Managing an unconscious casualty Flashcards

1
Q

Causes of unconsciousness

FISHHSHAPED

A
FISHHSHAPED
Fainting
Infections (not all)
Shock 
Head injury
Heart attack
Stroke
Hypoxia 
Abnormal temperatures (hyper/hypothermia)
Poisoning
Epilepsy
Diabetes (hyper/hypoglycaemia)
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2
Q

Definition of Epilepsy

A

Epilepsy is a disorder that effects the brain.

The cells in the brain, known as neurons, conduct electrical signals and communicate with each other in the brain using chemical messengers.

Epilepsy is a diagnosed condition where a sufferer has 2 or more unprovoked seizures

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3
Q

causes of seizures

A
A seizure is abnormal bursts of neurons firing off electrical impulses, which can cause the brain and body to behave strangely. 
Causes can include; 
Epilepsy 
Hypoglycaemia
Hypoxia
Brain damage
Tumours 
Alcohol withdrawal
Drugs 
Fever (particularly in children)
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4
Q

Signs and symptoms of a seizure

A

Suddenly loss of responsiveness
Rigidity and arching of back
Breathing may be noisy and become difficult
Lips may become cyanosed
Convulsive movements occur
The jaw may clench
Casualty may become incontinent
Saliva may be blood-stained if tongue or lips have been bitten
Tiredness – casualty may feel tired and fall into a deep sleep
Just before a seizure a casualty may have a brief warning (aura)
Strange feeling
Special smell or taste

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5
Q

management of seizures

A

Dangers- Clear space, do not restrain. Loosen tight clothing
Response- AVPU - Continuously reassess
Airway- Do not forcibly open the airway
Breathing- High flow oxygen required in seizure
Adults till 94=98%
Paediatrics irrespective of SPO2
Circulation- Radial pulse, colour, temperature of patient
Disability- Pupils, Sleep after the seizure is normal (Post Ictle)
Expose and Examine- Any injuries? Secondary Survey
Recovery position post fit
Call an ambulance if:-
Seizures > 5 mins
It’s their first seizure
Patients not sure of reason for seizure
Unresponsive for >10minutes
Has sustained and injury from seizure

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6
Q

Define Status Epilepticus

A

Convulsion continue for more than 30 minutes or longer with no rest period

Potential life threatening. Can result in neurological damage, respiratory failure and cardiac arrest.

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7
Q

4 ways poisoning can occur

A

Ingestion

Inhalation

Absorption

Injection

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8
Q

Treatment for poisoning from an unknown substance

A

ABC (primary survey)
Oxygen (<94% Sats) high flow oxygen in carbon monoxide poisoning
Vital signs
Try to establish the event, drug or substance involved and the quantity
Never induce vomiting
Take any substances found to the hospital for inspection.
Call for paramedic for further treatment and urgent evacuation

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9
Q

Treatment for snakes and scorpion bites

A
Lie patient down
Get a description of what has bitten the patient 
Identify and record symptoms
Correct  ABC 
Oxygen if required (<94% Sats)
Gain IV access (qualified personnel) 
If hypotensive consider fluids (qualified personnel) 
Analgesia as needed 
Rapid transfer 
Measure circumference of affect limb and mark area of Oedema
Check tetanus status
Document any bleeding and paralysis
Immobilise with pressure bandage 
Rapid evacuation
DO NOT:
Elevate limb
Allow patient to walk around 
Wash the limb
Feed patient 
Vital signs
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10
Q

Definition of diabetes

A

It usually occurs when there is a deficiency or absence of insulin, or insulin resistance at a cellular level, causing abnormally high levels of glucose in the blood

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11
Q

Definition of Type 1 diabetes

A

Mainly occurs in children, young and adolescent adults
The cause is not fully understood but thought to be an autoimmune problem
Insulin producing cells called β-islet cells in the pancreas are destroyed and either don’t produce any or enough insulin
This causes glucose to build up in the blood stream as there is no ‘key’ to allow it into the cells.
Treatment is usually with insulin injections.

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12
Q

Definition of type 2 diabetes

A

Most common of the 2 types, and makes approximately 90% of cases
Causes can be due to lifestyle or predisposing factors such as obesity, sedentary lifestyle, increasing age, genetic factors
With type II diabetes there may be less than, more than or normal amounts of insulin being produced, but there is still a problem with glucose entering a cell as the ‘key’ doesn’t fit the lock, causing blood glucose levels to rise
Treatment can be dietary changes, medication and sometimes insulin injections.

