Paramedic Assessment

Diabetes and Hypertension are two major diseases that cause the high rate of morbidity and mortality to each country worldwide. Therefore, each person must be very critical in the kind of lifestyle they have because these diseases are primarily caused by faulty lifestyles and family history. This is similar to the patient that we have in this study. Our patient, who is a 54-year old woman, is suffering from diabetes and hypertension. She even had a previous attack of angina and cerebrovascular accident (CVA) making her more at risk for certain complications.

Merely knowing her age makes her at risk, because people aging 40 years and above are faced with higher risks for cardiovascular disorders. The other risk factors that the patient experiences are sedentary lifestyle, family history, no exercise, and alcohol drinker. Records show that the patient is suffering from left-sided body weakness, and this occurs due to the previous CVA attack which she suffered from. Having this disability, she finds it hard to do some activities on her own and thus, she needs the assistance of other people.

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However, our patient is blessed to have a supportive and loving family who takes good care of her. Also, because of this left-sided body weakness, she finds some of the musculoskeletal assessment exams difficult to perform, especially on the weaker (left) side of her body. The data also reveals how different is the response of the left side from the right side of the body. For example, the deep tendon reflex assessment showed that the right side has 2+ response which is a normal response while the left side has 1+ response which is a hypoactive response.

It is also stated that the left side experiences decreased range of mobility, and weaker sensations and responses compared to the right side. Browsing through the data, it is said that the patient is taking some maintenance medications, mainly for her hypertension and for her diabetes. She is also currently on physical therapy treatment to help her left side body gain strength again. One good thing about the patient is the fact that she is not suffering from any allergies, because if she does have some allergies, providing care for her especially through medications makes it more complicated.

Everyone must be careful in caring for a patient who has allergies because such people are sensitive and small mistakes can cause a lot of trouble to the patient. It was said that the patient was seen lying uncomfortably in a chair due to the dizziness, shortness of breath, and headache that she feels. This made her anxious, not only because of the dizziness, but also due to the assimilation of the feelings she is having within. The patient felt anxious because she assimilates this feeling with the previous experience that she had when she experienced angina and CVA before.

Her blood pressure reveals her hypertension with the value of 180/120 mm Hg. However, it is a good thing that aside from these, the other vital signs of the patient shows normal responses, and the cranial nerves shows no significant deviation from the normal. The other parts of her body shows normal results, and that is a very great impression because that means the patient is still safe from the unnerving complication of her diseases, and it means that she is still safe as long as she abide to the maintenance instructions that her doctors gave her. IMPLICATIONS FOR THE PARAMEDIC

Indeed, each paramedic whether within the pre-hospital or in hospital environment must be fully aware of the overall portrait of the patients that they will be approaching. Patients experiencing various medical conditions and emergencies may have more than 1 medical issue within, and each of these must be properly given attention to by each personnel that would assist them in all through out the process. A best example of the importance of the above statement is the case of our patient in this study. She definitely experienced previous and current maladies that paramedics should be aware of.

Paramedics must be knowledgeable of their patient’s case because in their field of work, what they are dealing with are patients’ lives. This gives them no room for erroneous mistakes. Even if it was said that “to err is human”, it is still hard to just accept that a life ended because of one mistake. Paramedics and the whole emergency team must be aware of how important their role is. They are the first people to get involve with the patient to provide first line treatment, and this is very important to predict the prognosis of the patient. Like what Zachary Meisel (2005) said in her article,

“But over the last 25 years, the importance of the “golden hour” has been enshrined: Research shows that critically ill patients who get the right medication or procedure quickly have a much better chance of survival. As a result, ambulance workers do a lot more active patient care than they used to. (p. 1)” In an emergency scenario, it is believed that the critical hour is the first 60 minutes after the trauma and the patient’s chances of survival are greatest if definitive treatments were given within this period of time (Trauma’s Golden Hour 2007).

Being a knowledgeable paramedic is really important, because in emergency situations, the patient’s prognosis is surely on your palms. Thus, proper treatments must be given and proper background check must be acquired from your patient. The patient in this study is suffering from a lot of diseases, one of which is hypertension. A disease of unknown etiology and is defined as a predicament of vascular regulation resulting from the malfunction of arterial pressure controlled mechanisms (Nettina 2006). This causes the blood vessels to vasoconstrict, causing decreased blood flow to various significant organs of the body.

