The Injury Prevention, Preventing Alcohol-Related Trauma in Youth, Hypothermia as a Potential Beneficial Treatment in Post Resuscitation Cardiac Arrest - Assignment Example

Critical thinking questions Student’s name: Tutor’s name: Institution: Date: Question 1 Your ambulance service has decided to support injury prevention activities in your local community. They are looking for evidence based guidance on whether they should invest in Preventing Alcohol Related Trauma in Youth (P.A.R.T.Y) or a falls prevention program (a standardized paramedic led falls risk assessment conducted by paramedics) for aged care facility residents. The injury prevention activity that the ambulance service needs to support the community is through the Preventing Alcohol Related Trauma in Youth (P.A.R.T.Y). The P.A.R.T.Y initiative program refers to an in hospital program for injury prevention, and is meant for youth between the ages 15 – 18 years old (Banfield et al., 2011). The mandate of this program is to create awareness among the youths regarding the dangers of driving under alcoholic influence. The youths are exposed to situations in which they experience what it would be like to be involved in a car accident. The current community setting has a large number of youths engaging in drug and substance abuse, and through this, they engage in accidents that end up ruining their lives forever. Each year many youths, lose their lives in accidents hence ending their lives prematurely without giving them an opportunity to live their dreams (Hilarski, 2013). Taking up this initiative would provide a viable solution towards ensuring that the lives of the youths are safe and they make sound decisions regarding their future. Through the Preventing Alcohol Related Trauma in Youth (P.A.R.T.Y) initiative, the youths are likely to be informed about the risks and the injuries attached to alcohol consumption and the means through which they can prevent such. In this manner, P.A.R.T.Y seeks to change their attitude towards alcohol consumption and subsequently reduce their risks of falling victims to the same. P.A.R.T.Y is meant for students in high school, and it involves a 2 and half hour presentation that have been approved by the department of education as a resource for sensitizing the students on the effects of drug us in their lives. The training is done in different ways, and one of the most commonly used is the DVD portion of P.A.R.T.Y which takes the students on a realistic journey of what happens from the scene of accident occurrence, over to the emergency department, then to the intensive care unit and finally into the rehabilitation centre. The DVD sums up with testimonials from persons that had survived the accident injuries. The P.A.R.T.Y program has proved to be effective in many countries such ass Canada, United States, Australia among others. The underlying technique triggers critical thinking among the youths and sensitizes them on the dangers of alcohol use and driving (Savola, 2010). The program further involves session where the students are allowed to engage in interactive exercises where they think and critically talk about the alcohol related injury and accidents. One of the factors that make this program effective is that it is performed by professionals such as doctors, nurses, firefighters, nursing students and police among others y who understand the experience and what it takes to recover from alcohol related accidents (Gentilello, 2009). The P.A.R.T.Y option is therefore preferable since it leads to the passing of information across to a large group of people at a given time and equipping them with relevant knowledge on the dangers related to alcohol use as well as the accidents and the impacts they have had on the lives of people. Question 2 The Northern Territory began “no speed limit trial” a 200km stretch of the Stuart Highway in April 2014. http://www.abc.net.au/news/2014-04-08/nt-no-speed-limit-trial-to-be-expanded/5376402. Compose a 500 word evidence based letter to the Northern Territory transportminister Peter Styles supporting or refuting this trial. Ensure your letter includes evidence related to kinematics of injury and the effectiveness of the trauma service in the area of the trial. The no speed limit trial on the Stuart highway, Australia is a move that has been termed as politically motivated and risky, owing to the number of risks attached to the decision. The decision by the county liberal government to abolish the speed limits on the 200km stretch places the lives of motorists as well as pedestrians in a great jeopardy. One of the most affected groups would be motorists. Imposing the no speed limit on the roads would allow motorists to drive at high speeds, which in the long run is likely to lead to a number of accidents (Underhill & Finlayson, 2009). Moreover, the speed limits would give room to people such as drug users to drive recklessly without considering the risks they pose to their cohorts. As well, there are young children and elderly who use the road constantly while crossing or going about their chores. The children may not have sufficient skills to manipulate through the road into safety zones in cases where the vehicles are over speeding. It is thus imperative that the move considers the welfare of children as well as the elderly who may not be quick enough to escape the various accidents likely to occur on the roads (Hegerfeldt, 2013). Over speeding is one of the major causes of accidents globally. Nearly a third of all motor accidents are often attributed to over speeding. It has been established that the faster the speed a vehicle moves, the lesser the time the drive has to react. This implies