Paramedics as One of the Areas under the Medical Field - Assignment Example

Clinical study Name Institution Course Date Introduction The case study is the study involving situations, an individual or even group of certain people. It is an essential technique practiced in various fields. It can be used to examine relations existing between two or more factors. The case study is commonly put underway by research institutions in trying to find out details about something or a situation (Brouhard, 2015). Clinical set up is one of the fields that utilize such a study. It is essential in analyzing different conditions, symptoms or even effects brought about by distinct stimuli to patients. Being one of the areas under the medical field, paramedics employ the use of case study. Paramedic is a profession that usually operates outside hospital fraternity. It undergoes its operation mainly in emergency situations for example inside an ambulance. It involves serving the work of doctors as they are not available at that moment. Paramedic offers specialized services to patients directly by not taking them to the hospital. Paramedics are required to be good at managing stress. They often work under chaotic, stressful and urgent situations, therefore, the need to manage their stress effectively. By doing so, appropriate and quality work would be guaranteed to patients. Case Study 1 History Call to: A Woman aged 22 years old. Currently complaining of lower abdominal pain and shoulder tip pain. Has been previously well and denies pregnancy. CC: Abdominal pain. IUD: Reported to having intrauterine devices Insitu LMP: Not sure NKDA: She has No Known Drug Allergy. Currently taking Effexor 75mg PMx: Nil Vital Signs: SaO2 - 98% room air Temperature – 36.50c Respiratory rate – 22/min Blood Pressure - 90/60. Pulse rate - 110bpm with amplitude of 1 Pain score - 7/10. Diagnoses Provisional diagnosis: Ectopic pregnancy Differential diagnoses: Urinary Tract Infection, Appendicitis, Vaginitis, hypotension, panic attack Epidemiology / Aetiology / Pathophysiology Tubal pregnancy, also known as ectopic pregnancy, is a complication that comes about when the implantation of fertilized ovum fails to occur in the uterine wall ('Medical treatment of ectopic pregnancy: a committee opinion', 2013). Instead, it usually occurs in the fallopian tube hence the name tubal pregnancy. Research indicates that occurrence of Ectopic pregnancy has been tremendously reducing in the recent past. There is an expectation that, the reduction will be continuing in the next two years until only 0.36 pregnancies out of 100,000 births are related to tube pregnancy. Another study shows that approximately two-thirds of such deaths occurred outside hospital fraternity when they were under emergency services. The complication is mainly as a result of damaged fallopian tube. Therefore, the egg is unable to go through the tube into the uterus. If the egg is finally left to attain maturity in the fallopian tube, it may cause damage to the tube hence the occurrence of vaginal bleeding and also an abdominal pain. Women with IUD insitu are more likely to experience ectopic pregnancy as it increases the risks. This is according to recent researches conducted worldwide. Appendicitis is a condition that occurs when there is an inflammation of the appendix. So far, the purpose of the appendix has not been explicitly stated as a human being can do without an appendix.Failure to take the inflammation carefully, it will lead to the bursting of the appendix (Escher, 2009). Meaning that toxic substances would be released in the abdominal region hence some pain would be experienced. Also, it can cause pain in the shoulder area.As indicated by various researchers, 1 out of 15 people is likely to be having appendicitis. Appendicitis occurrence is common to people between the age of 10 and 30 although we cannot conclude that the rest are safe. Least cases are reported to children under the age of 2 years. Appendix becomes inflamed when there is a particular blockage. Stool, infections or even cancer can be the primary causes of the inflammation. The swelling can result in alteration in the gaseous passage and severe cramps. Hypotension refers to blood pressure being low. Most of the time, hypotension is considered healthy, but this may not be the several cases as it may threaten one’s life. It can be caused by serious disorders of surgical nature. Study concerning hypotension has indicated that people living in urban setup are at a greater risk of developing the complication. However, the condition is common in women compared to men (Halliwill, Buck, Lacewell & Romero, 2012). Excessive loss of blood can lower blood pressure. Additionally, depression or anxiety can also lead to hypotension cases. People with hypotension disorder have a greater tendency of being depressed. Investigations First, I would perform urine pregnancy test. If the result is positive, I would then engage in scanning transvaginal ultrasound. An ectopic pregnancy will be excluded given that intrauterine pregnancy is observed after the scan. I would also investigate chorionic gonadotrophin concentration. Pregnancies under normal circumstances produce lower levels compared to ectopic pregnancy. Test on magnesium and glucose levels is also crucial in determining the level of depression so as to administer appropriate antidepressant. Assessing pregnancy hormone levels as indicated by the blood tests. Treatment Ectopic pregnancy needs to be treated so as to avoid severe blood loss and rupture. Treatment decision depends on the time complication is detected and overall patient condition. I would use of methotrexate as medicine aids at sparing the patient from anesthesia. However, the medicine has got side effects. It is likely to be effective when pregnancy hormones are at lower levels. Also when there is no heart activity in the embryo. Surgery can be appropriate when severe there is severe bleeding or high hCG levels. If she has Rh-negative blood type, then usage of Rh immunoglobulin may be appropriate. It protects later pregnancies from Rh sensitization. Transport Although prehospital care is essential in handling her complications, Quick transport to a surgical facility is also crucial. This depends on the changes in her conditions. If the prevailing conditions pose a threat to her, then the surgical operation is a priority especially ectopic pregnancy that has raptured. References Elliott, W. (2011). Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study. Yearbook Of Cardiology, 2011, 48-50. http://dx.doi.org/10.1016/j.ycar.2011.01.048 Halliwill, J., Buck, T., Lacewell, A., & Romero, S. (2012). Postexercise hypotension and sustained postexercise vasodilatation: what happens after we exercise?. Experimental Physiology, 98(1), 7-18. http://dx.doi.org/10.1113/expphysiol.2011.058065 Medical treatment of ectopic pregnancy: a committee opinion. (2013). Fertility And Sterility, 100(3), 638-644. http://dx.doi.org/10.1016/j.fertnstert.2013.06.013 Case Study 2 History Call to: A pregnant woman aged 34 years old taken to a hospital to deliver. She has had no Eventful pregnancy in the past. Antenatal care attended to by the antenatal clinic at the maternity hospital . She is taking Multivitamin All blood tests, screening and ultrasounds up to date. No abnormalities detected NKDA: has not known drug allergy. GP: She is G1P0 36 week gestation period CC: moderate constant abdominal pain. Pv: No visible vaginal bleeding PMx: Has no PMx Vital Signs: SaO2 - 99% room air Temperature – 36.80c Respiratory rate – 21/min Blood Pressure - 75/50. Pulse rate - 120bpm with amplitude of 1-2 Pain score - 6/10. Diagnoses Provisional: Placental abruption Differential: Constipation, Deep Vein Thrombosis, Placenta previa Epidemiology / Aetiology / Pathophysiology Placenta serves a great purpose during the pregnancy. It provides oxygen and nutrients to the baby. Placental abruption is a condition whereby placenta separates from the uterine wall. It rarely occurs during pregnancy. Separation causes alterations in the supply of nutrients and food to the babyStudy indicates that, under a bracket of 200 births, only one case of placental abruption diagnosed. It represents only 1 percent of total pregnancies, and almost all of the cases can be treated depending on the kind of separation (Saphier & Kopelman, 2013). There are two separation types complete and partial, and they often lead to premature birth cases. In situations where there are multiple placental separations, it is estimated that 15% will result in the death of the baby. The condition causes the uterus to be hard, and one may also have dark blood with no clots. Therefore, when the abdomen is touched rigidness would be felt. This condition usually affects women with preeclampsia and also hypertension. Melasma is a condition that causes a pregnant woman to turn pale or even yellow commonly observed on the forehead, lips, chin, and nose. It may also cause observance of tiny tears beneath the skin. 90 percent of pregnant women globally experience such a condition. These changes are usually caused by hormones or linked to the enlargement of the uterus (Rodrigues & Pandya, 2015). The skin turns pale if one has got deep vein thrombosis and turns yellow if one has cholestasis of pregnancy. For an overweight woman, it can be difficult for the baby to be heard. This is due to padding involving Doppler and baby. Investigations Blood test to determine the complete blood cell (CBC) count. This will aid in determining her hemodynamic status. However, it may not necessarily estimate maternal blood loss Study of Fibrinogen is also crucial. Pregnancy goes hand in hand with hyperfibrinogenemia. If the level of fibrinogen is below 200mg/dl, the coagulopathy may be significant. Prothrombin time (PT) study is also necessary. It helps in the determination of DIC as it occurs in almost 20 percent of patients. Treatment Placental Abruption is treated depending on individual factors. Severity and location of the separation are crucial considerations ('Abruptio Placentae Treatment & Management', 2015). Also, pregnancy age cannot be left behind while assessing the condition. If partial, then extreme bed rest will be a necessary thing to do to her. It is then followed by monitoring her keenly for any changes that may occur. Blood transfusion also may necessitate as well depending on her current situation. If total separation is observed, then the safest thing to do is delivery. In cases where there is fetal stability, I will do a vaginal delivery. Otherwise, caesarean delivery can be done if the fetus is not stable if the mother continues to experience severe bleeding. Unfortunately, reattachment of the placenta to the uterine wall is impossible hence no treatment. For hemodynamically stable patients, patients with no observable fetal jeopardy and those with preterm fetus can have an advantage from corticosteroids. Tocolysis needs to be handled with caution as it may lead to distress on both the mother and the fetus side. Magnesium sulphate is administered during tocolysis. Beta-sympathomimetic may cause cardiovascular complications, and that is why they are much avoided. It may cause tachycardia that may eventually lead to maternal blood loss. Transport Transportation to an Intensive care unit may be necessary after or before giving birth. The necessity arises if she is observed to be hemodynamically