CMGs Flashcards
(121 cards)
1
Q
OPA contraindications
A
gag reflex
2
Q
OPA complications
A
- gagging, vomiting, aspiration
- trauma to soft tissues, tongue, palate, pharynx
- improper sizing can either push tongue into oropharynx or occlude the epiglottis
3
Q
OPA indications
A
- to prevent airway obstruction from tongue in pts without gag reflex
- used as bite block post ETT insertion unless Thomas block has been used
4
Q
OPA insertion
A
Check and clear airway of any obstructions. Measure corner of mouth to earlobe. Position head and open mouth.
Adult: Insert OPA halfway so tip is facing roof of mouth. Then turn 180 degrees over pt’s tongue and insert until flange is resting against pt’s lips
Paed<8yrs: insert with tip facing away from roof of mouth, therefore does not need to be rotated.
5
Q
NPA indication
A
used when OPA cannot be used e.g. trismus or extensive oral injuries
6
Q
NPA insertion
A
- select appropriate size - width of tube should approximate diameter of pt’s little finger
- measure from tip of nose to earlobe for correct length
- lubricate
- position head in neutral position and select wident nostril (generally pt’s right side)
- insert by pushing tip of nose upwards, passing tube parallel to floor of nasal cavity
- if obstruction occurs, attempt to gently rotate tube and continue to insert
- if obstruction remains, attempt through other nostril or use smaller NPA
- ensure to observe any signs of gag reflex
- maintain head in triple airway manoeuver
7
Q
NPA contraindication
A
resistance during insertion/unable to insert easily
8
Q
NPA complications
A
minor nasal trauma
can induce gag reflex in sensitive pts (remove if this occurs)
may exacerbate BOS#
9
Q
LMA indications
A
unconscious patients
10
Q
LMA contraindications
A
- Facial fractures where you cannot visualise landmarks
- Airway burns
- Continuous/active vomiting.gag reflex
- Epiglottitis
- Airway swelling
11
Q
LMA complications
A
- does not prevent gastric contents from entering airway
2. excessive and continuous airway soiling from any origin
12
Q
PEEP indications
A
Use in ventilated pts who meet PEEP criteria:
- cardiac arrest
- severe asthma/COPD exacerbations
- Near drownings
- severe APO
- CO poisoning
- intubated pts
13
Q
PEEP contraindications + precautions
A
suspected pneumothorax
prec: suspected raised ICP, CVA, TBI, etc
14
Q
PEEP complications
A
- hypotension
2. decreased CO and barotrauma at higher values
15
Q
CPAP indications
A
conscious pts who are able to follow instructions with:
- respiratory distress (inc. HR, dec. sats, acc muscle use)
- APO, severe asthma, COPD exacerbation
- CO poisoning, smoke inhalation, near drowning, anaphylaxis
16
Q
CPAP contraindications
A
- unconscious pts
- facial trauma
- hypoxia due to trauma
- cardiac & respiratory arrest
- pneumothorax
17
Q
CPAP complications
A
- hypotension
- barotrauma
- aspiration
- gastric distention
- decreased CO at higher values
18
Q
Steps in ‘stepwise approach’ to pain relief
A
- non-pharmacological (e.g. position, splinting, cool burns, reassurance, gentle handing)
- inhaled/enteral (mild-mod) e.g. methoxy, panadol, ibuprofen, GTN, advise for OTC meds w caution
- parenteral mod-severe e.g. morph, fent, ket, IV panadol, midaz
19
Q
primary goals of airway management in order
A
- oxygenation
- ventilation
- protection
20
Q
airway options for DLOC and breathing
A
- basic manoeuvres - posture, suction, OPA/NPA
- consider LMA
21
Q
airway options for DLOC not breathing
A
- LMA preferred
- basics - posture, suction, OPA/NPA
22
Q
arrest drugs shockable
A
- adrenaline after 2nd shock then every 2nd loop
- amiodarone 300mg after 3rd shock
- mag sulfate if torsades or after 4th shock VF
- sodi bic prolonged resus >15min or reversible e.g. hyperK, tricylcic
23
Q
arrest drugs non shockable
A
- adrenaline 1mg immediately then every 2nd loop
- sodi bic prolonged >15min or otherwise ind
24
Q
arrest correctable causes (4Hs 4Ts)
