Comparison of Queensland Ambulance Service with other Ambulance Services - Coursework Example

Critical Thinking Questions Student’s Name Institution Critical Thinking Question Comparison of Queensland Ambulance Service (QAS) Current Spinal Injury Management with Ambulance Service of NSW and ACT Ambulance Service Introduction Victims having spinal cord injury demand suitable management within the instant post-injury moment for the survival and reduction of expensive and disabling permanent opportunities of neurological shortages. Surfacing time-essential neuroprotective psychoanalysis demands quick identification and patients’ transfer to centres having experts for early intrusion. The management of patients having spinal injuries is characteristically not steady or standardized in one institution. Neither is it steady or standardized from centre to centre or between centres in geographic areas. The strategies of treatment are grounded upon individual or institutional experiences of the provider, practitioner training and available resources at hospital. Outcome of the patients can be affected by management. Thus, clinicians globally struggle to offer the most excellent and appropriate care. Severally, patients are not fully abreast what is the best care, or, if aptness matters. In multiple situations preeminent care include various treatment mechanisms, all possessing admissible success rates as well as sensible intrinsic risks. Comparison of QAS, Ambulance Service of NSW and ACT Ambulance Service Guidelines The QAS guidelines are as provided in the following explanations. The theory of pre-hospital spinal cord injury (SCI) management is to lessen neurological shortfall and avert secondary injury (Queens Ambulance Service, 2016). That is achieved through various ways. First, suitable spinal immobilisation is performed to the affected individual. Second, high index of SCI’s suspicion is maintained. Third, there is the recognition and life threats’ reversal within the primary survey. The other way is supporting the ventilator and cardiovascular. The other way is ensuring suitable thermoregulation (Queensland Ambulance Services, 2013). Patients possessing neurogenic shock might show poor reactions to volume substitution treatment, diminished blood pressures, and declared bradycardia. In particular, that is correct of spinal cord injuries concerning, or, over the concerned spinal outflow’s site. Patients having taken drugs (counting alcohol) demand extra questioning and assessment before making judgement of a spinal cord injury. As such, care should be employed in such a case. In case the paramedic identifies neurogenic shock, she can administer IV fluids to the patient and offer inotropic support depending on the patient’s condition. Individuals having spinal cord injury should be transported to the spinal centres for further check up and treatment. In more emergency cases, air transport should be used in transporting the patient to the treatment facilities. On the other hand, the guidelines of the ACT Ambulance Service are as follows. First, the patient should be instructed to stop moving the head. Additionally, the neck should not be bended and the head should not be rotated. Moreover, all movements should be reduced. Second, if there is deduced cord lesion, 100% oxygen therapy should be administered. Urinary catheter and IGT should be inserted before extended air or, secondary transportation. On the hand, Ambulance Service of NSW SCI guidelines as follows. Three major areas require being considered when handling victims suspected of possessing spinal cord injuries. First, the care entails avoiding augmenting and enduring spinal cord damage. Second, it entails coping the spinal shock phase. Lastly, the care engrosses coping of the reflex phase. Patients ought to be transported to the hospitals on spinal boards having the spine being completely halted. The management starts with applying the ABC’s action. As such, the circulation, breathing and airway are attended. Recent Change in Australian Resuscitation Council Guideline 9.1.6 The evidence in support of the semi-rigid collar’s use is poor (Saint John’s Ambulance, 2016). As such, some evidence exists of potential damage. The first thing within management of an alleged spinal injury is restriction of spinal movement instead of the placing of whichever cervical collar. The semi-rigid cervical collar’s application is never a priority to management (Saint John’s Ambulance, 2016). Also, it is not an ultimate cure for supposed spinal cord injury. Paramedics are required to exercise great caution with alert patients who posses sensory such as, tingling or motor shortfalls (paralysis). As such, they are obliged to consider waiting for professional help before applying whichever cervical collar or ahead of transporting the patient. Conclusion Spinal cord injury victims’ demand suitable and quick management before their situation deteriorates or they die. The management of patients having spinal injuries is characteristically not steady or standardized in one institution or centre. Some evidence of damage exists of applying semi-rigid collar to spinal cord injury’s patients. Pre-hospital Management of Tension Pneumothorax The primary action within the chest trauma’s management is retaining elevated suspicions levels. After suspecting or identifying a pneumothorax has been made, the subsequent action is deciding whether there is the presence of tension pneumothorax (Lee, Revell, Porter & Styen, 2007). The tension pneumothorax is characterised by tracheal deviation, hypotension, independent deficient breath sounds, enlarged neck veins and tachycardia (Lee, Revell, Porter & Styen, 2007). Once those findings are confirmed, the chest requires being decompressed instantaneously to guard circulatory crumble. In simple terms, decompression of the chest is freeing the air