Management of Musculoskeletal Injuries in the Trauma Patient - Assignment Example

SHОRT СRITIСАL THINKING QUЕSTIОNS Student’s Name Institution Question 1 For several years now pre-hospital ultrasound has been applied in the assessment and treatment of abdominal trauma victim. In sternly injured patients, studies show that time plays a key role thus the outcome remains significantly dependent on early care in addition to the initial life support. The innovation of portable handheld ultra sound devices which are lowered and powered by batteries has brought about the potential of using ultrasound within a pre-hospital scene. It is important to note that this has gained a possibility for early treatment in addition to early diagnosis. A number of studies in the recent times have been instituted with the purpose of systematically searching for substantiation in regard to the role played by pre-hospital ultrasound in the assessment and treatment of abdominal trauma. However, according to such explorations the data related to the application of ultra-sound in a pre-hospital setting was found to be scarce. Subsequently such data was considered to be of low quality and described a wide-range of patients given that it also exhibited clinical challenges. These past studies as well as ongoing studies have asserted that, from an evidence viewpoint, answering such a question may be a challenge. However it is equally of importance to point out that a number of studies indicate that rapid assessments within pre-hospital settings plays a significant function. All this is for the reason that the outcome of a rigorously injured patient is greatly influenced by the early surgical care delivered as well as the initial life support. Particularly, time is vital in penetrating truncal injury as well as the blunt abdominal trauma. Several research reports have shown that pre-hospital ultrasound is feasible beside the process being reliable in exposure of haemopericardium or haemoperitoneum in comparison to the small accuracy exhibited in haemodynamic measurements and physical examinations as well. When an assessment or diagnosis is carried out early, the pre-hospital physician is provided with the necessary knowledge that help in prioritization of the applicable initial treatment. Pre-hospital ultrasound carried out by non-radiologists has extensively been adopted in several emergency units throughout the globe and especially the United States with an increasingly growing list of therapeutic and diagnostic applications. This is a procedure that has the capacity to provide vital data and information required to direct the management of abdominal trauma patients in the field as well as helping triage such individuals to relevant hospital destinations. The procedure is helps providers decide on the trauma Center preferable in regard to the magnitude of the damage and also assist in choosing on the most appropriate transport method for the patient. Blunt abdominal trauma specifically turns out to be a challenging element when it comes to management of trauma. Detection at the early stages possess a key impact on the outcome of the patient. Computed tomography, in comparison to physical examination, is acknowledged to be specific and sensitive test when considering abdominal injuries considered to be blunt. Nevertheless, it is apparent that computed tomography is contraindicated in patients who are hemodynamically unstable for the reason that it is time consuming. For this reason, “Focused Assessment with Sonography for Trauma” (FAST) delivers speedy and easily pertinent screening technique to detect patients for crucial laparotomy devoid of any additional analytics. This is to show that pre-hospital ultra sound can be carried out with great specificity and sensitivity and this has the capacity to bring about tangible assistance given the condition of a patient. All these point out that pre-hospital ultrasound is even more effective compared to other forms of initial assessment. The inference here can be that pre-hospital ultra sound is accurate and reliable thus provides good grounds for treatment. It has the capacity to guide on best practices for abdominal trauma patients for the reason that it provides a real time assessment. It helps in distinguishing vital cases from those scenarios which can be considered to be modal or not that serious. Pre-hospital ultrasound is reliable when it comes to dictating best practices for abdominal trauma patients and this is in relation to how they should be managed i.e. how they should be moved, what trauma Centers they should be taken to and also what initial treatment they can be offered. All these determine patient outcome and can be considered an evidence based practice. References Bluth, E. I. (2008). Ultrasonography in urology: A practical approach to clinical problems. New York: Thieme. Bluth, E. I. (2008). Ultrasound: A practical approach to clinical problems. New York: Thieme. Trauma Surgery: Volume 2: Thoracic and Abdominal Trauma. (2014). Milano: Springer Milan. King, L. J., & Wherry, D. C. (2010). ABC of Imaging in Trauma. New York, NY: John Wiley & Sons. Question 2 Old age is a well-documented risk factor when considering confrontational outcomes following unrecognized trauma. Patients over the age of 55 are at risk of increased mortality and morbidity and this is because of significant traumatic injuries which in a number of cases go unacknowledged. For this reason geriatric triage is used in the pre-hospital setting for this population so as to increase quality of life and also alleviate suffering. A number of academic explorations conducted in the recent past exhibit that compared to younger counterparts, geriatric trauma patients demonstrated high levels of morbidity as well as mortality. A geriatric triage criteria in the pre-hospital setting for individuals of age 55 and over helps in improving their value of life and may likewise confidently impact the sequence of trauma through reducing pain and bodily, mental, social besides spiritual complications in an all-inclusive way. Older persons are more normally affected by multiple comorbid difficulties. Minor complications may have a greater psychological impression and the accumulative effect of these may be much superior to that of any single disease. Older persons are at greater risk of adversative drug reactions and of iatrogenic ailment and suffer the added problems of mental damage, economic adversity, and social isolation. This is displayed most evidently by epidemiological studies asking chief informants about the symptoms undergone by people in the final year of life. In specific, seeing, hearing, bladder besides bowel regulation complications, mental mix-up and dizziness all upsurge with age. The complications causing pain include, consequently, those that are referred as “the troubles of old age,” in addition to those due to death-causing diseases. An age appropriate geriatric triage criteria in the pre-hospital setting addresses these complications by providing an environment that exclusively allows for disease impact reduction through a palliative