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13
Q

Causes and S/S of Hypoglycaemia

A

May be due to medication mistakes, missed or delayed meals, infection
A low blood glucose level is defined as <4.0mmol/L. Normal range 4.0 – 5.6mmol/L.

Signs and symptom:
Sweating 
Palpitations 
Shaking
Hunger 
Irritable, confused, drowsiness, uncoordinated, aggressive and anti-social behaviour
Rapid onset
Fitting 
Headache
Nausea
Dizziness
Seizures
Unconsciousness
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14
Q

Management of Hypoglycaemia

A

ABC
Oxygen if required (<94% Sats)
Measure BM
Administer oral glucose gel (40%) if conscious and able to swallow.
Reassess blood glucose level after 10 minutes
Glucagon (IM) if unable to give glucose
Recovery position
Transfer patient to hospital
Continue patient management until more definitive care

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15
Q

Signs and symptoms of hyperglycaemia

A

A high blood glucose reading often >20mmols/l

Gradual onset (hours to days) 
Dry skin 
Deep sighing rapid respiration
Rapid weak pulse 
Restless, drowsy, or lethargic
Sweet fruity breath
Excessive urination
Excessive thirst
Abdominal pain
High blood sugar reading
Hypotension
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16
Q

Management of hyperglycaemia

A

ABCDE
Oxygen if required (<94% Sats)
Measure Blood sugars
Recovery position if unconscious
Transfer or arrange emergency transfer to hospital
Continue patient management until more definitive care

17
Q

Glucagon

A

Glucagon is a hormone that induces the conversion of glycogen to glucose in the liver, thereby raising blood glucose levels.

Administered intramuscular (IM)
Adults - 1mg
Children 7 years old and under - 500mcg
Babies less than 1 month - 100 mcg

18
Q

Definition of hypothermia

A

Hypothermia is defined as a core body temperature below 35 degree C. It is a potentially life-threatening condition.

19
Q

3 levels of hypothermia

Temperature ratings for each

A

Mild 32 – 35 degree C
Moderate 28 – 32 degree C
Severe <28 degree C

20
Q

Management of hypothermia

A

ABCDE
Oxygen if required (<94%)
Identify signs and symptoms of hypothermia
Record patients temperature and vital signs
Warm food and drink if patient is conscious
Shelter and rewarm (slowly). Replace wet clothing with dry
Not dead until warm and dead. Hypothermia may mimic death
DO NOT give alcohol, apply direct peripheral heat or rub the skin

21
Q

heat exhaustion s/s

A

Headache, dizziness, nausea, vomiting, tachycardia
Hypotension, sweating, muscle pain, weakness and cramps
Temperature - >37 - <40 degrees C
May rapidly progress to heat stroke

22
Q

Heat stroke s/s

A

Core temperature >40 degrees
Hot, dry skin (sweating is present in about 50% of cases of heat stroke)
Extreme fatigue, headache, fainting, facial flushing, vomiting and diarrhoea
Seizures

23
Q

Management of heat injuries

A

ABC
Remove patient from hot environment
Remove all clothing
Commence cooling with fanning, cool sponge, water misting
Record temperature
Oxygen if required (<94%)
Fluid therapy (Class 1) Class 2 can help assist
Cool oral fluids
Check BM and vital signs
Recovery position and transfer to definitive care

24
Q

Stoke FAST test

A

F - Facial weakness – The casualty is unable to smile evenly and mouth or eye my droop

A - Arm weakness – The casualty is only able to raise one of their arms

S - Speech problems – The casualty is unable to speak clearly or talk non-sense

T - Time – Time to call 999/112 or evac.

25
Q

Advanced Airways- Adrenaline
Dosages
Indications
Actions

A

1mg to 10ML 1:10,000
Indications
Cardiac Arrest
Shockable rhythms - administer after 3rd shock then every alternate shock 5th, 7th etc.

Non-shockable rhythms – administer adrenaline immediately as soon as IV access is achieved, then alternate loops.

Actions
Increases heart rate (If present)

Vasoconstriction and increases perfusion

Adrenaline enhances myocardial and cerebral blood flow during CPR

CPR becomes more effective due to increased peripheral resistance, this maintains a central blood reserve

26
Q

Advanced Airways- Amidarone
Dosages
Indications
Effects

A

300mg in 10ML
Indications
Cardiac arrest shockable rhythms.
Administered by clinician after 3rd shock via IV/IO
After 5th shock administer half dose of 150mg by clinician via IV/IO

Actions
Antiarrhythmic (suppresses bad heart rhythms)
Stabilises and reduces electrical irritability of cardiac muscle.

27
Q

2 Drugs used is advanced cardiac arrest

A

Adrenaline

Amidarone