The Influence of Knowledge Skills in Conveying Patient to Hospital - Essay Example

College: The influence of knowledge skills in conveying patient to hospital As a paramedic, one is at the disposal of knowledgethat aids him or her in determining which medical condition are worth being treated in hospitals and which ones can be managed from home (Sear & Mani-Babu, 2011). Managing a patient from home can be done through first aid, use of pain killers and other home made remedies. Some of the conditions that are manageable at home without include back pain, heartburn and indigestion, migraines, acne, constipation and sprains or strains among others. There are many benefits of managing minor ailment at home without necessarily conveying the patients to hospital. One of them is cost cutting measures, minor ailments constitute to almost 80% of costs in UK hospitals, this cost relates to the time spend by the doctors in consultation and more than 91 % in prescriptions. In addition, the time and money spend by the patient are greatly reduced if minor ailments are handled from home (Blackham et al, 2008). One of the common ailments that occur from time to time especially among sports men and women in ankle injury. The nature of the ankle is complex because of its ability to undergo a wide range of movement flexion, eversion, extension and inversion among other movement .It can transverse the uneven ground through the various movements, can support the full weight of the body especially during activities like running and jumping. The ankle indeed has special feature of the human body. When an ankle sprains it is important to carry out a detailed assessment based on the history and patient assessment to make the right decision on whether to convey to hospital or not. One of the best and commonly used assessments for ankle sprain is the Ottawa Ankle Rules (Stiell et al 2008). Ottawa Ankle Rules are simple guidelines put in place by the National Health Service to help emergency physicians in making decisions on whether to use radiography for patients with ankle injuries. These guideline are instrumental towards reducing the use of radiography on ankles, the time wasted in waiting for radiography processes and inflated costs related to radiography among other procedures in the hospital. Clinically, it may not be easy to differentiate between a fracture from a severe sprain, that is the main reason why X rays are carried out. X rays point out the obvious distortion to the ankle or any instability. The Ottawa Rules awe developed in 1992 to reduce the total number of X rays that are unnecessary and at the same time miss out on possible X rays. They are applicable to adults as well as children (Keogh et al, 1998). To successfully carry out an assessment on the ankle, it is vital for a paramedic to understand the anatomy of the ankle. There are two joints that control the movement of the ankle, the true ankle joint commonly referred to as the tibiotalar joint, this joint controls the articulation between the lower side of the tibia, the talus body and the two alleoli. It allows dorsiflexion and the plantar flexion of the ankle. The subtalar joint is the other joint, it controls articulation between the talus and the calcaneus, it makes is possible for the joint to control inversion and eversion of the ankle (Anis et al, 1995). There are a number of ways that a paramedic can use to determine whether a patient should be conveyed to the hospital or not. As stated earlier some of the benefits of not conveying a patient to the hospital include chances of reducing the likelihood of radiography, reducing the entire cost that is likely to occur due to prescription and consultation fee. It also promotes the use of home made remedy that is encouraged for minor ailment (Keogh et al, 1995). Apart from detecting the real cause of a medical problem, radiography has a number of side effects. Some of them include nausea, overexposure of the skin to light which may later cause skin cancer, dizziness and fatigue. Thus as a paramedic it is important to extensively asses a fracture or sprain to warrant the need of taking the patient to hospital and further taking him or her through radiography (Slimmon &Brukner ,2010). Ankle sprains are classified into three major grades, the first one is Grade 1 injuries that that involve the stretch of the ligament that have microscopic tearing and not macroscopic. Grade 1 injuries have little swelling and very minimal functional loss or instability allowing the patient to fully support themselves. Grade 2 injury lead tote stretching of the ligament with a little tearing, it has moderate and sometimes severe swelling. The patient may not be able to bear the weight without feeling sever pain. Grade 3 involves a complete rapture of the ligament followed by immediate swelling and ecchymosis. The patient cannot bear weight and have to experience sever pain if they try to stand. Some of the common causes of acute ankle pain include joint pathology, stress fractures, achilled tensonitis and anterior process of the calcaneus. i) History