A
hypoxia
hypovolaemia
hypo/hyperkalaemia or other metabolic
hypo/hyperthermia
thrombosis -pulmonary or coronary
tension pneumo
tamponade
toxins
25
ROSC Pt Mx
(SAVE 12 BPs CTG)
SpO2 94-98%
Advanced airway if not in
Ventilate 8-10bpm - do not hyperventilate
EtCO2 35-40mmHg
12 lead ECG and repeat en route - STEMI Mx PRN
BP 5/60 - maintain SBP >100
Correctables if not addressed
Temperature - aim normothermic; no active rewarm unless <32; no active cool unless >39; do not allow to shiver
Glucose
26
paediatric arrest when to start CPR
unresponsive + not breathing and:
1. no pulse felt; OR
2. HR<60 with no other signs of circulation
27
paediatric arrest Mx age cut offs, compression:vent ratio, jules to shock
24hrs - 8yrs manage as paed arrest
15:2 (remains 15:2 with advanced airway); 4j/kg - if monitored VF/VT arrest --> 3 stacked shocks
28
paed arrest drug doses
adrenaline 0.01mg/kg IV fast push
normal saline 20ml/kg
29
newborn definition, compression ratio, adrenaline dose
birth - 24hrs
3:1
0.01mg/kg IV/IO or 0.02mg/kg ETT
30
newborn definition, compression ratio, adrenaline dose
birth - 24hrs
3:1
0.01mg/kg IV/IO or 0.02mg/kg ETT
31
newborn resus steps
- prevent heat loss and stimulate, dry bub and wrap/cover incl. head (not face); premi or low birth weight dry head only and place in ziplock bag up to neck
- clamp and cut cord
- suction only if required
- HR<100 or apnoeic/gasping --> ventilate w RA @40-60 w 5cm PEEP
- 30sec later if HR still decreased --> check for leaks, airway adjunct and add 100% O2
- consider IV access - do not delay CPR or vent for this
- if HR<60bpm --> start CPR 3:1 w 100% O2
- if after 30sec nil improvement w CPR --> adrenaline IV/ETT, rpt every 3mins while HR<60 despite effective CPR/vent
32
newborn ROSC/regains vigor Mx
- early transport
- maintain HR and resps
early BGL and Tx if <2
33
QRS complex normal and abnormal width
normal = <0.12
wide = ≥0.12
34
when to treat bradyarrhythmia and how
HR<60 w poor perfusion
- IVF if no LVF to maintain SBP>90
- ICP for atropine/adrenaline infusion/pacing (ROSC)
35
when (what HR) to consider pharmacological Tx for tachycardia - adult and paed
>150 adult or >180 paeds if symptomatic/associated poor perfusion
36
Mx for AF/flutter >150
- IV fluid challenge, 250 bolus if no LVF and rpt to maintain SBP >90; ACS/APO Tx concurrently as appropriate
37
severe/life-threat asthma Mx
- salbutamol + atrovent
- expiratory chest squeeze
- consider IM adrenaline
- CPAP or BVM with bronchodilators
- mindful of tension pneumo in deteriorating manually ventilated Pts
38
COPD Mx
- salbutamol + atrovent
- maintain SpO2 88-92% w lowest concentration O2 possible
- CPAP w bronchodilators
39
APO Mx
- sit legs dependent if LVF
- GTN SL
- ACS/arrhythmia Tx concurrently
- CPAP + increase as required
- bronchodilators after 2x GTN if wheezing
40
temp goal for hyperthermia
aim <38
41
heat stroke S+S and Tx
- ALOC, temp>40, absent sweating
Mx - rapid cooling, IV resus, check BGL, ECG and Tx arrhythmias, aggressive seizure Mx, do not allow to shiver
42
mod-severe hypothermia S+S/distinction and Mx
- significant ALOC, bradycardia, bradypnoea, no shivering, temp<32, arrhythmias - alow AF, junctional, VF/asystole
Mx - gentle handling, remove wet clothing and dry, gentle rewarm - wrap in warm blanket then space blanket, warm IVF,
*early BGL and low threshold for Tx (body needs energy to produce heat)
- IPPV PRN, do not hyperventilate
- consider need for meds as low temp can alter actions
43
cardiac arrest due to hypothermia differences
- no more than 3 shocks if VF/VT
- no more than 3 adrenaline doses
** do not cease resuscitation
(fixed and dilated pupils can be transient)
44
foreign body complete airway obstruction Mx of conscious Pt
- 5 back blows
- 5 chest thrusts (head down for gravity if poss)
- repeat both if fails
- if fails --> transport w 100% O2
45
unconscious Pt w complete upper airway obstruction
