Biology Coursework: Improving Trauma Treatment Through EPR
Identify a problem.
Trauma pateints are those who have suffered serious and life threatening injuries. First response teams have little time to stabilise their condition and attempt to save their life. Whilst surgeons and doctors have the technology, skills and knowledge to be able to save victims of blunt or penetrating trauma, they have very limited time in which to do it. “The Golden Hour” is the time period from the injury of the patient in which appropriate medical treatment will prevent death. However, this “Golden hour” can be anything from minutes to the hour, giving medics very little to work with.
Describe/Explain methods to solve this problem.
Recently there have been large leaps in trauma medicine, and this time frame has been extended. One method which is being researched is that of EPR, Emergency Prevention and Resuscitation. This is in effect a form of suspended animation. The patient’s heart is stopped, and the body cooled to below 10°C by flushing the circulatory system with a chilled saline solution, at which point the patient has no brain activity or pulse. These extreme temperatures greatly reduce the body’s requirement for oxygen, allowing cells to continue to live without the patient breathing or having a heartbeat. This lack of circulation and metabolism allows doctors and surgeons to repair any serious injuries and greatly increase the patient’s chance of survival. Once the patient has been patched up they are revived by transfusing warm blood back into the body and sometimes using an electrical shock to restart the heart.
So far this method has only been tested on pigs and dogs, with great success, (Experimental r...
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... than when using the Minimal Fluid Resuscitation method, particularly when the method was used with mild hypothermia, which involves using cooled fluids, usually to around 30-34⁰C.
Quote experiments/results?-Rosie Connolly 3/7/10 10:07 AM
Sources
Safar Centre for Resuscitation Research
Research projects, papers, etc.
Worldwide recognised.
Access to research papers – does this count as paper based even though I’ve found them online?
US government Clinical Trials service.
Information on the human trials in EPR.
New scientist article reporting first breakthroughs with mice.
NEED TO FIND.
Evaluate source.
Article
http://www.mirm.pitt.edu/news/article.asp?qEmpID=273 ?
References to surgeons, research papers and trials.
Biased – part of Pittsburgh Uni, the centre of the trials.
Targeted Temperature Management at 33 degree versus 36 degree after Cardiac Arrest (Neilsen et al)
Hypothermia is a common problem in surgical patients. Up to 70% of patients experience some degree of hypothermia that is undergoing anesthetic surgery. Complications include but are not limited to wound infections, myocardial ischemia, and greater oxygen demands. The formal definition of hypothermia is when the patient’s core body temperature drops below 36 degrees Celsius or 98.6 degrees Fahrenheit. Thus, the purpose of the paper is to synthesize what studies reveal about the current state of knowledge on the effects of pre-operative warming of patient’s postoperative temperatures. I will discuss consistencies and contradictions in the literature, and offer possible explanations for the inconsistencies. Finally I will provide preliminary conclusions on whether the research provides strong evidence to support a change in practice, or whether further research is needed to adequately address your inquiry.
Voelzing, L., Willoughby, L., & Loree, K. (2008). Therapeutic induced hypothermia: when every minute counts -- a multidisciplinary team approach. Dynamics, 19(2), 43. Retrieved from EBSCOhost.
Hypothermia protocol for the post cardiac arrest patient has been an evidence based practice of this therapy for about a decade now. This intervention, often used in the critical care setting, is now expanding to primary emergency responders as well. This paper will present some of the notable research that has been done on therapeutic hypothermia, and current use of this intervention.
It is appreciated that the given case study contains other factors such as psychological trauma and the impact of blood loss. However this essay is going to explore the efficacy of pre hospital immobilisation utilising cervical collars and extrication/ orthopaedic stretchers, reflecting on an account from the paramedic’s practice. A modified framework of Gibbs Reflective cycle (1988) will be used. Including Description, Feelings, Evaluation, Conclusion and Action Plan. This essay is supported throughout using relevant evidence and seminal work.
From research through SAHMSA and increased knowledge through my choice in graduate-level courses, I learned how to best integrate a trauma-informed approach into my clinical practice. This example from my concentration practice shows how I sought to choose interventions from an evidence-based practice perspective, seeking to meet my clients and support their dignity and worthwhile also using approaches and interventions which have been shown effective through research. Although a trauma-informed perspective would have been beneficial in my foundation internship, it became imperative in my concentration internship and I increased my competency and supported the dignity and worth of my clients by choosing to learn about and integrate a trauma-informed approach in my clinical practice.
Iyer, Anand. 2007. No one is dead until warm and dead. The Journal of Thoracic and Cardiovascular Surgery, vol. 134: 1042-1043.
...warming protect any affected body part from direct pressure and ensure the patient is well-hydrated. Do not rub frostbitten skin, attempt to rewarm using a fire or stove, rewarm if there is any possibility of refreezing, and allow the tissue to refreeze if it is successfully thawed (Simon, Bryan).
