Trauma and Pre Hospital Care - Essay Example

? Trauma and Pre Hospital Care Trauma and Pre Hospital Care Question Focused Assessment with Sonography in Trauma (FAST) is a diagnostic modality that can be used by trauma surgeons to establish whether there are intra-abdominal injuries. The pre hospital management is the care the patient receives immediately in the event that they have been injured. To evaluate a patient who has blunt abdominal trauma poses a challenge to many hospital surgeons and or doctors. There are various modalities that doctors use especially when they are in this condition. These are diagnostic peritoneal lavage (DPL), computerized tomography (CT) and also (FAST) Focused Assessment with Sonography in Trauma which is not available in all countries (Krausz 2001). Yes, FAST has a place in prehospital management because it helps identify the intra-abdominal injuries faster. DPL and CT are the commonly used modalities. These diagnostic regimens are made in such a manner that all general surgeon may be able to apply them in case of evaluating (BAT) Blunt abdominal trauma, in its initial stages (Moore 2005). FAST is used in the initial evaluation stages, but hemoperitoneum is excluded in the diagnostic modalities. In case, the Focused Assessment with Sonography in Trauma (FAST) does not work or turns negative then the computerized tomography and or diagnostic peritoneal lavage (DPL) may be used in the initial evaluation (Schwarcz 2007). When the resort has been to DPL then gross blood on the initial aspiration is what is used to make the clinical decisions. In the event that this is done successfully, that is there been a positive DPL then a CT scan is done as a follow up strategy (Felice 2008). This is especially if there are suspected injuries at the pelvic regions, pancreas, diaphragm and also genitourinary tract. Laparotomy that is exploratory is usually evident in unstable patients (hemodynamically) with a positive FAST. If the patients are stable (hemodynamically) and they have a positive FAST, then the CT will ensure that there is non- operative care and management of injuries (Blow 2008). Many surveillance studies have indicated that the mentioned diagnostic modalities; CT, DPL and repeated FAST are used on stable patients (hemodynamically) with FAST results that cannot be determined (negative results) (Root HD 2002). Most times when these diagnostic tests (CT, FAST and DPL) are carried out the patients usually have manifested abnormal mentation or the findings from examining the patients physically are equivocal. There are instances when patients have the seat belt signs this is managed by ensuring that the patient is admitted, and observation and physical exams carried out on them. In cases where the FAST and or CT test have determined an intraperitoneal fluid then the patient DPL is finally used to determine the nature of that fluid (Rodriguez 2002). Question 2 Bali is a tourist destination for many people especially in the Australian sides. The climate is excellent for holidaying and the destination can suit anyone’s budget. Moreover, the Balinese people are of a friendly nature. This peaceful and happy environment was disrupted once with a nightclub bombing in October 2002. Many people were left injured, and about a hundred people died (Lopez-Viego 2002). The Bali bombing victims were not given normal fluid doses that were set by the Parkland formula. This is because of many reasons. Firstly and foremost, the resources were limited. There are several hospitals in Bali. Sanglah is a leading hospital in the region. On this particular day, Sanglah laid a corridor with a maze and partially covered walkways. The patients were many, and there were inadequate resources to cater for all their needs. The hospital was filled with all sorts of patients ranging from those with minor injuries, Blunt abdominal trauma, minor burns and lacerations (Rodriguez 2002). There were wards that had been set aside for patients who had sustained severe injuries for intensive care. Despite all the efforts that had been made to ensure that all these patients had proper healthcare, there was limited resources and that hindered the success of treating some of these victims (Andersen 2002). There were limited equipment to carry out the operations and evaluations of patients. The oxygen, monitoring equipment, central venous lines and large bore cannulas were also unavailable. Many of the patients who required fluid were not given the ‘normal’ fluid therapy doses as set out by the Parkland formula (Bivins 2008). This is because of all the inadequacies they had. The ‘rule of nines’ is what was used in the estimations of body surface areas percentages (total) and the Parkland formula. These percentages are what were used to estimate the patient’s fluid needs (Bivins 2009). The amounts that each required were written on the patient’s on fluid charts and some on their sheets. The volunteers were instructed to ensure that if patients received the required amount of fluid. The setbacks that were mostly experienced were the problem of minimal flasks especially those that only have 500 ml for the saline (DeMaria 2001). This forced the volunteers to pump in fluids. The bored holes were sometimes blocked or slowed by this. Furthermore, patients underwent excruciating pain as even the pain medications were limited. In the case of the 60 year old male who had crushed into a tree, was administered with pain medication in order to reduce his pain, FAST was carried out followed by CT scans to check the fractures in the femur (Mackersie 2000). Blood transfusion was also done to counter the fact that the patient had lost some blood. Due to the severity of the crush amputation of the leg was done. Administration of oxygen was also done to ensure constant circulation since the patient was short of breath. Question 3 Crush injuries are sustained from instances such as bombing, falling of structures, tornadoes