Forensic Nursing combines nursing science with the investigation of injuries or deaths that involve accidents, abuse, violence or criminal activity. Sexual Assault Nurse Examiners (SANE nurses) are one of the most recognized types of forensic nurses, but they have special training in one type of injury. Forensic nursing programs typically involve a broader set of skills, encompassing some or all of the following:
Interpersonal violence, including domestic violence, child and elder abuse/neglect, psychological abuse
Forensic mental health
Legal nurse consulting
Emergency/trauma services, including auto and pedestrian accidents, traumatic injuries, suicide attempts, work-related injuries, disasters
Patient care facility issues, including accidents/injuries/neglect, inappropriate treatments & meds
Public health and safety, including environmental hazards, alcohol and drug abuse, food and drug tampering, illegal abortion practices, epidemiology, and organ donation
Death investigation, including homicides, suicides, suspicious or accidental deaths, and mass disasters
Forensic nurses find that their additional training improves their basic nursing skills, and allows them to derive greater career satisfaction from helping patient in another rather unique way.
Approximately 37 training programs exist, ranging from certificate programs that require a specific number of hours of training, to degree programs (typically Masters level programs). Many of the certificate programs are available as online training.
Trauma professionals who don’t routinely take care of burns tend to radically overestimate the size of burns. This can create significant problems for the patient, because the formula used to determine fluid rates and total crystalloid given are based on burn size.
Don’t flood your patient! Watch this 5 minute video instead.
Last year, a lot of the papers presented at EAST were a bit ho-hum. But I’ve been reviewing the abstracts for the upcoming January 2016 meeting, and there’s a lot of good stuff! Although you do need to take this with a grain of salt, because sometimes the paper does not live up to the hype of the abstract. But many of the abstracts look so good, that I’m going to dedicate both December and January Trauma MedEd newsletters to reviewing them.
There are lots of intriguing ideas coming! Here are a few that I will be writing about:
Suction evacuation of hemothorax
(F)utility of CPR in hemorrhagic shock
(F)utility of blood administration in the helicopter
EMS scene time and mortality
Does Mucomyst (acetylcysteine) predispose to pneumonia?
Distracted driving prevention
How long is DVT a potential risk in TBI?
Plus I’ll pick apart a number of really crappy abstracts
Focused abdominal sonography for trauma (FAST) has been around in one form or another for about 40 years. Sonographic examination of the abdomen was used in Europe in the 1970s, while the US was using diagnostic peritoneal lavage (DPL). FAST finally moved to the US in the 1990s and continues to this day. It has also been incorporated in the Advanced Trauma Life Support Course sponsored by the American College of Surgeons.
About 10 years ago, emergency physicians began using sonography to evaluate the thorax as well. The technique was primarily used to detect air (and possibly fluid) in the pleural space. Sensitivity and specificity have increased nicely over the years as the technology and our experience has improved.
Most trauma centers incorporate FAST into their trauma activations. Although it was initially vetted using blunt trauma patients, it can be and is used for evaluation in penetrating trauma. But relatively few centers expanded it to eFAST to evaluate the chest. Should they?
Bottom line: Definitely! Extended FAST adds about a minute to the overall exam and may provide information before the chest x-ray is obtained. It may also show pathology that the typical trauma chest x-ray cannot due to patient body habitus and supine positioning. I recommend that the eFAST be the standard of care in trauma activations if you have an ultrasound machine. Important! But be sure to have a way to record and perform quality reviews of the information obtained.