approach. The procedure of triage, as it linked to patients of geriatric trauma, refers to the effort of providing the identified population with the relevant range of medical resource while taking into consideration variables such as the population’s communicated desire, the functional survival prognosis, the availability as well as cost of medical resources and also the severity of illness. The pre-hospital phase of care for geriatric trauma patients involves decision making in regard to the fitting destination of patients. Alternative techniques of management are vital to make sure there is high efficiency and superior quality of emergency care for the escalating statistics of geriatric adults in the world. What is needed for adults with acute severe injury and illness is a protocol for case finding as well as rapid diagnosis to sustain early treatment which is condition specific. Improved geriatric triage criteria in the pre-hospital setting for older adults necessitate the providers to look way beyond the diagnosis as this helps solve the impact of other variables in regard to the health of the patient. Such variable comprises of polyphamarcy and chronic medical conditions, finances and transportation, and lastly depression and isolation. This is to imply that geriatric triage criteria in the pre-hospital setting possess a number of benefits for the identified group given the benefits it has the capacity to produce. The quality life delivered by this procedure is exceptional and this is exhibited by a series of studies conducted by a number of research bodies in the past. The studies in a way agree that there is a big difference between the quality of life lived by those who involve in this procedures. Another benefit which can be deemed as not strong though relevant is that the immunity system is boosted thus the opportunistic diseases are kept at bay. It is important to note that opportunistic diseases are always a big problem to the identified population, i.e. individuals above age of 55, because the general immunity always fall down. However the use of geriatric triage approach in a pre-hospital setting always help in guarding against such. Most traumatic injuries in the identified population is always as a result of getting weak both physically and biologically and generally reduced coordination of the whole body. The main point here is that the quality of life is enhanced through using geriatric triage criteria in the pre-hospital setting. References Carpenter, C. R. (2012). Geriatric Emergency Medicine, An Issue of Clinics in Geriatric Medicine. London: Elsevier Health Sciences. Deutschman, C. S., & Neligan, P. J. (2010). Evidence-based practice of critical care. Philadelphia, PA: Saunders/Elsevier. Peitzman, A. B. (2013). The trauma manual: Trauma and acute care surgery. Schmitt, K.-U. (2010). Trauma biomechanics: Accidental injury in traffic and sports. Heidelberg: Springer. Question 3 The management of major pelvic trauma in a pre-hospital setting has included the application of splints such as the T-pod/SAM splint and the MAST/PASG. In this case it will be important to apply the current evidence so as to compare the effectiveness of these apparatuses and thereafter justifying which of one these devices is the most beneficial to the patient when considering a patient having a major pelvic trauma. It may be important to take a look at each of these devices then finally deciding of the best depending on the perceived advantage. However it will be best to consider the characteristics of the ideal pelvic binder then see the device, among the stated, which satisfies the indicated criterions. It is important to note that all these pelvic binding instruments are in a position to give a simple alternative to surgical fixators. An ideal pelvic binder should be user friendly as this will allow for easy application in a pre-hospital setting. Features of an ideal pelvic blinder An appropriate pelvic blinder should be fit for application in the emergency setting but of much importance it should be suitable for use in the pre-hospital environment. For this reason it ought to be light and should be easily applied by a single person. This is because many times when an accidents occurs there are large possibilities that there may only be a single person to help a casualty. For this case the device should not be complex to use as any complexity may lead to slow action thus leading to further damage on the casualty. A complex device, i.e. not user friendly can’t be used by a non-professional but chances of professionals quickly arriving at an accident scene are very low. It is for this reason that complex devices are not preferred for the reason that non-professionals may find difficulty and even fail to use them. For the reason that there may be need for the device to stay put for 24 hours, there is subsequently a need for the device to be inform of a soft material so that it adds comfort instead of creating further irritation. Additionally, the ideal pelvic binder should not encourage pressure ulceration. When a device induce pressure ulceration further damage may result thus further injury in the pelvic area can be expected if the binder is not that soft. Any binder which is not in the shape of a soft material is disqualified. A good pelvic binder should be cheap enough to be disposable or even washable. An expensive device may not be affordable for the purposes of pre-house settings given the financial capacity of different household. For this reason it should be economical. The SAM sling This pelvic binder is user friendly, i.e. easy to apply however it is notable that it limits the accessibility of the groins for purposes of angiography. However for purposes of pre-hospital setting they may come in handy thus are relevant. The T-POD The device is considered to be easy to use. One size is considered to fit all patients for the reason that it is adjustable. It can be fixed by one person in the field as it is designed with a pulley system that is easy to tighten. Again it is light weight and compact and this design of it makes transport easy. It is fully radiolucent as it is made with no metal and for this reason it scanning is made easier as it doesn’t have to be removed. It appears to be the best option that can be used in a pre-hospital setting. The MAST/PASG These two devices operate almost in the same way. It is however uncertain on the exact help they provide as their use has always been full of controversy. Several studies have indicated no significant advantage to individuals with intensive loss of blood above the pelvis. For this they are not suitable for use in a pre-hospital setting. References Management of Musculoskeletal Injuries in the Trauma Patient. (2014). New York, NY: Springer New York. Schmitt, K.-U. (2010). Trauma biomechanics: Accidental injury in traffic and sports. Heidelberg: Springer. Trauma Surgery: Volume 2: Thoracic and Abdominal Trauma. (2014). Milano: Springer Milan. Deutschman, C. S., & Neligan, P. J. (2010). Evidence-based practice of critical care. Philadelphia, PA: Saunders/Elsevier. Read More