Notebook

Notebook

” The writer Could add any useful information in the netbook to make it looks good and Perfect . ”

III. Notebook Assignment – Final Report
You will be required to complete a notebook on this experience. The notebook will account for 100 points of your grade. Attention will be given to proper layout, spelling and grammar. The notebook should be well organized!
A.    Future Job Possibilities (30 pts)
1.    Discussion of Skills- skills, knowledge, insights, etc. you have gained as a result from this experience.
2.    Training needed- to qualify as entry-level staff member in this agency or organization and opportunities within agency or organization if hired. Include job openings currently available or will be open in the near future.
3.    Brief evaluation and discussion – How your experience will impact your
future.
4.    Summarize your major responsibilities and projects
B.    Administration of agency or organization providing internship (10 pts)
1.    Organizational chart – of agency or organization (may need to create own if necessary).
2.    Funding – Where it comes from.
3.    Job description – brief summary of 3-4 agency positions
4.    In-service training – for regular employees
5.    Public relations and advertisement – how is this accomplished?
C.    Agency Program and Services (20 pts)
5.    Purpose of the Agency- why does agency exist?
6.    Agency goals- what are the stated goals?
7.    Clientele served- who benefits from the agency services, in what ways?
8.    Types of programs offered- list all the programs.
9.    Effectiveness of programming- in what ways do the programs make a difference?
D.    Evaluation (10 pts)
10.     Strengths- discuss what you believe to be the main strengths of the agency or organization.
11.    Weaknesses- discuss what you believe to be the main weaknesses of the agency or organization.
E.    Appendix- include forms, materials, handouts you received from the agency or organization, including anything you developed/created or revised. (20 pts)
Notebook organization- includes neatness (sections above clearly outlined), grammar, and spelling. (10 pts)

Spinal and Head Injury Lesson Plan

According to the U.S. National Library of Medicine, a spinal cord injury is extremely serious because of it is essential to the proper functioning of the human brain and body; the cord is located in the neck and the back and if it is damaged it could result in paralysis below the area of the injury (1).  There are numerous causes for spinal cord injuries but the most common include wounds that occur as the result of a stabbing or shooting, traumatic injury to the face, neck, head chest or back, car accidents, injury from electrocution, sports injuries, or falling from extreme heights.
In addition to spinal cord injuries, the U.S. National Library of Medicine states head injuries have the potential to be equally serious (1).  There are two types of head injuries, closed and open. A closed head injury involves an accident where the head has been hit extremely hard but the skull was not broken.  An open head injury also called a penetrating injury; is an accident that occurs when the object that it the head broke the skull and entered the brain.  This is most likely to occur if the victim has been shot in the head or the victim’s head has gone through a windshield as the result of a car accident (U.S. National Library of Medicine: Head Injury, 1).
Head injuries are usually caused by scalp wounds and fractures to the skull; the most common traumatic brain injury us a concussion; this occurs when a person is hit in the head and their brain is shaken. Head injuries can occur anywhere; the most common causes are falls, assault and traffic related incidents; these injuries can range from moderate to severe, with the most severe being brain damage or even death to both adults and children.

Overall Objective:  To increase the likelihood that first responders will be able to quickly recognize spinal and head injuries and act quickly and efficiently.

Topic Objective:
To recognizing and respond effectively to a spinal cord injury

Topic Outcomes: To learn about spinal cord injuries.
Time: 12 minutes
Slides
Lecture

Slide Four: One million people in the US encounter minor incidents of traumatic brain injury and are treated and released from emergency departments in the hospital (1).

