Small Group Discussion 3.2: Outline of a Research Article
The Use of Hypothermia as a Treatment for Traumatic Brain Injury
1. Introduction and core story elements
a. What is the overview of the purpose of the study and the problem discussed?
i. Research has shown that hypothermia has neuroprotective effects and might be an effective source of treatment for patients with head injuries. When discussing the treatment of patients with traumatic brain injuries, hypothermia is a controversial issue. The purpose of this study was to compare existing research on the use of hypothermia with TBI patients to determine if it is an adequate form of treatment.
b. Is the problem clearly stated? . Yes. Hypothermia has been shown to have …show more content…
i. All studies found that ICP was decreased and CPP increased with the hypothermia groups. ii. Hypothermia is not a widely used treatment due to risk for complications associated with hypothermia such as pneumonia, seizures and infection. iii. Re-warming of the patient should be performed cautiously
b. Was the literature relevant? . The literature is outdated; publishing dates ranged from 1997 to 2006. This article was published in 2009; only one of the articles used for research was within five years, all others were older. The literature would be more relevant if it was more recent. The literature that was used although it may have been outdated, did support the problem researched; using hypothermia as a means of treatment for a traumatic brain injury.
c. What exactly did the literature state to support the problem statement and question? . Across all of the studies, hypothermia is effective in that ICP was decreased and CPP increased.
i. Research from multiple meta-analyses found that hypothermia can be effective. The specific studies reviewed by Clifton (2001) and Marion (1997) resulted in conflicting findings. ii. Clifton (2001) and Shiozaki (2001) stopped their studies before completion due to high rate infection and lack of benefit from hypothermia. It was found to be detrimental to the patients. iii. Marion (1997), Jiang (2006), and Polderman (2002) make strong recommendations for hypothermia.
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However, other resources, such as mobile doctors may be available to prevent the patient from requiring hospital admission (17). Furthermore, certain approaches to pain relief, such as warm running water and cold packs, are not always readily available to paramedics. Thus implementing these procedures as a necessary part of paramedic practice would not prove practical. However, paramedics should be aware of the different approaches to relieving pain for these patients and be further aware that if the resources are available, they should be utilised in order to provide as much relief as possible to the suffering
Mild hypothermia is generally considered gentle and safe although a minor subset of patients may experience side effects such as infections, coagulation and electrolyte disturbances and potentially life-threatening arrhythmias during post-cardiac arrest care.
Awareness about traumatic brain injury has increased because of combat operations in Irag and Afghanistan and in the National Football League. The debate over the nature of traumatic brain injury is an ongoing issue. Some think of categorizing from mild to the server is the condition of TBI that can lead to a person bring over diagnosed or misdiagnosed. The other side points out that the focus should not be on diagnosis put on the recovery and treatment of the symptoms.
The purpose of this case study is to examine the specific case study of a 40 year old male who suffered a traumatic brain injury as the result of a fall from a roof. For future reference the term "Traumatic Brain Injury" will be abbreviated here as TBI and "Intracranial Pressure" as ICP. In this study we will explore the medical findings that are common in such an injury and how they relate to the Paramedic in the field. The specificity of this case will be broken down to define relevant terminology and findings that were present to the paramedics that responded to this call. Lastly, TBI's will be explored and discussed for their relevance in the field, contributing factors and comorbidities as they relate to paramedicine.
As we all know, the human brain is the most insubstantial and vital organ in the human body as it is the command center for every other body part (newscientist.com). Any slight wound to this organ could lead to severe consequences usually encountered at that very moment. It may be an extremely low chance of a major head injury, but it does happen to millions of people annually. One single concussion, provided with the lack of healing, could lead to short-term and long-term memory loss, depression,
Purpose: The purpose of this speech is to educate and inform my audience of the risks inherent from unintended hypothermia. I’m eager to alert perioperative staff of the potential dangers as well as the preventative measures that can be taken in order to avoid complications associated with unintended hypothermia. My central idea is hypothermia management saves lives.
Medical and technological advances have led to greater survival rates in individuals suffering from various illness and injury throughout history. This includes individuals who suffer traumatic and nontraumatic brain injuries. Approximately 1.5 million people in the United States sustain a brain injury each year with the survival rate of over 90 percent making brain injury the leading cause for disability in the United States. (Mysiw, Bogner, Corrigan, Fugate, Clinchot, & Kadyan 2006). Cognitive, physical, sensory and behavioral changes are widely noted in individuals in the months and years following a brain injury. However, the psychosocial, psychological and emotional effects of these injuries are less discussed and therefore these aspects can be overlooked when anticipating a course of treatment. Individuals who sustain acquired brain injuries experience significant, lasting impairment in the psychosocial, psychological and emotional aspects of their lives and better understanding of these issues can lead to better treatment and coping skills for these individuals.
