Reflective Report on Emergency Medical Care Practice and Learning

This reflective report details a paramedic's experience during a procedural sedation for a child's lip laceration. The report covers the paramedic's feelings, evaluation of the situation, analysis of the use of ketamine, and a proposed action plan. The paramedic reflects on the challenges of administering ketamine, the importance of therapeutic relationships, and the significance of proper consent procedures. The report highlights the importance of understanding medication dosages, managing anxiety, and the need for continuous learning in emergency medical care. The paramedic discusses the use of ketamine, its effects, and its application in procedural sedation, drawing upon relevant research. The report concludes with a self-assessment and a plan for future practice improvement.

Running head: REFLECTION
Reflection
Name of the student
Name of the university
Author’s name

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Description
The case is about a child who was accompanied by his mother because he sustained a lip
laceration. The doctor commented on the patient and the mother belonging from a loose tooth
family to which the mother nodded with a sheepish smile. A verbal consent from the mother was
taken and a video was made of the whole procedural sedation of the child for the lip laceration
surgery. The physician asked the paramedic about the medication and went on to divert the child
for the injection of the sedative. The mother was given the choice to stay with the child during
the procedure which, she agreed. The child was increasingly restless of being administered with
the sedative. The SOAPME procedure was undertaken for checking the presence of equipments
such that the surgery could be started. To maintain an open airway, a towel support was
provided. The superior labial artery got cut in the middle of the procedure and he started
bleeding. 9 milligrams of ketamine was again administered as he was waking up. The edges of
the skin were put together while he woke and another dose was given. He was monitored until no
risk of respiratory depression and regain consciousness.
Feelings
As a paramedic, one of my responsibilities is to ensure that the best care for the patient is
delivered irrespective of their age, gender, belonging and race. However, it is was my inability to
give an exact amount of ketamine as a form of sedative to the patient at one go which resulted in
him waking up quite some times during the duration of the whole procedure. It was evident that
numerous times he lost consciousness which mad made me anxious that he may feel the pain of
the procedure. It was during this time that the child was stopped from moving and administered
the dosage again. The nurse could not comfort the child and make him feel less scared. It is

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because of the inability of the nurse to make a therapeutic relationship with the child which made
me even more anxious of the whole procedure. In addition, the inability to take a written consent
from the mother about a video being taken for the procedural sedation of the child was another
instance which I just took in an instance because of the growing pressure. I think because of the
patient being small in age and the pain that he is going through, is why it did not cross my mind
to take a consent form for the mother and make her sign it after giving her the appropriate
information.
Evaluation
It is because of the young age of the patient which made me more nervous and made me
shaky at first. A therapeutic relationship between the nurse, me and the physician was not
developed which, in turn, increased the chances of the child being very anxious and scared when
he was being injected with the ketamine dose. It would have been better if I would have struck a
professional and a therapeutic relationship to make the child more comfortable and calm about
the procedure of injection and the laceration surgery. The SiO2 started working entirely after the
half of the procedure was conducted which could have increased the chances of the child
suffering from bleeding internally or externally. This could be avoided if immense attention was
paid to each thing before the start of the surgery. Procedural sedation and analgesia (PSA) for
situations, for example, reduction of fracture and repair of lacerations are basic signs for IV
inclusion in childrens. IN ketamine has increased late notoriety for repair of laceration and
analgesia and has shown great hemodynamic dependability. However, in the case of the child, it
was not able to generate a positive result.

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Analysis
Ketamine, an intravenously administered nonbarbiturate stimulant with an initiation of
seconds, is a non-competitive N-methyl-D-aspartate (NMDA) and glutamate receptor blocker
with calming, pain relieving, and anticholinergic effects. It is used profoundly for new
approaches that do not require relaxing of the skeletal muscle. Ketamine is used through the
hepatic tube, with a half-life of about 45 minutes. The point of Seiler and Staubli's review (2019)
was to determine which patient characteristics were linked to doctors choosing N2O 70 per cent
or ketamine as the steady specialist in our paediatric ED after N2O 70 per cent had been
provided. The use of ketamine PAS changed to N2O PAS, particularly in young people more
experienced than three years and for the reduction of displaced fractures at the upper extremities.
It is because of this paper that I can understand the importance of the usage of the drug, ketamine
for the procedural sedation in paediatric patients.
Conclusion
From the situation, it can be concluded that because of my inexperience or feeling
nervous was one of the primary issues which resulted in the child losing consciousness every
now and then of the laceration surgery. It can be clearly understood that the administration of
procedural sedation has been one of the most advanced method of administering anaesthesia to
the patient to reduce the chances of the patient suffering from post-operative pain. This
professional experience had made me understand that I have the confidence in myself to deal
with a critical situation and a critical administration procedure.

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Action plan
As per the scenario, it made me learn about the exact amount of dosage that is to be
administered to the patient to paediatric patient. In addition, not getting nervous and
apprehensive about the treatment because of low confidence levels can lead to more mistakes
being conducted which may put the life of the patient in danger. Overall, it can be concluded that
procedural sedation by ketamine is one of the best procedures for the administration of
anaesthesia for the patient to deal with lesser amount of pain.

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References
Seiler, M., & Staubli, G. (2019). Ketamine procedural analgosedation before and after
introducing nitrous oxide 70% in a paediatric emergency department. Swiss medical
weekly, 149(0910).