the role that paramedics play in improving patient outcomes Academic Essay

Report This task requires the development of a report (2300 words) that investigates the role that paramedics play in improving patient outcomes (including survival rates and reduction of disability) in specific areas of trauma management. The intended audience are paramedics in Australia and New Zealand, and the report should be in a format that could be submitted for publication in a paramedic journal, for example the Journal of Paramedic Practice. Topic Intravenous isotonic fluid has been used by paramedics for several decades to restore intravascular volume and improve perfusion in cases of hypovolaemia associated with trauma. However, evidence suggests that crystalloid such as Hartmanns solution or normal saline can dilute clotting factors and increase the risk of hypothermia. In addition, the administration of large volumes of fluid may increase systolic pressure and dislodge clots, causing re-bleeding where haemostasis may have already occurred. You are asked to write a report that analyses the evidence for the use of fluids and blood products in the management of severe hypovolaemia in trauma. This report must examine the application of the evidence in the paramedic practice setting, and this should include an analysis of the strengths, limitations and risks associated with the interventions that are included in the report. Recommendations for practice must be included in the report. The topic will require a literature search through a database such as PubMed. If you cannot find data on the selected topic this may indicate that your search strategy was limited or did not include reliable search terms. Writing the report The following structure is recommended: Introduction (approximately 500 words). This section sets the scene for the reader. You should clearly describe the topic you are investigating and inform the reader why this is an important area of study, and briefly explain how you are going to report on the topic. Methods (approximately 250 words). Describe the methods used to search for evidence and the inclusion/exclusion criteria used. You should list the search terms and databases used to conduct the search. Results (approximately 250 words). This section lists the evidence that addresses your research topic. You will need to analyse the evidence and describe strengths and weaknesses. For example, were there weaknesses in the study design? How may the results apply to paramedic practice in Australia? Include results, figures and measurements. Discussion (approximately 1250 words). What are the implications for paramedic practice? Is there a need for further research due to gaps in the existing evidence? Are the findings reflected in current paramedic practice guidelines? What recommendations could you make regarding current or future paramedic practice? Conclusion (approximately 250 words). This final section summarises the report, but does not include any new information. There should be sufficient information in the conclusion for the reader to understand the focus of your study and the outcomes of your investigation of the evidence. Please also include evidence throughout the scope of the report (Intro, results, discussion, recommendation, and conclusion): -That crystalloid such as Hartmanns solution or normal saline can dilute clotting factors and increase the risk of hypothermia. -The administration of large volumes of fluid may increase systolic pressure and dislodge clots, causing re-bleeding where haemostasis may have already occurred. -Analyse the evidence for the use of fluids and blood products in the management of severe hypovolaemia in trauma. Please make sure the report structure follows a logical order and links to each section. Please include Results figures and measurements throughout the report, especially to appear in results section. Please keep in mind the following areas when writing the report. To assess the effects of early versus delayed, and larger versus smaller volume of fluid administration in trauma patients with bleeding Correlation between tachycardia, hypotension bradycardia and fluid resuscitation in hypovolemic patients. Hypotensive trauma patients to receive fluids compared to no fluids Early fluid administration vs no fluid Large vs small volume fluid resuscitation I have included some references and studies to include for the report- Intro, results, discussion, recommendation, and conclusion. (Please see below) References for repleting intravascular volume- Nolan J 2001, Fluid resuscitation