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Nursing care of the critically ill patient the trauma bed — a case study
NURSING CARE OF THE CRITICALLY ILL PATIENT THE TRAUMA BED - A CASE STUDY STEPHANIE CLARK' S.R.N.. C.C.R.N. Royal Hobart Hospital.' Hobart.
In November 1986, the Intensive Care Unit of the Royal Hobart Hospital purchased Australia's first, and to date only, Roto Rest Kinetic Treatment Table or Trauma bed as it is commonly knovvn. The bed itself is of a fairly simple design but it is certainly state of the art in the treatment of the immobilised patient.
M.P.M.R. that the problems associated vvith immobility begin to appear. In the late 60's Dr. Francsis X. Keane, head of Prosthetics and Orthotics at the National Rehabilitation Centre in Ireland, designed the Roto Rest Kinetic Treatment Table as a means of providing the M.P.M.R. for the irnrnobilised patient. Dr. Keane observed that if a person turned himself or made a gross body movement every 11.6 minutes during normal sleep, then he vvould have to be t u r n e d more frequently by 81 passive mechanical means in order to achieve the same degree of protect~cm from the com p I i c B t'l' 0 n s 0 f immobility.
The human body deteriorates vvith lack of use and it is obvious that a person must carry out a-~ certain amount of activity, belovv vvhich serious degeneration occurs. Many studies have been' carried out on this minimal activity requirement, and it has been demonstrated that normal, healthy, sleeping subjects vvill make a gross body movement every 11.6 minutes.(1)(2) This obviously essential activity has been termed the Min i rn u m P h y s'i 0 I 0 gi c a I Mobility Requirement (M.P.M.R.].
From this carne the concept of the Kinetic TreatfTlent Table (K.T.T.], a bed that vvould rotate automatically through a pre-set arc, 124"', every three and a half minutes. In the late 70's, tvvo American doctors modified the K.T.T. and designed a full range of traction to fit the bed. The trauma bed vvas born. Any form of traction can be applied
It is vvhen a person is confined to a bed for vvhatever reason and is unable to meet this
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No.1
from cervical, upper extremity, pelvic and lovver extremity. It is extremely light-vveight and easy to set-up. A unique feature of the traction apparatus is the flexion cable s y s t e m vvhich absorbs the moverrtent of the bed vvhile it is in rotation and so keeps the limb in alignment and vvith vveight applied at all tirrtes. In addition to continuous turning, the K.T.T. can be stopped in various lateral positions to allovv nursing procedures to be carried out. It should be noted hovvever that most nursing functions can be carried out vvhilst the bed is in rotation. Three main hatches are located on the bed cervical, thoracic and rectal vvhich allovvs access to the patients entire back. Perhaps the most time consurrting aspect of the K.T.T. is actually placing and balancing a patient on the bed. They must be placed in the centre of the bed and their position is maintained by closely fitting body and extrerrtity packs. Hovvever, once the patient is positioned and t h e bed c o r r e c t l y balanced, the K.T.T. has proven to be of enorrrtous help to both patients and nursing staff. EFFECTS OF KINETIC THERAPY ON BODY SYSTEMS
At present, the hazards of irrtmobility hypostatic pneu,-nonia, D.V.T., decubitus _ulcers, to name a fevv are all treated separately as they occur, instead of treating the cause itself. Research has shovvn that the K.T.T. has a beneficial effect on ,-nost body systems. Pulrrtonary -' the constant rotation to 62'~ each side allovvs for continuous postural drainage and rrtobiJization of secretions. This improves the ventilation/perfusion in the lungs and also helps prevent hypostatic pneumonia and atelectasis.(3) Cardiovascular - as each leg is elevated every three and a half minutes, it atlovvs for gravitational drainage of the veins, t h e r e b y helping t o prevent venous stasis and reducing the potential for deep vein thrombosis. Recent studies carried out in the U . S·'. A. - h a v e derrtonstrated this quite graphic~lIy.(4) Gastro-intestinal the continuous rrtotion of the Roto Rest has been shovvn to stimulate peristalsis and so help reduce the incidence of constip ation and i m.p a c ti 0 n i n t h e irnrrtobilised patient. Skin