Decreased blood flow to the target organs (heart, eyes, brain, kidneys and peripheral blood vessels) lead to damages to these organs and leads to more complicated consequences. According to Smeltzer, et al. , the usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision (2008: 1022). The major symptoms of hypertension are headache, epistaxis, dizziness, tinnitus, blurred vision, nocturia, and retinopathy (Stillwell 2007, p107).

Learning the above condition of the patient, a paramedic must be careful in assessing the patient. Since the hypertension that the patient has can lead to stroke, a paramedic must know how to assess and provide treatment properly to avoid further disabilities. A paramedic must carefully assess the patient first by doing three things. According to the American Heart Association, the first 3 things that should be assessed in an emergency are airway, breathing and circulation. This is an act well-known all over the world, and is aimed at decreasing cardiovascular-related deaths, especially stroke.

Diagnosing stroke for a patient suffering from some symptoms is critically important so that proper medications and treatments will be provided to improve the prognosis. A pre-hospital screening assessment done to check whether it is stroke or not is the Los Angeles Pre-hospital Stroke Screen (LAPSS). This is a tool used to identify stroke by checking facial grimace, hand grip, and arm weakness (Kidwell, et al. 2000). Being a paramedic, one must be able to carry out all the following procedures:

• Administer first-aid treatment and life-support care to sick or injured persons in pre-hospital setting. • Perform emergency diagnostic and treatment procedures, such as stomach suction, airway management or heart monitoring, during ambulance ride. • Observe, record, and report to physician the patient’s condition or injury, the treatment provided, and reactions to drugs and treatment. • Immobilize patient for placement on stretcher and ambulance transport, using backboard or other spinal immobilization device.

• Maintain vehicles and medical and communication equipment, and replenish first-aid equipment and supplies. • Assess nature and extent of illness or injury to establish and prioritize medical procedures. • Communicate with dispatchers and treatment center personnel to provide information about situation, to arrange reception of victims, and to receive instructions for further treatment. • Comfort and reassure patients. • Decontaminate ambulance interior following treatment of patient with infectious disease and report case to proper authorities.

• Operate equipment such as electrocardiograms (EKGs), external defibrillators and bag-valve mask resuscitators in advanced life-support environments. Assessments during the pre-hospital setting must be done continuously every 5 minutes until the patient arrives at the hospital. Documentation will proceed, and abnormal findings will be reported to the proper people to take care of the patient in the hospital setting. Great differences vary between pre-hospital treatments from in hospital treatment. Pre-hospital treatments are limited by resources and some machineries compares to in hospital treatments.

However, pre-hospital treatment is truly significant in the prognosis of the patient because whatever treatment that would be given by the paramedics to the patient while being transferred to a hospital can greatly decrease the mortality rate of the injured patient. Rapid response and intervention is crucial to the treatment of stroke (NINDS 2009) because the longer treatments could be provided, the more extensive the damage becomes. References Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL 2000, ‘Identifying stroke in the field.

Prospective validation of the Los Angeles prehospital stroke screen (LAPSS)’ Available from: ;http://www. ncbi. nlm. nih. gov/pubmed/10625718? dopt=Abstract; [21 May 2010] Meisel, Z 2005, ‘Ding-a-Ling-a-Ling— Ambulances can be dangerous places’, Slate. Washington Post. Newsweek Interactive Co. LLC. Available from : ;http://www. slate. com/id/2129684/;. [22 May 2010]. National Institute of Neurological Disorders and Stroke (NINDS) 2000, ‘Know stroke. Know the signs. Act in time’ Available from: ;http://www. ninds. nih. gov/disorders/stroke/knowstroke. html;. [22 May 2010].

Nettina, SM 2006, Manual of Nursing Practice, 8th edn, Philadelphia, Lippincott Williams ; Wilkins. Smeltzer, SC, Bare, GB, Hinkle, JL ; Cheever, KH 2008, Textbook of Medical- Surgical Nursing, 11th edn, Philadelphia, Lippincott Williams ; Wilkins. Stillwell, SB 2007, Critical Care Nursing Reference, 4th edn, Singapore, Elsevier. Summary Report for: 29-2041. 00 – Emergency medical technicians and paramedics, 2008. Available from: ;http://online. onetcenter. org/link/summary/29-2041. 00;. [22 May 2010]. Trauma’s golden hour 2007, Available from: ;http://www. traumafoundation. org/restricted/tinymce/jscripts/tiny_mce/plugins/filemanager/

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