Applied Clinical Paramedic Care

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APPLIED CLINICAL PARAMEDIC CARE ‘One of the most common symptoms in patients presenting to the ambulance service is pain’ (Joint Royal Colleges Ambulance Liaison Committee (JRCALC) 2006a: 1). Porth (1994: 982) suggests that pain is, ‘a complex and personal phenomenon. It involves not only anatomic structures and physiologic behaviours but psychological, social, cultural and cognitive factors as well. It can be an overwhelming experience, often disruptive to customary behaviour, and when severe it demands and directs all of one’s attention’. This assignment will analysis the pathophysiology of pain and the related care of severe pain in patients who may be attended by the emergency ambulance services by the use of ketamine as an analgesic agent. This assignment will also explore the pharmacokinetics and pharmacodynamics and the routes of administration and rates of absorption of ketamine. The legal issues associated with drug administration and the protocols utilised by paramedics to deliver drugs in the out of hospital setting will be discussed and how prescription drugs can have adverse effects on patients during exacerbation of illness or injury will also be analysed. One of the most vital points to consider in relation to the control of pain and the administration of analgesia in the pre hospital setting is that, in many cases, it is inadequate (Lord and Parsell: 2003 and Hennes, Kim and Pirrallo 2005). It could be said that any delay in handing a patient over to the Accident and Emergency Department, due to a particular busy period or during a major incident, thus delaying in hospital analgesia administration, amplifies the beneficial impact of adequate pre hospital administration of pain relief. Categorization of pain types can be grouped into four according to source, fast versus slow, referred and duration (acute versus chronic). The sources of pain

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