CONFEOERATION JOURNAL Vol. 1 19
-
No.1
the
rrtost
obvious
and perhaps costly complication of immobility is the formation of decubitus ulcers. Tissues beneath the skin have shoVV'n regions of ischaemia after only tVV'enty minutes of continuous pressure and actual tissue degeneration has been shoVV'n to occur in one hour. As pressure points are continuo.usly changing VV'hile the patient is automatically rotating, decubitus ulcer formation is thereby prevented.(5)
- lacerated supraorbital region and occiput - numerous haematomas - aspiration of gastric contents during transport to hospital Mrs M vvas resuscitated, intubated and ventilated and then t r a n s f e r r e d to the operating theatre for insertion of pins in both ankles for application of traction. Arterial blood gases at this stage shovved an oxygenation of 83mmHg on an Fi02 of 50%. Over the next tvvelve days Mrs M's condition failed to improve, in· fact respiratory function deteriorated. Left lovver lobe collapse vvas detected tvvo days post admission and persisted despite tVV'o fibreoptic bronchoscopy's. Efforts to vvean Mrs M from the ventilator proved fruitless and her oxygenation on an Fi02 ·of 45% 50% r~mained around 55-60mmHg.
Neurological as the patient has t o be disturbed much less than VV'ith treatment on a conventional bed, anxiety and sleep deprivation can be markedly reduced. Genito-urinary It has been demonstrated that the incidence of urinary stasis is reduced, as vvith each turn, t h e r e is impr.oved gravitational emptying of each kidney and b e t t e r bladder drainage.(6)
Mrs M also presented nursing s t a f f VV'ith a number of difficult nursing problems. Her skin vvas very fragile and there vvas a g r e a t risk of decubitus ulcer formation. Both leg fractures vvere unstable and vvith cu mbers 0 me t r ac t ion applied, it vvas difficult to change her position to deliver good pressure care and physiother-apy. Also,
CASE STUDY Mrs M, a 69 year old female, vvas admitted to the intensive care unit folloVV'ing an altercation VV'ith a turning car - Mrs M VV'as a pedestrian. Injuries sustained VV'erei - fractured right humerus - fractured tibia and fibula bilaterally
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too long to allovv propel~ placement of the lovvel~ extremity packs. Hovvever, a large bolt cutter solved this problem, As Mrs M had traction on both legs it allovved us to experiment vvith the lovver extremity traction set-up. The traction apparatus is very versatile and enables you to 'build' exactly vvhat you need, as vve did vvith Mrs M.
any manual movement caused Mrs M extreme pain. Tvvo vveeks follovving her adITlission it vvas decided to place Mrs M on the K.T.T .. We had hesitated in doing this because, at this stage, not all the intensive care unit staff had been instructed in the use of the bed. Hovvever, it vvas felt that Mrs M could benefit enormously from the K.T.T. and so I agreed to provide total back-up and constant inser-vice for the first fevv days, to proITlote staff and patient acceptance of the bed.
Once Mrs M vvas correctly positioned and traction applied, the bed required re-balancing. The bed is designed along the principle of a sail-boat - the bed vvith a patient placed on it IS counter balanced by a 'keel' under the bed. It is most iITlportant to accurately place the patient and balance the bed to prevent excessive vvear and tear on the motor and gear mechanism. This can be time consuming, especially vvhen traction has been added to the bed.
Mrs M vvas to be the first patient in Australia to be placed on the Kinetic TreatITlent Table. Before placing Mrs' M on the bed, I spent a considerable aITlount of tiITle vvith her family, explaining the concept of the bed, shovvingthem hovv i t vvorked and outlining the benefits. If at all possible it is vvorthvvhile placing a relative on the bed first to allovv them to experience it as this can be reassuring for both family and patient.