enmeshed in the pleural opening (Gilmore, 2013).The quickest method of doing that is through needle decompression. The procedure involves putting in a big bore needle within the second intercostal gap, at the line of midclavicular. The most favourable needle to utilise in treating tension pneumothorax with grown up patients is the 3.25 inch 14 gauge (or bigger diameter) needle (Gilmore, 2013). At the moment of putting in the needle, it requires being put in at an angle of 90 to the wall of the chest. That is the crucial point since it places the needle in the pleural space (Gilmore, 2013). Using other angles might possess opportunities of striking other structures within the vicinity like the heart or blood vessels. Various steps require being followed when carrying out the chest decompression. First if possible, the patient demands being oxygenated (Lee, Revell, Porter & Styen, 2007). Second, a suitable site should be chosen. As such, the site should be the ailing part at the 2nd intercostal space as well as alongside the mid-clavicular line. Third, the site should be cleaned with povidine solution or alcohol. The other step is preparing the needle. As such, if the needle possesses flash chamber or leur-lock, they must be removed (Lee, Revell, Porter & Styen, 2007). The other step is placing in the needle in the 2nd intercostal space at an angle of 90° to the chest. Importantly, that should be above the 3rd rib. The other step is listening to the exiting air’s rush from the needle (Lee, Revell, Porter & Styen, 2007). The other step involves taking out the needle and leaving in place the catheter, appropriately to discard the needle. The other step is securing the catheter within place using the tape. The other step is ensuring that the tension has lessened and the condition of the patient has improved (Lee, Revell, Porter & Styen, 2007). If no improvement would be realised, the process would require being repeated using another needle inserted next to the 1st needle. The next step would be monitoring and reassessing the patient. If needle decompression would fail, open thoracostomy would be considered. It would then be followed by the chest drain. Within positively pressure aired victims who might possess distinctive air escapes, it would be potentially hazardous covering an unwrapped thoracostomy with commercial chest stick due to the seal blocking’s risk. There are various processes of performing thoracostomy. First, the arm of the patient is seized and the fifth intercostal space is recognized just frontal to the cenral-axillary line. The second step involves cleaning the chest using chloraprep swabstick. The third step is infiltrating local anaesthetic to the subcutaneous tissue; skin downwards the surrounding place and pleura. However, in traumatic cardiac arrests, that step would not be demanded. The other step entails making 3-5cm transverse openings above the 5th rib’s line. The other step is continuing the tubular track via the intercostal muscles utilising dulled dissection along the pleural. Lastly is the insertion of a finger alongside the track in the pleural opening and sweeping about the space to identify the bowel or adhesions’ presence and if there is deflation or inflation of the lung. For a sucking chest wound, Chest Seal is used. The step involves using a tube having a one-valve which expands from the middle to permit air to flee. That is like the 3-sided dressing, though possessing reduced time amount’s for placing. The other approach same as Chest Seal dressing is simply putting a defibrillator pad upon the injury. Even though it never permits pleural air’s escape, the adhesives of pads solves the difficulties of a lot of time required in taping three dressing’s parts. It as well resolves the adhesive’s failure to affix to the chest wall of the patient. If massive haemothorax would have been detected the management would be as offered in the subsequent description. When respiratory compromise would be absent (hypoxia, tachyponea), haemothorax’s drainage would demand being delayed till arriving at the Emergency Department where there will be availability of blood products, cardiothoracic surgery and cell salvage. If a thoracostomy would unearth a huge bleeding from the thoracic opening, a chest sewer would be valuable, but not be required to extend the time of on-scene. Holding tightly a pre-hospital chest sewer for exsanguinating haemothorax would be considered though it is very risky as a result of the presence of a lying beneath pneumo-haemothorax. Conclusion Suffering from tension pneumothorax threatens individuals’ lives. It might occur as either an open or a closed chest wound. The medical practitioner should be eagerly conscious that high likelihood of tension pneumothorax is high if the victim possesses an open disturbance along the wall of the chest. Good evaluation aptitudes, suitable equipment, as well as the education to efficiently ease a tension pneumothorax become critical to saving patients from that critical situation. References Gilmore, S. (2013). Treating Sucking Chest Wounds and Other Traumatic Chest Injuries. Journal of Emergency Medical Services. Retrieved 5 May 2016 from http://www.jems.com/articles/print/volume-38/issue-8/patient-care/treating-sucking-chest-wounds-and-other.html Lee, C., Revell, M., Porter, K, & Steyn, R. (2007). The Pre-hospital Management of Chest Injuries: A Consensus Statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburg. Emergency Medical Journal, 24(3), 220-224. Queensland Ambulance Service. (2016). Clinical Practice Guidelines: Trauma/Spinal Cord Injury. Retrieved 5 May 2016 from https://ambulance.qld.gov.au/docs/clinical/cpg/CPG_Spinal%20cord%20injury.pdf St John Ambulance Australia. (2016). Medical Advisory Panel Bulletin February 2016. Retrieved 5 May 2016 from http://members.stjohn.org.au/docs/Spotlite%202016%20March.pdf Read More