Reflection Essay on the Clinical Event
The event that I am focusing on is cardiac compression, as an emergency procedure that paramedics apply to respond to complications that happen in relation to breathing problems and spontaneous circulation of blood from the heart to other organs of the body. Cardiac compression, which is also known as chest compression is a practice recognised as a live saviour especially for patients who generate the small amount of blood flow to the heart and brain and people who have breathing problems (Rajab et al., 2011). For the person receiving medical care through chest compression to receive the services in the right manner, the paramedic should carry out the activity through cardiac massage or thoracic pumping mechanism as a way of optimising the flow of the air in the breathing system of a human being. According to Hollenberg, Svensson, and Rosenqvist (2013), a standard cardiopulmonary resuscitation (CPR) is known for its benefit of enhancing the survival of patients either at home or patient in the ambulance set to take the patient to the medical unit for hospitalisation. Thus, to make sure that the reflection presented in this paper is supported by what I have learned, I plan to look at the principles of cardiac compression, with the primary focus being on my understanding concerning compression process and how I can use the activity to respond to respiratory arrest. Other areas of focus in this reflection include the process of cardiac compression for treating a patient who has collapsed due to respiratory complications caused by consumption of alcohol excessively.
Patient’s History
Based on the medical data that the patient present, it is noted that the typical respiratory rate of the patient is 20 breaths per minutes. Other records of the patients relate to the peripheral capillary oxygen saturation (SpO2) level, and as the clinical records show, it is identified that the level of SpO2 for the patient is 100%, which is an indication of the fact that the patient has a normal SpO2. The patient’s blood pressure is normally rated, where the test showed the BP is 130-135 mm Hg. However, in some cases, the BP was 150 mm Hg, which would make the paramedic conclude that the patient had hypertension or high blood pressure. Upon measuring the pulse rate of the patient, varying figures were established. As such, the pulse rate as per the patient record is 96 to 86, which is a normal rate of a healthy person. The body patient temperature is 35.7°C, while patient Glasgow Coma (GCS) score were 14 and 19. Finally, the blood glucose level (BGL) of the patient is 4.5 mmol/L, which makes paramedic conclude that the patient has a normal blood sugar.
Thoughts and Emotions
Throughout my learning on the case study concerning the respiratory arrest, I feel that cardiac compression is an essential procedure that paramedics can use to respond to life complications for patients who has collapsed due to alcohol overdose. Moreover, as CPR is a significant technique of ensuring that patients do not lose their lives because of respiratory arrest incidents, I think that CPR should be commenced as soon as patients under fibrillations show any sign of complications. Evidently, based on my observation of the case study on the patient who has collapsed due to alcohol overdose, I think that each stage of CPR can restore the normal functioning of the respiratory system, which I believe is a good way of enhancing that the normal operation of the human body is enhanced. Based on literature presented by Hollenberg, Svensson, and Rosenqvist (2013) I feel that chest compression is a process that consists of forceful oscillation of the half of the sternum and for paramedics to carry out the process successfully they must use a technique that is highly standardised and procedures based on individual professionalism.
This means that for me to ensure that I am doing a good compression practice; I should follow a specific procedure based on particular activities. For example, to respond to the case of respiratory arrest, as a paramedic I will focus on assessing the sound of the heart of the patient for one full minute, examine the respiration aspect of the patient for one minute, and measure the reaction of the eye (pupil) to the light (Government of South Australia, n.d.). Besides, as a paramedic, I have learned that it is essential to keep record and documentation of the examination practice because the documentations will help me implement decisions with regards to the treatment needs of the patient with breathing complications. The other thing that I feel is significant for the paramedics to know when addressing the issue of respiratory arrest is the causes of the respiratory failure, as understanding the causes of the situation will enhance that the paramedic knows potential techniques to apply when addressing the issue or even knows how to initiate cardiac compression process.