- start CPR and arrest Mx if no pulse
- 5 chest thrusts supine
- extricate foreign body w laryngoscope and magills
- ICP for airway (surgical)
- if no other option continue chest thrusts and re-evaluate
- notify hospital and urgent transport w 100% O2
46
partial foreign body airway obstruction Mx
- minimise interventions
- encourage coughing
- maximise O2 therapy
- prompt transport
47
laryngospasm Mx
- position supine
- firm jaw thrust
- 100% O2
- if unresolved --> BVM + PEEP
-ICP backup for RSI
*(commonly transient and self-resolving, give time for basics to work)
48
upper airway swelling causes
- epiglottitis
- infection
- trauma
- croup
- burns
- anaphylaxis
insect sting
49
upper airway swelling Mx
- do not examine
- maximise O2
- minimise Pt distress
- prompt transport
- anaphylaxis/insect: IM adrenaline
- burns/epiglottitis/croup: adult IM, paed nebulised
- complete obstruction -> 100% O2, urgent transport + prenotify; ICP for airway Mx (RSI)
50
abdominal high-risk presentations to consider
- ACS
- suspected AAA
- sepsis
- uncontrolled GI haemorrhage
- mesenteric ischaemia
- ectopic pregnancy
- pelvic fracture
- perforated viscus
51
abdominal trauma Mx
- haemorrhage control + consider pelvic splint
- cover + support protruding viscera with moist sterile dressing
- cover/dress open wounds
- leave penetrating objects in situ unless cannot be secured for transport
- NBM, analgesia, rapid transport
- consider flexing knees if spinal immobilisation required to reduce pressure on abdomen
52
define shock
state of poor perfusion most reliably indicated by tachypnoea, tachycardia, diaphoresis, pallor, DLOC, decreased cap refill
53
TBI target BP
≥100
54
types of shock and examples
hypovolaemic:
- haemorrhagic - bleeding
- non-haemorrhagic - dehydration, burns
distributive - anaphylaxis, burns, sepsis, spinal/neurogenic, addisonian crisis
obstructive - tamponade, tension pneumo, PE
cardiogenic - AMI, arrhythmia, drugs
55
general shock Mx + parameters
- aim SBP ≥90
- SpO2 > 94
- early and rapid transport
- assess for cause of shock and Mx PRN
56
special Mx for obstructive shock
- use lowest tidal vol and PEEP value if IPPV while still providing adequate oxygenation
- gentle handling
- ICP for chest decompression PRN
57
cardiogenic shock special Mx points
- do not hyperoxygenation (SpO2>94)
- 12 lead ECG
- ACS Tx concurrently PRN
- arrhythmia Tx concurrently
- IV fluids only indicated if SBO<90 and clinical signs of shock and NO APO (250-500mL challenge and repeat if good effect)
58
haemorrhagic hypovolaemic shock Mx special points
- minimum scene time, early + rapid transport; perform interventions en route
- control bleeding - tourniquet, splint, pack wounds and apply pressure, realign long bones
- manual spinal precautions - full spinal immobilisation is not to delay extrication/transport
- MINIMAL warm fluids to maintain SBP of 90
- adrenaline infusion NOT indicated in trauma
59
causes of altered consciousness Pts
A - alcohol, acidosis
E - epilepsy, environment, electrolytes
I - insulin
O - overdose, oxygen
U - underdose, uraemia
T - trauma, tumour, toxins
I - infection
P - pharmacology, poisons, psychogenic
S - sepsis, seizure, shock, stroke
60
ACS S+S
- chest pain/tightness/heaviness/discomfort/pressure
- pain/discomfort in one/both arms, jaw, back, neck, stomach
- SOB
- N+V
diaphoresis/sweaty/clammy
- lightheaded/dizzy
(if in doubt, treat for ACS)
61
ACS Mx
- 12 lead ECG +/- 15 lead if indicated
- O2 if SpO2<94% or shocked
- aspirin
- GTN SL
- analgesia to abolish pain
- antiemetic
- IV fluids if hypotensive (and no APO)
62
STEMI additional Mx
- transmit ECG
- prompt transport - do Tx en route if possible
- prenotify hospital (still must prenotify after call w STEMI Dr)
- ICP for heparin checklist
63
Pneumothorax Mx
- avoid coughing, no Valsalva, avoid IPPV
- (diminished A/E may be unreliable in manually vented Pts)
- ICP for tension pneumo decompression