and hurricanes etc. The case in discussion is one of a 25 year old male who is suffering from a blast trauma. He was about six meters away from the blast. He sustained injuries that were internal as he complained of stomach pains and he was bleeding through the nose and ears. If this crush victim does not receive proper medical attention he will lose his life (Rankin 2008). The crush injuries pathophysiology begins with the injury of the muscle and then eventual death of the muscle cells. The three mechanisms responsible for the death of the muscle cells include; lysis that is immediate disruption of the cell, direct pressure on the muscle cells that cause them to be ischemic, the prolonging of this process causes them to cell membranes to leak. As a result of these cells usually switch to anaerobic metabolism (Bilge 2001). Another cause is vascular compromise this is the situation where large vessels are compressed thus causing excessive loss of blood from the patient. Also, in the event of a crush, there are toxins that are released some of these toxins have significant impacts on the individual suffering the injury. The toxins include amino acids, purines (uric acid), myoglobin, lactic acid, nitric oxide among many others (Bilge 2001). The appropriate treatments with regard to fluid, pain, extrication management; the air tract should be secured and protected from dust or any other external bodies. This is essential especially for extrication management as it will free the victim from the area of the blast into a better environment where their conditions may be tackled for their eventual recovery. Ventilation has to be adequate to ensure there is enough circulation of oxygen in the area where the patient is. In the case of fluid, since many people lose a lot of blood in injuries of this kind, most importantly fluid loss or any other dehydration is corrected to the normal state (Fischer 2008). There should be many intravenous lines as a lot of blood or fluid is required at this point. It is essential to note that fluids containing potassium should be avoided at all costs. Normal saline fluid should be encouraged (DeMaria 2001). In this case since the patient kept complaining of stomach pains. It is crucial that a diagnostic modality like FAST Focused assessment with Sonography in Trauma, DPL and CT be applied, but this come right after the ECG is carried out because is what is used to estimate the possible injury levels in before the victim is taken to a hospital setting (Bilge 2001). It is vital to find out which type of hyperkalemia the patient suffers once his crush injury symptoms manifest themselves (Heinemann 2001). This will be essential in evaluating the BAT (blunt abdominal trauma) and thus facilitate appropriate treatment after establishing the cause of pain. For the pain the patient is experiencing it is essential that pain medication be administered (Cantor 2009). Also since the patient was reported to have shallow labored breath and had diminished air entry it is vital that this patient be administered with hyperbaric oxygen. This oxygen might improve the outcome of the patient. Notably, treatment of the patient should begin almost immediately after they have been found before any extrication. Any delays might result in long term effects and even eventual death of the victim. The extrication process can take up to six hours (Barba 2001). Question 4 With reference to question three’s scenario, the possible patterns of injury in this case could be due to the bodily movements from the bombing area to where the body lands after the explosion/ cavitation from the area of impact. In most cases, this injury patterns are as a result of exchange in energy (Van Dongen 2005). The type of trauma encountered in this case is the blunt trauma. As the body lands, it is likely that the pains it encounters are mostly internal. These pains are because of the organ collision. They may include compression, change in velocity that may cause shears and avulsions. There are also possible injuries that may have occurred on the skull of the victim. That explains why the patient was bleeding through the ears and nose. Other possible resulting situations could be because of cerebral contusions (Barba 2001). The Newton’s law states that a body remains motionless unless it has been prompted by a force. In this case the force that has been noted is the one that comes from the bomb. It has exerted a force that has made the bomb that blasted six meters away from where he was. The causes of injury by this force are evident from the confusion of the victim and bleeding from the ears and nose. The energy law states that motions are in most cases prompted by a force. The only possible reason why the twenty five year old was injured was because of the force that blast impacted on him (Schurink 2007). Force also known as energy exchange causes the injury in body tissues. The injuries are mostly as a result of compression, shear, avulsion and contusion. Energy exchange causes cavitation. This mostly occurs due to the motion produced by the force (Blow 2008). The cavity may be temporal or permanent. Temporal cavity entails that that is short lived, dependent on how elastic the object involved is, it is also produced by stretching and the compression particle that is produced is within limits. For permanent cavitation, the energy exchange is usually clearly visible on completion (Barba 2001). It causes eventual destruction due to lack of limits. The energy exchange is also dependent on the two bodies that are interacting; one body may be in motion or both. In this case the body of the blast victim was in motion. The force is also dependent on the particle numbers involved in the interaction; the interface. That is the interacting bodies density and air, water and solid density. The area of interaction is also crucial in determining the pattern of injury. 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