SECTION A Clinical Questions from Weeks 1-3 Mechanism of injury and neurotrauma 1. Identify, define and categorise three types of time criticality. 1. Actual: Vital signs If, at the time the vital signs survey is taken, the patient is in actual physiological distress, then the patient is considered ‘actual time critical’. Neonate First 28 days Infant 1-12 months Child 1-8 years Older child 9-12 years Adult >14 years Conscious state ALOC ALOC ALOC ALOC ALOC Respiratory rate 60 50 35 25 30 SpO2 170 170 130 120 >120 Systolic BP N/A 20% or in children >10%, or other complicated burn injury including to the hand, face, genitals, airway, respiratory tract - Serious crush injury - Major open fracture, or open dislocation with vascular compromise - Fractured pelvis - Fractures involving two or more of the following: Femur, tibia, humerus 3. Potential: Mechanism of injury The patient is considered ‘potentially time critical’ if at the time the vital signs survey is taken, the patient is not physiologically distressed and there is no significant Pattern of actual Injury or illness, but does have a Mechanism of Injury with the potential to deteriorate to actual physiological distress. - Ejected from vehicle - Fall from height >3m - Involved in an explosion - Involved in a high impact RTC with incursion into occupant’s compartment - Involved in vehicle rollover - Involved in an RTC in which there was a fatality in the same vehicle - Entrapped for >30 minutes 2.
Through basic observations, health professionals are able to evaluate the performance of an individual’s health status. In relation to Casey, it is noted in her Observation Chart that in the time span of two hours the patient’s health status had changed from being relatively normal (to the patient) to an increased respiratory rate, heart rate and temperature as well as a decrease in blood pressure. It is also noted that the patient has a score of 8 in the pain scale (compared to the score of zero two hours previously), relating to the lower abdomen. Programs such as Between the Flags acknowledges the fact that the early recognition of deterioration of patients can reduce harm to patients through designing and implementing systems which provide a structural response in the event of a deteriorating patient, such as Rapid Response and Clinical Review. There are two phases involved in the rapid response, which includes the afferent phase and the efferent phase. The afferent phase focuses on the overall monitoring and recognising the deteriorating patient whereas
The Joint Commission. (2015, June 3). PC.01.02.03: The Hospital assesses and reassess the patient and his or her condition according to defined timeframes. Retrieved from The Joint Commission:
Vital observations were carried out efficiently, they were recorded every 15 minutes and a cardiac monitor was attached to continuously monitor for any deterioration. As a student nurse I assisted by recording vital observations using NEWS and assessing consciousness by using the Glasgow coma scale to ensure there were no signs of brain trauma (Le Roux, Levine and Kofke, 2013). In line with the NMC, my mentor supervised and countersigned my observations (NMC, 2011b). I promoted good patient safety as deterioration would be recognised early and appropriate care provided. Throughout the treatment process I witnessed and provided person centred care. Nursing and medical staff continuously checked patient comfort and obtained consent for treatment being provided.
Usually, we start the observations around 22:00, reporting any NEWS score over 3 or anything untoward to the the Staff Nurse who will inform a doctor who may order an ECG, which I would perform and report straight back to him/her. This is an example of how communication and co-operation is so important to working in partnership. Any missing ‘cog’ in a machine could spell disaster, especially in the care industry.
Immediately life threatening A patient with chest pain, severe blood loss, MVA, sepsis. These types of patient are prompt to deteriorate, and their life could be at risk if not treated within 10 min of arrival in ED. (Basnet, Bhandari and Moore, 2012)
1. For each of the following diagnostic test results, note which specific part of the brain would have to be damaged to create those symptoms. (include right and left sides in your analysis).
Axel and skeleton frame injuries are something that are very common in the world of sports. The National Football Ledge(NFL) has a foundation of physical impact and is very strenuous on the axel and skeletal frame. Thoracic disc herniations in the one of the most common injuries the NFL and it requires the greatest amount of time to recover which is 189 days. Thou the injury is very high in football nearly 15 percent of American suffer from Thoracic Disc Herniation. Degeneration the most common cause of Thoracic disc herniation “As a disc's annulus ages, it tends to crack and tear. These injuries are repaired with scar tissue. Over time the annulus weakens, and the nucleus may squeeze (herniate) through the damaged annulus. Spine degeneration
Brainstem Injuries and the Neuropsychologist The Neuropsychologist plays an essential function in assessment and rehabilitation after an injury to the head. Neuropsychologists essentially bear responsibility for testing and tracking the patients thinking ability. Below are key functions provided by clinical neuropsychologists: - Carrying out detailed assessments of cognition, emotion, behavior, and social competence; - Devising and implementing training programs; - Liaising with educational agencies/ employers to advise on the resumption of educational/ vocational life; - Advising on the management cognitive deficits/ disabilities; - Advising and providing long term care; - Providing
A major component of the care Paramedics provide is the assessment of a patient’s physical status, which is the ground for any further treatment. The assessment method that an Advanced Care Paramedic follows is a systematic assessment referred to as the Primary Survey. The aim of this fundamental assessment is to give an initial diagnosis of the patient as well as identifying any imminent threats to the patient. This assessment is used so that a Paramedic can decide how to treat the patient while staying within the boundaries of their scope of practice. Throughout this essay the concept of a primary survey within the scope of practice of an Advanced Care Paramedic will be understood. Additionally
Disability – Assessment of disability involves evaluating the patient’s central nervous system function. Assess the patient’s level of consciousness using the AVPU scale. Talk to the patient if they are alert and talking they are classified as A. If the patient is not fully awake establish whether they respond to the sound of your voice (opening their eyes, making any sounds) if they do they are classified as V. If the patient does not respond to voice administer a painful stimulus (gently rubbing the sternum bone). If they respond they are a P on the AVPU scale. And finally if they do not respond to any of the above they are a U, you should then move onto the more detailed Glasgow Coma Scale (GCS). You will assess the patient’s pupils (eyes) and motor responses (arms and legs) among other things to give the patient a score out of 15 (15 being the highest). A GCS of fewer than 8 is a medical emergency and you would then have to go back to assessing the patient’s airway.
The extrapyramidal motor system contains every motor pathway except the pyramidal system. There are 2 types of extrapyramidal motor syndrome, the basal ganglia motor syndrome and cerebellar motor syndrome. Extrapyramidal motor syndrome will result in posture or movement disturbance without severe paralysis. While on the other hand, pyramidal motor syndrome results in severe symptoms like paralysis of voluntary movement, increased tendon reflexes, Babinski sign, absence of involuntary movements, spasticity in muscles, and presence of hypertonia. Pyramidal motor systems primary pathway is for voluntary movement. This is why when there is injury to the extrapyramidal motor system there is no paralysis of voluntary movement. The major
ECG : ventricular rate 54 beats/min, HR varying from 39 to 60 during a 45 minute period of monitoring, infrequent PVCs, ST elevation in leads II, III and avF indicating inferior injury or ischemia secondary to acute MI.
As a Hospitalist NP, the patients that I admit for our group are not critically ill. Most times, the conditions for which are they are admitted warrant an admission, but they are treatable conditions. If the treatment is successful, the patients are discharged within two to four days. If they decompensate during their hospitalization, a rapid response code is called. Their disposition
This essay aims to provide a discussion of vital signs and how they are relevant to contemporary nursing practice. This is done by;