64
uncomplicated rib fracture Mx and flail chest
- position of comfort and analgesia to allow adequate tidal volume
- kids and elderly high risk for significant injury following any given MOI, so require transport for assessment
- flail - prioritise effective analgesia and position sitting to maximise ventilation if possible
65
open/sucking chest wound Mx
- cover w commercial chest seal; if signs of tensioning, peel back and burp wound allowing air to escape and reseal
- use defib pads (cables removed) if nil commercial seal
- low threshold for ICP/decompression
66
penetrating object in chest Mx
- do not remove, protect from movement
- if appears to be intracardiac (i.e. moving w each heartbeat) - do not secure
- gentle handling
67
cardiac arrest following chest trauma Mx
- as per agonal trauma/traumatic arrest
- address relevant reversibles - hypoxia, hypovolaemia, tension
68
paediatric chest trauma special notes/consideration
- soft + flexible bones = can have minimal external signs of injury but have significant internal injuries
- rib fractures signify significant mechanism --> suspect serious injury, check for multiple injuries, assume time criticality
- compensate well, evidence of shock is late sign
69
examples of high-risk features in spinal precautions assessment
- MVA > 100kph
- axial load to head
- fall >3m
- fall >4 stairs
- MVA w rollover/ejection
- bicycle collision
- personal mobility devise e.g. e-scooter, segway
70
examples of low-risk features in spinal precautions assessment
- delayed onset midline tenderness/pain
- ambulatory prior to ACTAS arrival
- simple rear end MVA (unless pushed into oncoming traffic, hit by large truck/bus or hit at >100kph
71
Factors to determine self-extrication vs assisted extrication in spinal precaution Pts (if no to any of these --> assisted)
- GCS 15
- sober
- physically capable
- obeys commands/cooperative
- simple extrication
72
Spinal injuries Mx
- position supine and maintain precautions
- O2 to maintain SpO2>94, IPPV if hypoventilating
- IV fluids PRN - assess all other causes of shock before concluding spinal shock
- consider antiemetic
73
categories and causes of autonomic dysreflexia
bladder - UTI, blocked IDC, distended/overactive bladder, bladder/kidney stones
bowel - constipation, impaction, haemorrhoids, rectal irritation (enema/manual evacuation)
skin - pressure injury, tight clothing, burns
other - labour, fractures, any irritable stimulus, intercourse, menstrual cramps, distended stomach
74
common S+S of autonomic dysreflexia
- hypertension
- bradycardia
- pounding headache
- blurred vision
- flushed and diaphoretic above injury
- pallor and goosebumps below injury
- SOB
- nasal congestion
- irritable/combative
75
initial actions in autonomic dysreflexia
- ask Pt/carer if cause suspected
- elevate head with legs dependent if possible
- check bladder drainage - unblock if obstructed - drain 500mL immediately then 250mL every 15/60 until empty
- avoid pressing over bladder
- monitor BP every 2-5/60
76
pharmacological Tx for autonomic dysreflexia
- commence if BP remains elevated (>150/>20 above known baseline)
- GTN 400mcg or 300mcg SL, total 3 doses
- paed = 150mcg SL total 3 doses
- analgesia with caution - Pt may not be able to feel/report noxious stimuli if suspected cause
77
eye emergencies general Mx
- avoid stimulus which raises intraocular pressure
- position supine with elevated head 30 degrees
- early antiemetic - ondansetron
- adequate analgesia
- avoid over-infusing IVF
- NBM if possible
78
eye trauma Mx
- assume all eye trauma is ruptured globe
- avoid direct pressure over eye
- haemorrhage control through pressure around eye/eyelids
- cover injured or both eyes dependent on Pt condition/tolerance
- leave penetrating objects in situ
- support extruding eyes with moist dressing, do not push back in socket
79
chemical eye burns Mx
- irrigation for at least 30min, ideally until reviewed by Dr