I had modified the ventilator circuit to prevent drag during rotation, Intravenous lines had ample length provided the I.V. poles vvere positioned close to the bed. The indvvelling cat h e t e r vv,a s p a sse d dovvn through the rectal hatch and the bag vvas hung off the base of the
Mrs M vvasduly placed, positioned and 'packed' onto the bed. At this stage vve had a minor problem vvith the pins in both ankles. They vvere CONFEDERATION JOURNAL
Vol. 1
21
No.1
bed. A t this stage the bed and the patient vvere t-eady for automatic rotation.
Rate: 8 T.V.: 650 P.E.E.P.:8 Fi02: 45%
Mrs M vves naturally very apprehensive and tense. It is important to stay by the patient and maintain eye contact during the first fevv rotations to allay any fears. This vve did vvith Mrs M.
Ph: PC02: P02: HC03: B.E.:
Haemodynamically, Mrs M \Nas stable prior to K.T. vvith a blood pressure range of 120/70 - 100/60, pulse range of 100-120 and a temperatut-e of 38.5....· \Nhich had persisted for the past ten days. Once r o t a t i o n vvas commenced and Mrs M had become accustomed to it, it \Nas noted that there \Nere no changes in her haemodynamic status.
Watching Mrs M through the first fevv .-otations it vvas evident that she experienced pain from her fractured right humerus vvhen the bed vvas in the extreme right lateral position. As the trauma bed has a variable. rotation pin vvhich allovvs you to select suitable degrees of rotation, I changed Mrs M to the moderate right setting. This setting rotates the bed the full 62- on the left ~ide but only rotates to 40- on the right side. As vveight-bearing only begins once you exceed 45- tilt, this prevented her putting \Neight on her right arm, thus cornpletely alleviating her discomfort.
HO\Never, three hours follo\Ning commencement of K.T., Mrs M's oxygenation sho\Ned quite a significant improvement vvith a P02 of 95.8 mmHg being recorded. This vvas such a remarkable change in such a short period of time. T\Nenty-four hours follovving commencement of K.T. Mrs M had a clear chest on auscultation and good air entry in both bases. Chest x-ray shovved resolution of left lovver lobe collapse.
Mrs M vvas commenced on Kinetic therapy at 6:30pm on a Friday evening. Prior to com m .e n c e men t , her ventilator settings and arterial blood gases vvere: mode:
7.55 35.9 56.3 32 9.1
Three days follovving commencement of K.T. Mrs M had been \Neaned
I.M.V.
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No.1
from the ventilator and on an Fio2 of 35% had a P02 of 100 mmHg. Mrs M vvas left on the K.T.T. for a further thirty-six hours and then placed on a conventional bed prior to her vvard transfer.
physiotherapy vvas given vvith the bed flat, as side hatches drop dovvn to allovv you to give full range of motion exercises to all limbs. Chest x-rays vvere easy to obtain and did not necessitate moving the patient at all. The x-ray cassette is slotted into a groove unqerneath the bed and simply moved up or dovvn to the desired position. We found the quality of x-ray taken this vvay to be satisfactory.
NURSING CONSIDERA TloNS
The nursing staff vvho cared for Mrs M vvhile she vvas undergoing K.T. found the bed of enormous value both to them and the patient. We found most nursing procedures could be carried out vvhilst the bed vvas rotating. The bed vvas usually only stopped for lengthy procedures such as dressings, blood sampling etc. When vvashing the patient the bed vvas locked in the 62··~ lateral position and the latches unlocked in turn, t h e s u p p o r t packs removed and the exposed area vvashed, The entire back could be vvashed vvithout moving the patient. During Kinetic therapy Mrs M's skin improved remarkably vvith previously· reddened areas disappearing.
Mrs M tolerated kinetic therapy vvell. Traction to both legs vvas maintained vvithout any problems arIsIng. Kinetic therapy enabled her to sleep for long periods undisturbed, vvhich she enjoyed. Also, Mrs M novv experienced little pain as vve did not have to manually turn her every tvvo . hours something vvhich had caused her extreme discomfort due to the bilateral fractures and extensive bruising. Mrs M's fal'T\ily vvere apprehensive at first and needed a lot of reassurance. We found vve needed to take the bed out of rotation for about tvventy minutes during their visit to allovv them better personal contact.
