Effectiveness Of Prehospital Oxygen Administration & Anesthesia - Essay Example

Running Head: Effectiveness Of Prehospital Oxygen Administration & Anesthesia Administration Pre-Hospital Oxygen And Anesthesia Delivery In Trauma Patients Name Institution Date Prehospital oxygen and anesthesia administration Prehospital oxygen and anesthesia delivery will entail the care that trauma patients receive before they are able to get the definitive management or the ideal management. The care is mainly aimed at being able to sustain the survival of the patient from the time of occurrence of the medical condition up to when the patient will be able to get the ideal management of the condition he or she will be having. The prehospital care given to the patients will vary from one event to another basing on the protocols which are to be used in the dissemination of care to the patients.prehospital oxygen delivery will involve the artificial supply of oxygen to the patient whereas prehospital anesthesia will involve the use of anesthesia in the management of the trauma patient (Tsai, 1987). For instance , the management of head injury the pre-hospital care will begin with assessment of patient’s and making an overall impression , this will be centered at ensuring the patient is breathing, his circulation is normal and to rule out the life threatening features. The assessment will also involve the analyzing if the scene of the accident is safe for the patient or still offering a threat to the life of the patient. It is also important to take note of the population being affected by the same incident within the same scene. Initial assessment would be that of the airway, checking whether the patient is breathing or not and immediately being able to offer a solution by providing ventilation. This will be followed by ensuring that the airway is patent.Assesment of normal circulation then follows and will involve checking if the patient is actively bleeding; the bleeding has to be arrested by applying direct pressure at the bleeding site, elevation of the bleeding site or using a tourniquet. Assessment of perfusion and this will be by observing the skin color paleness and also the checking of the capillary refill followed by assessment of the patient for any deformities or disabilities (Haluka, 2003). The patient will be assessed basing on the Glasgow coma scale in checking the severity of the injury. Later on, the A.V.P.U (alert, verbal, pain, unresponsiveness respectively) is determined through the patients response to various stimuli (Haluka, 2003).The triage is used while dealing with a large population at the scene or site of accident and will comprise of the immediate who are the patients that will require less time and also equipment to be able to contain there problem and their lives are not at great risk. The delayed includes patients who have an injury but do not require immediate attention even though there condition could get worse as the time progresses (Haluka, 2003). The patient will then be put on oxygen to sustain the perfusion of the brain tissues. Numerous oxygen delivery ways that could be used to offer the administration of oxygen to the patients at the scene. Oxygen is delivered in two ways, the non breather masks and the nasal canula.The two adjuvants mainly vary in terms of the volume of oxygen they are able to deliver. Non breather adjuvants are used mainly in the provision of higher oxygen volumes (Tsai, 1987). Various conditions would lead to difficulty in intubation and when the nature of the trauma in relation to prehospital oxygen delivery. Some of conditions would make the provision of oxygen delivery in this case to be contraindicated and this would go in the long run to affect the outcome which includes the patient sustaining trauma on the neck and significant reduction of the mobility of the neck while at the same time having trauma to the head, the restriction of the movement of the jaw especially in the fracture of the jaw as this would render intubation of the patient to be hard (Murphy R et al 2001). When to administer anesthesia to a patient with head injury Administration of anesthesia in a prehospital scenario starts by rapid sequence intubation.Rapid sequence induction is an anesthetic technique that is used mainly to provide the suitable condition for intubation to be done. The technique is mainly used to prevent the soiling of the airway. the prehospital rapid sequence intubation is also important because it will improve the safety of using anesthesia which will result inspiration especially in emergency surgery.prehospital rapid sequence intubation also goes o to provide the complete relaxation of the muscles for intubation. Prehospital rapid sequence intubation can be performed with different recipes and this will include the use of a sedative agent e.g. etomidate or a neuromuscular blocker e.g. suxamethonium. Prehospital rapid sequence intubation is indicated when the patient will be having the problems in the airway, when the gcs is below 9, or when the patient is having respiratory insufficiency or the respiratory detoriation (Mackenzie R & Lockey DJ, 2004) Prehospital rapid sequence intubation can be grouped into phases which will include: The first phase will involve Positioning which has to do the placing of the patient in a supine position where the patient can be assessed at 360 degrees and this will be done prior to the induction of the patient is done. The positioning should be in a controlled environment for example on the stretcher as this will prevent the dangers of the patient aspirating during the movement of the patient. This could also be done by the use of airway adjuncts. This will be followed by Preoxygenation that will take about five minutes to the beginning of the paralyzing phase. This will also occur five minutes prior to paralyzing and it involves the provision of oxygen with a high reservoir mask. The third phase is Preparation that will entail the carrying out of the abcde and also getting ready of the equipment to be used and enabling the patient to be at a supine and stable position. This occurs five minutes to the paralyzing phase. the forth phase will be Premedication that will involve the giving of medication and in the case of head injury, fentanyl or atropine is given depending on age. This will be done two minutes to paralyzing phase. The fifth phase is Paralysis and sedation where induction and the application of pressure on the cricoid are done. Passage of endotracheal tube will be done 30-40 seconds after paralysis and will involve the use of the bougie.The cord is located and an endotracheal tube is placed. The final phase will be Post intubation care that will involve the inflation of the cuff, the checking of the abcdef before the transfer of the patient to hospital and it will be done a minute after the paralyzation has been completed (Mackenzie R & Lockey DJ, 2004). Administration of anesthesia however should be done by a trained and experienced health personel to avoid fatalities from the procedure. Those not well trained should only be advocated to use the delivery of oxygen alone and rushing the patient to hospital for further management (Miguel A. et al, 2009). The possible side effects of anesthesia delivery would include the risk for hypoxia in a patient with brain injury and this might go on to further add the insult to the injury that has been sustained hence it will even worsen the condition of the patient. The increasing of ventilation when delivering oxygen at a rate that is above 10/min and the presence of a positive end expiratory pressure would further cause the detoriation of the patient and could lead to even mortality (Mackenzie R & Lockey DJ, 2004). Despite the use of prehospital oxygen and anesthesia administration, the mortality of most patients has been on the increase purely because of the secondary insults head injury patients normally have and this would range from; Hyperventilation results from alteration of cerebral metabolism to an aerobic state and a drop of the jugular venous oxygen saturation. All this will result in a considerable increase in the amount of lactic acid within the brain. Hypocapnea will result into the fall of intracranial pressures and ischemia of the brain that eventually result in the increase of the venous congestion hence on providing oxygen and anesthesia would add to the crisis at hand by increase of intrathoracic pressures and a decrease in the venous return to the heart (Miguel A. et al, 2009).Hyperglycemia in traumatic head injuries is associated with marked increase in the hormones, sympathetic responses and catecholamine’s which leads to an increase in the levels of blood glucose reducing the intracranial pressures. Reduction in the amount of cerebral blood flow and a decreased venous return hence even with the provision of oxygen and anesthesia will be realized. This causes the accumulation of lactic acid and an increase of the ischemia of the brain tissues (Moppet, 2007).Hypotension leads to low perfusion of organs and also the brain tissues will be rendered ischemic and this will greatly affect perfusion even when the oxygen and anesthesia are administered due to some cells being already dead due to hypo perfusion (Moppet, 2007). References Mackenzie R & Lockey DJ (2004).Pre-Hospital Emergency Anesthesia, J R Army Med Corps retrieved on 20th April 2011 from http://www.ramcjournal.com/2004/pre-hospital _care/mackenzie5.pdf Tsai (1987).Technologies, therapies and empiricism in pre-hospital care: Retrieved on the 30th March 2011 from www.iitd.ac.in/tripp/publications/paper/injury/mvfiwoco Haluka, M (2003). Pre-hospital trauma life support fifth edition mosby. Moppet, K (2007). British journal of anesthesia 99(1):18-31 Brain injury: assessment, resuscitation and early management. Miguel A. et al (2009). Prehospital Intubations and Mortality: A Level 1 Trauma Center Perspective. Murphy R et al (2000). Emergency oxygen therapy for the breathless patient . Guidelines prepared by North West Oxygen Group. Emerg Med J Read More

