EOS revision Flashcards
(61 cards)
1
Q
What does VIRCA stand for
A
Voluntary, Informed, Relevant, Capacity, Advice
2
Q
What does voluntary mean and what factors can affect a person’s susceptibility to coersion
A
without coercion or psychological pressure.
Pain, fatigue, depression and fear can affect susceptibility
3
Q
Explain informed
A
informed about condition, treatment recommended and possible risk if treatment not provided.
4
Q
Explain capacity and factors that affect it
A
capacity can be affected by clinical condition (ALOC), effects of substances, elicit substances and prescribed pharmacological preparations.
Higher risk requires higher capacity
5
Q
Explain Advice
A
if decision is valid paramedic advice should:
- provide advice aimed at patient safety and comfort and measures that patient should take if circumstances change and treatment and/or transportation to hospital is desired
6
Q
When may a paramedic reasonably consider a patient’s refusal to be invalid
A
- patient has impaired decision making capacity; AND
- there is no other person present that is authorised to provide consent on behalf of the patient; AND
- patient is suffering rom a condition which required urgent treatment and/or transportation to hospital in order to meed imminent risk to the patient’s life or health; OR
- the patient is suffering extreme pain or distress
7
Q
When is transport not required (Paramedic decision)
A
- patient not suffering any obvious illness or injury and the assessment findings do not raise any reasonable suspicion that an illness or injury exists
- the patient is suffering from a MINOR condition that is transient and unlikely to escalate or deteriorate and where urgent attendance at hospital is not warranted
8
Q
Alternatives to ambulance transport
A
- no ambulance transport required and no subsequent medical assessment or treatment indicated
- no ambulance treatment required, but subsequent support services and/or non-urgent medical treatment is indicated
- ambulance/first aid treatment is required and provided and further medical assessment and treatment is not indicated
- ambulance/first aid treatment is required and provided and non-urgent medical treatment and/or other support services are indicated
9
Q
Factors to consider regarding non-transport of patients
A
- clinical findings
- social history and support network
- non-urgent medical referral
- referral to support services
- access to private transport
- person’s wishes
- age of patient
10
Q
High risk features of ACS
A
- Repetitive or prolonged chest pain and/or discomfort
- Persistent or dynamic ST elevation or new T wave inversion
- Hypotension
- Syncope
- Sustained VT
- Left ventricular dysfunction
- Prior PCI (previous 6 months)
- Presence of known DM or renal impairment
- Transient ST segment elevation in more than 2 contiguous leads
11
Q
PCI referral indications
A
- Proximity to pPCI facility - <60 minutes from diagnositc 12 lead
- Assessments: GCS 15 AND classic ongoing chest pain <12 hours
- 12 Lead ECG consistent with STEMI (Normal QRS width or RBBB identified on 12 lead)
12
Q
pPCI procedure
A
1) confirm patient indicated
2) complete referral checklist
3) obtain informed consent from the patient and request that they sign autonomous pPCI referral checklist
4) contact appropriate pPCI facility.
