Treat and refer guidelines

Question 1

What are the indications NOT to T&R for Hypoglycaemia

Answer 1

• Incomplete recovery
• Unwitnessed onset
• Prolonged episode
• Pt on oral hypoglycaemic medication
• OD on medication
• unable to consume further carbohydrates
• Unable to be monitored for 4 hours
• No PHx of diabetes
• Cause requires further investigation
• Injury/seizure
• Pregnancy

Question 2

What are the indications NOT to T&R for Epistaxis

Answer 2

• Unable to control bleeding after 15min
• Recent Hx of facial/head trauma
• Hx of bleeding disorder of anticoagulant therapy

Question 3

What are the indications NOT to T&R for Suspected Gastroenteritis

Answer 3

• Significant dehydration requiring fluid IV
• Potential GIT bleeding
• Severe/constant abdominal pain
• BGL >17
• Absence of diarrhoea
• PHx of inflammatory bowel disease
• Pregnancy
• Co-morbidities

Question 4

What are the indications NOT to T&R for Heroin OD

Answer 4

• Incomplete recovery (GCS<15, RR<10)
• > 1 dose of naloxone
• Opioids other than heroin involved
• Polypharmacy OD
• Other causes of altered CS
• Seizure
• Suspected aspiration / APO
• Pregnancy
• Pt is a risk to others

Question 5

What are the indications NOT to T&R for Minor burns

Answer 5

• Burn involves face/hands/feet/major joints/genitalia
• Circumferential burns of limbs/chest
• Partial/full-thickness burns
• Smoke inhalation or inhalation injury
• Chemical, electrical or radiation burns
• Suspected non-accidental burns
• Associated traumatic injuries
• Pain unable to be controlled with oral analgesia
• Co-morbidities that may impair wound healing

Question 6

What are the indications NOT to T&R for Minor wounds

Answer 6

• Uncontrolled serious bleeding
• Neurovascular impairment or loss of function
• Penetrating injury/degloving/crush injuries
• Other injuries requiring hospital Mx
• Pain unable to be controlled with oral analgesia
• Suspected muscle / tendon damage
• Foreign material unable to be cleaned out of wound
• Bite wounds
• Wound > 6 hours old
• Signs of infection
• Co-morbidities

Question 7

What are the indications NOT to T&R for seizure

Answer 7

• Incomplete recovery (to normal GCS)
• Suspected non-epileptic cause
• No PHx of epilepsy/first presentation seizure
• Different to usual presentation
• Concurrent illness
• Injury/aspiration/submersion
• Patient administered IM/IV midaz
• Unwitnessed seizure
• Hx of multiple seizures per episode
• Pt has feeling of impending seizure
• Unable to be monitored by a responsible adult
• Pregnancy
• Pt requests transport

Question 8

What are the indications NOT to T&R for Soft tissue injury

Answer 8

• Evidence of significant # or dislocation
• Neurovascular impairment
• Pain unable to be controlled by oral analgesics
• Suspected non-accidental injury
• Ankle/foot injuries - positive ottawa ankle rules

Question 9

What are the indications NOT to T&R for Lower back pain

Answer 9

• Pain not isolated to Lower back
• Loss of bladder/bowel control
• Saddle anaesthesia
• Lower limb weakness/numbness
• Hx of fall or significant trauma
• PHx osteoporosis or chronic steroid use
• Suspected dissecting AAA
• Pain unable to be controlled by oral analgesics
• PHx of cancer or recent unexplained weight loss
• Fever pr recent PHx of infection
• PHx of IV drug use
• Immunocompromised