Hypovolemic shock in trauma victims is a life-threatening condition. In the prehospital environment, EMS providers treat hypovolemic shock by attempting to control hemorrhage and by providing fluid resuscitation with crystalloid solutions. It has long been debated which crystalloid solution provides the ideal fluid resuscitation for victims of traumatic hypovolemic shock; whether it be solutions with similar concentration to human blood (isotonic solutions), or whether fluids should be of higher crystalloid concentration (hypertonic solutions). This report will review the current data on hypertonic versus near isotonic fluid resuscitation for victims of traumatic hypovolemic shock. The main source for this report is a Cochrane Review by Bunn, Roberts, Tasker, and Daksha, 2004.
Augustine Medical, Inc. was founded by Dr. Scott Augustine, an anesthesiologist from Minnesota, in 1987. The company was created to develop and market products for hospital operating rooms and postoperative recovery rooms. The company provides innovative solutions to combat postoperative conditions such as hypothermia. Medical research indicates that 60 to 80 percent of all postoperative recovery room patients are clinically hypothermic. Hypothermia is caused by a patient’s exposure to cold operating room temperatures that are required by surgeons to control infection, and for the personal comfort of the surgeon. Hypothermia can also be a result of heat loss due to evaporation of the fluids used to scrub patients, evaporation from exposed bowel, and breathing of dry anesthetic gases. Dr. Augustine’s personal experience in the operating room convinced him that there was a need for a new system to warming patients after surgery. Dr. Augustine also realized that the market for this new product would be enormous! Statistics indicate that approximately 21 million surgical operations are performed annually in the United States, and that approximately 5,500 hospitals have operating rooms and postoperative recovery rooms that include 31,365 postoperative recovery beds and 28,514 operating rooms. Upon the realization of this need and existence of the market, Dr. Augustine went on to develop The Bair Hugger Patient Warming System then he acquired a patent. The Bair Hugger Patient Warming System consists of a heat source and a separate disposable warming cover that directs a gentle flow of warm air across the body. The Bair Hugger heat source uses a reliable high efficiency blower, a sealed 400W heating element, and a microprocessor based temperature control to create a continuous flow of warm air. The heat source complies with all safety requirements for hospital equipment. Augustine Medical, Inc. was able to find investors that contributed to the initial capitalization of $500,000. These initial funds that were collected were used for staff support, facilities, and marketing. The funds were also used to cover the fixed costs of the company while in its first year. The company subcontracted the production of the heater/blower unit and manufactured the warming covers in-house. The company only par...
Emergency and Trauma nursing is a field in nursing that deals with traumatic events that need immediate attention of the health care professionals. Nurses are the first to be exposed to the trauma and have to act as quickly as possible to save the patient’s life. These traumatic events also pose a threat to the nurse’s mental, physical and emotional well-being. There are still gap in the existing knowledge of this research.
M., et al). The first category was generally soldiers who had minor injuries requiring minimal care before quickly returning to the battlefield. The more seriously injured were placed in the second category where they would be transferred to a hospital for further medical attention. The last group was soldiers who were deemed to be beyond help and they were not expected to live despite medical treatment. When resources were limited, the last group would receive the least attention. William Keen states that in this book Treatment of War Wounds, “It is often physically impossible to give speedy and thorough treatment to all. (Keen, 13) this meant that triage was necessary in order to save as many lives as possible. The second concept of patient prioritization on World War One was The Golden Hour. This concept stated that a patient must be treated within sixty minutes of their trauma. This data was gathered by the French during the First World War and was quickly adopted by many
Pulmonary contusions are another consequence from trauma to the chest, possibly not as severe as examples prior, but still dangerous. A pulmonary contusion is usually due to a blunt trauma to the thoracic cavity; the trauma causes blood to accumulate in the lung tissues and alveoli without lacerating the lung tissues. The lungs swell with the blood in the tissues, like a contusion anywhere else on the surface of the body, hence the term, “bruised lung.” With a pulmonary contusion, the patient will present, “...Tachypnea and tachycardia; while auscultating, rales and decreased breath sounds can be heard. Wheezing, coughing, and productive blood streaked sputum can be present; hypotension and reduced cardiac output accompany. Respiratory distress
Animal testing was successful. Now, the non-invasive technique has proven itself during its first human tests.
This care can include rendering aid for a variety of medical conditions such as stroke, heart attack, and trauma. As we have identified previously, pre-hospital emergency care has been around for a really long time. However, it wasn’t until the mid 1960’s that the importance of, and the need to improve pre-hospital care really began to take shape. Pre-hospital care is important to our society because it gives a greater chance of survival to someone who is experiencing one of the previously mentioned conditions. For example, if someone has suffered a stroke, there is a narrow time frame that person has for the the clot busting medication to be administered in order to dissolve the clots which are causing the stroke. With prompt pre-hospital emergency care and rapid transport, the patient’s chance of survivability is greatly improved. Trauma is another area in which pre-hospital emergency care plays a critical role in survivability. According to the National Trauma Institute, “trauma injury accounts for 30% of all life years lost in the U.S.” (National Trauma Institute. (n.d.). Retrieved July 15, 2016,