The patient will be assessed basing on the Glasgow coma scale in checking the severity of the injury. Later on, the A.V.P.U (alert, verbal, pain, unresponsiveness respectively) is determined through the patients response to various stimuli (Haluka, 2003).The triage is used while dealing with a large population at the scene or site of accident and will comprise of the immediate who are the patients that will require less time and also equipment to be able to contain there problem and their lives are not at great risk.

The delayed includes patients who have an injury but do not require immediate attention even though there condition could get worse as the time progresses (Haluka, 2003). The patient will then be put on oxygen to sustain the perfusion of the brain tissues. Numerous oxygen delivery ways that could be used to offer the administration of oxygen to the patients at the scene. Oxygen is delivered in two ways, the non breather masks and the nasal canula.The two adjuvants mainly vary in terms of the volume of oxygen they are able to deliver.

Non breather adjuvants are used mainly in the provision of higher oxygen volumes (Tsai, 1987). Various conditions would lead to difficulty in intubation and when the nature of the trauma in relation to prehospital oxygen delivery. Some of conditions would make the provision of oxygen delivery in this case to be contraindicated and this would go in the long run to affect the outcome which includes the patient sustaining trauma on the neck and significant reduction of the mobility of the neck while at the same time having trauma to the head, the restriction of the movement of the jaw especially in the fracture of the jaw as this would render intubation of the patient to be hard (Murphy R et al 2001).

When to administer anesthesia to a patient with head injury Administration of anesthesia in a prehospital scenario starts by rapid sequence intubation.Rapid sequence induction is an anesthetic technique that is used mainly to provide the suitable condition for intubation to be done. The technique is mainly used to prevent the soiling of the airway. the prehospital rapid sequence intubation is also important because it will improve the safety of using anesthesia which will result inspiration especially in emergency surgery.

prehospital rapid sequence intubation also goes o to provide the complete relaxation of the muscles for intubation. Prehospital rapid sequence intubation can be performed with different recipes and this will include the use of a sedative agent e.g. etomidate or a neuromuscular blocker e.g. suxamethonium. Prehospital rapid sequence intubation is indicated when the patient will be having the problems in the airway, when the gcs is below 9, or when the patient is having respiratory insufficiency or the respiratory detoriation (Mackenzie R & Lockey DJ, 2004) Prehospital rapid sequence intubation can be grouped into phases which will include: The first phase will involve Positioning which has to do the placing of the patient in a supine position where the patient can be assessed at 360 degrees and this will be done prior to the induction of the patient is done.

The positioning should be in a controlled environment for example on the stretcher as this will prevent the dangers of the patient aspirating during the movement of the patient. This could also be done by the use of airway adjuncts. This will be followed by Preoxygenation that will take about five minutes to the beginning of the paralyzing phase. This will also occur five minutes prior to paralyzing and it involves the provision of oxygen with a high reservoir mask. The third phase is Preparation that will entail the carrying out of the abcde and also getting ready of the equipment to be used and enabling the patient to be at a supine and stable position.

This occurs five minutes to the paralyzing phase. the forth phase will be Premedication that will involve the giving of medication and in the case of head injury, fentanyl or atropine is given depending on age.

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