Paramedic Care, Principles and Practice - Assignment Example

Running Head: Paramedic Quiz Paramedic Quiz Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Lecture Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Question 1 Online medical control has a number of advantages when used by paramedics. First, paramedics are able to deal with novel emergency situations. Secondly, through online medical control paramedics are able to quickly resolve disagreements about the care to be given to the patient (Rottman et al, 1997). OLMC also helps in case there is another medical practitioner on the scene who might assist in patient care. The drawbacks associated with online medical control include increase of on-scene time as it takes time to consult the base station (Rottman et al, 1997). Secondly, online medical control is likely to result in inappropriate therapeutic decisions (Eckstein and Suyehara, 2002). Furthermore, the online medical control needs a qualified physician to be on standby probably at a command stations waiting to issue directions to paramedics on the field. According to Holliman, Wuerz and Meador (1994) the set patient care guidelines result in a lower frequency of paramedic errors than other medical command systems. Furthermore, protocol based care is also founded in recent evidence on patient care on the field which directing physicians in the online medical control may be unaware of. On the other hand some potentially beneficial intervention may not be included in the set care guidelines especially in cases of cardiac arrest (Eckstein and Suyehara, 2002). In conclusion, the set care guidelines are safer command system as compared to the online medical control. Furthermore, in most instances where online medical control is consulted it is only a reiteration of the set care guidelines. Question 2 (a) Vehicles at a road accident The first step in a road accident is to size up the size up and access the situation from all possible angles; evaluate the layout of the accident and asses the flow of traffic in the area and the dangers it posses to the safety of the scene (Coats and Davies, 2002). To control motor vehicle hazards, block or barricade the lane where the accident has occurred and position the emergency vehicle here. Where emergency vehicles are to be used as barricade heavy vehicles like fire apparatus should be used (Khorasani-Zavareh et al 2009). The steering wheel should be turned in a way to direct the vehicle away from the casualty or paramedics incase it is struck by oncoming vehicles. Get people up and down the accident scene to direct traffic away. 2 (b) Mentally disturbed patient with a knife Assess the situation by trying to determine whether the patient may hurt himself/herself with the knife. Count the number of people the patient may harm in case they turn violent. Take a mental note of how quickly you can get assistance from other staff in dealing with the situation (Duxbury and Whittington, 2005).Notify the hospital security of the situation. Try to talk the patient into surrendering the knife while keeping a safe distance from the patient. Do not try to dispossess the patient of the knife as this is very dangerous. If the patient has to be physically disarmed let the hospital security or law enforcement officers take charge. 3. Need for a secondary assessment Secondary assessment also referred to as the head to toe assessment and is a comprehensive assessment of the patient. The primary assessment of a patient is aimed at making sure all life threats are under control. The primary assessment is therefore done under severe time constraints and at this point the underlying cause of patient’s problem is not tackled (Benson, Koenig and Schultz, 1996). The secondary assessment is aimed at caring and discovering the specific problem that are affecting the patient. The secondary assessment is the foundation of care that will be offered to the patient once they are handed over to other medical practitioners. At the scene of an accident a secondary assessment helps to show those who are close by that the patient’s complaint is being addressed. A secondary assessment also gathers information from bystanders and witnesses who may provide crucial leads about the patient’s injury (Bledsoe et al, 2006). The patient’s medical history is gathered during secondary assessment; medical history may provide a basis for the diagnosis of the patient’s problem. Furthermore, medical history is a determinant of the type of medication will receive in the other phases of care. Vital sign including pulse, skin signs, pupils and respiration taken during secondary assessment are important in determining how fast a patient should reach a healthcare facility (Harbison et al, 1999). 