•    230,000 people in the US are hospitalized annually and
•    99,000 will indicate a lasting disability.
•    In children, annual head trauma leads 600,000 visits to the emergency department and 95,000 admissions to hospitals for kids

Slide Seven: Types of head injury
•    Concussion
•    Epidural hematoma
•    Skull fracture
•    Concussion:  this kind of injury is a head injury that can result in immediate loss of alertness and awareness for a certain period of time after a traumatic occurrence usually ranging from a few minutes to a few hours.
•    Epidural hematoma which transpires when there is formed blood clot below the skull and on the top of dura that is the tough covering surrounding the brain.
Slide Eight:
•    Skull fracture: This is a situation where the skull bone breaks. It entails several types of skull fracture such as:
Slide 11:
•    Head Injury Symptoms which varies with the severity of the head injury. Some of the symptoms related to head injuries include:
o    Confusion
o    Loss of consciousness
o    Vomiting
o    Dizziness
o    Sweating
o    Seizures
o    Severe headache
o    Blurred vision etc.
o    Skull fracture
o    Depressed skull fracture
o    Diastatic skull fracture
o    Basilar skull fracture
Slide 13: Diagnosis:  involve physical evaluation and diagnostic tests such as x-rays, blood tests, electroencephalogram, and computed tomography scan.
Slide Eight:  Treatment depends on the severity of the injury and may include:
•    Ice
•    rest
•    Observation
•    Instant medical attention
•    Use of stitches
•    Admittance for observation
•    Surgery

Slide 15:  For a head injury, physician can determine the treatment based on:
•    Age of patient
•    Degree of the injury in the head
•    Head injury type
•    Patient’s tolerance to a given medications or therapies
•    Patient’s opinion or preference

A physician can determine the treatment based on:
•    Age of patient
•    Degree of the injury in the head
•    Head injury type
•    Patient’s tolerance to a given medications or therapies
•    Patient’s opinion or preference

Usually, the early symptoms of injuries in the spinal cord is the spinal shock and often results in loss of movement and feeling below the site of the injury.

Diagnosis
It is always difficult to diagnose and manage spinal trauma, and usually a missed injury can lead to a serious difficulties. In case of accidents which involve a suspected spinal injury, it must be assumed until it is proven otherwise. During assessment and diagnosis, the spine must be secured and immobilized all the time. Initially the assessment comprises clinical examination and may also include imaging tests, including x-rays, magnetic resonance scans, and computed tomography scans. When tests are being taken, it should not involve only the region that the injury is suspected but the entire spine must be included

Topic Objective-Spinal Cord Injuries:  Understanding the Spine
Topic Outcomes: To learn about the parts of the spine

Time: 16 minutes
Slides
Lecture

Slide 16
Definition of a Spinal Cord Injury

Understanding the spine:  Cognitive Definitions
The four major sections of the spine:
•    Cervical,
•    Thoracic
•    Lumbar
•    Sacrococcygeal Vertebrae

The Anterior Column:
•    anterior longitudinal ligament
•    anterior portion of the vertebral body
•    anterior portion of the intervertebral disc.

Slide 20:
The Middle Column:
•    posterior longitudinal ligament
•    posterior body
•    posterior intervertebral disc

Posterior Column:
•    ligamentum flavum
•    posterior elements
o    facet joints
o    pedicles,
o    transverse processes,
o    laminae and
o    spinous processes
Notes:  Multiple ligaments and muscles surround the posterior elements. These structures protect the spinal cord and nerve roots.

Intervertebral disc
•    outer annulus fibrosus
•    inner nucleus pulposus

Composition of the outer annulus fibrosus
o     Comprised of  lamelliform: connective tissue bands

Composition of the inner nucleus pulposus
o     mucinous,
o    colloidal gel
?    proteoglycans
?    collagen
Notes:  Colloidal gel has high water content [70 to 80 percent fluid]).

References
American Family Physician. “Recognizing Spinal Cord Emergencies.” Recognizing Spinal Cord Emergencies. American Family Physician, 15 Aug. 2001. Web. 18 June 2015.