- (but do not delay transport for irrigation - do en route); look it all directions and pull apart eye lids while irrigating
- remove contact lenses ASAP
- remove debris from eye but do not delay irrigation
80
burns Mx
- 30 minutes active cooling in absence of complicating factors - e.g. multi-trauma, airway burns, hypothermia/large burn causing rapid heat loss
- burns can hold heat up to 3hrs post-injury; so cool within this timeframe
- limb - remove jewelry, clothing and elevate part
- cool the burn, warm the Pt
- assess airway involvement/respiratory compromise - S+S: hoarse voice, inspiratory stridor, singed facial hairs, soot in mouth, see-saw breathing, exp wheeze
- if burnt in confined space + DLOC --> 100% O2 w PEEP, suspect CO poisoning
- adequate analgesia
- IV fluids PRN - consider airway Mx if aggressive fluids required
- cover burns for T/P w gel dressing\
- prompt transport
81
seizure types and when to begin active Mx
- focal (one area of brain, may retain awareness, may be ALOC)
- generalised (both brain hemispheres, tonic clonic, absence, tonic, clinic, myoclonic, atonic)
- unknown (unclassified, myoclonic atonic
- Mx when ≥5 minute seizure activity from any seizure type as above or multiple seizures without full recovery to baseline awareness between seizures
82
seizure Mx
- protect from injury
- midaz IM
- BGL early - especially if nil seizure Hx
- treat complications e.g. hyper/hypothermia, hypoglycaemia, injury)
- pregnant Pts with nil seizure Hx -> first line drug = MgSO4
paeds with seizure/fever > 38
- remove excess clothing
- cool cloths to axillae, neck, groin
- midaz for active seizing
- do not allow to shiver
- panadol oral (15mg/kg)
83
stroke Mx
- assess and Mx airway PRN
- breathing support PRN w IPPV/O2 - maintain SpO2>94, do not hyperventilate
- aim EtCO2 27-40mmHg if IPPV
- position of comfort
- early BGL - treat hypo w caution, avoid hyperglycaemia
- aim SBP >100 w IVF PRN
- complete CRESST score and call stroke Dr if ≥ 4
- 12 lead but not to delay transport - report any occurrence of AF to stroke team
- prenotify hospital + call stroke team
- minimise scene time
- if confident --> 18G to non affected ACF
- transport relative/friend who can confirm time of onset OR AT LEAST record phone number and handover to hospital
84
clot retrieval/thrombolysis eligibility
1. >18yrs
2. known time of onset within 24hrs
3. not requiring high level nursing home care
4. not permanently bed-bound or terminally ill
5. CRESST ≥ 4
85
Drowning Mx
- prolonge arrest Mx PRN
- O2 - highest practical i.e. 100% NRB or CPAP (if resp distress/hypoxia) ASAP, then titrated to response
- consider precipitating events e.g. intox, hypo, trauma, seizure
- C-collar PRN
- ICP for airway + IGT
- hypothermia Mx concurrently - dry and warm Pt
- prenotify + transport closest hosp
86
diving emergencies two types of decompression illness
decompression sickness ("the bends") and arterial gas embolism
- occur within 24hrs of dive
87
decompression illness S+S
neuro: motor/sensory deficits, confusion, seizures, unconscious
resp: dyspnoea, pneumo/subcut emphysema, APO, haemoptosis, cyanosis
cardiac: chest pain, cardiac arrest
other: join pain, pruritis, itchiness, tremour, lymphoedema
88
decompression illness Mx
- position supine, DO NOT elevate head; L) lateral if unconscious
- cardiac arrest Mx PRN
- high flow O2 - highest % practical and continue despite apparent improvement
- monitor for pneumothorax - barotrauma related pneumo may tension
- Pts are always dehydrated - rehydrate w IVF as per 14
- Mx hypothermia
- ascertain dive profile - depth, duration, sequence/number, breathing mixture, decompression stops, any uncontrolled ascents
- check dive partner
- monitor symptoms progression
- analgesia PRN
- transport to TCH
89
questions to ask in diving emergencies
- depth of dive
- duration of dive
- number of dives
- sequence
- breathing mixture
