PST2102: Trauma Studies for Paramedics - 45-year-old male - Haemorrhagic shock – Class III | Case Study Assessment Answers

August 17, 2017
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Question: Trauma Studies for Paramedics - Case Study

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Case Study - 45-year-old male Trauma Studies for Paramedics 

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Solution: Trauma Studies for Paramedics - Case Study

Introduction

Thepaper presents a case study that is an analysis of an incident involving an approximately 45-year-old male. The patient at first seemed to be unconscious and was lying prone in a pool of blood outside a boarding house. The paramedics were called at approximately 7:30 am to a patient having multiple stab wounds to the back, chest, and arms. The patient who is a middle-aged man is wearing anunderpants and a blood-soaked singlet on a moderatelycold spring morning. The stabbing of the patient is estimated to have occurred the night before at 11:00 pm that is approximately 8.5 hours ago. Further patient assessmentby the paramedic’s reports thathe is conscious and out of danger.The victim is noted to be confused, pale, drowsy and cool to the touch. The man is thus deemed to be in Class 3 Haemorrhagic shock state.

This paper will thus present the preliminary diagnosis for the patient in the case study while examining the pathophysiology of his condition and how the condition affected his treatment process. The paper also explains why the patient was normotensive four hours earlier and why he became hypotensive upon the arrival of the paramedics. The paper then identifies with supportive evidences the body systems that need to be addressed in the patient so as to ensure their proper functionality. The permissive hypotension concept about fluid management and penetrating injuries will also be discussed. With a sound rational, the case study outlines the patient management before summarising the report’s key findings.

Management and preliminary diagnosis for patient

The patient has a preliminary diagnosis of Class 3 Haemorrhagic shock. Haemorrhagic shock is hypovolemic shock resulting from blood loss. The primary steps to the treatment of class 3 haemorrhagic shock are to control the points of bleeding in the body of the patient with immediate effect to prevent further blood loss and replace the fluid. Fluid replacement for the patient will help in hemodynamic parameters normalization. Fluid treatment is hence necessary for the patient since bleeding has temporarily stopped due to clot formation, hypotension, and vasoconstriction. The treatment will help in radial pulse restoration or hypotensive resuscitation. Crystalloid will be administered using 2L of isotonic sodium chloride solution to respond to the shock of the blood vessels, a process that should continue until hemodynamic of the patient are stabilized. Every litre of the fluid is expected to expand the blood volume by at least 20 to 30% (Yoshimura, 2013).

While the administration of the fluids is on, the wounds should be dressed so as to prevent further bleeding. Lammer (2011) notes that different methods can be used to dress wounds depending on the depth of the cuts and the rate of bleeding. For the patient, clotting has stopped the bleeding in some cuts while light bleeding can still be observed in the deep cuts. As a result, the wounds needs to be dried and bandaged with pads to control the bleeding after cleaning them with warm water and spirit. The spirit will be used to kill germs and initiate drying or clotting in the case of more bleeding.

Pathophysiological process associated with this condition

The acute loss of blood as a result of haemorrhagic shock leads to responses that can systematically divert the circulation volume of the patient away from the non-vital organ systems to conserve the blood volume for the vital organ functionality. However, the acute haemorrhage in the patient as a result of shock from blood loss has resulted in a decrease in the pulse pressure and cardiac output. The changes are sensed by the baroreceptors in the atrium and aortic arch. The decrease in the circulation volume causes neural reflexes as well as increased sympathetic outflow to other organs and the heart as well (Kim, Chung, & Lee, 2003). The responses in the patient were observed as a result of the increase in vasoconstriction, heart rate, blood flow redistribution away from the kidney, gastrointestinal tract, and skin among other organs.

The presence of beta-endorphin and glucocorticoid release shows the occurrence of the multisystem hormonal response to the haemorrhagic shock occurrence. Decreased mean arterial pressure also occur leading off the production of rennin and a sequential water and sodium reabsorption. Apart from these global changes, organ-specific responses are also observed. For instance, the brain is known to have a remarkable autoregulation keeping a constant cerebral blood flow of the wide range arterial blood pressure. In the patient, the kidney was able to tolerate the 90% of the absolute blood flow within the hours of blood loss. A significant decrease in the circulatory blood volume was also observed due to the reduction in pressure of the flow of blood due to the deep cuts in the body of the patient. The quick response by the paramedics has initiated a possibility of early and appropriate resuscitation to avert damage to the affected organs as well as adaptive act mechanisms aimed at preserving the organs (Abrahams & Waber, 2013).

The body systems that must be addressed for proper functionality

The body uses a series of physiological mechanisms and anatomical features to meet its metabolic demands. In the context of shock and bleeding, the cardiovascular system of the patient and other related systems of the patient needs to be addressed for proper functionality (Yoshimura, 2013). For instance, the heart is the major functionality organ of the cardiovascular system as it constantly ensures the pumping of blood from the lungs to the rest parts of the body. Patients heart was checked especially the vessels and the valves to ensure they were not damaged. With the high volume of blood lost, mitral valve should be in a position to ensure that the recovery process efficiently distributes the blood to different parts of the body (Traverso, 2011).  The vessels and the arteries are also responsible for blood distribution across the body. When the heart properly controls the body systems, then the body cells, tissues, and organs can work effectively and can increase the chances of recovery of the patient (Traverso, 2011). The blood pressure of the patient was assessed to determine his heart rate and the stroke volume. As a result of the deep cuts that caused internal haemorrhage, the paramedics helped the patient to ensure the internal part of the body was able to form a clot to stop a possible internal bleeding (BickeLL, Wall & Pepe, 2010).

Why this patient was then normotensive

It is evident that the patient had a normal blood pressure even after the loss of blood due to the wounds and deep cuts on the body. It is possible because the patient history showed no sign of any cardiac complication except for the excess loss of blood that made him very unconscious. As a result, the patient was given a reduced isotonic sodium chloride solution during fluid treatment. It was clear that the patient was out of danger and could successfully recover despite the heavy blood loss according to the studies by Michael et al. (2001).

Permissive hypotension in relation to fluid management and penetrating injuries

The resuscitation traditional fluid strategy in a haemorrhagic trauma patient is necessary for the systolic blood pressure maintenance at a normal level. In their research, Duttin, MacKenzie & Scalea (2012), they note that one human experiment has showed an improved survival in patients when restriction of the fluid resuscitates. However, numerous laboratory studies have it that there is an improved survival when resuscitation is present in patients with blood pressure that is lower than normal.

In their study, Abrahams & Weber (2013) hypothesised a lower fluid resuscitation titration than a normal blood pressure for patients with active haemorrhage shock. The result is an increased chance of survival for such patients. The study results explained that it is as a result of improvement in therapeutic and diagnostic technology. However, Bickell, Wall, & Pepe (2010) argue that it is as a result of SBP impression for tissue oxygen delivery for such patients. About the case study, the patient showed to have improvement after the steps taken to monitor the patient.

Conclusion

The occurrence of trauma in patients is a common health complication that occurs regularly. In case it occurs, there major goal of the primary care is always to ensure the patient is out of danger and can recover as quickly as possible. The primary steps to the treatment of class 3 haemorrhagic shock are to control the points of bleeding in the body of the patient with immediate effect to prevent further blood loss and replace the fluid. Fluid replacement for the patient will help in hemodynamic parameters normalization. Fluid treatment is hence necessary for the patient since bleeding has temporarily stopped due to clot formation, hypotension, and vasoconstriction.

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