CPGs

Question 1

Hypovolaemia Guideline Adults

Answer 1

Do a PSA HR100mmHg Normal Saline 20ml/kg BP100 and BP

Question 2

Modifying factors of Hypovolaemia

Answer 2

Complete Spinal cord transection- pts with isolated neurogenic shock (500ml Bolus) to correct hypotension Chest injury- consider TPT Penetrating trunk injury, aortic aneurysm or uncontrolled haemorrhage- accept carotid pulse and tx immediately GI haemorrhage-consider lesser vols of fluid and accept a bp of 80-100mmHg

Question 3

Signs of Significant dehydration

Answer 3

decreased sweating and urination fatigue ACS dizziness hypotension tachycardia skin turgor dry mouth dry tongue evidence of poor fluid intake compared to fluid loss

Question 4

Chest injuries

Answer 4

supplement o2 pain relief position pt upright if possible

Question 5

Open chest wound treatment

Answer 5

3 sided sterile occlusive dressing

Question 6

insertion site for cannula Adults

Answer 6

Second intercoastal muscle mid-clavicular line above rib below right angles to chest towards body of vertebrae towards the spinal cord

Question 7

Simple Pneumothorax ss

Answer 7

unequal breath sounds in the spontaneously ventilating pt low spo2 on room air subcutaneous emphysema

Question 8

TPT ss

Answer 8

increased JVP low spo2 on supplemental o2 (late stage) decreased conscious state in the awake pt tracheal shift poor perfusion or increase HR or+/- Decreased BP decreased EtCO2 increased peak inspiratory pressure/ stiff bag

Question 9

Simple Pneumothorax treatment

Answer 9

continue basic life support supplement o2 Monitor closely for the possible development of TPT

Question 10

Traumatic Blunt Head Injury ss

Answer 10

any loss of conciousnedd exceeding 5/60 skull fracture (depressed,open or base of skull) vomiting more than once neurological deficit seizure

Question 11

Traumatic head injury treatment (airway)

Answer 11

if airway is patent and Vt adequate(with trismus) DO NOT insert NPA or OPA if airway is not patent and gag is present, insert NPA and ventilate If intubation is not possible/ authorised and gag is absent insert LMA

Question 12

Traumatic head injury treatment (ventilation)

Answer 12

Ensure adequate ventilation and Vt of 10ml/kg Maintain Spo2 >95% and the rx causes of hypoxia

Question 13

Traumatic head injury treatment (perfusion)

Answer 13

Normal Saline= hypovolaemia aim for a SBP>120mmHg after 40ml/kg reassess

Question 14

Traumatic head injury treatment (general care)

Answer 14

Seizure- Midazolam Hypoglycaemia Triage to highest level of care as per time critical guideline, if pt does not meet guidelines triage pt to the next highest appropriate level of trauma care

Question 15

Spinal Injury (pt that means time critical guidelines)

Answer 15

mx airway as appropriate provide spinal immobilisation pain relief Hypovolaemia tx without delay as per time critical guidelines

Question 16

Spinal immobilisation for the following

Answer 16

Age>55 History of bone disease or muscular weakness Unconscious or any acute/chronic altered conscious state or period of loss of unconsciousness drug or alcohol affected significant distracting injury e.g extremity fracture/dislocation spinal column/ bony tenderness neurological deficit/changes if none of the above are present then spinal immobilisation/cervical collar not necessary

Question 17

ss of airway burns

Answer 17

evidence of burns to upper torso, neck and face facial and upper airway oedema sooty sputum burns that have occurred in a enclosed space singed facial hairs resp distress hypoxia

Question 18

Burn Cooling

Answer 18

should be for 20 minutes should be with gentle running water that is between 5-15 degrees if running water is not avaliable, cooling may be comenced by immersing the affected area in still water which should be refreshed every few minutes to avoid it warming

Question 19

Burn treatment

Answer 19

assess pt as soon as practical cover the pt with blankets- avoid pt shivering pain relief elevate affected area in transit to minimise oedema cling wrap applied longitudinally to allow for swelling burnaid can be used when no other can be

Question 20

Burns- Fluid (Adult)

Answer 20

if TBSA >15% Normal Saline IV fluid replacement % TBSA x pt wt (kg)= vol (ml) given over 2 hours from the time of burn

Question 21

Fracture management

Answer 21

control external haemorrhage support injured area immobilise the joint above and below the fracture pain relief correct hypovolaemia appropriate splinting

Question 22

Actions before or after splinting

Answer 22

realign long bones open fractures with exposed bones should be irrigated with a sterile isotonic solution prior to realignment and splinting traction splint suspected fractured of the pelvis- anatomical splinting

Question 23

Pain Relief (Non-IV therapy) Adults

Answer 23

If elderly/frail/ or weight

Question 24

Pain relief (IV therapy) Adults

Answer 24

Morphine up to 5mg IV, repeat up to 5mg IV @5/60 max 20mg Morphine >60kg : 10mg IM, repeat 5mg after 15/60

Question 25

Nausea + vomiting Adults

Answer 25

Methoxyflurane 3ml, if effective repeat 3ml Stemetil 12.5mg IM if after 15mins it doesn't work and pain still \>7 and hospital destination is \>15min Morphine 2.5mg @5/60, max dose 20mg if allergic to morphine Fentanyl 25mcg IV @ 5/60, max dose 200mcg NO IV ACCESS if elderly/frail/weight

Question 26

Hypoglycaemia Adults

Answer 26

Responds to command Glucose 15g oral if poor response consider Dextrose IV or Glucagon Does not respond to command Dextrose 10% 15g (150ml) IV if unable to insert IV- Glucagon 1 IU IM if inadequate response Repeat Dextrose 10% 10g (100ml) IV titrating to pt conscious state Normal Saline 10ml Flush

Question 27

Seizures Adults

Answer 27

seizures 5/60 or 2 seizures without recovery Mx airway and ventilation oxygen therapy Midaz 10mg IM repeat Midaz 10mg IM once only

Question 28

Burns Paeds

Answer 28

3 x %TBSA x pt wt (kg)= vol of fluid(ml) given over 24 hours from the time of burn administer half of the 24 hour fluid over the first 8 hours

Question 29

Pain relief Paeds

Answer 29

Non IV therapy Fentanyl 10-24kg= Fentanyl 25 mcg IN \>25kg= Fentanyl 50mcg IN repeat dame dose 2 5-10/60 MAX 3 DOSES Methoxyflurane 3ml, repeat 3ml Morphine 0.1mg/kg IM

Question 30

Hypoglycaemia Paeds

Answer 30

Respond to commands Glucose 15g oral Does not respond to command 25kg= Glucagon 1 IU IM

Question 31

Seizures Paeds

Answer 31

Large Child= Midaz 5mg IM Small Child= Midaz 2.5 mg IM Infant= Midaz 1mg IM Newborn= Midaz 0.5mg IM repeat original dose once

Question 32

Burns TBSA Adults

Answer 32

Question 33

Burns TBSA Paed

Answer 33