that a driver moving at a speed of 110KM/ h upon spotting a child crossing the road, may not have sufficient response time to apply brakes or diverge (Hegerfeldt, 2013). The same applies to vehicle breakdowns on the roads where the driver may not have spotted the other vehicle on the road. In 1999, over speeding was considered one of the main contributing factors to fatal car accidents. In fact, it accounted for 30 % of all the fatal crashes, and in these crashes, 12,628 lives were lost. Over speeding comes with a huge economic cost, which was approximated to stand at $28 billion per year by NHTSA (Hegerfeldt, 2013). The above figures are deplorable and imposing the no speed limit rule on the road would increase the chances of fatal car accidents. Over speeding is considered a calculated and deliberate behavior in which the driver is aware of the impeding risks but chooses to ignore the dangers. About 90 percent of legally licensed drivers have admitted to over speeding at some point in their lives and have admitted to committing this act regularly (Barber & Hemenway, 2011). Allowing the “no speed limit” rule on the Stuart high way would therefore place the lives of many citizens in danger, and there would be a number of lives lost during the time. As the research has proven that most drivers over speed knowingly, the case on the Stuart highway would, be no exception since more drivers would be tempted to exceed the recommended speed limit. The number of accidents on the highway is therefore likely to increase, due to recklessness, drunk driving, and minors who may not have legal privileges to drive on the highways (Joksch, 2009). The absence of speed limits on the road is a loophole that may attract minors into testing their driving skills on the busy highway. As a result many more accidents would occur. In lieu of the above argument, it is important that the “no speed limit” limit be abolished on the road and proper safety measures be instituted to protect pedestrians as well as motorist who use the road. Hypothermia is a potential beneficial treatment in post resuscitation cardiac arrest. What is the benefit of hypothermia in trauma resuscitation, and what is the evidence to support your position? Hypothermia was proven t be an effective method of resuscitation as early as 1803. This discovery was made after the Russians covered one of their patients with snow and hopped for a return of spontaneous circulation (ROSC). In the recent ages, there are a number of case reports where therapeutic hypothermia has been used treating injuries (Kwok, Arawwawala, & Kenny, 2012). Subsequently two publications in the year 2002 brought a new revelation into the issue. The publications brought new recommendations which included that unconscious adult patients having spontaneous circulations in their after out of hospital care needs to be placed under between the temperatures 32°C to 34°C for 12 to 24 hours in cases where the initial rhythm is ventricular. The cooling has been observed to be of great importance for in hospital cardiac arrest as well as other rhythms. Consequently a study was performed by the Hypothermia After Cardiac Arrest (HACA) group on patients who had been resuscitated after ventricular fibrillation and Ventricular tachycardia arrest. The individuals were selected randomly to undergo the test with a target temperature of between 32 – 34o C. TH was then induced with the use of mattress to bring cold air over the body, and the low temperature was maintained through the use of ice packs which were added to maintain the temperatures. In regards to the outcome, 75 out of the 136 patients within the hypothermia group reported favorable neurologic outcome, as compared to the other within the normothermia group where only 54 out of the 137 depicted positive response (Walters, Morley & Nolan, 2011). In addition, another study was performed in other four hospitals. In this study, 77 patients suffering from VF arrest were selected and randomly assigned to either the TH or the normothermia groups with a main body temperature of 33oC which was initiated in the field and then arrived at within two hours and was maintained constant through the use of cold packs for 12 hours. In the end, 21 out of 43 patients registered good outcome, and were discharged either to a rehab facility or to their homes. The normothermia group had 34 patients treated out of whom only 9 were discharged (Brown & Bourdeaux, 2011). From the above analysis, it is evident that hypothermia is a potential treatment for post resuscitation cardiac arrest. The two experiments clearly depict the ability of hyperthermia to offer treatment to patients. The main benefits of the hypothermia resuscitation are that it is safe and yields proper results fasts (Brown & Bourdeaux, 2011). From the above mentioned experiments, it is noted that the patients that underwent the hypothermia treatment registered quick response to their situations, as compared to the others that were exposed under normal conditions who did not yield effective results as their cohorts. This proves the notion that the use of hypothermia in post resuscitation cardiac arrest is important and medically viable as a medical intervention. Question 3 Provide the evidence related to two pre-hospital interventions that can be performed by paramedics that will reduce the development of the triad of death (hypothermia, acidosis, and coagulopathy). Regardless of the much advancement that have been made in the field of trauma care over the past decades, trauma still stands out to be the main cause of death among people of various age groups. According to recent research, trauma is still the leading cause of death in