unstable ('Abruptio Placentae Treatment & Management', 2015). Such instability may be due to the development of shock, therefore, the need to monitor her central. Encountering complications when undergoing operation can also lead to instability of the mother. A facility containing Neonatal Intensive Care Unit is the most appropriate place to transfer her to in case fetus is observed to be preterm. The transfer should be done after giving birth if stabilization of the mother is required during the delivery. References Abruptio Placentae Treatment & Management. (2015). Medscape. Retrieved from www.http://emedicine.medscape.com/article/252810-treatment#d1 Rodrigues, M., & Pandya, A. (2015). Melasma: clinical diagnosis and management options. Australasian Journal Of Dermatology, 56(3), 151-163. http://dx.doi.org/10.1111/ajd.12290 Saphier, N., & Kopelman, T. (2013). Traumatic Abruptio Placenta Scale (TAPS): a proposed grading system of computed tomography evaluation of placental abruption in the trauma patient. Emerg Radiol, 21(1), 17-22. http://dx.doi.org/10.1007/s10140-013-1155-3 Case Study 3 History Call to: A woman in labor booked into the local, private maternity hospital to birth her baby Antenatal care has been attended to by an obstetrician. PMx: fibroids and asthma Taking Multivitamins, Ventolin PRN All blood tests, screening and ultrasounds up to date NAD Allergy to penicillin GP: G3P2 41 weeks gestation period. Vital Signs: SaO2 - 99% room air Temperature – 36.90c Respiratory rate – 20/min Blood Pressure - 110/70. Pulse rate - 95bpm with amplitude of 2 Labour - 2 hours Contractions – 5 minutely with moderate in strength Fetal heart – 130bpm Diagnoses Provisional: Intrauterine infection Differential: postmature labor Epidemiology / Aetiology / Pathophysiology Intrauterine infection is the most significant although it rarely occurs. The condition is as a result of the premature rupture of membranes leading to the fetus being infected while still in the womb due to microbial invasion of the amniotic cavity (DONG & ZHU, 2009). According to obstetricians, IUI can be a much risky but the truth is that it can, however, be managed easily. IUI is taken to be dangerous because it can cause chorioamnionitis that may lead to the death of both the mother and the baby. The condition registers the least number of pregnancies globally ('IMPACT FACTOR OF INTRAUTERINE INFECTION ON THE DEVELOPMENT OF PERINATAL PATHOLOGY OF NEWBORN', 2013). Postmature labor is a condition whereby the baby has not yet been born after one or more weeks after the normal gestation period. It is also referred to as posterm or prolonged pregnancy (Greer, 2012). It can cause malnutrition of the fetus and poses a high risk to both the mother and the fetus. After the two weeks, the placenta starts to become old and eventually unable to perform its purpose. Therefore, malnutrition of the fetus might occur. This syndrome accounts for 20 percent of total pregnancies that continues past the usually expected dates. It mostly occurs given that the mother has had such a syndrome previously. Also, it may be as a result of irregularity in menstrual cycles. The situation can cause placental perfusion. Usually during the last phases of pregnancy, there is deposition of calcium into blood vessels. There is also deposition of proteins on the placental surface. The two depositions lead to malnourishment of the fetus as they result in placental insufficiency. There is always a necessity for induction of labor for a post-maturity pregnancy. Ultrasounds are mainly used to determine whether the placenta is aging and also the amount of the amniotic fluid. Investigations I would begin by examining her cough and ensure separation of her labia. Then I will confirm liquor discharged and the urine. By coughing, I will be keenly observing; Her cervix dilation Effacement degree Observe openness of the cervix I would smell or test the pH of the fluid discharged to ensure certainty. She might be having gestational hypertension. Assess her breathing and if she is intubated ventilate using 100 percent saturated oxygen. Treatment As a woman with intrauterine infection, there is a tendency that she will be septicaemic. Therefore, she might experience septic as an outcome. I will use intravenous fluids to resuscitate her if the necessity arises. Administer the required inotropes. I will prepare for delivery if need be Prescribe to her intravenous antibiotics. She is allergic to penicillin therefore metronidazole and chloramphenicol are appropriate. The damage may require surgery to be repaired. Hysterectomy may also be necessary. No matter the pregnancy duration, It is crucial to empty her uterus soonest. If it fails to respond spontaneously, I will administer to her oxytocin infusion cautiously Antibiotic therapy should be practiced Transport Prompt transportation may be necessary if her complications worsen Surgery urgency may arise, and therefore availability of immediate transportation from the maternity to a proper surgical facility must be there Further complications may occur after surgery, and, therefore, it can facilitate transfer to an intensive care unit References Brouhard, Rod.(2015).5 Steps to Become a Paramedic.About health.webDONG, Y., & ZHU, H. (2009). Intrauterine infection of the fetus by Cryptococcus:a case report. Acad J Sec Mil Med Univ, 29(12), 1371-1371. http://dx.doi.org/10.3724/sp.j.1008.2009.01371Greer, I. (2012). Evidence over hope for pregnancy complications. Blood, 119(14), 3192-3193. http://dx.doi.org/10.1182/blood-2012-02-410365IMPACT FACTOR OF INTRAUTERINE INFECTION ON THE DEVELOPMENT OF PERINATAL PATHOLOGY OF NEWBORN. (2013). SISP, (5). http://dx.doi.org/10.12731/2218-7405-2013-5-42 Read More