- patient Gender, age, address, transport time
5) if patient is accepted confirm preferred anti-platelet agent with cardilogist
6) If unable to be accepted discuss optison for referring to alternate facility or administering pre-hospital fibrinolysis
7) in some cases (Pain < 1 hour) cardiologist may request CCP to administer fibrinolysis over pPCI
8) Transport Code 1
13
Q
pPCI drugs
A
Hepatin 5000 units
Antipletelet - Ticagrelor 180mg OR alternative
14
Q
Cardioversion Indications
A
Rapid ventricular rate with compromised cardiac output in the following rhythms
- Pulsatile VT
- SVT
- Atrial flutter
- Atrial fibrillation
15
Q
Cardioversion Contraindications
A
VT/pulseless VT
Dysrhythmia where patient is adequately perfused
16
Q
Cardioversion settings
A
1 = 100j 2 = 150j 3 = 200j
17
Q
Transcutaneous pacing Indications
A
Symptomatic Bradycardia (HR < 60)
18
Q
Transcutaneous Pacing contraindicatins
A
Overdrive pacing of ventricular rhythm
Asystole
19
Q
Transcutaneous Pacing, checks to ensure capture
A
Electrical capture - see rhythm
Mechanical capture - check pulse
20
Q
Causes of acute pulmonary oedema
A
Left Ventricular failure - ACS, arrhythmia, pericarditis, endocarditit, myocarditit, valve dysfunction
Increased intraventricular volume - Fluid overload, non-compliance with fluid restrictions or diuretics, renal failure
Pulmnary venous outflow obstruction - mitral valve stenosis
21
Q
Mild Asthma presentation
A
Alert nil accessory muscle use nil tachypnoea variable wheeze talks in sentences saturation > 94% no cyanosis
22
Q
Moderate asthma presentation
A
Alert mild accessory muscle use mild tachypnoea mild tachycardia variable wheeze talks in phrases saturation 90-94% no cyanosis
23
Q
Severe asthma presentation
A
agitated moderate accessory use some physical exhaustion marked tachypnoea marked tachycardia variable wheeze talks in words saturation <90% cyanosis/sweating patient seated upright, unable to lie supine, pursed lip breathing hyperinflated thorax
24
Q
Life-threatening Asthma presentation
A
confusion/drowsy severe accessory muscle use or minimal due to tiring physical exhaustion marked tachypnoea hypotension/bradycardia often silent chest unable to talk saturation < 90% cyanosis/sweating patient seated upright, unable to lie supine, pursed lip breathing prolonged expiratory phase hyperinflated thorax
25
Define Chronic Bronchitis
```
Daily sputum production for at least 3 months over 2 or more consecutive years
Presentation:
- cyanosed
- overweight
- oedematous
- chronic cough
- chronic sputum production
- cor pulmonale (late sign) - abnormal enlargement of right side of heart due to disease of lungs or pulmonary vessels
```
26
Define Emphysema
```
Dilation and destruction of alveoli. Loss of elasticity and enlargement of these air spaces lead to hyperinflation of lungs and increased WOB
Presentation:
- thin
- barrel chested
- dyspnoea
- pursed lip breathing
- tachypnoea
- intercostal or suprasternal recession
- tripod posture
```
27
Hyperkalaemia causes
Medical: renal impairment, DKA, addison's disease, metabolic acidosis
Medications: potassium sparing diuretics, ACE inhibitors, NSAIDs
Cellular injury: rhabdomyolysis, crush injury, burns
28
Hyperkalaemia Presentation
muscle weakness, paresthesia
signs/hx of causes
generally unwell, nausea, vomiting, diarrhoea
ECG changes
29
Causes of Cardiac Arrest Hs and Ts
```
Hypoxia
Hypothermia/hyperthermia
Hypokalaemai/hyperkalaemia/metabilic disorder
hypovolaemia
Hydrogen - Acidosis
Hypoglycaemia - no longer a H
```
```
Tension pneumothorax
Tamponade - cardiac
Toxins
Thrombosis (pulmonary/coronary)
Trauma - not reversible
```
30
Severe allergy/anaphylaxis - define
Any acute illness with typical skin features (urticarial rash or erythema/flushing and/or angioedema)
PLUS
involvement of respiratory and/or cardiovascular and/or persistent severe gastrointestinal symptoms
OR
Any acute onset of hypotension or bronchospams or upper airway obstruciton where anaphylaxis is considered possible, even if typical skin features are not present
31
Mild or moderate allergic reaction presentation
swelling of lips, face, eyes
hives or welts
tingling of mouth
abdominal pain
32
Anaphylaxis presentation
Difficulty/noisy breathing/stridor
swelling of tongue