Furthermore, I have observed that CPR procedure might be complex, particularly in cases where the patient is suffering from the aspect of stroke. In such situations, I am supposed to execute the compression activity instantly so that to ensure stroke does not make the respiratory attack worse. In reference to this point, Kasner and Gorelick (2004) proclaim that patients with stroke may experience respiratory difficulties because stroke is known for its impacts on the respiratory system and the entire process of breathing. Here, I think that for the paramedics to ensure that the CPR practice is of high quality, it is necessary for one to understand that stroke can disturb the breathing system that includes causing disturbance of the central rhythm generation as well as reducing respiratory drive, which is known for its impacts of weakening the respiratory system. Conversely, to assess the patient with the aim of finding out if he or she has stroke issues, I have learned that paramedics are supposed to use ROSIER, as an assessment tool with the sensitivity of predicting if the patient under respiratory arrest has stroke or whether the person has the stroke mimic (Government of South Australia, n.d.). Nor et al. (2005) argue that ROSIER is a greater scale that paramedics can apply to recognise the aspect of stroke in an individual and the tool is effective when differentiating acute stroke from mimics stroke, as they happen to the person who has just collapsed.
With no doubt, from the case study and the learning materials, I now understand that alcohol is one of the leading causes of respiratory failure, in particular when consumed consistently. Based on literature presented by Samuels and Ropper (2010), alcohol is recognised as a component that has negative implications on the tracheal intubation, which might complicate the respiratory system and support needed for the respiration system of an individual to function efficiently. In addition, Vonghia et al. (2008) have posited that when people take excessive alcohol, the practice is likely to cause respiratory depression and decrease airway sensitivity, which is a major influence on the performance of the respiratory system. From this argument, I think that significant amount of alcohol can lead to respiratory arrest, and if I am supposed to address respiratory failure through CPR, I will ensure that I test the patient to know if alcohol abuse has been the cause of the complication and used the findings to initiate the chest compression activity. From the reading materials, I have observed paramedics should consider ensuring that the level of oxygen is adequate for a patient affected by the problem of respiratory arrest is important. Hence, as a paramedic, to ensure that the respiratory arrest patient receives adequate oxygenation, I will recommend Naloxone a synthetic drug, which is used to treat respiratory depression and any other complications (Government of South Australia, n.d.). Naloxone is an important medicine because it can be prescribed to any paediatric patients either adults, young children, or even newborns.
Evaluation and Analysis
To analyse the chest compression process for a person under respiratory complications, I will reflect on the process itself and outline the things that I need to conduct so that I can ensure that the procedure is of high quality and it saves the life of a person. First, to execute the CPR on the respiratory failure patient, I would ensure that the patient is lying in bed and I am in a good position of using Bag Valve Mask (BVM) Ventilation. Khoury et al. (2016) allude that it is important for paramedics to use BVM because the device is a critical component of airway management and it provides oxygenation and ventilation, which is necessarily relevant for patients who are in a respiratory arrest condition. In reflection to this point, I believe that it would be worthwhile for me to use the BVM to attend to patients with breathing problems because the device will help the patient with the respiratory difficulties move the thick bronchial secretions, which is a better way of enhancing the movement of the air within the breathing system. The use of the BVM device is also imperative because this allows patients to improve the compliance of the respiratory system and use the prescribed care after the completion of chest compression. When I reflect on Santhanam (2013) presentation, I now understood that as a paramedic it would be substantial for me to use Bag-Valve-Mask Ventilation to initiate respiratory support to adult patients and apneic children with breathing problems. Similarly, the literature shows that paramedics can utilise the BVM device to deliver or enhance positive pressure breaths when compressed to improve the functionality of the breathing system (Finucane, Tsui, & Santora, 2010). Personally, to attend to patients with breathing difficulties, I will use BVM and chest compression together because this will ensure that the activity serves the intended purpose and it is beneficial for the patients receiving the care service.
