Peripheral and Regional Hospitals vs State Major Trauma Center, Administration of Tranexamic Acid, Treatment Modality of Traumatic Brain Injury - Assignment Example

SHОRT СRITIСАL THINKING QUЕSTIОNS Student’s Name Institution Advantages or disadvantages of bypassing peripheral and/or regional hospitals in favor of a State Major Trauma Center There are many factors that have to be considered before deciding to bypass a peripheral and regional hospital such as Worcestershire Royal Hospital in favor of a state Major Trauma Center such as the North West London major trauma centre which is situated at St Mary’s Hospital (Li & Baker, 2012). It is important to note that most of these Major Trauma Center are always far away from the rural areas given their remoteness. As much as bypassing the regional hospital has advantages in most cases the consequences can turn to be very critical and even lead to death of a loved one. The advantages of bypassing a peripheral hospital may be in regard to the quality of the Major Trauma centers. This is to imply that Major Trauma Centers are of quality compared to the regional hospitals thus this serves as an advantage of bypassing. In various cases patients may have to be transferred for a long period of time in the ambulance to a major trauma center than they would have done suppose they were taken to the nearest peripheral hospital. Nevertheless it means that on arrival, patients are to be attended to by a specialist through all expertise as well as facilities required. It is important to note that there are some critical cases that should always be taken to the nearby peripheral hospital for cases of immediate response. This is because there might be adverse effects on survival suppose such critical cases are subjected to delays of treatment. For major trauma patients, spending additional extra time before accessing a hospital which has the appropriate team of experts is more valuable than accessing the nearest peripheral hospital. Expertise attention at major trauma centre possesses a significant impact on the journey time that is the duration taken in the ambulance, on medical outcomes and has the potential of increasing the rates of survival by 20 percent. Individuals who sustain critical injuries require superior quality specialist care to provide them with the best recovery and even survival chances. For patients who are seriously injured access to specialized treatment at a major trauma centre delivers huge impact on their medical outcomes than the trip duration to hospital. As opposed to the local or peripheral hospitals Major Trauma centers like such as the North West London major trauma centre which is situated at St Mary’s Hospital have the capacity to save lives and subsequently foil any long term disabilities. This is achieved by providing patients with urgent admission to devoted theatres which boast of specialist trauma teams. State of the art equipments are used in such Major Trauma Centers. All this is done to guarantee instant treatment, 24 hours a day, throughout the week. It is important to note that peripheral hospitals such as Worcestershire Royal Hospital lack the much needed expertise as well as facilities to deal with grave cases. Peripheral hospital such as the one indicated above lack the appropriate rehabilitation that is witnessed at the St Mary’s major trauma Centre. For this reason bypassing the peripheral/ regional hospital in preference of the Major Trauma centre may prove to be an advantage. The major trauma centre boasts of support from dedicated disciplinary therapy teams (In Oestern, Trentz & In Uranues, 2013). The staff comprises of dieticians, language and speech therapists, occupational therapists and physiotherapists who have extensive assortment of specialist skills including acute respiratory management, hand therapy, amputee prosthetic limb management, orthopedics, pediatrics and neurosciences. This is to mean that going to the peripheral hospitals instead of the Major Trauma Centre will imply foregoing the bet procedures of rehabilitation and this can have dire consequences on the recovery and healing process of the patient. The inappropriately skilled staff at regional hospitals does not help the patients in sufficient recovery from the time of admission. In conclusion, it is significant to note that advantages as well as disadvantages of bypassing peripheral and/or regional hospitals in favor of a State Major Trauma Center depends on the quality exhibited by both. As much as the regional hospitals may be important in stabilizing a patient who is in a critical condition and needs the most urgent attention, it does not have the necessary quality in terms of expertise and equipment to enhance recovery from major traumas. References Li, G., & Baker, S. P. (2012). Injury research: Theories, methods, and approaches. New York: Springer. In Oestern, H.