Basic Flashcards
(124 cards)
1
Q
What is important to do before or en-route to an emergency?
A
Any form of pre-planning e.g. calculate drug doses, pull up CPG’s etc
2
Q
In what order should you conduct a patient assessment?
A
Primary - treat imminent threats
VSS
Secondary
Additional assessments
3
Q
What is the purpose of primary assessment?
A
Quick assessment to rapidly determine imminent threats to life needing immediate treatment
4
Q
What are the components of the primary survey?
A
Danger (risk assessment)
Response (AVPU)
Airway (clear + open)
Breathing (normal)
Circulation (pulse check)
5
Q
In what situation might you rearrange the order of the primary survey?
A
If suspected cardiac arrest you can check circulation prior to airway and breathing
6
Q
In what situation is it ok to abandon the primary survey and move onto the next assessment?
A
If the patient is fully alert and responsive as this indicates that they must be adequately breathing and well circulated
7
Q
How do you assess a patients response in the primary survey?
A
Escalate attempts to provoke eye opening
A - alert with eyes open
V - eyes open to verbal cue
P - eyes open to pain stimulus (trapezium squeeze, eternal rub)
U - unresponsive/no eye opening
8
Q
What assessment would need to follow an AVPU test if not on A level?
A
A GCS assessment
9
Q
How do you assess the airway in the primary survey?
A
Check if clear - remove any fluid/secretion with suction, remove FB’s in mouth
Ensure open by look, listen and feel - may need jaw thrust or OPA
10
Q
How do you assess breathing in the primary survey?
A
Look, listen, feel for normal breathing = rate 12-20 and adequate volume
Shallow, slow or agonal needs immediate care on completion of survey
11
Q
How do you assess circulation in the primary survey?
A
Palpate for radial pulses —> carotid
If none = CPR
Carotid only = peripheral shut down
12
Q
What special care is needed when palpating carotid pulse?
A
Only perform with patient lying down as can cause reflex bradycardia = drop in BP = syncope
Never palpate both at once = reduced cerebral perfusion
13
Q
What are the steps to performing a pulse check?
A
Explain + consent
Palpate pulse for 30s and multiply by 2 (if irregular or slow/fast then do full minute)
Record
14
Q
What might be the issue if pulses are different on each side of the body?
A
Coarctation (narrowed aorta), block or aneurysm
15
Q
What 6 vital signs are taken?
A
BP
Pulse
Respirations
Temperature
Oxygen Saturations
BGL
16
Q
What is the normal range for blood pressure?
A
Systolic: 100-150
Diastolic: 60-90
17
Q
What factors affect systolic BP?
A
Contractility
Filling
18
Q
What factors affect diastolic BP?
A
Blood volume
Vessel size / resistance
19
Q
What is the cardiac output equation?
A
CO = HR x SV
20
Q
What is the blood pressure equation?
A
BP = CO x PR
21
Q
What is pulse pressure?
A
The difference between the systolic and diastolic blood pressure
We feel this when palpating a pulse
22
Q
What is a narrow pulse pressure and what might cause it?
A
The systolic and diastolic BP are close together
Hypovolaemia, heart failure
23
Q
What is wide pulse pressure and what might cause it?
A
The systolic and diastolic blood pressures are far apart
Anaphylaxis, septic shock, tamponade
24
Q
What is the normal adult pulse rate?
A
60-100 bpm
25
How can we tell if the pulse pressure is narrow or wide?
Narrow = weak pulse
Wide = bounding pulse
26
What 3 factors should be documented regarding pulse VS?
Rate
Regularity
Strength
27
What is a normal respiratory rate?
10-20 breath/min
28
How do you assess the respiratory rate?
Count how many breaths are taken in 30s and multiply by 2
If time between breaths is >7s = hypoventilation
If time between breaths is 3-6s = normal
If time between breaths is <2s = hyperventilating
29
What is Kussmaul breathing?
Fast and deep regular breathing
Cause: usually metabolic acidosis
30
What is Cheyne-Stokes breathing?
Repeating cycles of hypopnoea - hyperpnoea - apnoea (small TV, rapid rate)
Cause: CHF, reduced brain perfusion
31
What is Biot’s breathing?
Alternating periods of hyperpnoea and apnoea (big TV)
Cause: brain injury
32
What is considered a normal temperature?
36-37.8 degrees
33
Define mild, moderate and severe hypothermia.