Topic Objective:
To recognizing and respond effectively to a spinal cord injury

Topic Outcomes: To learn how to properly respond to a suspect spinal cord injury.
Time: 12 minutes
Lecture

Slide 25:
Spinal Cord Injury EMT Procedure
•    Step One: manual cervical immobilization  (definition)
•    Step Two: rapid neurological exam (definition)

o    ABCDE’s
?    A: Airway Maintenance with CERVICAL SPINE protection
?    B: Breathing and Ventilation
?    C: Circulation with hemorrhage control / shock assessment
?    D: Disability: Neurological status
?    E: Exposure/Environmental control

Step Three: Address problems revealed during the exam.
•    Potential next steps:
o    Log roll
o    Xray and FAST Exam
o    Secondary Exam
o    Resuscitation and stabilization
Spinal Cord Injuries are difficult for pre-hospital personnel to determine.  After a traumatic injury Staff should:
•    Always address the possibility of spinal cord injury.
•    Protect the cervical spine region
•    Conduct detailed assessment, a
•    Gather  good patient history
•    Recognize the signs, trauma to the cervical region may cause:
o    transection,
o    bruising or swelling to the cord,
o    injury to the musculoskeletal structures of the region.
•    a spinal injury may not be obvious to the pre-hospital provider. Therefore, a

Injuries that are high on the spinal cord often cause:
•    a more severe prognosis
•    a greater chance for a catastrophic outcome.
•    breathing problems ( chess wall restriction)
•     neurological deficits such as:
o    quadriplegia,
o    paraplegia,
o    paresthesia,
o     incontinence
o    and/or priapism.
Patients suspected of spinal injury with neurological deficit should be:
•    secured on a long spine board with a cervical collar
•    Immobilized to the spine board including:
o    the torso,
o     pelvis,
o    lower extremities
o    the head.

Topic Objective-Spinal Cord Injuries:  Understanding the anatomy of the nervous system and the physiology of shock

Topic Outcomes: To learn better manage the neurogenic shock patient.

Neurogenic shock: shock resulting from the spinal injury
•    Definition:  Neurogenic shock is the loss of autonomic nervous system response. Spinal shock normally lasts for a few hours to a few weeks and may perhaps subside over time to disclose the actual extent of the injury. There are other initial symptoms such as breathing difficulty, spasticity in the muscles, problems with blood pressure and heart rates, and even the loss of bowel and bladder functioning. The severity and the location of the spinal injury may result in varying long-term effects of the spinal trauma.
Notes:  The brain, spinal cord and peripheral nerves control neurological activity in the body; this activity is voluntary and involuntary.
The autonomic nervous system:
•    heart rate,
•    blood vessel calibration,
•    digestion,
•     respiration, etc.
The autonomic nervous system:
•    Sympathetic
•    parasympathetic
sympathetic nervous system when stressed results in the “fight or flight” response which increases the following:
heart and respiratory rates,
blood pressure,
blood vessel constriction,
diaphoresis
and other stress responses.

The parasympathetic system regulates the body’s “rest and digest” response:
•    Ensures the body responds to stress.
•    Injury in sympathetic nerve clusters may cause  a loss of sympathetic response resulting in:
o     bradycardia,
o    hypotension (due to vasodilation),
o    decrease in respiratory rate,
o    warm and dry skin,
o    other non-sympathetic responses or shock.
– How to prevent neurogenic shock:
•    A working pump (heart);
•    adequate volume (blood)
•     (a working vascular system).
Two common ways to address neurogenic shock:
•    Saline Infusion
•    Dopamine infusion if saline is administered and ineffective
•    Immediate treatment is required for spinal trauma normally at the location of the injury in order to mitigate additional injuries to the spine
•    immobilization of the head, back, neck and to control swelling
•    steroid medication
•    perform an evaluation of the spinal cord state, release pressure from the injured area
•    stabilize fractured spines and treat injuries to other parts of the body
•     long-term interventions include:
o     mechanical ventilation for breathing assistance
o     feeding tubes to supply additional calories and nutrition
o    Or a catheter to drain the bladder.

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