CPP

Question 1

1. According to conscious state assessment, when is a pt not suitable for NEPT?

Answer 1

1. Reduction in GCS by >2 points from pt normal CS within past 24hrs (unless mechanically ventilated with mp escort)
2. Paed who is not alert without suitable escort

Question 2

2. According to PSA, when is a pt not suitable for NEPT?

Answer 2

1. BP <100 unless normal (acute hypotension after dialysis is ok)
2. HR <50 or >100 unless normal for pt (pt with temporary pacing wire for bradycardia is ok)

Question 3

3. According to the RSA, when is a pt not suitable for NEPT?

Answer 3

1. Moderate or severe respiratory distress, unless normal for pt
2. Respiratory distress which does not improve after rest or mx with breathing difficulties protocol

Question 4

4. When is a major trauma pt not suitable for NEPT?

Answer 4

1. Pt meets any criteria for major trauma (VSS, specific injuries, high risk criteria), unless assesses as suitable for NEPT transport by a mp and after consultation with ARV
2. ARV pt (unless approved by consulting retrieval physician)
   - PIPER pt
3. Undiagnosed spinal cord compression sx where the treating mp suspects SCI

Question 5

5. What are the parameters around when an ACD can be accepted in good faith?

Answer 5

Home-to-hospital, documentation may be sighted or accepted in good faith.
Inter-hospital or hospital-to-home, documentation must be provided.

Question 6

6. Anaphylaxis Rx

Answer 6

• Epipen
• O2 10-15L/min
• Don’t walk or stand pt, if inadequate perf position supine with legs raised
• Wheeze - treat as per breathing protocol
• Repeat epipen after 5mins
• Rx as cardiac arrest is unconscious/not breathing

Question 7

7. Rx Mild/Moderate respiratory distress:

Answer 7

• Position upright
• O2 8L/min
• Wheeze/hx of asthma: Salbutamol 4-12 doses via pMDI OR 5mg neb and if pre-existing COPD add IB 500mcg
• repeat salbutamol 5mg once and consult for further Rx

Question 8

8. Severe respiratory distress Rx:

Answer 8

• Position upright
• O2 8L/min
• Wheeze/hx of asthma or COPD: Salbutamol 10mg neb and IB 500mcg
• repeat salbutamol 5mg once and consult for further Rx

Question 9

9. Which chest pain pts are unsuitable for NEPT?

Answer 9

1. Pt over 20 with potential cardiac chest pain that remains unresolved after admin of usual medication
2. Pts requiring immediate time critical transfer for coronary angiography/cardiac surgery.

Question 10

10. What are considerations for a pt who develops chest pain with known IHD during Tx?

Answer 10

Where pain is not unusual, can Rx with GTN, up to 3 doses. If pain is no resolved after GTN admin or pt develops instability of VSS or cardiac rhythm, or pain significantly worse than normal - emergency ambulance should be called.

Question 11

11. Rx for Chest pain:

Answer 11

• Apply cardiac monitor and prepare for deterioration
• Aspirin 300mg if not already administered in previous 24/24
• GTN: 300mcg if not previously administered or 600mcg
• Repeat GTN at 5/60 until pain free
• Rx with methoxy if pain persists/GTN C/I

Question 12

12. When can hypoglycaemia be Rx by NEPT?

Answer 12

1. Occurs in a pt with history of diabetes mellitus and hypoglycaemia is found on arrival or occurs during Tx
2. Pt with diabetes mellitus presents with Sx at public event

Question 13

13. What is the Rx for hypoglycaemia?

Answer 13

• Responds to commands - Glucose past 15g
• Doesn’t respond to commands - Glucagon 1mg IM if pt ≥25kg, 0.5mg if <25kg
• If unimproved and BGL<4, Glucagon IM if not already admin

Question 14

14. Rx for N/V:

Answer 14

Ondansetron 4mg, repeat once after 20/60 if Sx persist

Question 15

15. Inadequate perfusion four parts:

Answer 15

1. Skin CPC
2. HR <50 or >100
3. BP 60-80
4. Either alert and orientated to TPP or altered

Question 16

16. RSA components:

Answer 16

Appearance, Speech, Sounds, RR, Rhythm, Effort, HR, Skin, CS

Question 17

17. GCS

Answer 17

E: none, pain, voice, spontaneous
V: none, incomprehensible, intelligible single, confused, orientated
M: none, extension, abnormal flexion, normal flexion, localises, obeys

Question 18

18. MSA components:

Answer 18

Observe: Safety, Appearance, Behaviour, Affect (SABA)
Listen: Speech, Thought process, Cognition (STC)
Discuss: Thought content, Self-harm, Perceptions, Environment (PETS)

Question 19

19. Paed weights:
    - Newborn
    - 3 months
    - 6 months
    - 1 yo
    - 1-9 yo
    - 10-11 yo

Answer 19

• Newborn - 3.5kg
• 3 months - 6kg
• 6 months - 8kg
• 1 yo - 10kg
• 1-9 yo - Age x 2+8
• 10-11 yo - Age x 3.3