Mild: 36-35
Moderate: 35-33
Severe: <33 (disrrythmia, bradycardia, rigid, dilated pupils)
34
What is the general rule with rewarming?
Do it slowly
Don’t apply heat directly to skin (slow circulation = burn)
Warm blankets in a warm environment ideal
35
What is pulse oximetry and the normal range?
% of Hb saturated with O2
96-100%
36
What is the normal BGL?
4-8mmol/L
37
What is a significant difference between the way adult and paediatric vital signs present?
Adults compensate with visibly changing vital signs
Paediatric continue to function with normal VS until suddenly can’t cope and deteriorate quickly
38
What makes up the secondary survey?
History taking using SAMPLE and OPQRST
Vital signs
Physical head to toe assessment
39
What method can be used to perform the physical secondary survey on a medical patient?
TRIP DOCS
Temperature
Rash
Injection marks
Pulses
Diaphoresis
Oedema
Colour
Smell
40
What method can be used to perform the physical secondary survey of a trauma patient?
DCAP BTLS
Deformities
Contusions
Abrasions
Puncture
Burns
Tenderness
Lacerations
Swelling
41
What are the components of an abdominal physical assessment during secondary survey?
IPPA
Inspect: signs of injury, scars, distension
Palpate: rolling palm to finger in each region for lumps, pain
Percussion: tap first finger against each region to hear hollow vs solid organs
Auscultate: listen for bowel sounds in all quadrants
42
How do you perform auscultation for an IPPA assessment?
Start at 3-5cm above umbilicus (1200) and repeat at 0300, 0600 and 0900
43
What organs are in the upper right quadrant?
Liver
Stomach
Gallbladder
Duodenum
Right kidney
Pancreas
Transverse colon
44
What organs are in the upper left quadrant?
Liver
Stomach
Left kidney
Pancreas
Spleen
Transverse colon
Small intestine
45
What organs are in the lower right quadrant?
Large and small intestine
Appendix
Reproductive and urinary organs (not kidney)
46
What organs are in the lower left quadrant?
Large and small intestine
Sigmoid colon
Reproductive and urinary organs (not kidney)
47
What organs are in the right hypochondriac region?
(Top R)
Liver
Kidney
Gallbladder
Small + large intestine
48
What organs are in the epigastric region?
(Top middle)
Liver
Stomach
Spleen
Duodenum
Adrenals
Pancreas
49
What organs are in the left hypochondriac region?
(Top L)
Liver
Stomach
Pancreas
Kidney
Spleen
Large + small intestine
50
What organs are in the right lumber region?
(Middle R)
Ascending colon
Small intestine
Kidney
51
What organs are in the umbilical region?
Duodenum
Small intestine
Transverse colon
52
What organs are in the left lumbar region?
(Middle L)
Descending colon
Small intestine
Kidney
53
What organs are in the right iliac region?
(Bottom R)
Appendix
Caecum
Ascending colon
Small intestine
54
What organs are in the hypogastric region?
(Bottom middle)
Bladder
Sigmoid colon
Small intestine
Reproductive organs
55
What organs are in the left iliac region?
(Bottom L)
Sigmoid colon
Descending colon
Small intestine
56
What is used to complete a thorough neurological assessment?
Glasgow coma score
57
What is the Glasgow coma score?
Assesses eye opening (4), verbal response (5) and motor control (6) to give a score between 3-15
58
What is important to consider when assessing GCS?
What their normal response would be e.g may have dementia, syndrome etc
59
What mnemonic is used to perform a respiratory assessment?
CAPERSSS
Consciousness: AVPU
Appearance: tripod, anxious, pale etc
Pulse: normal/bounding/flat
Effort: strain - accessory muscle, tug
Rate: 10-20 normal
Rhythm: regular, TV, pause
Skin: colour, sweaty, cyanosis
Speech: talk in full sentences
Sounds: auscultation
60
What is airway wheeze?
High pitched whistle
Cause: constricted airway
61
What is airway crackles/rales?
Bubbling/popping/clicking noise
Can be moist/dry and fine/coarse
Cause: fluid in small airways
62
What is airway ronchi?
Low pitched rattling, snoring, gurgling or wheeze
Cause: blocked large airway
63
What is airway strider?
High pitched variable sound involving upper airway
Cause: obstructed upper airway
64
How is perfusion status assessed?