- decompression stops
- uncontrolled ascents
- (check dive partner)
90
when to treat for shoulder dystocia
- when shoulders not delivered within 60 seconds of head delivery
91
actions immediately after newborn delivery
- place bub on mum's chest and dry w towel/stimulate
- note time of birth
- cover with blanket
- clamp @ 10cm, 15cm from bub and 1x closest to mum and cut between 1st and 2nd
- APGAR @ 1 and 5 minutes
- encourage breast feeding
- assess HR and RR
- assess for PPH
- placenta delivery - mindful, do not delay transport for this, transport placenta to hospital for assessment
92
when to bypass straight to TCH maternity in child birth
premature labour (20-34 weeks)
93
which type of breech MAY be delivered pre-hospital (though all not preferred)
buttock presenting (frank)
94
Prolapsed cord Mx - pulsating
- urgent transport
- minimal handling of cord (prevent vasospasms)
- position exaggerated Sims' - L) lateral w pillow under hip
- gently place cord back into vagina or support with moist, warm pads if unable
95
non-pulsating prolapsed cord
- minimal handling
- L) lateral with pillow under hip
- manual pressure to foetal presenting part to alleviate cord compression
96
shoulder dystocia Mx
- assume and manage if shoulder not delivered within 60sec of head
- ** urgent backup as bub may require resus
- position mum at edge of bed, gentle downwards traction on head
- discourage pushing and encourage to breathe through contractions
- NO FUNDAL MASSAGE
- position knees to nipple
- if nothing for further 30-60sec --> apply suprapubic pressure in combo w knees to nipple + gentle traction
- if nothing in 30-60 --> position on hands and knees and apply traction
- proceed to internal manipulation
- URGENT transport if not delivered
- transport knees to nipple position w 30 degree pelvic tilt
97
antepartum haemorrhage timing and S+S
- any vaginal bleed after 20 weeks gestation, occurring before labour
- may have contractions
- bleed may be fully or partially concealed
- may have abdo or pelvic pain, tender uterus, signs of shock
- causes: placenta praevia, placental abruption, trauma, infection
98
PPH causes
trauma
tissue
tone
thrombin - coagulopathy
99
PPH definition
blood loss >500ml occuring within 12 weeks post-delivery
100
PPH Mx
-position supine and maintain body warmth
- high flow O2
- IVF as per shock guideline - warmed if poss
- fundal massage if placenta delivered and continue
- absolute LAST RESORT fundal massage when placenta not delivered - in setting of torrential PPH
- examine for trauma + pressure to bleeds
- enc to empty bladder/breast feed to promote uterine contraction if practical
- urgent transport to ED ASAP
- transport blood-soaked pads/towels for blood estimation at hosp
101
hyperkalaemia S+S (ECG)
- bradyarrhythmias common
- diminished/absent P waves
- tall peaked T waves
- widened QRS
- sine wave pattern
- VF/VT/asystole
102
conditions where hyperkalaemia should be considered
- kidney failure/dialysis
- crush injury incl prolonged unconsciousness/long lie
- DKA
103
hyperkalaemia Mx
(if ECG changes present)
- salbutamol
- IV fluids - caution as Pts may be on restrictions
- ICP for CaCl + sodi bic
104
anaphylaxis definition
- acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis cannot be positively excluded, without typical skin features
OR
- typical skin features - urticaria, erythema, flushing, angioedema
PLUS
- involvement or cardiovascular or respiratory or severe + persistent GI symptoms
105
anaphylaxis Mx
- remove allergen if still present and possible
- posture supine/sitting
- do NOT allow to walk event if appears to have improved
- IM adrenaline
- O2 therapy
- IV fluids PRN
- consider bronchodilators AFTER adrenaline for wheeze
- consider prolonging resus if cardiac arrest with aggressive IV fluids + IV adrenaline
106
S+S of crush syndrome and when they occur
- occur after the release of the release of compressing force