Chest physiotherapy vvas easily carried out vvith the bed locked in the 62- lateral position and suctioning vvhilst in this position allovved for bette,auctioning of the dependent lung. Limb CONFEDERATION JOURNAL
vvith Vol. 1
23
Our first experience the Trauma bed Ot-
No.1
Kinetic Treatment Table, I feel, vvas a great success. Acceptance by the staff vvas overvvhelming. They found it very easy to give total patient care vvith a minimum of fuss. I also think i t significantly reduced Mrs M's stay in the I.C.U.
3. Schimmel, L. et al. A mechanical method to influence pulmonary perfusion in critically ill patients. ,Journal of Critical Care Medicine 5, 6. 4. Welch, G.W. (1981). Effects of kinetic bed on venous filling and emptying of the lovver extremit~ Presented at the Third World Congress on Intensive Care and Critical Care Medicine. Washington
As vve place more patients on the trauma bed I believe the research carried out in the U.S.A. (7) shovving that you can reduce a patients stay in I.C.U. by 50~b, if treated vvith kinetic therapy, vvill be validated.
D.C. 5. Leininger, P. et al. (1983). Some nevv facts about pressure sores. Physicians Update 1\.. 4~
REFERENCES 6. Olson, E.V. (1969). The hazards of immobility. The American ..Journal of Nursing 67, 4.
1. Johnson et al. In vvhat position do healthy people sleep? ,Journal of American Medical Association 94, 2059-62.
7. Adelstein, W. & Watson, P. (1983). Cervical spinal injuries. ,Journal of Neurosuraical Nursing 15, 2, April.
2. Kleitman, N. Sleep and vvakefulness. Chicago: The University of Chicago Press.
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CONFEDERATION JOURNAL
Vol. 1
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No.1
In November 1986, the Intensive Care Unit of the Royal Hobart Hospital purchased Australia's first, and to date only, Roto Rest Kinetic Treatment Table or Trauma bed as it is commonly knovvn. The bed itself is of a fairly simple design but it is certainly state of the art in the treatment of the immobilised patient.
M.P.M.R. that the problems associated vvith immobility begin to appear. In the late 60's Dr. Francsis X. Keane, head of Prosthetics and Orthotics at the National Rehabilitation Centre in Ireland, designed the Roto Rest Kinetic Treatment Table as a means of providing the M.P.M.R. for the irnrnobilised patient. Dr. Keane observed that if a person turned himself or made a gross body movement every 11.6 minutes during normal sleep, then he vvould have to be t u r n e d more frequently by 81 passive mechanical means in order to achieve the same degree of protect~cm from the com p I i c B t'l' 0 n s 0 f immobility.
The human body deteriorates vvith lack of use and it is obvious that a person must carry out a-~ certain amount of activity, belovv vvhich serious degeneration occurs. Many studies have been' carried out on this minimal activity requirement, and it has been demonstrated that normal, healthy, sleeping subjects vvill make a gross body movement every 11.6 minutes.(1)(2) This obviously essential activity has been termed the Min i rn u m P h y s'i 0 I 0 gi c a I Mobility Requirement (M.P.M.R.].