Assessment of circulation
Conscious level: AVPU
Pulse rate: 60-100
Radial pulse: present? >90mmHg which is needed to perfuse vital organs
Blood pressure: normal
Skin colour: warm, pink, dry
65
How do you perform a history assessment?
SAMPLE
Signs/symptoms
Allergies
Medication - regular and today
Past medical history (surgery, disease)
Last in/out
Events leading up
66
What tool is used to perform a pain assessment?
OPQRST
O: onset and origin (where, when, pattern)
P: palliation + provocation (what makes better + worse)
Q: quality (what it feels like)
R: radiation (pain spread)
S: severity (1-10)
T: time + treatment (what done to relieve and when)
67
What pain score system is used to assess pain in adult, paed and infant?
Adult 1-10
Paed Wong-baker
Infant PLACC
68
What assessment must be performed on a newborn at 1 and 5 minute mark?
APGAR
Appearance (colour)
Pulse rate
Grimace (irritability)
Activity (muscle tone)
Respirations
69
What is the expected APGAR score?
Most babies will be 6-8 (out of 10) when first born but should improve to a 10 at the 5 minute mark
Any deteriorations indicate need for intervention
70
What is an indication that a wound need stitches?
If the edges are gaping
71
What is used to assess total body surface area of burns?
Rule of nines
72
What is the Parkland formula?
An equation for how much fluid a burns patient needs
4ml x BSA% x weight
Give the first half of the volume in the first 8 hours and the remaining in the next 16 hours
73
How much blood can be lost in a femur or pelvic fracture?
2L femur
4-6L pelvic
74
What lead set is used in the ambulance and what is the placement?
4 lead
Ankles and wrists or chest and hips
75
What is Einthovens Triangle?
Depicts what view of the heart is achieved over a 3 lead ECG
We use lead II from RA to LL
76
What creates upright or downward ECG?
In Einthoven’s Triangle if the flow of electricity is - to + it’s upright but if it is flowing backwards then it is downward. Different leads on the ECG are +/-. Again this is why lead II is best
77
What is the 6 step method to interpreting ECG?
Rate
Regularity
P waves
PR interval
QRS complex
Everything else
78
How do you assess rate on an ECG paper?
300 method
300 large boxes per 1 minute so count how many large boxes are between QRS and divide by 300 to get beats per minute
79
How do you assess regularity on an ECG paper?
Use spare paper to mark first 3 QRS and line up with remaining complexes
Up to 1 small square variation is acceptable
80
How do you assess P waves on an ECG paper?
Look for presence, rounded and upright before each QRS
81
How do you assess PR interval on an ECG paper?
Start of P to start of QRS
Should be <5 small boxes
82
How do you assess QRS complexes on ECG paper?
Should be narrow and 2-3 small boxes
83
What is the everything else part of assessing ECG paper?
Looking for missed or additional beats
Strange looking complexes
84
What are the only instances where you can stop CPR?
If an appropriate level paramedic or doctor calls death
If you are too exhausted
85
What do you do if patient vomits during CPR?
Pause, turn on side and clear the airway. Restart CPR
86
What is airway dead space?
The air not participating in gas exchange (e.g. everything outside of alveolar)
About 350ml in an adult so the TV needs to be more than this
87
How much oxygen and nitrogen in air?
21% oxygen
79% nitrogen
88
How do you size an NPA?
Nostril to tragus
89
What are the rules of airway suctioning?
Short bursts to avoid oxygen depletion
Don’t suction beyond where you can see
90
What is the flow rate and indication for nasal cannula?
2-4L/min
Maintenance of SpO2 or when SpO2 still >91%
91
What is the flow rate and indication for Hudson mask?
6-10L/min
Moderate hypoxia and when nasal cannula not enough
92
What is the flow rate and indication for a non-rebreather mask?
10-15L/min
Severe hypoxia
93
What is the flow rate for a nebuliser?
6-8L/min
94
What is important about treatment of digestive system complaints?
Almost always transport as too hard to diagnose
95
What is important to note about pain patterns with abdominal issues?
Irritation of the peritoneum an cause generalised or referred pain (e.g. pancreatitis causes shoulder tip pain)
Distension can be obstruction or haemorrhage
96
What is cord prolapse?
Umbilical cord comes out before baby
Gets compressed and reduced oxygen and nutrient flow to baby
97
What is the treatment principles for cord prolapse?