4. Vital signs The vital signs that are an indicator to the patient’s condition include the patient’s temperature, blood pressure, respiration rate and heart rate. Others may include skin signs and pupils. Taking more than one vital sign helps to assess the patient’s conditions more accurately by triangulating the information obtained (Holcomb et al, 2005). Furthermore, just one vital sign cannot reveal the patient’s condition without taking the other vital signs in consideration. According to Lorincz et al (2004), the entire chain of health care depends on the accuracy of vital signs taken at baseline. Each vital sign is an indicator of the whether something is going wrong in the patient. A comparison of the patients initial vital sign at baseline are compared to subsequent vital signs results to determine whether the patient’s condition is improving or not. A patient’s temperature is a check for the presence of a systematic infection or inflammation that is indicated by a fever (Schmidt et al, 2000). Increased respiration is mostly a compensating response to shock and is important in the patient diagnosis. 5. Why would an elderly person with a low blood pressure be considered at risk? According to Gheorghiade et al (2006), low blood pressure in elderly patients places the patient at an increased risk of a new-onset heart failure. According to Boshuizen et al (1998), lower rates of diastolic blood pressure in elderly patients is greatly increases the risk of heart failure. Isolated diastolic hypotension indicated by blood pressure less than 60mm Hg places a patient at an increased risk of a fatal heart attack. However, lower systolic blood pressure has not been linked with higher probability of developing new-onset heart failure. Boshuizen et al (1998), agree that elderly patients with low blood pressure are at an increased risk of dying. Working with Systolic blood pressure values, the Glynn et al (1995) found out those elderly individuals who have a systolic blood pressure of less than 140 where at increased risk of dying from any cause. According to Glynn et al (1995), prehospital systolic blood pressure (PHSBP) of below 110mm Hg was a possible indicator of shock in trauma patients above 65 years. Furthermore, elderly patients with a PHSBP below 109 mm Hg spent more time on a ventilator or intensive care. 6. Explain why an unconscious patient should be placed laterally or have their airway Manually controlled by the Paramedic. A patient who is unconscious should be positioned laterally also referred to as the Lateral Recumbent position or the left lateral recumbent. According to Van Herwaarden et al (2000) there are two reasons for placing a patient in this position. First, this position prevents the tongue from involuntarily blocking the airway as would occur the patient was lying on his back. According to Jan, Marshall and Douglas (1994) gravity tends to pull the tongue of somebody who have lost ability to control their muscles towards the posterior wall or the throat in effect blocking the airway. The second reason for placing a patient in the lateral position is to prevent aspiration. Aspiration is a situation where the stomach content enters the lungs as the top of the food pipe (esophagus) is right next to the wind pipe (trachea). The entering of stomach content into the lung may results in an infection referred to as aspiration pneumonia. The first problem of the tongue blocking the airway in unconscious patient can be solved by the use of airway manual control by the paramedic (Fiz et al, 2008). 7. Explain why CCR is becoming preferred over CPR. Cardiocerebral resuscitation (CRR) refers to a patient resuscitation technique that has been shown to decrease the rates of brain damage in the event of cardiac arrest. According to Ewy (2005), the main difference between CCR and CPR is that the former consists of mouth-to-mouth ventilation. The main reason that CCR is preferred is that it does away with mouth-to-mouth ventilation. Mouth-to-mouth ventilation have been found to be counterproductive as they reduce the time a responder is engaged in chest compressions which are crucial in maintaining blood flow in both the brain and the heart (Ewy, 2006). According to Kellum, Kennedy and Ewy (2006), the use of CCR has resulted in a 300 percent increase in survival rate for victims of cardiac arrest. Furthermore, Continuous chest compressions are associated with a decrease in the cases of brain damage among patients experiencing cardiac arrest. CCR also increases the number of people who are willing to perform first aid on victims of cardiac arrest as first responders. 