPU)[11]
Please watch this optional video if you would like to see a demonstration of the Confusion Assessment Method for the ICU (CAM-ICU):
You might also be interested in this optional video on how to use the Alert, Voice, Pain, Unresponsive scale (AVPU):
The following strategies can be used to help establish consistent and reliable communication with a patient:
- check if the patient can consistently nod / shake their head, blink for yes or no, etc.
- use picture communication boards or letter spelling boards
Body Systems Assessment[edit | edit source]
Table 1 provides a summary of key body systems to assess during a physiotherapy intervention, but for more information on assessing a patient in ICU, please see: Physiotherapy Assessment of the Patient in ICU.
Body systems | What to assess? |
---|---|
Cardiovascular
system |
|
Pulmonary system |
|
Integumentary system |
|
Musculoskeletal system |
|
Outcome Mesures[edit | edit source]
The following outcome measures can help track changes in a patient's functional mobility over time:
General Goals[edit | edit source]
Goals might include:
- increase tolerance for upright mobility
- complete basic activities of daily living in a sitting position
- incorporate breathing techniques with upright mobility
- incorporate strategies for delirium prevention and delirium management
- use alternative approaches to decrease agitation and increase a patient's participation
- incorporate positioning strategies for pressure sore prevention and pain and oedema reduction
- educate family and friends on delirium prevention strategies:[14]
- perform frequent reorientation
- keep the lights on and the windows open during the day
- limit activities that require a lot of concentration
- limit the number of individuals speaking to a patient at a time
- limit external noises (close the door, turn off the television)
- provide mental breaks after periods of high stimulation
Patient Management Post-Intensive Care Unit[edit | edit source]
After a patient transfers from ICU to a general ward, physiotherapists should:
- reasses the patient (this includes obtaining a more specific social history)
- establish specific goals with the patient
- complete a systems review
- work to increase the patient's independence with functional mobility
- assess the patient's need for an assistive device
Assessment[edit | edit source]
Assessments post-ICU should include the following:
- basic functional mobility, including bed mobility, transfers, and gait
- outcome measures to track the patient's progress:
- e.g. Activity Measure for Post-Acute Care "6-Clicks" Short Form (AM-PAC "6-Clicks")[15]
- can be completed by any provider
- enables increased communication and tracking of mobility between members of the interdisciplinary team
- e.g. Activity Measure for Post-Acute Care "6-Clicks" Short Form (AM-PAC "6-Clicks")[15]
- balance assessment if indicated
- e.g. Dynamic Gait Index
- functional activity tolerance assessment
- e.g. Two Minute Walk Test or Six Minute Walk Test
- vitals must be monitored throughout
General Goals[edit | edit source]
- to improve independence
- to improve activity tolerance
- to improve breathing mechanics and secretion management
- to ensure a safe return home
Interventions[edit | edit source]
Rehabilitation interventions at this stage of care may focus on the following:
- improving the patient's functional mobility
- providing education for the patient on their weight-bearing status
- as mobility improves, progressing to the least restrictive assistive device
- progressing activity tolerance and endurance (i.e. increase duration of ambulation and then speed of ambulation)
- pulmonary education as needed; topics may include:
- coughing with cough pillow / towel roll to help manage pain when coughing
- active cycle of breathing
- huff coughing
- incentive spirometer
- inspiratory muscle training
- education on post-concussive syndrome support strategies where necessary:
- visual task reminders
- taking cognitive breaks during the day
- placing time limits on activities, especially those that require a lot of concentration or a lot of in-depth thought
- multidisciplinary / interdisciplinary conversations to ensure a successful and safe discharge into the community
- establishing follow-up care and reintegration into the community for the patient upon discharge from acute care
Resources[edit | edit source]
- Al Hanna R, Amatya B, Lizama LE, Galea MP, Khan F. Multidisciplinary rehabilitation in persons with multiple trauma: A systematic review. J Rehabil Med. 2020 Oct 2;52(10):jrm00108.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci. 2018 Sep;30(9):1193-1201.
- ↑ Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, Yu K, Chen X, Zhu L, Ma J, Qin Y. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One. 2019 Oct 3;14(10):e0223185.
- ↑ Naess HL, Vikane E, Wehling EI, Skouen JS, Bell RF, Johnsen LG. Effect of Early Interdisciplinary Rehabilitation for Trauma Patients: A Systematic Review. Arch Rehabil Res Clin Transl. 2020 Jun 25;2(4):100070.
- ↑ 4.0 4.1 4.2 Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients. Indian J Crit Care Med. 2019 Feb;23(2):73-77.
- ↑ 5.0 5.1 5.2 Downey R. Case Discussion on the Continuum of Care for a Patient with Multiple Trauma. Plus Course 2024
- ↑ Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SP. The right team at the right time - Multidisciplinary approach to multi-trauma patient with orthopedic injuries. Int J Crit Illn Inj Sci. 2017 Jan-Mar;7(1):32-37.
- ↑ Binnie A, Lage J, Dos Santos CC. How can biomarkers be used to differentiate between infection and non-infectious causes of inflammation? Evidence-Based Practice of Critical Care. 2020:319–324.e1.
- ↑ Langer T, Brusatori S, Gattinoni L. Understanding base excess (BE): merits and pitfalls. Intensive Care Med. 2022 Aug;48(8):1080-83.
- ↑ ICU REACH. Richmond Agitation-Sedation Scale (RASS). Available from: https://www.youtube.com/watch?v=-jnUsQIzSUs [last accessed 26/4/2024]
- ↑ Miranda F, Arevalo‐Rodriguez I, Díaz G, Gonzalez F, Plana MN, Zamora J, Quinn TJ, Seron P. Confusion Assessment Method for the intensive care unit (CAM‐ICU) for the diagnosis of delirium in adults in critical care settings. Cochrane Database Syst Rev. 2018 Sep 10;2018(9):CD013126.
- ↑ Romanelli D, Farrell MW. AVPU Scale. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538431/ [last access 26.4.2024]
- ↑ Critical Care Nursing 101. Confusion Assessment Method (CAM-ICU). Available from: https://www.youtube.com/watch?v=slCX_6iV0fg [last accessed 26/4/2024]
- ↑ Top Hat Tutorials. The AVPU Scale. Available from: https://www.youtube.com/watch?v=olToUEk0Ayo[last accessed 26/4/2024]
- ↑ Low Stimulation Environment Guideline. Available from https://craighospital.org/wp-content/uploads/sites/Educational-PDFs/852.LowStimulationGuidlines.pdf [last access 26.4.2024]
- ↑ Herbold J, Rajaraman D, Taylor S, Agayby K, Babyar S. Activity Measure for Post-Acute Care "6-Clicks" Basic Mobility Scores Predict Discharge Destination After Acute Care Hospitalization in Select Patient Groups: A Retrospective, Observational Study. Arch Rehabil Res Clin Transl. 2022 Jul 16;4(3):100204.