Relieve pressure with gravity or manually:
-Transport in a position that relieves pressure on the cord (knee to chest or exaggerated sims)
-Physically create space for the cord
The cord must continue to pulsate
Be careful when touching as may cause cord to spasm - use a swab
98
What are the treatment principles for a miscarriage?
Transport
Analgesia
Fluid
Keep any tissues/clots for labs
99
What is placental abruption?
Placenta detaches from uterine wall prior to delivery
Risk of haemorrhage or reduced blood flow to baby
100
What are the treatment principles for placental abruption?
Transport
Fluid
Analgesia
Antiemetic
TXA
Position to reduce aortic compression
101
What is placenta previa?
Placenta grows over vagina opening
Patient should have booked C/S but if early labour risk of haemorrhage and difficulty
102
What are the treatment principles for placenta previa?
Transport
Fluid
Antiemetic
103
What is pre-eclampsia?
Occurs in second half of gestation
Hypertension >140, oedema and proteinuria (headache, seizure)
104
What is a primary PPH?
<24hours after delivery
TX: transport, fluid, fundal massage, manual compression
105
What is a secondary PPH?
>24hours and <6weeks of delivery
TX: transport, fluid, antiemetic, analgesia
Often feel progressively worse over time, continued bleeding, reduced lactation
Usually retained product causing bleeding and infection
106
What are the 4 T’s of PPH?
Tone
Tissue
Trauma
Thrombus
107
What is nuchal cord?
Cord wrapped around baby neck
108
What are the treatment principles of nuchal cord?
1. Try to unloop
2. Try to stretch over shoulders to deliver through it
3. Curve baby so somersaults out
4. Apply 2 clamps and cut in the middle but will need urgent delivery
Careful not to cause spasming or trauma to cord
109
What occurs in first stage of labour?
Contractions and dilation increasing in strength and frequency until fully dilated
Ruptured membranes can occur
TX: non-narcotic pain relief (only midwives and doctors check dilation)
110
What occurs in second stage of labour?
Pressure in pelvis creates urge to push and baby is born
Bloody show occurs
Encourage pushing, move skin around crowning head, support head as emerging - check clear airway and cord
Perineum may tear
111
What things do you need to do when baby is born?
Note gender and time
Stimulate if needed to cry and wrap
Place face down over mothers thighs to drain airway secretions (consider suction)
Conduct APGAR
Assess cord
112
What is involved with assessing the cord after the baby is born?
If pulsating then allow skin to skin
Once no longer pulsating clamp at 10cm, 15cm and 20cm and cut between the 15 and 20 clamp
113
What occurs during third stage of labour?
Delivery of the placenta
May take up to an hour
Allow to occur naturally, contractions and pushing may occur
Collect in bag for hospital check
114
What is the treatment principles with a snakebite?
Pressure bandage to crush lymph vessels from transporting venom to the blood and circulating around the body
Immobilise to prevent skeletal muscle movement from pumping lymph vessels
115
How do you apply a C-spine collar?
Need two medics: one to stabilise
Size by neck width
Slip back Velcro piece under neck and feed through
Line up front chin notch and secure velcro
116
How do you remove a helmet?
Keep on unless patient panicking, airway compromised or need to access to stop bleeding
Patient in supine position
One medic to stabilise head
One medic slowly pull helmet from above
117
How do you apply an arterial tourniquet?
Put around affected limb as high as possible
Secure the initial velcro strap
Twist to tighten until bleeding stops and secure twist piece
Note time of applicaiton
118
Approximately where does a pelvic binder get applied at?
At the greater trochanter level (about buttocks)
119
What is transport critical?
Patient needs TX outside your scope of practise e.g. stroke
120
What is actual time critical?
Patient needs immediate TX on scene e.g. cardiac arrest
Transport still high priority
121
What is emergent time critical?
Patient has a pattern of injury or illness with a high chance of deterioration
E.g. penetrating injury, pelvic injury, AAA, snakebite
122
What is potential time critical?
Patient with a mechanism of injury or past history with a high chance of sudden deterioration
E.g. fall >5m, MVA >60kph, blast injury, asthma with previous ICU
123
What considerations need to be given as to what hospital you will transport to?
Facilities patient needs
Distance/time/traffic
Contingency if deteriorate
Your skill level and equipment
124
What is mandatory reporting?
If you think a child is not having their needs met (education, food, shelter, abuse, medical care, subject to behaviour causing psychological harm) then it must be reported