-J., Trentz, O., & In Uranues, S. (2013). General trauma care and related aspects. Great Britain., & Great Britain. (2010). Major trauma care in England: Report. London: Stationery Office. Discuss the current evidence related to the administration of TRANEXAMIC ACID in severe trauma. Include in your answer the indications, contraindications and side effects of this medication. TXA is a competitive inhibitor of plasminogen. Subsequently at a high concentration tranexamic acid turns out to be a non con competitive plasmin inhibitor. This implies that TXA hinders the fibrinolytic procedures in the similar means as aminocaproic acid. It is found to be approximately 10 times more effective than aminocaproic acid (Bradman & White, 2007).Considerably; TXA binds more sturdily than aminocaproic acid to both the weak and strong locations of the plasminogen molecule in a ratio matching the effectiveness variation existing between the compounds. Administration of tranexamic acid also known as the TXA at an early stage has been linked with a drop in mortality rate as well as blood product requirements in rigorously injured patients. Subsequently, it has significantly shown condensed loss of blood in addition to transfusion requirements in key elective pediatric surgery. However, in regard to the administration of TXA in pediatric trauma no published data have inspected. Tranexamic acid is useful in cases of severe trauma; this is in consistency with a retrospective assessment of the entire pediatric trauma cases reported and admitted to the North Atlantic Treaty Organization Role 3 hospital situated in Camp Bastion. This is in Afghanistan. A logistic regression analysis of select sub groups as well as patients was undertaken to make out factors related with mortality and Tranexamic acid use (Bissonnette & Anderson, 2011). In this case the set adult dosing of Tranexamic was administered to all patients. The acid was administered in just about 10% of pediatric combat trauma patients, characteristically in the situation of metabolic acidosis, rigorous abdominal or extremity trauma. The administration of tranexamic was in parallel associated with mortality decrease. There existed no undesirable safety- or medication-associated impediment acknowledged. Therapeutic indications TXA is indicated for short term usage for risk of hemorrhage or hemorrhage in patients with increased fibrinogenolysis or fibrinolysis. 1. Local fibrinolysis as occur in the conditions stated below: a. Surgery of the bladder and prostatectomy b. Traumatic hyphaema c. Cervix conisation d. Epistaxis e. Menorrhagia 2. Hereditary angioneurotic oedema 3. Managing haemophiliacs dental extraction Contraindications TXA administration is contraindicated: 1. In patients having subarachnoid hemorrhage This refers to an unusual kind of stroke that is brought about by bleeding on the brain surface. It turns to be a very severe condition and can lead to death. 2. In patients who are hypersensitive to tranexamic acid or any related ingredient. 3. In patients having intravascular clotting. Disseminated intravascular clotting refers to a state where by blood clots form all over the small blood vessels of the body (McDonald, Burroughs, Feagan & Fennerty, 2010). Such blood clotting has the capacity of reducing in addition to blocking the flow of blood thus destroying the organs within the body. 4. In patients having acquired defective color vision. Side effects Swelling or pain in both or one leg Migraine headache Problems with vision comprising color vision Sudden weakness or numbness, particularly on a single body side Breathing difficulties and sudden chest pains Back and joint pain Runny or stuff noise Cramping or muscle aching References Bradman, V & White, R (2007). Handbook of drug administration via enteral feeding tubes. Place of publication not identified: Pharmaceutical Press. Bissonnette, B., & Anderson, B. J. (2011). Pediatric anesthesia: Basic principles, state of the art, future. McDonald, J. W. D., Burroughs, A. K., Feagan, B. G., & Fennerty, M. B. (2010). Evidence-Based Gastroenterology and Hepatology. New York, NY: John Wiley & Sons. Therapeutic hypothermia as a treatment modality of Traumatic Brain Injury (TBI) Therapeutic hypothermia refers to an intervention applied in reduction of the core temperature of the body to below 35 degrees Celsius. This approach has gained dominance in the management of acute injury of the brain after a number of small clinical experiments in patients following Traumatic Brain Injury, stoke and cardiac arrest. The most significant characteristic of Traumatic Brain Injury revival is that no therapeutic involvement has been verified to improve outcome (Morganti-Kossmann, Raghupathi & Maas, 2012). After TBI, therapeutic hypothermia is normally belated because of investigation, resuscitation and stabilization of the polytrauma patient who may have various instant treatment options. Subsequently it is thought that hypothermia may be contraindicated in the hugely wounded patient for the reason that it has the capacity to contribute to coagulopathy. Up to date, eight Meta analyses have been carried out to