The history and examination of the sprained ankle helps towards deciding whether there is a higher probability of a fractured ankle or a foot fracture. Applying the Ottawa Rules is the best strategy to be sued by the paramedic. Learning the history of the case will help in determining whether the ankle has a fracture or not. To successfully carry out an efficient history, the following procedure should be undertaken.It is important to ask the patient how long the injury occurred to tell if the injury is still fresh or has undergone some changes. The mechanism of the injury should also be know, some of the mechanism may include crossing un even ground especially during sports or abruptly changing direction .Through this, the paramedic will be able to tell whether there was an inversion or eversion or if the injury was a result of jump. This will enable one to tell the most likely grade of injury that would have occurred. During this process the patient will also need to state the sound that he or she heard during the injury, however this may not be quick in differentiating between a sprain and a fracture. The patient should describe the type of pain that they felt, and what happened after the injury. For example was the patient able to support their full weight, were they able to walk and incase it was a sport, if they were in a position to continue with the game (Cooke & Marshal, 2009). Any previous ankle injury should also be looked into. It will help in learning if the patient has had any previous fracture or sprain and the procedures that were undertaken to control or manage the injury. This will also point out if the patient has undergone previous x-rays and if a fracture was detected in the process. The past medical history should also be used for example if the patient has suffered from osteoporosis and metabolic bone disease. The drug history of the patient will also be determined, for example the use of hormone drugs the Depo for family planning may have a given degree to the contribution of the fracture of sprain. On the same note the long term use of corticosteroid increase the risk of osteoporosis. If the history of the sprain point out that the injury is unlikely to have resulted to a fracture then there will be no point of conveying the patient to the hospital. However, in such a situation, the paramedic should give first aid and other measures that will ease the pain and restore the ankle to s normal position. However, if the history points out that a fracture was imminent, that the paramedic should make it a point to take the patient to hospital (Berquist & Berquist, 2010). ii) Examination The paramedic should also incorporate the patient’s response to get an indication of the normal range of injury and normal range of movement. While examining the patient, the paramedic should be sensitive to the pain and distress of the patient. The following procedures can be used in examining the patient so as to determine whether they should b e taken to hospital or not. Inspection: If the patient was able to walk in by themselves and the extent of discomfort and disability. The physical look of the injured place, that is, if it has a swelling or some bruises. The paramedic should also be able to find out is effusion is present or for any open wound. If for example the patient cannot walk by themselves, there is a swelling and the present of effusion should prompt the paramedic to convey the patient to hospital. If the danger sign are not present, then first aid or home made remedy should be applicable (Dowling, et al, 2009). Palpation: when palpating a patient it is advisable to ask if they are feeling soreness around the area. Getting a verbal response will give the paramedic higher clues on whether the ankle is fractured or not compared to silent palpitation. When a paramedic makes use of the patient’s response, they get their clinical sign from them and no longer deal with objective sign such as heart murmur or enlarged liver. Dealing with an extension of symptompatology and subjectivity in analysing the fracture will be important. If the patient experiences some pain at the calcaneal pressure then the patient should be conveyed to the hospital. Other ways through which examination son the injury can be carried out is examination of the neurovascular injury, examination of the movement or power, co existing bruises or injuries and carrying out of specific tests, that is the Thompson test, talar tilt test, the anterio drawer test and tests for the syndesmosis injury such as the squeeze, inerosseous membrane tenderness test and external rotation stress test ( Slimmon & Brukner, 2010). If the examination points out that a fracture has occurred, then the paramedic should take the step of conveying the patient to the hospital for further analysis. However, if the patient shows very minimal correlation of a fracture with the test conducted, then the paramedic should not convey the patient to the hospital (Dowling, et al, 2009). There are some fractures that are easily and commonly missed, these are proxima fibula, tibial