the United States, and it is estimated that 40percent of these deaths are caused by hemorrhage. The triad of death mainly comprising of hypothermia, acidosis, and coagulopathy have been particularly identified as the major cause of death for patients suffering from traumatic injuries (Hossain, 2011). A study performed in 1982 revealed that tissue injury and hemorrhage were the major cause of this triad of death. The triad was observed to progress and finally the victim succumbs to death. Researchers have proposed a number of pre hospital interventions that can significantly help in reduction of the triad development. The triad requires close medical attention as well as surgical management, which would help in reducing the occurrence of these (Peer & Schwartz, 2010). Researchers have proven that for successful resuscitation of ill trauma patients, the medical professionals need to have in-depth knowledge about the trauma and its effects. The understanding of these triads of death should be the basis through which the medical practitioners perform their roles (Mikhail, 2009). One of the major steps towards stopping the triad is to stop bleeding. The triad begins and end with bleeding hence engaging in quest to stop the bleeding can help in ensuring that the triad stops. During this process, the professionals should hold pressure through the use of combat gauze, bind the pelvis and apply tourniquet among other options. Doing this helps in the prevention of massive blood loss, which could later on lead to death. The combat gauze is good in preventing bleeding and therefore can offer valid solution to triad patients. In attempt to prevent blood loss, Tranexamic acid should be administered; this is an antifibrinolytic, which stops clot breakdown and therefore decreasing blood loss. This should however only be used on patients whose systems permit its usage (Peer & Schwartz, 2010). Two large studies have revealed that TXA decreases mortality in trauma cases. The administration of this drug would help in stopping of bleeding and ensuring quick recovery. The second pre hospital intervention involves the use of hypothermia. This is where the body of the victim is subjected to temperatures below 35oC for a period of over 12 hours. Hypothermia has been observed to e very effective in treating trauma patients. This method has been tried for a long time and has revealed great results. Despite the many beliefs that hypothermia causes pneumonia, it has equally proven to be effective in treating trauma patients (Mitra et al., 2012). Many patients have shown great response to recovery through the use of hypothermia as compared to the other means of treatments. With this evidence, it can be concluded that some of the pre hospital interventions for the triad of death mainly lies on stopping bleeding. Through these interventions, the triads of death can be prevented. References Hossain, M. (2011). P03-557 - Abstracting the triad of death, existence and adjustment to death: death and adjustment hypotheses. European Psychiatry, 26, 1727. Mikhail, J. (2009). The Trauma Triad of Death: Hypothermia, Acidosis, and Coagulopathy. AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 10(1), 85-94. Mitra, B., Tullio, F., Cameron, P. A., & Fitzgerald, M. (2012). Trauma patients with the 'triad of death'. Emergency Medicine Journal, 29(8), 622-625. Peer, R. M., & Schwartz, S. I. (2010). Development and treatment of post-traumatic pulmonary platelet trapping. The Journal of Trauma: Injury, Infection, and Critical Care, 15(9), 834. Banfield, J. M., Gomez, M., Kiss, A., Redelmeier, D. A., & Brenneman, F. (2011). Effectiveness of the P.A.R.T.Y. (Prevent Alcohol and Risk-Related Trauma in Youth) Program in Preventing Traumatic Injuries: A 10-Year Analysis. The Journal of Trauma: Injury, Infection, and Critical Care, 70(3), 732-735. Gentilello, L. M. (2009). Alcohol and Injury: American College of Surgeons Committee on Trauma Requirements for Trauma Center Intervention. The Journal of Trauma: Injury, Infection, and Critical Care, 62(Supplement), S44-S45. Hilarski, C. (2013). The Relationship Between Perceived Secondary Trauma And Adolescent Comorbid Posttraumatic Stress And Alcohol Abuse: A Review. Stress, Trauma, and Crisis, 7(2), 119-132. Savola, O. (2010). Alcohol Intake And The Pattern Of Trauma In Young Adults And Working Aged People Admitted After Trauma. Alcohol and Alcoholism, 40(4), 269-273. Brown, J. M., & Bourdeaux, C. P. (2011). Predicting neurological outcome in post cardiac arrest patients treated with hypothermia. Resuscitation, 82(6), 653-654. Kwok, A., Arawwawala, D., & Kenny, A. (2012). An audit to assess the effectiveness of therapeutic hypothermia for post-cardiac arrest patients. Resuscitation, 83, e99. Mayer, S. (2009). IN21-TU-01 Hypothermia and post-resuscitation care after cardiac arrest. Journal of the Neurological Sciences, 285(45), S18. Walters, J. H., Morley, P. T., & Nolan, J. P. (2011). The Role Of Hypothermia In Post-cardiac Arrest Patients With Return Of Spontaneous Circulation: A Systematic Review. Resuscitation, 82(5), 508-516. Barber, C., & Hemenway, D. (2011). Too many or too few unintentional car deaths in official U.S. mortality data?. Accident Analysis & Prevention, 43(3), 724-731. Joksch, H. C. (2009). The relation between motor vehicle accident deaths and economic activity. Accident Analysis & Prevention, 16(3), 207-210. Underhill, T. J., & Finlayson, B. J. (2009). A review of trauma deaths in an accident and emergency department.. Emergency Medicine Journal, 6(2), 90-96. Hegerfeldt, G. C. (2013). Driving at the Quantum Speed Limit: Optimal Control of a Two-Level System. Physical Review Letters, 111(26), 13. Read More