Cryotherapy involves the use of low temperatures to remove heat form a body part. It decreases pain and inflammation, promote vasoconstriction (narrowing of blood vessel) and prevent the development of waste products.
He then took samples of urine, blood, and mucous as body temperatures lowered. Through this tortured, Rascher used the data to create the hypothermia treatment called "active rapid rewarming." More than 90 people lost their lives for this medical advancement (Adams).
A traumatic brain injury (“TBI”) occurs when the brain is somehow injured, rattled, or wounded from an external source of force. The means of acquisition and the severity of TBIs are unique to each patient; therefore, symptoms and rehabilitation can vary greatly depending on the patient’s condition following the incident and how they sustained the injury. The severity of a TBI is generally classified into one of three categories: mild, moderate, or severe, and this type of diagnostic criteria influences how a patient with TBI is treated by medical staff and rehabilitation specialists. TBIs can affect a specific part of the brain that was directly impacted, leaving the patients with only one or a few areas of impairment, or the damage can
Concussions, classified as a mild traumatic brain injury, are a growing problem in the United States. Research is being done to determine immediate, short-term, and long-term effects as well as the most effective way to treat concussions and the best way to prevent them. The general population is learning more about concussions as more information becomes available. This is especially important because the spread of knowledge of concussions is crucial in preventing and treating concussions. It is important that people
Considering no two brain injuries are the same, treatment is stipulated accordingly. In the case of mild injury management, it is fairly low maintenance, requiring a lot of rest and over-the-counter pain medicine. However, the patient must be monitored religiously in case of worsening or new symptoms where immediately medical attention is vital. Once cleared by a doctor, the patient steadily returns to their normal schedules. Immediately after moderate and severe injuries, treatment is concentrated on prevention of secondary damage resulting from inflammation, bleeding, or reduced oxygen supply to the brain. Medications prescribed to diminish chance of secondary loss include diuretics, anti-seizure drugs, and coma-inducing drugs. Surgery is crucial in removing hematomas (clotted blood), repairing skull fractures, and opening a window in the skull in order to relieve pressure and allow room for swelling. A large part of treatment is rehabilitation. The goal is to get patients back to their normal daily routines. Rehab usually
Malignant Hyperthermia (MH) is a genetically inherited, pharmacogenic disorder involving a severe malfunction within the skeletal muscles, causing them to be stuck in a contracted state. It is found to be triggered in susceptible patients by the administration of certain anesthetic agents during and after surgical procedures. It may also be activated by the use of other drugs, such as muscle relaxants and triggered by other circumstances such as stress, trauma, and even exercising. Not only are the muscles normal physiology affected, but abnormalities of the whole body occur disrupting its natural homeostasis. If it is not treated immediately, it can be fatal. Susceptibility is found in patients who have had a known family history of MH. In order for a medical professional or a patient to be prepared to handle MH one must understand how it affects the normal physiology of the body, what signs to look for, and how it can be diagnosed, treated, and prevented. There is no cure for MH, but there are specific drugs and precautionary measures that are used to prevent and treat it when a patient is susceptible.
Hypothermia has two main types of causes. It classically occurs from exposure to extreme cold. Commonly this includes alcohol intoxication but may also include low blood sugar, anorexia, and advanced age. Hypothermia may be diagnosed based on either a person's symptoms in the presence of risk factors or by measuring a person's core temperature. One of the lowest documented body temperatures from which someone with accidental hypothermia has survived is in a near-drowning of a 7-year-old girl in Sweden. Survival after more than six hours of CPR has been described. Symptoms of mild hypothermia may be vague, Increased urine production due to cold, mental confusion, and hepatic dysfunction may also be present. Hyperglycemia may be present, as glucose consumption by cells and insulin secretion both decrease, and tissue sensitivity to insulin may be blunted. Sympathetic activation also releases glucose from the liver. In many cases, however, especially in alcoholic patients, hypoglycemia appears to be a more common presentation. Low body temperature results in shivering becoming more violent. Muscle mis-coordination becomes apparent. Movements are slow and labored, accompanied by a stumbling pace and mild confusion, although the person may appear alert. Surface blood
Secondary brain injury can occur within hours to days after the primary insult (Lump, 2014). The clinical indicators of secondary brain injury consist of increased intracranial pressure (ICP), hypotension, hypercapnia and hypoxia (Lump, 2014). Subsequently, it can potentially have vast impacts on the patient’s mortality and recovery rate (Salottolo et al., 2014). Performing neurological assessments such as GCS, pupillary and vital sign observation on TBI patients hold great importance as it detects early symptoms of secondary brain injury and provides information on the impairment of consciousness (Salottolo et al., 2014). Therefore, in order to provide high-quality holistic nursing interventions for patients in critical episodes, it is imperative to gain understanding of the use of intensive assessments.