From this carne the concept of the Kinetic TreatfTlent Table (K.T.T.], a bed that vvould rotate automatically through a pre-set arc, 124"', every three and a half minutes. In the late 70's, tvvo American doctors modified the K.T.T. and designed a full range of traction to fit the bed. The trauma bed vvas born. Any form of traction can be applied
It is vvhen a person is confined to a bed for vvhatever reason and is unable to meet this
CONFEDERATION JOURNAL
18
Vol. 1
No.1
from cervical, upper extremity, pelvic and lovver extremity. It is extremely light-vveight and easy to set-up. A unique feature of the traction apparatus is the flexion cable s y s t e m vvhich absorbs the moverrtent of the bed vvhile it is in rotation and so keeps the limb in alignment and vvith vveight applied at all tirrtes. In addition to continuous turning, the K.T.T. can be stopped in various lateral positions to allovv nursing procedures to be carried out. It should be noted hovvever that most nursing functions can be carried out vvhilst the bed is in rotation. Three main hatches are located on the bed cervical, thoracic and rectal vvhich allovvs access to the patients entire back. Perhaps the most time consurrting aspect of the K.T.T. is actually placing and balancing a patient on the bed. They must be placed in the centre of the bed and their position is maintained by closely fitting body and extrerrtity packs. Hovvever, once the patient is positioned and t h e bed c o r r e c t l y balanced, the K.T.T. has proven to be of enorrrtous help to both patients and nursing staff. EFFECTS OF KINETIC THERAPY ON BODY SYSTEMS
At present, the hazards of irrtmobility hypostatic pneu,-nonia, D.V.T., decubitus _ulcers, to name a fevv are all treated separately as they occur, instead of treating the cause itself. Research has shovvn that the K.T.T. has a beneficial effect on ,-nost body systems. Pulrrtonary -' the constant rotation to 62'~ each side allovvs for continuous postural drainage and rrtobiJization of secretions. This improves the ventilation/perfusion in the lungs and also helps prevent hypostatic pneumonia and atelectasis.(3) Cardiovascular - as each leg is elevated every three and a half minutes, it atlovvs for gravitational drainage of the veins, t h e r e b y helping t o prevent venous stasis and reducing the potential for deep vein thrombosis. Recent studies carried out in the U . S·'. A. - h a v e derrtonstrated this quite graphic~lIy.(4) Gastro-intestinal the continuous rrtotion of the Roto Rest has been shovvn to stimulate peristalsis and so help reduce the incidence of constip ation and i m.p a c ti 0 n i n t h e irnrrtobilised patient. Skin
CONFEOERATION JOURNAL Vol. 1 19
-
No.1
the
rrtost
obvious
and perhaps costly complication of immobility is the formation of decubitus ulcers. Tissues beneath the skin have shoVV'n regions of ischaemia after only tVV'enty minutes of continuous pressure and actual tissue degeneration has been shoVV'n to occur in one hour. As pressure points are continuo.usly changing VV'hile the patient is automatically rotating, decubitus ulcer formation is thereby prevented.(5)
- lacerated supraorbital region and occiput - numerous haematomas - aspiration of gastric contents during transport to hospital Mrs M vvas resuscitated, intubated and ventilated and then t r a n s f e r r e d to the operating theatre for insertion of pins in both ankles for application of traction. Arterial blood gases at this stage shovved an oxygenation of 83mmHg on an Fi02 of 50%. Over the next tvvelve days Mrs M's condition failed to improve, in· fact respiratory function deteriorated. Left lovver lobe collapse vvas detected tvvo days post admission and persisted despite tVV'o fibreoptic bronchoscopy's. Efforts to vvean Mrs M from the ventilator proved fruitless and her oxygenation on an Fi02 ·of 45% 50% r~mained around 55-60mmHg.
Neurological as the patient has t o be disturbed much less than VV'ith treatment on a conventional bed, anxiety and sleep deprivation can be markedly reduced. Genito-urinary It has been demonstrated that the incidence of urinary stasis is reduced, as vvith each turn, t h e r e is impr.oved gravitational emptying of each kidney and b e t t e r bladder drainage.(6)
Mrs M also presented nursing s t a f f VV'ith a number of difficult nursing problems. Her skin vvas very fragile and there vvas a g r e a t risk of decubitus ulcer formation. Both leg fractures vvere unstable and vvith cu mbers 0 me t r ac t ion applied, it vvas difficult to change her position to deliver good pressure care and physiother-apy. Also,
CASE STUDY Mrs M, a 69 year old female, vvas admitted to the intensive care unit folloVV'ing an altercation VV'ith a turning car - Mrs M VV'as a pedestrian. Injuries sustained VV'erei - fractured right humerus - fractured tibia and fibula bilaterally
CONFEDERATION JOURNAL
20
Vol. 1
No.1
too long to allovv propel~ placement of the lovvel~ extremity packs. Hovvever, a large bolt cutter solved this problem, As Mrs M had traction on both legs it allovved us to experiment vvith the lovver extremity traction set-up. The traction apparatus is very versatile and enables you to 'build' exactly vvhat you need, as vve did vvith Mrs M.
