Sports-Related Injuries, Concussion Management in Adolescent Athletes, Paediatric and Adult Airway Differences - Assignment Example

Critical Thinking Questions Name: Instructor: Course: Date: Critical Thinking Questions Question 1 Introduction Sports injuries are prevalent as well as concussions are among the most common injuries in athletes. This is as a result on what the athletes are exposed to. A concussion refers to a pathophysiological process that is complex that involves mild neurological impairments which heals naturally (Halestead et al., 2010). They can be caused by a direct blow to one of the body parts or the head whereby force is felt in the head. The management of concussions in adolescent athletes has been mainly based on the traditional return to play approach after confirming the symptoms of an athlete are at baseline levels. The severity of concussions varies and there are acute concussions that require proper care as well as treatment and as a result, sports trainers, officials, athletes, and even parents have embraced training in order to recognize as well as increase awareness about concussions than before. Due to the varying degrees of concussions, it is important to make informed decisions regarding treatment and consult professionals and experts from sports medicine, brain injury, and other related fields and handle every case individually. Concussions are characterized by five main features; firstly, they may be as result of “a direct blow to the head, face, or neck” or some other bod part transmitting an impulsive force to the head. Secondly, they are characterized with the onset of mild neurological function impairment that calms naturally. Thirdly, the evidence disturbances in functionality rather than structural harm and can lead to neuropathological changes. Fourthly, the clinical symptoms of a concussion are graded and be characterized with loss of consciousness or not and can be resolved sequentially. Finally, concussions have not evidenced abnormality based on standardized neuroimaging. Concussions are characterized by emotional, physical, sleep, and cognitive signs and symptoms with headache being the primary symptom reported. Current research and return to play management of concussions Some experts in dealing with sport related injuries have reviewed the return to play decisions for adolescent athletes who suffer concussions focusing on post traumatic amnesia, loss of consciousness, concussion number as well as the duration the signs and symptoms of a concussion take to resolve at rest but with exertion progressively as the main influences in determining the return to play decisions. The objectives of concussion management in adolescent athletes is to ensure quick recovery while at the same time making the athlete aware of the activities that can potentially slow the recovery rate and avoid them. Giving concussions adequate time enhances physical as well as cognitive recovery fully in an athlete. The treatment of concussions in adolescent athletes is challenging for the reason that their brains are undergoing development and also there lacks consensus (Straus, 2010). Returning to play for an athlete who has had a concussion is individualized because different people recover differently. The return to play traditional management of concussions is therefore subjected to thorough examination to ensure an athlete only returns to play when an athlete reports no symptomatic signs at rest of during exertion. Recent research has evidenced the need for longer recovery duration to allow cognitive function to recover fully despite the fact most adolescent athletes become asymptomatic a week after a concussion. In addition, a conservative approach should be employed in making decisions regarding return to play of adolescent athletes who have had concussions. It is also evident that most sports bodies as well as institutions have found it imperative to return athlete who are suspected to have concussions to play only after thorough examination and clearance from licensed sports medicine professionals and other relevant experts (Straus, 2010). Current management of concussions therefore contraindicates the traditional return to play management strategy as evidenced by the increased concern on thorough evaluation of concussions by sports medicine professionals to make sure full physical and cognitive recovery of adolescent athletes prior to returning to play. Experts have also engaged in research to establish the long term effects of concussions in order to improve their management as well as ensure awareness to coaches, sports officials, parents, as well as athletes themselves to avoid long term effects that impact on the quality of life in adulthood. Other problems associated with recurrent concussions is the second impact syndrome which occurs if an athlete sustains a concussion and before full recovery gets another head injury. The risks associated with such cases include congestion of the cerebral vascular which can potentially progress leading to swelling of the cerebral part and eventually death. As a result, it is evident that return to play management strategy for concussions in athletes is a contraindication to the proper and effective management of concussions to recover fully. Return to play is thus only appropriate for athletes who are able to recover fully within the anticipated time frame as evaluated by the experts. When the process of recovery takes longer than expected or the athlete has sustained multiple concussions, it is wise not to allow return to play but seek professional advice and care for the athlete. In most adolescents the brain is still developing necessitating many to recommend for a more conservative approach to the management of a concussion. In the event of unclear evidence, the decision-making process becomes very complex even at the professional or expert level and early retirement of the athlete may remain the only option (Concannon, 2014). In addition, it is important to allow for the effective recovery of all functional abilities of the athlete to ensure peak performance is maintained even after return to play through the proper management of concussions. Question 2 Pediatric airway management The ability to