swelling/tightness in throat (difficulty swallowing)
difficulty talking and/or with hoarse voice
wheeze or persistent cough
persistent dizziness or collapse
pale and floppy (young children)
33
Causes of secondary seizures
```
Hypoxia and Hypercarbia
metabolic - hypoglycaemia, hyponatraemia, hypocalcaemia, hyperthydoidism, uraemia
Hyperthermia (febrile convulsions)
Hypotension
Pregnancy - eclampsia
meningitis/encephalitis
drugs/toxins (intoxication/withdrawal)
cerebral pathology (tumour, stroke, trauma)
```
34
Causes of secondary brain injury
```
hypoxia and hypercarbia
hypotension
reperfusion injury
hypoglycaemia
hyperthermia
Anaemia - lack of red blood cells carrying oxygen
```
35
Signs of life threatening chest injury
- Unequal air entry and/or crackles
- Asymmetrical or paradoxical chest wall movement
- Surgical emphysema
- Chest hypomobility
- Bubbling or sucking wounds
- Extreme tachypnoea
- Tracheal shift
- Hypotension
- ALOC
- JVD
- Muffled heart sounds
- Cardiac dysrhythmias
36
Signs of Blood loss
15% blood loss - minimal or no tachycardia response. BP changes don't usually occur
15-30% (750mL - 1.5L) blood loss - tachycardia, hypotension, peripheral hypoperfusion, ALOC
>40% (2L) blood loss - haemodynamic compensation at its limits, decompensation iminent, ALOC
37
Neurogenic shock
Interruption to normal sympathetic nervous system function by high spinal cord or direct CNS injury can result in loss of vasomotor tone, resultant hypotension and, in certain cases, bradycardia. Occurs especially in injuries above T5 – site of sympathetic spinal outflow
38
Spinal shock
Transient condition following acute cord injury that is characterised by flaccid paralysis below site of lesion, areflexia and anaesthesia. Will often resolve over moths following initial injury and spinal reflexes will, in most instances, return
39
NEXUS criteria
```
No posterior midline cervical-spine tenderness
No signs of intoxication
Normal level of consciousness
No focal neurological deficit
No painful distracting injury
```
40
Superficial Burns Appearance and Sensation
Appearance - erythema, brisk cap refill
| Sensation - painful
41
Superficial Dermal Burns Appearance and Sensation
Appearane - moist, reddened with blisters, brisk cap refill
| Sensation - painful
42
Deep dermal Burns Appearance and Sensation
Appearance - white slough, reddened and mottoled, sluggish or absent cap refill
Sensation - painful
43
Full Thickness Burns Appearance and Sensation
Appearance - dry, charred, whitish, absent cap refill
| Sensation - painless
44
Signs of life-threatening burns
Respiratory compromise/airway burns
- facial/oral burns
- singed nasal hairs
- carbonaceous sputum
- tachypnoea, stridor, hoarseness
Hypovolaemia is not an acute sign of burns. Circulatory shock early indicates other injury/pathology involved
45
Signs of limb threatenign burns
Deep dermal and full thickness burns cause inelastic dead tissue "eschar"
Circumfrential burns can compromise limb vasculature supply leading to ischaemia if untreated
46
Indications for burns unit
- Partial thickness burns > 20% all ages or >10% in <10 years and >50 years
- Full thickness burns >5%
- Burns involving face, eyes, hands, feet, genitals, perineum or overlying major joint
- all inhalation burns
- all significant electrical burns
- burns in people with significant comorbidities
47
SAT score
INSERT IMAGE
48
Causes of behavioural disturbances
Situational (grief, overwhelming stress)
Psychiatric (schitzophrenia, bipolar, PTSD, psychosis)
Subtance related (psychostimulant, cocaine, ketamine, LSD, cannabis, alcohol)
Organic Disorders (dementia, head injury, hypoxia, sepsis, hypoglycaemia)
49
Causes of heat related illnesses
Intrinsic - infection, malignant hyperthermia, serotonin syndrome, anticholinergic syndrome, neuroleptic malignant syndrome, status epilepticus, CNS infection, CVA (involving hypothalamus), endocrine disorder, drug, toxicity
Environmental
50
Severity of Heat related illness - Heat stroke vs heat exhaustion
- Heat exhaustion (core temperature 37-40)
Systemic reaction to heat stress where the depletion of body fluids and electrolytes occurs without adequate replacement. Heat exhaustion may progress rapidly to heat stroke if unmanaged.