any manual movement caused Mrs M extreme pain. Tvvo vveeks follovving her adITlission it vvas decided to place Mrs M on the K.T.T .. We had hesitated in doing this because, at this stage, not all the intensive care unit staff had been instructed in the use of the bed. Hovvever, it vvas felt that Mrs M could benefit enormously from the K.T.T. and so I agreed to provide total back-up and constant inser-vice for the first fevv days, to proITlote staff and patient acceptance of the bed.
Once Mrs M vvas correctly positioned and traction applied, the bed required re-balancing. The bed is designed along the principle of a sail-boat - the bed vvith a patient placed on it IS counter balanced by a 'keel' under the bed. It is most iITlportant to accurately place the patient and balance the bed to prevent excessive vvear and tear on the motor and gear mechanism. This can be time consuming, especially vvhen traction has been added to the bed.
Mrs M vvas to be the first patient in Australia to be placed on the Kinetic TreatITlent Table. Before placing Mrs' M on the bed, I spent a considerable aITlount of tiITle vvith her family, explaining the concept of the bed, shovvingthem hovv i t vvorked and outlining the benefits. If at all possible it is vvorthvvhile placing a relative on the bed first to allovv them to experience it as this can be reassuring for both family and patient.
I had modified the ventilator circuit to prevent drag during rotation, Intravenous lines had ample length provided the I.V. poles vvere positioned close to the bed. The indvvelling cat h e t e r vv,a s p a sse d dovvn through the rectal hatch and the bag vvas hung off the base of the
Mrs M vvasduly placed, positioned and 'packed' onto the bed. At this stage vve had a minor problem vvith the pins in both ankles. They vvere CONFEDERATION JOURNAL
Vol. 1
21
No.1
bed. A t this stage the bed and the patient vvere t-eady for automatic rotation.
Rate: 8 T.V.: 650 P.E.E.P.:8 Fi02: 45%
Mrs M vves naturally very apprehensive and tense. It is important to stay by the patient and maintain eye contact during the first fevv rotations to allay any fears. This vve did vvith Mrs M.
Ph: PC02: P02: HC03: B.E.:
Haemodynamically, Mrs M \Nas stable prior to K.T. vvith a blood pressure range of 120/70 - 100/60, pulse range of 100-120 and a temperatut-e of 38.5....· \Nhich had persisted for the past ten days. Once r o t a t i o n vvas commenced and Mrs M had become accustomed to it, it \Nas noted that there \Nere no changes in her haemodynamic status.
Watching Mrs M through the first fevv .-otations it vvas evident that she experienced pain from her fractured right humerus vvhen the bed vvas in the extreme right lateral position. As the trauma bed has a variable. rotation pin vvhich allovvs you to select suitable degrees of rotation, I changed Mrs M to the moderate right setting. This setting rotates the bed the full 62- on the left ~ide but only rotates to 40- on the right side. As vveight-bearing only begins once you exceed 45- tilt, this prevented her putting \Neight on her right arm, thus cornpletely alleviating her discomfort.
HO\Never, three hours follo\Ning commencement of K.T., Mrs M's oxygenation sho\Ned quite a significant improvement vvith a P02 of 95.8 mmHg being recorded. This vvas such a remarkable change in such a short period of time. T\Nenty-four hours follovving commencement of K.T. Mrs M had a clear chest on auscultation and good air entry in both bases. Chest x-ray shovved resolution of left lovver lobe collapse.
