What steps should be followed when verifying death?
- if clear and obvious signs of death (decomp, rigor m.,injuries incompatible w life) = yes
- if no ssx breathing for 1 min/no central pulse/no audible hr/pupils dilated and unreactive = wait 10min
- If no ssx RR for 1 min/no central pulse/no audible HR/pupils dilated unreactive/3 lead ECG shows asystole
When should oxygen be administered?
SPO2 <94% on air (except CORD/high risk) Airway obstruction Respiratory distress Shock Severe TBI CO poisoning Smoke inhalation Decompression illness Condition requiring sedation
What are high risk pts re oxygen and how should they be treated with oxygen?
CORD/ morbidly obese/on home O2/CPAP or BiPAP/neonates
- high risk adult titrate to known normal SPO2 or 88-92%
- if neonates titrate to 90-95% 10 mins after birth
What are grounds for believing a pt is not competent?
- unable to understand information
- unable to understand consequences of their decisions
- unable to remember information
- Has attempted suicide
- Has made a gennuine or significant threat to commit suicide
Treatment may be provided against a patients will if what?
- Pt is believed not competent
- Treatment is believed to be in pt best interest
- Risks assoc ttmt < risks assoc not ttmt
- ttmt non contracting a valid advanced directive
What are the analgesia indications for mild/moderate/severe pain?
Mild - paracetamol and maybe ibuprofen
Moderate - paracetamol and maybe ibuprofen, tramadol and inhaled analgesia - call for paramedic backup if pain not controlled
Severe - maybe inhaled analgesia call for paramedic backup for pain relief
What are contras and cautions for paracetamol?
Contras: paracetamol poisoning Cautions: dose last four hours/ adominal pain/ severe liver disease
What are contras and cautions for ibuprofen?
Contras: 3rd trimester pregnancy Cautions: dose last four hours abdo pain age >= 75 dehydration/shock renal impairment bleeding disorder clinically significant bleeding bronchospasms with NSAIDS taking warfarin pregnancy
What are contras and cautions for tramadol?
Contras: <12 yo Cautions: tramadol last 4 abdo pain age >=75 confusion pregnancy
What are contras and cautions for entonox?
Contras: scuba last 24 decompress illness bowel obstruction pneumothorax Caution confined space chronic pain and frequent ambulance use
What are contras and cautions for methoxy?
Contras: hx or family hx of malignant hyperthermia unable to obey commands known renal impairment had methoxy in last week
Caution:
confined spaces
pre-eclampsia (hypertension in pregnancy)
age >=75