- Heat stroke (>40)
Potentially life threatening condition that can result in multi-organ failure and death
51
Hypothermia Severity
- Mild (35-32) – vasoconstriction, apathy/lethargy, ataxia, tachycardia, tachypnoea and normotension
- Moderate (32-28) – confusion, delirium, ALOC, hypotension, bradycardia and muscle rigidity
- Severe (<28) – stupor, coma, diminished or absent signs of life, dilated pupils, reusced/absent reflexes, apnoea. Dysrhythmias including SB, slow AF (may present with J wave) VF and asystole
52
Time critical abdominal emergencies
```
Ectopic pregnancy
Ruptured AAA
Peritonitis and sepsis
Testicular/ovarian torsion
Uncontrolled castrointestinal tract haemorrhage
- Upper GIT- oesophagus, stomach and duodenum
- Lower GIT - small bowel and colon
Acute Bowel obstruction
Acute pancreatitis
```
53
Respiratory Status Assessment
INSERT IMAGE
54
SEPSIS Diagnosis
```
Suspected or known source of infection
AND
SIRS (two or more of the following)
- Temperature >38.3 or <36
- HR > 90
- RR > 20
- BGL >6.6 (unless diabetic)
- Acute ALOC
```
55
Severe SEPSIS
Sepsis AND evidence of organ hypoperfusion or dysfunction
- SBP <90 or MAP <65
- O2 <90%
- Not passed urine for >8 hours
- prolonged bleeding from minor injury or gums
56
Breaking Bad News
GRIEV_ING
Gather - ensure everyone present
Resources - call for support resources (family, friend, minister, other)
Identify - Identify yourself and patient by name. Identify state of knowledge of family relative to events of the day
Educate - Briefly educate about events that have occurred
Verify - verify that family member has died. Use word dead/died
_Space - five space and time for emotion and allow time to absorb information
Inquire - Ask if there are any questions ad answer them all
Nuts and Bolts - funeral service, police, personal belongings. Opportunity to view body if possible
Give - give information about normal process that will follow
57
What legislation is relevant to Ambulance Paramedics
Ambulance act 1991, section 38 and 39
58
Ambulance Act QLD 1991 Section 38
(1) An authorised officer, in providing ambulance services, may take any reasonable measures— (
a) to protect persons from any danger or potential danger associated with an emergency situation; and
(b) to protect persons trapped in a vehicle, receptacle, vessel or otherwise endangered; and
(c) to protect themselves or other officers or persons from danger, potential danger or assault from other persons.
(2) Without limiting the measures that may be taken for a purpose specified in subsection (1)(a) or (b), an authorised officer may, for that purpose—
(a) enter any premises, vehicle or vessel; and
(b) open any receptacle, using such force as is reasonably necessary; and
(c) bring any apparatus or equipment onto premises; and
(d) remove from or otherwise deal with, any article or material in the area; and
(e) destroy (wholly or partially) or damage any premises, vehicle, vessel or receptacle; and
(f) cause the gas or electricity supply or motor or any other source of energy to any premises, vehicle, vessel or receptacle to be shut off or disconnected; and
(g) request any person to take all reasonable measures to assist the authorised officer; and
(h) administer such basic life support and advanced life support procedures as are consistent with the training and qualifications of the authorised officer.
(3) Without limiting the measures that may be taken for a purpose specified in subsection (1)(c), an authorised officer may, for that purpose, require any person not to enter into or remain within a specified area around the site of the danger to a patient.
59
Ambulance Act QLD 1991 Section 39
(1) The State is to indemnify every service officer against all actions, proceedings and claims in relation to—
(a) acts done, or omitted to be done, by the officer under section 38; or
(b) acts done, or omitted to be done, by the officer in good faith for the purposes of section 38.
(2) For the purposes of subsection (1), a service officer includes a person required under section 38(2)(g) to assist an authorised officer
60
8 step model for working through ethical dilema
1) Identify problem
2) Consider significance of context and settings
3) Identify and utilise resources
4) Develop possible solutions to the problem
5) Consider the potential consequences of various solutions
6) Choose and implement course of action
7) Assess the outcome and implement changes as needed
61
Ethics - Principles approach
autonomy, beneficence, non-maleficence, justice