Strengths and Weaknesses
Typically, the case study on respiratory arrest has been helpful to me in different ways. As such, the case study together with the readings materials has given me the skills and knowledge that will boost my role as a paramedic set to work in an ambulance, where I am needed to respond to respiratory arrest emergencies. The case has made me know the need to understand the importance of physical strengths as a crucial element required during the chest compression process. The reading has also given me the ability to work in a changeable environment, either in the hospitals or in the ambulance where emergency chest compression is conducted. As literature indicates, when paramedics use case studies and are being educated with resourceful materials about health care events such as chest compression, they gain resourceful skills that they use to carry out the practical activities relating to chest compression (Elling & Elling, 2013). However, I feel that limited time and resources that are set for us to use as a source of knowledge, do not give paramedics an opportunity to develop adequate skills as some of us would like or prefer. For this reason, this is weakening the capabilities of the paramedics, and therefore, for the paramedics to be fully prepared learning institutions should increase the resources and time that paramedic staffs require to study in order to acquire necessary skills to carry out emergency tasks.
Conclusion and Actions
This paper presents a reflection on a clinical event based on the learning of the way paramedics can use his or her skills to give emergency medical care to seriously ill people and individuals who need to be stabilised before they are being hospitalised. The reflection heed on showing personal emotions, thoughts, analyses of the points that I have learned throughout my coursework, and case studies regarding the respiratory arrest. Although the readings and the case study have been didactic and resourceful to me, it is has been difficult to integrate the practical and theoretical knowledge, especially without the support of the educators or healthcare supervisors. Therefore, I would propose that for paramedics to become fully engaged and knowledgeable adequately, it would be substantial for the educators and healthcare leaders to consider implementing informative methods of education that will allow paramedics to apply the available resources to acquire knowledge that is necessary for understanding activities such as cardiac compression.
References
Elling, B., & Elling, K. M. (2013). Paramedic exam review. Clifton Park, NY: Delmar Cengage Learning.
Finucane, B. T., Tsui, B. C.-H., & Santora, A. H. (2010). Principles of airway management. New York: Springer.
Fuhrman, B. P. (2011). Pediatric critical care. Philadelphia, PA: Elsevier Saunders.
Government of South Australia, (n.d). Declaration of life extinct. Clinical Practice Guideline.
Government of South Australia, (n.d.). Narcotic overdose. Clinical Practice Guideline.
Government of South Australia, (n.d.). Notification of stroke. Clinical Practice Guideline.
Hollenberg, J., Svensson, L., & Rosenqvist, M. (2013). Out‐of‐hospital cardiac arrest: 10 years of progress in research and treatment. Journal of Internal Medicine, 273(6), 572-583.
Kasner, S. E., & Gorelick, P. B. (2004). Prevention and treatment of ischemic stroke. Philadelphia: Butterworth-Heinemann.
Khoury, A., Sall, F. S., De Luca, A., Pugin, A., Pili-Floury, S., Pazart, L., & Capellier, G. (2016). Evaluation of Bag-Valve-Mask Ventilation in Manikin Studies: What Are the Current Limitations? BioMed Research International. 1-9. doi: 10.1155/2016/4521767
Nor, A. M., Davis, J., Sen, B., Shipsey, D., Louw, S. J., Dyker, A. G., … & Ford, G. A. (2005). The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. The Lancet Neurology, 4(11), 727-734.
Rajab, T. K., Pozner, C. N., Conrad, C., Cohn, L. H., & Schmitto, J. D. (2011). Technique for chest compressions in adult CPR. World Journal of Emergency Surgery, 6(1), 6-41.
Samuels, M. A., & Ropper, A. H. (2010). Samuels’s [sic] Manual of neurologic therapeutics. Philadelphia, PA: Lippincott Williams & Wilkins.
Santhanam, I., (2013). Pediatric Emergency Medicine Course (PEMC). Jaypee Brothers Publishers.
Vonghia, L., Leggio, L., Ferrulli, A., Bertini, M., Gasbarrini, G., Addolorato, G., & Alcoholism Treatment Study Group. (2008). Acute alcohol intoxication. European Journal of Internal Medicine, 19(8), 561-567.
