Paraphrasing to rewrite a short essay.

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I need paraphrasing to rewrite a short essay.

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Pre hospital major trauma prptocol: The objective of pre-hospital major trauma protocol is to reduce preventable death and permanent disability and to improve patient outcomes by matching the needs of the injured patient to an appropriate level of care in a safe and timely manner. The interventions decision in the prehospital setting is based on anatomic, physiologic and high mechanism risk criteria, available resources, and time and distance factors to hospital. Major trauma in the pre-hospital setting can be identified when there is a minimum of one out of three criteria present. These are: the presence of abnormal vital signs; the presence of an assumed or actual anatomic injury; or the existence of a high-risk mechanism of injury in at-risk patients. Airway management considerations: Traumatic brain injury: • • • • • • Rapid sequence induction (RSI) should be provided unless patient is in cardiac arrest. This includes patients with absent airway reflexes. Midazolam should not be used to control combativeness prior to RSI in head injury. Judicious opioid pain relief should be administered. In the rare circumstance where combativeness is preventing preoxygenation, then all other preparations for the RSI should be undertaken and a small (20 - 40 mg) bolus of Ketamine may be given to enable preoxygenation. Unconscious patient unable to be oxygenated and ventilated using BVM and the oropharyngeal airway (OPA), the nasopharyngeal airway (NPA, the laryngeal mask airway (LMA) or intubation (ETI). Massive facial trauma is present and RSI is considered unsafe due to the inability to undertake the Difficult Airway Guideline. A commonly reported issue in “can’t intubate/can’t oxygenate” cases that leads to patient harm is a fixation error, where a provider focuses on trying to achieve a particular task (such as intubation) instead of progressing to another option to manage the airway. In these circumstances it may be appropriate for another paramedic (including junior staff) to prompt the next step in the guideline, balancing the need to remain respectful with the need to protect the patient from harm. Intubation does not need to be attempted and be unsuccessful in order to enter the Difficult Airway Guideline. If a patient appears at assessment to present a difficult airway (e.g. due to factors such as morbid obesity, short neck, small mouth or facial trauma) this guideline may be an appropriate starting point for airway management and using another technique such as (OPA), NPA, and (LMA). Circulation management considerations: Uncontrolled bleeding • In patients with uncontrolled bleeding (e.g. ruptured ectopic pregnancy, penetrating truncal trauma, limb avulsion) ongoing bleeding may lead to poor cerebral perfusion and coma. • • • • • • RSI in these patients is potentially harmful. The sedation may drop BP further and the added scene time increases total blood loss. The appropriate treatment for these patients is urgent transport and immediate surgery. RSI should NOT be undertaken in patients who become unconscious when the coma is likely to be secondary to blood loss unless RSI is judged to be absolutely essential due to an unmanageably combative patient or it is impractical to transport unintubated. This applies to both air and road transport. Airway management with a bag-valve-mask (BVM) is to be maintained in conjunction with prompt transport. Intubation (without drugs) should be considered if airway reflexes are lost. Normal Saline IV (max. 40 mL/kg) titrated to patient response (unless in the setting of penetrating truncal trauma or uncontrolled overt bleeding) • Aim for SBP > 120 mmHg. If SBP < 100 mmHg after 40 mL/kg: • Consult with appropriate trauma service, If consult is unavailable, Normal Saline 20 mL/kg IV. ...
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Surname 1
Pre hospital major trauma protocol:
Prehospital major trauma protocol’s main aim is reduction of death which refers to preventing
and improving patient outcomes. In order to achieve this, the needs of injured patient’s needs are
matched to a suitable level of care which is done in a timely and safe manner. In the pre-hospital
setting, the decisions of the interventions are done while considering available resources such as;
distance and time factors to the hospital, anatomic, high level mechanism and physiologic risk
criteria. Identification of major trauma in the prehospital setting is done if there is at least one
criteria out of the three present. These criteria include:

Existence of vital signs which are abnormal
Existence of an actual or assumed anatomic injury
At-risk patients having high risk injury mechanism.

Airway management considerations:
Traumatic brain injury:

Provision of Rapid Sequence Induction is required unless injured patient is experiencing
cardiac arrest. This includes patients having absent airway reflexes.
Use of Midazolam is preferable when controlling combativeness which precedes RSI in a
head injury. Administration of Judicious opioid pain reliever should be done. Additional
preparations for RSI shall be done rarely when combativeness prevents pre-oxygenation.
A relatively small Ketamine bolus (20-40mg) may be provided for enabling of preoxygenation.
Patient who is unconscious and unable to be ventilated and oxygenated by BVM and the
nasopharyngeal airway, intubation or laryngeal mask airway.
Massive facial traum...

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