Mrs M vvas commenced on Kinetic therapy at 6:30pm on a Friday evening. Prior to com m .e n c e men t , her ventilator settings and arterial blood gases vvere: mode:
7.55 35.9 56.3 32 9.1
Three days follovving commencement of K.T. Mrs M had been \Neaned
I.M.V.
CONFEDERATION JOURNAL
22
Vol. 1
No.1
from the ventilator and on an Fio2 of 35% had a P02 of 100 mmHg. Mrs M vvas left on the K.T.T. for a further thirty-six hours and then placed on a conventional bed prior to her vvard transfer.
physiotherapy vvas given vvith the bed flat, as side hatches drop dovvn to allovv you to give full range of motion exercises to all limbs. Chest x-rays vvere easy to obtain and did not necessitate moving the patient at all. The x-ray cassette is slotted into a groove unqerneath the bed and simply moved up or dovvn to the desired position. We found the quality of x-ray taken this vvay to be satisfactory.
NURSING CONSIDERA TloNS
The nursing staff vvho cared for Mrs M vvhile she vvas undergoing K.T. found the bed of enormous value both to them and the patient. We found most nursing procedures could be carried out vvhilst the bed vvas rotating. The bed vvas usually only stopped for lengthy procedures such as dressings, blood sampling etc. When vvashing the patient the bed vvas locked in the 62··~ lateral position and the latches unlocked in turn, t h e s u p p o r t packs removed and the exposed area vvashed, The entire back could be vvashed vvithout moving the patient. During Kinetic therapy Mrs M's skin improved remarkably vvith previously· reddened areas disappearing.
Mrs M tolerated kinetic therapy vvell. Traction to both legs vvas maintained vvithout any problems arIsIng. Kinetic therapy enabled her to sleep for long periods undisturbed, vvhich she enjoyed. Also, Mrs M novv experienced little pain as vve did not have to manually turn her every tvvo . hours something vvhich had caused her extreme discomfort due to the bilateral fractures and extensive bruising. Mrs M's fal'T\ily vvere apprehensive at first and needed a lot of reassurance. We found vve needed to take the bed out of rotation for about tvventy minutes during their visit to allovv them better personal contact.
Chest physiotherapy vvas easily carried out vvith the bed locked in the 62- lateral position and suctioning vvhilst in this position allovved for bette,auctioning of the dependent lung. Limb CONFEDERATION JOURNAL
vvith Vol. 1
23
Our first experience the Trauma bed Ot-
No.1
Kinetic Treatment Table, I feel, vvas a great success. Acceptance by the staff vvas overvvhelming. They found it very easy to give total patient care vvith a minimum of fuss. I also think i t significantly reduced Mrs M's stay in the I.C.U.
3. Schimmel, L. et al. A mechanical method to influence pulmonary perfusion in critically ill patients. ,Journal of Critical Care Medicine 5, 6. 4. Welch, G.W. (1981). Effects of kinetic bed on venous filling and emptying of the lovver extremit~ Presented at the Third World Congress on Intensive Care and Critical Care Medicine. Washington
As vve place more patients on the trauma bed I believe the research carried out in the U.S.A. (7) shovving that you can reduce a patients stay in I.C.U. by 50~b, if treated vvith kinetic therapy, vvill be validated.
D.C. 5. Leininger, P. et al. (1983). Some nevv facts about pressure sores. Physicians Update 1\.. 4~
REFERENCES 6. Olson, E.V. (1969). The hazards of immobility. The American ..Journal of Nursing 67, 4.
1. Johnson et al. In vvhat position do healthy people sleep? ,Journal of American Medical Association 94, 2059-62.
7. Adelstein, W. & Watson, P. (1983). Cervical spinal injuries. ,Journal of Neurosuraical Nursing 15, 2, April.
2. Kleitman, N. Sleep and vvakefulness. Chicago: The University of Chicago Press.
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CONFEDERATION JOURNAL
Vol. 1
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No.1