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.
Maintaining normal core body temperature (normothermia) in patients within perioperative environments is both a challenging and important aspect to ensure patient safety, comfort and positive surgical outcomes (Tanner, 2011; Wu, 2013; Lynch, Dixon & Leary, 2010). Normorthermia is defined as temperatures from 36C to 38C, and is maintained through thermoregulation which is the balance between heat loss and heat gain (Paulikas, 2008). When normothermia is not maintained within the perioperative environments, and the patient’s core body temperature drops below 36C, they are at risk of developing various adverse consequences due to perioperative hypothermia (Wagner, 2010). Perioperative hypothermia is classified into three
Tien, Homer. “The Canadian Forces trauma care system.” Canadian Journal of Surgery 54 (2011): 112-117.
Targeted Temperature Management at 33 degree versus 36 degree after Cardiac Arrest (Neilsen et al)
Richards, G. A., & Joubert, I. (2013, July 2013). Extracorporeal Membrane Oxygenation (ECMO). South African Journal of Critical Care, 29(1), 7-9. http://dx.doi.org/10.7196/SAJCC.161
The first was to see how long it would take to lower body temperature, and the next to decide how best to resuscitate a frozen victim. The doctors submerged a naked victim in an icy vat of water. They would insert an insulated thermometer into the victim’s rectum in order to monitor his or her body temperature. The icy vat proved to be the fastest way to drop the body’s temperature. Once the body reached 25 degrees Celsius, the victim would usually die.
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.
The data from World Health Organization (WHO) on the leading causes of death worldwide and the global burden of diseases shows that, traumatic injuries are the major cause of mortality, morbidity and disability among children (0 – 14 years) - being responsible for more deaths than the combination of other diseases1. It is against this backdrop that pre-hospital care during emergencies becomes very important in the management of the injured children as it is for adults. In most circumstances, earliest responder who could be a medical doctor, paramedic, or even layman are the first to provide the much needed life saving (basic or advance), vital medical care all with the aim of optimizing the victim’s physiological status prior to arriving nearest medical facility2, 3. Indeed, several evidences suggested that these first life-saving supports have effect on the morbidity and mortality of the injured patient2-4. But, recent researches have also shown that interventions like invasive airway management, IV access and fluid administration are associated with higher rate of complication and failure among paediatric patients, while the few that turned out to be successful were provided by specially trained and experienced personnel3. This is due to the difference in size and overall anatomy of children compared with adult, thus many of these procedures turn out to be difficult or results in complication when performed...
“An Examination of Animal Experiments.” Physician Committee for Responsible Medicine. N.p., n.d. Web. 13 Feb. 2014. .
"What are some common alternatives to the use of animals in medical and aesthetic product testing?" Voice for the Voiceless. 2001. Dec 9 2002. <http://members.shaw.ca/voiceforthevoiceless/ani_test.htm>.
Stokes, W. S. & Co. “Animals and the 3 R’s on Toxicology Research and Testing.” Human and Experimental Toxicology December 2015: 7. Academic Search Premier -.
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.
Biomedical Research | Animal Use Research. N.p., n.d. Web. The Web. The Web. 19 Apr. 2014.
* Heat and Cold Therapy has been used for centuries to manage soft tissue and joint injuries while relieving pain.
“Summary Report for: 29-2041.00 - Emergency Medical Technicians and Paramedic.” O*Net. 2008. Web. 18 Feb. 2010.
First aid is the immediate care given to victims of accidents before trained medical workers arrive. It includes self-help and home care if medical assistance is not available or is delayed. It also includes well-selected words of encouragement, evidence of willingness to help, and promotion of confidence by demonstration of competence. Its goal is to stop and, if possible, reverse harm. It involves rapid and simple measures such as clearing the air way, applying pressure to bleeding wounds or dousing chemical burns to eyes or skin [5].