8. Different Compression: ventilation ratio to adults The recommended compression: Ventilation rate for adults is 30:2, while that of children is 15:2. These two significantly different compressions: Ventilation rates are informed by a number of differences between adults and children. According to Babbs and Nadkarni (2004), infants require higher ventilation rates as their respiration rates during illness are much higher than those of adults going up 30/min at the age of 12 and 60/min at the age of three months. It is thus reasonable to choose one ratio of compression: Ventilation for children and another one for adults. However, it is not practical to set a compression: ventilation for children of various ages (Handley et al, 1997). Furthermore, it is easier to tell between a child and an adult in a cardiac arrest emergency situation. A second reason for giving children twice as many ventilations is the difference of etiology of heart attacks between children and adults. According to Mensah, Mendis and Greenland (2004), only 10 per cent of cardiac arrests among children are due to the onset of ventricular fibrillation while incidence among adults are much higher. Therefore, most adult victims of cardiac arrest have a store of oxygen in their lungs making ventilation a less vital. 9. Explain why a poor patient handover can place a patient at risk. Poor patient handover is indicated by a breakdown in communication from the team or person who has been taking care of the patient to another person or group which takes over responsibility for the patient. Patient handovers in health care settings are very common and thus they should be handled effectively (Ferran, Metcalfe and O'Doherty, 2008). One of the risks of patient handover is the partial communication or failure to communicate information that is vital in forming the patient diagnosis. Failure to pass on such information will affect all future treatment intervention applied for the patient. If information such as a patient’s medical history is not handed over properly then the future chain of health care is affected negatively (Jenkin, Abelson-Mitchell and Cooper, 2007). Therefore, patient handover is important in establishing important factors that determine the success of a patient stay in a healthcare facility including the type of medication the patient is going to receive (Ye et al,2007). The risk of poor patient handover is especially great where patients are unconscious or the person who was responsible for the patient before the handover is unavailable for consultation. 10. Why would a randomised controlled trial be better than ‘expert opinion’ when developing Paramedic Patient Care guidelines? Expert opinion as a source of evidence to develop paramedic patient care guidelines has a number of limitations. First, experts are likely to inadvertently or unconsciously use evidence selectively with an almost total disregard of studies that are contrary to their opinion (Wright, Swiontkowski and Heckman, 2003). The personal experience of an expert is also likely to lead to bias in the information provided on the magnitude of effect. Such biases stem from the experts training or experience of situations such as a patient dying in their care (Shekelle et al, 1999). Experts also pose a number of flawed assumptions about the history of diseases and may be under pressure from professional organizations, patients or other medico legal concerns. On the other hand Randomised controlled trials are systematically planned to avoid these pitfalls and biases (Deeks, 2001). References Babbs, C. F., & Nadkarni, V. (2004). Optimizing chest compression to rescue ventilation ratios during one-rescuer CPR by professionals and lay persons:: children are not just little adults. Resuscitation, 61(2), 173-181 Benson, M., Koenig, K. L., & Schultz, C. H. (1996). Disaster triage: START, then SAVE—a new method of dynamic triage for victims of a catastrophic earthquake. Prehospital and Disaster Medicine, 11(02), 117-124. Bledsoe, B. E., Porter, R. S., Cherry, R. A., & Armacost, M. R. (2006). Paramedic Care, Principles & Practice. Prehospital Emergency Care, 10(4), 522-523. Boshuizen, H. C., Izaks, G. J., van Buuren, S., & Ligthart, G. J. (1998). Blood pressure and mortality in elderly people aged 85 and older: community based study. Bmj, 316(7147), 1780-1784. Coats, T. J., & Davies, G. (2002). Prehospital care for road traffic casualties. BMJ: British Medical Journal, 324(7346), 1135. Deeks, J. J. (2001). Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ: British Medical Journal, 323(7305), 15 Eckstein, M., & Suyehara, D. (2002). Ability of paramedics to treat patients with congestive heart failure via standing field treatment protocols. The American journal of emergency medicine, 20(1), 23-25 Ewy, G. A. (2005). Cardiocerebral Resuscitation The New Cardiopulmonary Resuscitation. Circulation, 111(16), 2134-2142. Ewy, G. A. (2006). Cardiocerebral resuscitation should replace cardiopulmonary resuscitation for out-of-hospital cardiac arrest. Current opinion in critical care, 12(3), 189-192. Ferran, N. A., Metcalfe, A. J., & O'Doherty, D. (2008). Standardised proformas improve patient handover: Audit of trauma handover practice. Patient Saf Surg, 2, 24. Fiz, J. A., Gnitecki, J., Kraman, S. S., Wodicka, G. R., & Pasterkamp, H. (2008). Effect of body position on lung sounds in healthy young men. CHEST Journal, 133(3), 729-736. Gheorghiade, M., Abraham, W. T., Albert, N. M., Greenberg, B. H., O’Connor, C. M., She, L., ... & Fonarow, G. C. (2006). Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA: the journal of the American Medical Association, 296(18), 221 Glynn, R. J., Field, T. S., Hebert, P. R., Taylor, J. O., Hennekens, C. H., & Rosner, B. (1995). Evidence for a positive linear relation between blood pressure and mortality in elderly people. The Lancet, 345(8953), 825-829. Handley, A. J., Becker, L. B., Allen, M., van Drenth, A., Kramer, E. B., & Montgomery, W. H. (1997). Single-Rescuer Adult Basic Life Support An Advisory Statement From the Basic Life Support Working Group of the International Liaison Committee on Resuscitation. Circulation, 95(8), 2174-2179. Harbison, J., Massey, A., Barnett, L., Hodge, D., & Ford, G. A. (1999). Rapid ambulance protocol for acute stroke. The Lancet, 353(9168), 1935. Holcomb, J. B., Salinas, J., McManus, J. M., Miller, C. C., Cooke, W. H., & Convertino, V. A. (2005). Manual vital signs reliably predict need for life-saving interventions in trauma patients. The Journal of Trauma and Acute Care Surgery, 59(4), 821-829. Holliman, C. J., Wuerz, R. C., & Meador, S. A. (1994). Decrease in medical command errors with use of a “standing orders” protocol system. The American journal of emergency medicine, 12(3), 279-28 Kellum, M. J., Kennedy, K. W., & Ewy, G. A. (2006). Cardiocerebral resuscitation improves survival of patients with out-of-hospital cardiac arrest. The American journal of medicine, 119(4), 335-340. Khorasani-Zavareh, D., Khankeh, H. R., Mohammadi, R., Laflamme, L., Bikmoradi, A., & Haglund, B. J. (2009). Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators. BMC emergency medicine, 9(1), 8. Lorincz, K., Malan, D. J., Fulford-Jones, T. R., Nawoj, A., Clavel, A., Shnayder, V., ... & Moulton, S. (2004). Sensor networks for emergency response: challenges and opportunities. Pervasive Computing, IEEE, 3(4), 16-23. Mensah, G. A., Mendis, S., & Greenland, K. (2004). The atlas of heart disease and stroke. J. MacKay (Ed.). World Health Organization. Rottman, S. J., Schriger, D. L., Salas, J. H., & Lee, S. (1997). On-line medical control versus protocol-based prehospital care. Annals of emergency medicine, 30(1), 62-68. Schmidt, T., Atcheson, R., Federiuk, C., Mann, N. C., Pinney, T., Fuller, D., & Colbry, K. (2000). Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport. Academic Emergency Medicine, 7(6), 663-669. Shekelle, P. G., Woolf, S. H., Eccles, M., & Grimshaw, J. (1999). Clinical guidelines: developing guidelines. BMJ: British Medical Journal, 318(7183), 593. Van Herwaarden, M. A., Katzka, D. A., Smout, A. J. P. M., Samsom, M., Gideon, M., & Castell, D. O. (2000). Effect of different recumbent positions on postprandial gastroesophageal reflux in normal subjects. The American journal of gastroenterology, 95(10), 2731-2736. Wright, J. G., Swiontkowski, M. F., & Heckman, J. D. (2003). Introducing levels of evidence to the journal. The Journal of Bone & Joint Surgery, 85(1), 1-3. Ye, K., McD Taylor, D., Knott, J. C., Dent, A., & MacBean, C. E. (2007). Handover in the emergency department: deficiencies and adverse effects. Emergency Medicine Australasia, 19(5), 433-441. Read More