manage the paediatric airway effectively is a critical skill to support paediatric life. The paediatric airway bears both anatomical and physiological features that make it different from that of an adult. The paediatric airway has smaller nasal passages and for that reason its management requires an insight of the anatomical features and how they function to allow ventilation in the body. Pediatric airway management varies with age and an understanding of the differences is fundamental in ensuring only the appropriate tools and techniques are applied to the right age group as well as in the assessment of airway management methods that’s support pediatric life. Paediatric and adult airway differences There are numerous differences between a paediatric airway and an adult airway anatomically and physiologically. The paediatric airway has more rostral larynx whereby it is higher at the neck in comparison to that f adults. The larynx is also placed in a cephalic and superior position creating increased acute angulations between the base of the tongue as well as the tongue and therefore to facilitate the view posterior displacement becomes necessary. In addition, the paediatric larynx is also funneled shaped compared to that of adults, which appears cylindrical. The infants have a cricoid cartilage that is undeveloped while adults, the vocal cords in adults remain narrower. The cricoid cartilages develop fully between the ages of 10-12 years (Stricker, 2010). Pediatrics has a relatively larger tongue that may obstruct the airway while mandibles are normally shorter. Infants below age 5 remain obligate nasal breathers and in pre-schoolers there may be prevalent tonsils and adenoids that may necessitate some elective surgery. Therefore, these features lead to reduced upper airway space that affects procedures such as mask ventilation making them complex. The pediatric airway therefore evidences considerable differences from that of an adult and therefore the management of airways in pediatrics presents unique challenges that require a deeper understanding of both the anatomical and physiological to avoid complicating airway problems such as narrowing and also enable use of the most appropriate tools in airway management. Airway assessment, management tools and techniques The successful assessment of the pediatric airway is largely dependent on the knowledge of the physiological, anatomical as well as pathological features of the airway to effectively manage and ensure appropriate tools and techniques are developed for air management are applied. A deeper understanding of the critical differences between the pediatric and adult airway is very important because they imply different approaches on airway management for both infants and adults. The assessment of the airway should therefore be based on a historical analysis through questions that can reveal a potentially difficult airway which include problems during delivery or traumatic conditions affecting the airway. During assessment, signs of infections to the upper respiratory systems should also be analyzed to identify any signs of difficulty in breathing or speaking. Other indicators could be noisy breathing, difficulties during feeding, and hoarseness which can evidence airway issues and help in airway management (Mai, 2014). The management tools and approaches to airway management include mask ventilation that is conducted properly. In adults, one of two available techniques may be applied to reveal obstruction of upper airway emanating from mask ventilation which can be resolved by chin lifting and head tilting while adding pressure to the airway. The chin lift combine with jaw thrust serve to enhance the patency of airway especially in a lateral position. In pediatrics, face mask ventilation may lead to volume increase in the dead space to ventilation volume. The airway management tools have been carefully developed to offer unique services towards airway management and possess both advantages and disadvantages as well. However, it is important to consider some specific features such as the gastric port, reusability potential, ease of insertion, and seal pressure adjustment ability among others. The two most common supralottic tools include “the classic laryngeal mask airway (LMA) and the proseal LMA” which help support safety and effectiveness in pediatrics. The classic LMA has proved to be effective in successfully providing ventilation in children. Additionally, a manometer is normally used to measure the inflation pressure of the laryngeal mask airway cuff (Harless et al., 2014). Pharmacological agent’s benefits and risks Pharmacological agents can be broadly described as any parenteral, oral and topical substances that may be introduced to the body to alleviate or reduce specific symptoms and offer treatment or prevent an illness process as well as promote recovery from harm or injury. Pharmacological agents have both benefits and risks and are administered to the body through different routes in the treatment of pain. The availability of a wide range of pharmacological agents enables physicians and medical practitioners to treat with precision the individual and unique needs of diverse illnesses and patients as well as provide options when the initial pharmacological agent applied to a particular condition is either ineffective or cannot be tolerated by a patient. The are some principles that offer guideline in the optimal management of moderate to severe pain in children which include the two step strategy, regular interval dosing, use of appropriate administration route and design individual child treatment. Mild pain in pediatrics may be treated with paracetamol or ibuprofens that are used as a priority. For pediatrics assessed to have moderate to severe pain, an opioid should be administered to relieve the pain. The major benefit of pharmacological agents is pain relief and the ability to help provide treatment tailored to an individual’s needs and preferences. Pharmacological agents are also available and the withdrawal of a specific one from the market provides backup for another. Additionally, pharmacological agents have helped to improve their safety, effectiveness, selectivity as well as utility with