plafond, base of metatarsal and talus. It is also important for the paramedic to farmiliarise themselves with the causes of After assessing the history of the ankle sprain, its causes and completing the examination, the paramedic should undertake the initial management of the injury to the ankle. First of all, a primary survey based on the ABCDE principle of trauma care should be applied. The deformity of the neurovascular status of the injury should be clinically assessed, incase there is neurovascular compromise of the joint; the fracture should first of all be reduced before an X-Ray is undertaken. For simple sprains, the treatment should involve protection, rest, ice, compression and elevation (PRICE), the patient should avoid heat, running or alcohol, massaging should occur within the first 72 hours. Analgesia should be applied if necessary and the paramedic should be kin not to immobilize the joint. For severe sprains, a short period of immobilization in pneumatic brace can be applied to speed up the recovery ( Glas, et al , 2002). The decision, on whether to convey a patient with an ankle sprain to hospital or not is based on a number of factors. As discussed above, a paramedic should conduct an assessment on the history of the patient in regard to the sprain, drug history or any previous occurrence of the same problem. If the history points towards the likelihood of a fracture than the patient should be conveyed to the nearest hospital within the shortest time possible. The same applies to the decision upon conducting an investigation and examination on the injury. Minor sprains should be handled from home to prevent unnecessary alarm that may lead to increase costs and waste of time. As a paramedic, one should discreetly apply the Ottawa Rules to reduce the occurrences of X Rays in the patient with minor sprains without fractures .However; some critical symptoms should not be taken for granted as it may lead to misused fractures that may result to worse problems for the patient. The Ottawa Rules are mostly used by paramedics in determining whether a patient with ankle injury should be taken to hospital or if the injury can be managed right from home (Chandra & Schafmayer, 2010). References Anis A H, Stiell I G, Steward D F, Laupacis A. Cost –effectiveness Analysis of the Ottawa ankle Rules .Annals of Emergency Medicine 1995; 26:422-428. Auleley GR, Kerboull L, Durieux P, Courpied JP, Ravaud P.Validation of the Ottawa rules in France: A study in the surgical emergency departments of a teaching hospital. Ann EmergencyMed1998;32:14–18. Berquist H T and Berquist T H 2010 Imaging of the Foot and Ankle, Lippincott Williams & Wilkins, New York. Blackham J E J, Claridge T, Benger JR 2008 "Can patients apply the Ottawa ankle rules to themselves?". Emergency Medicine J 25 (11): 750–751 Chandra A and Schafmayer A ,Dignostic value of a clinical test for exclusion of fractures after acute ankle sprains. A prospective study for evaluating the Ottowa Ankle Rules in Germany. Unfallchirurg 2001;104 (7):617-21 Cooke M W , Marshal M, Treatment of severe ankle sprain: a pragmatic randomised controlled trial Health Technol Assess. 2009 Feb;13(13) Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and midfoot in children: A meta-analysis. Acad Emerg Med 2009;16 (4):277-287 Indigo T D 2011 Ottawa Ankle Rules Editor, Betascript Publishing, London. Ivin D Acute ankle sprain: an update. Am Fam Physician. 2006 Nov 15;74(10):1714-20. Glas AS; Pijnenburg BA; Lijmer JG; Bogaard K et al. Comparison of diagnostic decision rules and structured data collection in assessment of acute ankle injury. CMAJ 2002 ;166(6):727-33 Keogh S P, Shafi A et al. Comparison of Ottawa ankle rules and current local guidelines for use of radiography in acute ankle injuries. J R Coll Surg Edinb 1998;43:341-343 Kemla E ,Van de Port I and Backx F A systematic review on the treatment of acute ankle sprain: brace versus other Sports Med. 2011 Mar 1;41(3):185-97 Ottawa Ankle rules, Ankle Injury - X-ray for acute injury of the ankle and foot. Guidelines and Protocols Advisory Committee, British Columbia, January 2009. Sear R and Mani-Babu S Managing ankle sprains in primary care: what is best practice? A systematic Br Med Bull. 2011;97:105-35. Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implemetnation of Ottawa Ankle Rules .Journal of the American Medical Association 1994; 271:827-832. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, Stewart JP, Maloney J. Decision Rules for the Use of Radiography in Acute Ankle Injuries. Journal of the American Medical Association 1993; 269:1127-1132. Slimmon D and Brukner P Sports ankle injuries - assessment and management. Aust Fam Physician. 2010 Jan-Feb;39(1-2):18-22 Stiell I, Wells G, Laupacis A, Brison R, Verbeek R, Vandemheen K, Naylor D. A Multicentre trial to introduce clinical decision for the use of Radiography in acute ankle injuries. British Medical Journal 1995; 311:594-597. Van R, Van Ochten and Luijsterburg P A Effectiveness of additional supervised exercises compared with conventional BMJ. 2010 Oct 26; 341: Read More