establish the importance of therapeutic hypothermia in managing TBI. The Meta analyses have indicated that no high quality controlled trials which are random have been undertaken in this topic. They further show that all studies vary in their procedures and that not all researches comprise sufficient allocation randomization and concealment. A Cochrane assessment on therapeutic hypothermia in TBI from 2009 exhibited that there may be therapeutic advantage in the usage of hypothermia in rigorous TBI, with enhanced neurological outcomes and decreased mortality (Parrillo & Dellinger, 2014). Nonetheless, important advantage could merely be recognized from low quality trials and consequently the multi center trials of high quality discovered no statistical variation in the possibility of death following a TBI. This is whether management is undertaken by use of therapeutic hypothermia or not. All of the discussed explorations have assessed the application of early prophylactic therapeutic hypothermia. How hypothermia works The objective is to enhance functional outcomes by neuro-protection of neural tissue after an acute injury of the brain. Therapeutic hypothermia is pleiotropic and possible means it is thought to avert the death of the neuronal cell includes: 1. Through creation of a positive balance between demand and supply of oxygen through reduction of the cerebral metabolic rate. 2. Prevention or reduction of the blood brain barrier interruption through reduction of the arteriole permeability thus, consequently, inhibiting the development of cerebral oedema. 3. Condensed free radical development. 4. Reduced inflammatory reaction, comprising a shrink in the release of pro-inflammatory polymorphonuclear leukocyte and cytokines adhesion in the injured brain. 5. A reduction in the seizure activity, which subsequently diminishes the rate of cerebral metabolism and the potential of ischaemia. 6. A decrease in the manufacture of excitatory neurotransmitters, like glutamate. 7. Condensed apoptosis, a pre dominant outcome in all kinds of CNS- Central Nervous System Injury. Methods of cooling Cooling is normally well thought-out under the caption ‘maintenance’ and ‘induction’. Hypothermia induction needs careful preparation of the patient, comprising focal body warming, amplified sedation, and shivering management (Zasler, Katz & Zafonte, 2013). Effective techniques for therapeutic induction comprise brisk intravenous combination of intra- nasal nebulized perflourocarbon or intravascular cooling catheters with 20-30ml/kg refrigerated 0.9% sodium chloride. Both of these incur a significant cost. Hypothermia maintenance is normally supplied through surface cooling, without or with closes-loop feedback. A number of these apparatuses are blankets which are re useable which are less effectual however are not expensive, or water circulating hydrogel heat exchange pads, that are effective but are associated with huge costs. Such approximately cost 500 dollars per patient in the United Kingdom. Low-priced surface cooling with icepacks has the capacity of leading to erratic temperature control with possibility for low and high temperatures and can subsequently be labor demanding (Morganti-Kossmann, Raghupathi & Maas, 2012). Core cooling is attained by the application of intravascular catheters that bring about quick cooling with dependable closed-looped sustenance of temperature which is preferred. Nevertheless, it entails the usage of an all-encompassing process and has related process- and device- specific risks. On the other hand, extracorporeal circuits like cardiopulmonary bypass circuits can be put to task; such are effective in addition to being fast in attaining hypothermia however are not practical in the intensive care unit (ICU) situation and extremely insidious. It is normal to use a permutation of cooling (maintenance) and core (induction) approaches to attain the preferred brisk cooling and then to offer sustenance of hypothermia. Before concluding it is important to point out that traumatic brain injury (TBI) is a key cause of disability and death globally. Every year in the European Union (EU), TBI accounts for approximately one million hospital admissions, for the majority of the 10000 severely impaired severely impaired victims as well as 50 000 road traffic deaths. The long term morbidity of the disease and mortality are consequently related to an enormous societal and financial. Approaches to enhance outcome thus possess an essential role in the sharp management of TBI patients. References Morganti-Kossmann, C., Raghupathi, R., & Maas, A. I. R. (2012). Traumatic brain and spinal cord injury: Challenges and developments. Cambridge: Cambridge University Press. Parrillo, J. E., & Dellinger, R. P. (2014). Critical care medicine: Principles of diagnosis and management in the adult. Philadelphia, PA: Elsevier/Saunders. Zasler, N. D., Katz, D. I., & Zafonte, R. D. (2013). Brain injury medicine: Principles and practice. New York, NY: Demos Medical Pub. Read More