Case Study of Retrieval Medicine in Paramedic Field – Respiratory System Example

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"Case Study of Retrieval Medicine in Paramedic Field" is an interesting example of a paper on the respiratory system.   The patient is the victim of a road transport accident that happened on a country road in the wheat-belt of Western Australia. The patient was unresponsive but still breathing. He had a large laceration on his forehead and bruises around his right eye. Now the pre-hospital plan will incorporate all the necessary medical equipment to give life-saving facilities to the patient. The prime concern of the hospital management should be the speedy prevention of possible hemorrhage.

Equipment that is needed for this purpose is proper intubation equipment like breathing masks, laryngoscope, and endotracheal tubes of different sizes, IV lines, suction, and cardiac monitor instrument, oxygen supply equipment. As the patient can be in trauma, therefore hypoxia can occur anytime. In this case, supplemental oxygen is needed. The pulse rate is high in this patient. GCS stands for the Glasgow coma scale (Purnawan & Upoyo, n.d. ), which is a process, used for clinical assessment of the posttraumatic condition. In GCS process E1 stands for eyes are all right, V2 refers to incomprehensible sounds of verbal response and M3 stands for the stereotyped flexion of motor movement.

GCS of this patient is 6. It can lead to vomiting tendency of the patient, secretion of saliva or other body fluids, secretion of blood, the immune disorder can lead to foreign body attack. Therefore, in this situation, the aircraft option is the best option for the purpose of the safety of the patient, as it will take 35 minutes to reach there. An accident at this level has some other implication, which can further deteriorate the condition of the patient.

It can lead to cervical spine problems, congenital syndrome, anatomic abnormalities, gastric reflux, etc   (Christopher E Trethewy, 2012). Aircraft rescue can only ensure adequate oxygenation and ventilation to the patient so that neuromuscular blocking can be avoided. 1.2 Patient Selection Criteria for Rapid Sequence Intubation: Rapid sequence intubation (Sung Hoon Han, 2012) is an effective airway management technique. Patients who required this service need to have at least any of the following symptoms: Deteriorating the clinical situation with time. Having a problem in taking oxygen. Presence of risk related to anatomic abnormalities, congenital syndrome, gastric reflux, etc. Respiratory as well as ventilator problems. Vomiting, blood secretion, other body fluid secretion, and faint for a long time. It is the preferred method for patients suffering from endotracheal intubation. 1.3 Steps Required In the Performance of Pre-Hospital RSI: Planning: It will take 0-10 minutes.

This step involves the clinical staff and strategic designing of the patient rescue. To facilitate this purpose clinical staffs need to take the medical instruments according to the patient’ s needs (Stollings, Diedrich, Oyen & Brown, 2014). Preparation: It will take 0-5 minutes.

Clinical staffs need to confirm that the intubation equipment is functioning properly. The assistance of the anesthesia specialist is needed. Intravenous access is necessary. Proper planning of essential medicines and the sequence of the treatment is needed. The monitoring of the responses is necessary. Special attention should be given on the endotracheal tube. Clinical staff should ensure that the functional light bulb is operating on the laryngoscope blade (Braude & Braude, 2009). The positioning of the patient: It is for the case of the trauma in which cervical spine injury is suspected.

It should be in a way so that the head and the body will be in proper alignment. Throughout the sequence, the ET tube position should be verified. The cervical spine should be in straight alignment as due to cervical spine immobilization rheumatoid arthritis or ankylosing spondylitis can happen. In this case, neck flexion is prohibited (Lafferty, 2014). Preoxygenation: It will take 0-5 minutes. Oxygen cylinder and oxygen ventilation mask are needed to facilitate this step. The purpose of this step can be achieved through the delivery of high flow oxygen into the lungs.

Ventilation assistance needs to be given through the bag valve mask system. Pre-treatment: This process considers the administration of the medicines to decrease the adverse effects related to the intubation. It is administered with the aim of decreasing the psychological response to paralysis and laryngoscope. Some drugs can be used such as Lidocaine, an opioid analgesic, atropine, etc. These drugs mitigate the psychological reflex that happened due to trauma. Post intubation management: It will initiate mechanical ventilation. A chest radiograph examination needs to be done to assess the pulmonary status of the patient.

Main stem intubation needs not to occur. Medication should involve analgesic and sedative drugs for the purpose of patient comfort. It will help in decreasing the level of O2 demand as well as ICP. 1.4 Benefits and Risk Associated with Rapid Sequence Intubation: Rapid sequence intubation aims to make the emergency intubation easier as well as safer. Therefore, the process aims to decrease the complications related to the intubation process. The main rationale behind the process is to prevent the potential problems related to it such as the probability of aspiration pneumonia, increase in the arterial blood pressure, plasma catecholamine release, heart rate, intracranial pressure, intraocular pressure, etc (Cushman, Zachary Hettinger, Farney & Shah, 2010).

It may restrict the movement of the cervical spine therefore better control can be acquired during the process and which will be less prone to the injury. This process decreases the trauma in the passage of air, which occurs with the intubation. It also decreases the discomfort related to the intubation. Disadvantages of This Process Mainly Include the Following: Side effects and complications related to the drugs taken during the process. The long duration of the process leads to the decease hypoxia (Mace, 2008). Cricothyroidotomy can occur if the airway crushed or due to other emergent procedures in the airway. Critical Assessment: There are many theories, which create controversies regarding the steps of the rapid sequence intubation process.

However, according to the given case and the above analysis, we can conclude that RSI can be taken as a standard medical practice for emergency medicine airway management.

References

Braude, D., & Braude, D. (2009). Rapid sequence intubation and rapid sequence airway (1st ed.). Albuquerque, N.M.: Department of Emergency Medicine, University of New Mexico Health Sciences Center.

Christopher E Trethewy, S. (2012). Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomized controlled trial.Trials, 13, 17. DOI:10.1186/1745-6215-13-17

Cushman, J., Zachary Hettinger, A., Farney, A., & Shah, M. (2010). Effect of intensive physician oversight on a prehospital rapid-sequence intubation program. Prehospital Emergency Care, 14(3), 310--316.

Lafferty, K. (2014). Medscape: Medscape Access. Emedicine.medscape.com. Retrieved 8 August 2014, from http://emedicine.medscape.com/article/80222-overview#a30

Mace, S. (2008). Challenges and advances in intubation: rapid sequence intubation. Emergency Medicine Clinics Of North America, 26(4), 1043--1068.

Purnawan, I., & Upoyo, A. (n.d.). The Effect of Acupressure on the Glasgow Coma Scale in Ischemic Stroke Patients in Goeteng Taroenadibrata Purbalingga Hospital Central Java Indonesia.

Stollings, J., Diedrich, D., Oyen, L., & Brown, D. (2014). Rapid-Sequence Intubation A Review of the Process and Considerations When Choosing Medications. Annals Of Pharmacotherapy, 48(1), 62--76.

Sung Hoon Han, T. (2012). Rapid Spontaneous Reduction of a Huge Intracerebral Hematoma. Journal Of Cerebrovascular And Endovascular Neurosurgery, 14(2), 104. DOI:10.7461/jcen.2012.14.2.104

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