Question 20

20. HR
    - Newborn
    - Small infant
    - Large infant
    - Small child
    - Medium child

Answer 20

• Newborn - 110-170
• Small infant - 110-170
• Large infant - 105-165
• Small child - 85-150
• Medium child - 70-135

Question 21

21. RR
    - Newborn
    - Small infant
    - Large infant
    - Small child
    - Medium child

Answer 21

• Newborn - 25-60
• Small infant - 25-60
• Large infant - 25-55
• Small child - 20-40
• Medium child - 16-36

Question 22

22. BP
    - Newborn
    - Small infant
    - Large infant
    - Small child
    - Medium child

Answer 22

• Newborn >60
• Small infant >60
• Large infant >65
• Small child >70
• Medium child >80

Question 23

23. Initial Paediatric Assessment components:

Answer 23

• Appearance: tone, interactiveness, consolability, look/gaze, speech/cry - TICLS
• WOB: abnormal breath sounds, abnormal positioning, retractions, nasal flaring
• Circulation to skin: pallor, mottling, cyanosis

Question 24

24. Single and dual operator compression/ventilation rate for newborn, cpm and pause length for ventilations?

Answer 24

3 compressions : 1 ventilation, 90 cpm, 0.5s pause for ventilation

Question 25

25. Dual operator c/v rates for CPR infants and children?

Answer 25

15 c : 2 v

Question 26

26. When are the criteria for NEPT transport for suspected stroke?

Answer 26

Stroke sx and CS are stable and a registered mp has evaluated the pt

Question 27

27. For a pt with chest pain, what criteria would deem them suitable for NEPT?

Answer 27

1. Pt with suspected coronary syndrome who has post PCI inflation pain only - not supported by enzyme rise/ECG 2. Pt who normally self-administers GTN, and whose pain has fully resolved within 2 hours of the onset of pain 3. Pt with identified non-urgent chest pain 4. Pt with NSTEMI who has been haemodynamically stable for >2hrs and doesn't require pain relief

Question 28

28. Criteria for NEPT transport for Headache?

Answer 28

1. Normal headache presentation for this pt 2. SAH has been ruled out 3. Undiagnosed headache approved by mp for further testing 4. Subdural or SAH where mp has assessed pt as haemodynamically stable

Question 29

29. Criteria for NEPT transport for pt with abdo and back pain (non-traumatic)?

Answer 29

1. Back or abdominal pain in patient <60 years 2. Pt over 60 years with acute abdominal pain (<24 hours) where a registered medical practitioner has excluded the diagnosis of an aortic aneurysm 3. Pt>60 with acute abdo pain, but registered mp has approved NEPT to Tx for further testing

Question 30

30. Obstetric pts classification as emergency?

Answer 30

1. A patient with vaginal bleeding in the third trimester | 2. A patient in active labour.

Question 31

31. Pt in moderate respiratory distress:

Answer 31

``` A: distressed/anxious S: short phrases S: exp wheeze +/- ins wheeze, base crackles-mid-zone R: >20 R: Prolonged exp phase E: Marked chest movement +/- accessory muscle use P: 100-120bpm S: Pale and sweaty C: May be altered ```

Question 32

32. APGAR scores

Answer 32

Appearance: 0 - blue/pale, 1 - body pink/extremities blue, 2 - pink Pulse: 0 - absent, 1 - <100, 2 - >100 Grimace: none, 1 - grimaces, 2 - cries Activity: limp, 1 - extremity flexion, 2 - active motion Respiratory: absent, 1 - weak/gasping/ineffective, 2 - strong cry

Question 33

33. What patients suffering pain are not suitable for NEPT?

Answer 33

1. Pt>60 with sudden onset (<24hrs) and severe abdominal pain where AAA has not been excluded by mp 2. Pt with undiagnosed headache where treating mp suspects acute intracranial pathology

Question 34

34. Rx for pain

Answer 34

<4: Age<60 and weight>60 - paracetamol 1000mg, Age≥60 or weight≤60 500mg - if prolonged Tx and pain is not tolerable, treat as ≥4 ≥4: Methoxy 3mL, repeat

Question 35

35. When are stroke pt not suitable for NEPT?

Answer 35

Acute onset of stroke sx within 4.5hrs - unless mp has evaluated pt as suitable

Question 36

36. 5 heads criteria

Answer 36

Blunt head injury with/without LOC and now GCS 13-15: 1. Any LOC >5mins 2. Skull fracture 3. Vomiting more than once 4. Neuro deficit (loss of function/sensation) 5. Seizure

Question 37

37. Spinal immobilisation criteria:

Answer 37

Meets major trauma or 1. Age >55 2. Hx of bone disease 3. ACS 4. Intoxicated 5. Distracting injury 6. Midline tenderness/pain 7. Neuro deficit/changes

Question 38

38. Rx Paed Anaphylaxis

Answer 38

>5yrs/20kg - adult epipen ≤5yrs/20kg - epipen junior 150mcg - repeat after 5min O2 15L/min Supine with legs raised in inadequate perfusion Treat as breathing difficulties if wheeze