for the trauma patient, Resuscitation, 48(1):57-69. Dantzker D 1989, Oxygen Delivery and utilisation in sepsis, Critical Care Clinics, 5:81-98. Stern SA 2001, Low-volume fluid resuscitation for presumed hemorrhagic shock: helpful or harmful? Current Opinion in Critical Care, 7(6):422-30. Bickell WM 1993, Are victims of injury sometimes victimised by attempts at fluid resuscitation? Annals of Emergency Medicine 1993;22:225-6. Bickell WH, Bruttig SP, Millnamov GA, al e 1991, The detrimental effects of intravenous crystalloid after aortotomy in swine, Surgery, 110:529-36. Burris D, Rhee P, Kaufman C, al e 1999, Controlled resuscitation for uncontrolled hemorrhagic shock, Journal of Trauma Injury, Infection and Critical Care, 46:216-23 Turner J, Nicholl J, Webber L, Cox H, Dixon S, Yates D 2000, A randomised controlled trial of pre-hospital intravenous fluid replacement therapy in serious trauma, Health Technology Assessment, 4(31 Fowler R, Pepe PE 2002, Fluid resuscitation of the patient with major trauma, Current Opinion in Anaesthesiology 2002, 15(2):173-8. Revell M, Greaves I, Porter K 2003, Endpoints for fluid resuscitation in hemorrhagic shock, Journal of Trauma Injury, Infection and Critical Care, 54(5 Suppl):63-7 Champion HR. Combat fluid resuscitation: introduction and overview of conferences 2003, Journal of Trauma Injury, Infection and Critical Care, 54(5 Suppl):7-12. The Brain Trauma Foundation 2000, The American Association of Neurological Surgeons, and The Joint Section of Neurotrauma and Critical Care, Management and prognosis of severe traumatic brain injury, Journal of Neurotrauma, 17:p.6-7 Studies in relation to repleting intravascular volume- Bickell WH, Wall Jr MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al 1994, Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries, New England Journal of Medicine, 331(17):1105-9 Turner J, Nicholl J, Webber L, Cox H, Dixon S, Yates D 2000, A randomised controlled trial of pre-hospital intravenous fluid replacement therapy in serious trauma, Health Technology Assessment, 4(31). Dutton RP, Mackenzie CF, Scalea TM 2002, Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality, Journal of Trauma Injury, Infection and Critical Care, 52(6):1141-6. Sampalis JS, Tamim H, Denis R, Boukas S, Ruest SA, Nikolis A, et a 1997, Ineffectiveness of on-site intravenous lines: is prehospital time the culprit? Journal of Trauma-Injury Infection & Critical Care, 43(4):608-15. Hambly PR, Dutton RP 1996, Excess mortality associated with the use of a rapid infusion system at a level 1 trauma center, Resuscitation, 31(2):127-33. Kwan I, Bunn F, Roberts I, Committee, WP-HTCS 2001, Timing and Volume of fluid administration for patients with bleeding following trauma, Cochrane Database of Systematic Reviews, (1):CD002245 References for type of fluid- American College of Surgeons 1997, Advanced Trauma life support for Doctors Instruction Course Manual Book 1, First Impression: USA. Cain JG, Smith CE 2001, Current practices in fluid and blood component therapy in trauma, Seminars in Anesthesia 20(1):28-35 References for end points of fluid resuscitation- Mikhail J 1999, Resuscitation endpoints in trauma, AACN Clinical Issues 10(1):10-21. Porter JM, Ivatury RR 1998, In search of the optimal end points of resuscitation in trauma patients: a review, Journal of Trauma Injury, Infection and Critical Care, 44(5):908-14. Hameed SM, Cohn SM 2001, Gastric tonometry: the role of mucosal pH measurement in the management of trauma, Chest, 123 (5 Suppl): 475-81. Studies for End points of fluid resuscitation- Clay R, Shippy M, Paul L, Appel M, Shoemaker W 1984, Reliability of clinical monitoring to assess blood volume in critically ill patients, Critical Care Medicine 12(2):107-12. Shoemaker WC, Wo CC, Demetriades D, Belzberg H, Asensio JA, Cornwell EE, et al 1996, Early physiologic patterns in acute illness and accidents: toward a concept of circulatory dysfunction and shock based on invasive and noninvasive hemodynamic monitoring, New Horizons, 4(4):395-412. Davis JW, Shakford SR, Mackersie RC, Hoyt DB 1988, Base deficit as a guide to volume resuscitation, Journal of Trauma Injury, Infection and Critical Care, 28(10):1464-7. Canizaro PC, Pessa ME 1990, Management of massive hemorrhage associated with abdominal trauma, [Review] [34 refs], Surgical Clinics of North America, 70(3):621-34. Please make sure the report structure follows a logical order and links to each section. PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET AN AMAZING DISCOUNT

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