continued research to combine several agents with different therapeutic properties. Pharmacological agents are therefore important in the treatment of ailments and prevention of diseases. They are normally produced in order to exert some effects to the physiological, subcellular, behavioral or the systemic body functions and deal or eliminate possible hazards that cause diseases. On the other hand, they may also exhibit some risks and side-effects to the patient (World Health Organization, 2012). Some of these side effects may include nausea, confusion, dizziness, vomiting, and sedation among others. Some pharmacological agents are also normally contraindicated for special people especially pregnant women because they lead to birth defects, miscarriages and other life threatening conditions. Pharmacological agents are made of chemical elements and may lead to intolerance in some individuals presenting health risks rather than their desired therapeutic properties. In addition, dependence in pharmacological agents is another risk that may present itself in two ways. Firstly, physical dependence on drugs occurs when the body adjusts to a particular drug evidencing distinct symptoms if the pharmacological agent is withdrawn. This risk associated with pharmacological agents use can be life threatening in extreme situations interfering with critical physiological functions and can potentially lead to death. This may arise because physical dependence on a pharmacological agent necessitates its use for the normal function of the body and any withdrawal attempts results in serious complications. Secondly, an individual may develop psychological dependence on pharmacological agent’s evidence by a continued craving for the substance which can result to the compulsive ingesting of drugs. On the other hand, the frequency and consistency varies from one individual to another. Another risk associated with the use of pharmacological agents include addiction whereby an individual may overwhelming get involved in the compulsive use of a particular pharmacological agent. This may be characterized by a relapse is the agent is withdrawn and this is an extreme scenario where the use of pharmacological agents pervades the entire life experiences of the individual allowing the pharmacological agents to control his or her behavior. Administration routes in paediatric patients Paediatric patients should be treated through administration of drugs using the simplest and effective as well as the least painful route to promote their effectiveness (World Health Organization, 2012). This makes oral suspensions the most effective and convenient as well as the less costly administration route. However, other administration routes may used such as subcutaneous, intravenous, and transdermal in the absence of the oral route but this should be based on clinical evaluation, patient choice or availability. In addition, the administration using the intramuscular route is very painful and not recommended. The use of the rectal route to administer treatment presents bioavailability ineffectiveness limiting its applicability for morphine and paracetamol among other drugs. Every administration route has its degree of efficacy though it’s largely dependent on the setting and individual needs for drug administration. Physicians must as a result be able to carry out situational analysis as well as determine the most effective administration route in the treatment of a certain disease or conditions to make sure the most appropriate route is used. In addition, pediatric patients have physiological functions that are still undergoing development and therefore drug administration should be appropriate to the level of physiological functions to prevent interference with critical functions while at the same time ensure the desired treatment is achieved efficiently. Pediatric patients require high level evaluations as well as analysis on the most appropriate route of administration for pharmacological agents. The use of oral method is mostly viable and is one of the most effective in pediatric patients. References Concannon, L.G., Kaufman, M.S., & Herring, S.A. (2014). Competitive Sports: The Million Dollar Question: When should an Athlete Retire after Concussion? Retrieved from http://www.revdesportiva.pt/files/para_publicar/The_Million_Dollar_Question___When_ Should_an.7.pdf Halstead, M.E, Walter, K.D, & the Council on Sports Medicine and Fitness. (2010). Pediatrics: Official journal of the American Academy of pediatrics. Retrieved from http://pediatrics.aappublications.org/content/126/3/597.full Harless, J., Ramaiah, R. & Bhananker. S.M. (2014). Pediatric airway management. International Journal of Critical Illness & Injury Science. Int j Crit IIIn Inj Sci. 2014 Jan-March; 4(1): 65-70. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982373/ Mai, C., Mansour, C., & Padilla, R. (2014). Basics of Pediatric Airway Anatomy, Physiology and Management. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact =8&ved=0CDAQFjAC&url=https%3A%2F%2Fwww.bu.edu%2Fav%2Fcourses%2Fme d%2F05sprgmedanesthesiology%2FPowerpoint%2FPediatric%2520Airway%2FPediatric _Airway.ppt&ei=vThUVfqMFOiv7AbV9YDYDw&usg=AFQjCNEftx05Ws4qPuKlK9G Mdf25kqcl9g&sig2=Vf6epKQT2BzM3k3pN2RAIg Nelson, M. R. (2011). Pediatrics. New York: Demos Medical. Straus, L. B. (2010). Concussion Expert Revises Return To Play Guidelines. Retrieved from http://www.momsteam.com/health-safety/concussion-expert-revises-return-play- guidelines Stricker, P. (2010). Pediatric Difficult Airway Management: New Modalities. Retrieved from http://www.pedsanesthesia.org/meetings/2010winter/syllabus/pdfs/refcourses/fri/peds%2 0airway%20new%20modalities%20final.pdf Wertheimer, A., Levy, R., & O’Connor. (2007). Too Many Drugs? The Clinical and Economic Value of Incremental Innovations. Retrieved from http://www.who.int/intellectualproperty/topics/ip/en/Toomanydrugs2007.pdf World Health Organization (2012). WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medica illnesses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK138349/ World Health Organization, (2010). WHO guidelines for pharmacological management of pandemic influenza A (H1N1) 2009 and other influenza viruses: Part I. Read More