S+S:
- hypovolemia
- hyperkalemia
acute renal failure
- metabolic acidosis
- DIC
- hypothermia
- acute respiratory distress syndrome
107
crush syndrome Mx
(consider backup - Southcare, ICP etc)
pre-extrication
- IV access + aggressive fluid resus; warmed if poss
- in setting of haemorrhage: aggressive fluids + direct bleeding control > permissive hypotension
- prevent heat loss + active rewarm PRN
- tourniquets in lower limbs only if unable to get IV access/cannot do fluid resus and only apply immediately prior to removal of compressive force
post extrication
- rapid transport + notification direct to TCH
- continue IVF
- ECG monitoring
- analgesia
- splint + immobiliser injured limb at heart level - DO NOT ELEVATE
108
tricyclic overdose Mx
- ECG monitoring - ICP for arrhythmia Mx e.g. wide QRS
- aware of potential seizure activity
- if DLOC, consider hyperventilating if IPPV
- aim EtCO2 < 35mmHg
109
organophosphate OD Mx
- where possible, remove contaminated clothing, wash skin with soap + water
- if cholinergic S+S --> atropine 0.01mg/kg IM, doubled each dose while symptomatic
- prenotify hospital of contaminated Pts
110
CO poisoning/smoke inhalation
- remove Pt from danger
- resp distress + upper airway obstruction Mx PRN
- 100% O2 + PEEP if CO suspected
- urgent transport if DLOC
- always transport inhalation injury (APO late complication)
111
qSOFA criteria
- RR ≥ 22
- GCS < 15
- SBP ≤ 100
112
sepsis risk factors
- DLOC, confusion, headache, neck stiffness
- dysuria, increased urine frequency
- immunocompromised
- recent surgery/invasive procedure
- recent Hx rigors/fevers
- abdo pain, diarrhoea, distention
- cough, SOB, pneumonia
- cellulitis, wound infection, septic arthritis
113
septic shock criteria
suspected sepsis with any one or more of:
- mottled/cold peripheries
- lactate > 2
- SBP ≤ 90
- cap refill > 3 sec
- purpuric rash
114
septic shock Mx
- IV fluids to maintain SBP of 90 up to 20ml/kg, maintenance thereafter
- check for meningococcal
- rapid transport + prenotify
115
meningococcal prehospital identification criteria, other S+S
sudden onset of febrile illness with DLOC
+/- tachycardia, hypotension, peripheral shutdown
+/- purpuric/haemorrhagic/petechial rash
other S+S
- headache
painful + swollen joints
neck stiffness
photophobia
N+V
seizures
focal signs
116
meningococcal Mx
- PPE
- IV fluids - may require large vol to maintain SBP 90
- ceftriaxone 50mg/kg up to 2g IV (can be IM if nil access)
- urgent transport + prenotify
- Mx associated conditions e.g. seizure, hypoglycaemia
- may deteriorate by DLOC/hypotension after AB admin - be aware and ready w IVF to manage
117
traumatic arrest Mx in order
- load Pt + expedite transport if within 20minutes of TCH (incl loading time)
- aggressive haemorrhage control incl pelvic binder
- open airway - basic only
- aggressive IV resus up to 2L
- decompress chest bilaterally
- attach monitor (no CPR if en route - commence CPR now if staying on scene
- prenotify TCH early
- IV adrenaline as per arrest Mx
if remained on scene, same order as above Mx
- seriously consider ceasation of resus if after 10minutes of arrest Mx after initial actions nil sustained ROSC
- only transport if sustained ROSC, no CPR en route
118
adrenal crisis S+S
- N+V+D
abdo pain
fever
DLOC
hypotension
tachycardia
hypotension w postural drop
lethargy, fatigue, weakness
light headed, dizzy
hypoglycaemia
hyperkalaemia
118
adrenal crisis S+S
- N+V+D
abdo pain
fever
DLOC
hypotension
tachycardia
119
when to consider adrenal crisis (3 different criteria
1. a diagnosed adrenal insufficiency condition e.g. Addison's, congenital adrenal hyperplasia, supresellar tumour, brain injuries
2. experiencing infection, trauma or stress response e.g. dehydration, AMI, intense physical exertion
3. Pt is hypoperfused and or DLOC
120
adrenal crisis Mx
- IV fluids
- ICP for hydrocortisone
- hyperkalemia Mx PRN
- hypoglycaemia Mx PRN
