Guideline Questions Flashcards
1
Q
Other than analgesia, what 5 other interventions can contribute to pain control?
A
Splinting Posture Oxygenation Reassurance Temperature Control (SPORT)
2
Q
When managing pain, the aim is:
A. Complete Relief
B. Reduce to a tolerable level
A
B. Reduce to a tolerable level
3
Q
How long until IV Morphine reaches Maximal Effect?
A
15 Minutes (Significant variation among individuals)
4
Q
How long until IN Fentanyl reaches Maximal Effect?
A
5 Minutes (Significant variation among individuals)
5
Q
For pain that is going to be difficult to control with paramedic limits of morphine, what can/should you do?
A
Request Clinical Support
6
Q
When delivering Narcotics, What should also be administered?
A
Oxygen
7
Q
What are 6 adverse effects of Morphine?
A
Hypotension Respiratory depression Interactions with Other CNS Depressants Nausea and Vomiting Itchiness Constipation
8
Q
Before administering any pain relief, what subjective finding should be assessed?
A
Pain score
9
Q
What 2 type of pain can Paramedics administer Morphine to?
A
Musculoskeletal Injuries
Burns
10
Q
What are the 2 main clinical findings that must be met before administering Morphine?
A
SPB > 100mmHg
GCS 15
11
Q
What is the IV dose for Morphine, and at what interval is it given?
What is the end point for these repeated doses?
A
2.5mg every 5 minutes until pain is controlled
12
Q
What is the maximum number of doses of IV Morphine that we can give as Paramedics?
A
Until pain is controlled. There is no specific limit.
13
Q
If Morphine is not controlling pain, can you administer Fentanyl?
A
No
14
Q
What can you do if pain is not being controlled with IV Morphine?
A
Request Clinical support.
If that is not available, consult with the EOC Clinician
15
Q
When can paramedics administer Fentanyl?
A
When Morphine is unable to be administered
16
Q
What is the initial IN dose limit for Fentanyl?
A
180mcg
17
Q
What is the dose limit for second and subsequent doses of IN Fentanyl?
A
90mcg
18
Q
How does Fentanyl come?
What dose is in the vial?
A
600mcg in 2mL
19
Q
What is the procedure for drawing up a 180mcg dose of Fentanyl?
A
> Draw up at least 0.7mL in a 1mL Luer Lock syringe
You have 30mcg / 0.1mL (neeed 0.6mL for 180mcg dose)
Attach the NAD, and prime it with at least 0.1mL or until you have reached 0.6mL
20
Q
What is the minimum interval for Fentanyl doses?
A
5 Minutes
21
Q
What is the Maximum combined dose for IN Fentanyl?
A
360mcg
22
Q
What pain relief can we administer to paediatrics?
A
Methoxyflurane
23
Q
What can we do for paediatrics that pain has not been controlled by Methoxyflourane?
A
Request Clinical support
Consult with the EOC Clinician
24
Q
Under what circumstances might you consider morphine for chest pain?
What do you need to do before administering Morphine for Chest Pain.
A
Long country transfer
Consult with the EOC Clinician
25
What is the max dose of Methoxyflurane for paramedics?
3mL
26
If receiving a patient from a volunteer crew, what dose of Methoxyflurane may have been administered under Volunteer guidelines
6mL
27
If given authority, what is the Paediatric dose for IV Morphine?
50mcg / kg
28
If given authority, what is the Paediatric dose for IN Fentanyl?
0-4yo - 30mcg
5-9yo - 60mcg
10-13yo 90mcg
29
In severe ACPO, what should be activated early?
Clinical support for CPAP
30
Aside from GTN, what 3 other interventions are useful in the treatment of ACPO?
Oxygen
Posture
CPAP
31
What clinical findings need to be assessed before administering GTN?
```
Blood Pressure (Sufficient)
ECG (Rate and Rhythm)
```
32
Other than clinical findings, what is a contraindication for administering GTN?
Use of:
Viagra / Levitra in past 24 hours
Cialis past 48 hours
33
What is the interval for repeat doses of GTN? (guideline)
5 minutes
34
What is the dose for SL GTN?
400mcg
35
What is the max combined dose for GTN?
PRN, There is no limit
36
What is the half life of GTN?
3 minutes
37
What is the time to peak plasma levels for SL GTN?
3 Minutes
38
True or False
| A notification is required for ACPO patients
True
39
In Adult Cardiac arrest, what takes precedence over all other procedures?
Defibrillation (if indicated)
40
In Adult Cardiac arrest, once an advanced airway is in situ, ventilate:
>rate/minute
>ratio/compressions
> ? second intervals
Ventilate:
6/minute
15:1 to compressions
Every 10 seconds
41
What are the reversible causes of Cardiac Arrest?
| 4Hs & 4Ts
Hypoxia
Hypovalemia
Hyper/hypothermia
Hyper/hypokalemia
Tension Pneumothorax
Tamponade
Toxins
Thrombosis (STEMI/PE)
42
What legal consideration must be considered before commencing/continuing CPR?
End of life considerations/NFRs
43
In Cardiac arrest, at what point is IV Adrenaline given for:
> Shockable rhythms?
> Non Shockable rhythms?
> Shockable rhythms
after second shock, then every second loop
> Non Shockable rhythms
Stat, then every second loop
44
In a persistent VT, VF or PEA arrest, what is the minimum amount of time you should spend attempting resuscitation?
30 Minutes
45
In a persistent asystole arrest, what is the minimum amount of time you should spend attempting resuscitation?
10 Minutes
46
In an arrest, what needs to happen before ceasing resuscitation?
Discussion with all clinicians and interested parties at the scene
47
After ceasing resuscitation, when can you consider removing invasive equipment?
Expected death
Scene Management
Cultural Considerations
Note the reason in PCR
48
What 6 things should be done post ROSC?
```
Re-evaluate ABCDE
Advanced Airway
Evaluate Oxygenation / Ventilation
12 lead ECG (if does not delay transport)
Treat precipitating causes
Transport/Notify
```
49
What 4 concurrent clinical findings are required to declare life extinct?
```
Nil for 1 minute:
Heart Sounds
Pulse
Respirations
Pupil reactions
```
50
Why do we give aspirin to Chest Pain?
Reduce platelet aggregation around the thrombus.
51
Chewable aspirin begins to be detected in blood after _____minutes.
20 minutes
52
Peak serum levels for aspirin are _______minutes.
180 minutes (3hours)
53
Why can we give aspirin to patients already on Warfarin?
Warfarin is an anticoagulant that works on a different pathway than aspirin.
54
If chest pain is unrelieved with GTN and Oxygen, what can we do as Paramedics?
Clinical Support
| Consult with the EOC Clinician
55
In Unrelieved Chest Pain, and if permitted, what is the IV dose and frequency of Morphine?
1 - 2.5mg IV every 5 minutes RPN
56
In paediatrics, cardiac arrest is usually due to:
Hypoxia
57
In Paediatric Cardiac Arrests, the Compression/Ventilation ratio is:
15:2
58
In Cardiac arrest, what is the paediatric dose for DCCS?
4J / Kg
59
In a paediatric Cardiac Arrest, what ages can be cannulated, and what are the options for gaining access?
```
>1yo = cannulate
<1yo = request Clinical support for IO access. If no support, consider cannulating.
```
60
What is the Paediatric dose of adrenaline in Cardiac Arrest?
10mcg / kg
61
Do paramedics need to consult for Adrenaline in Paediatric Cardiac Arrest?
Yes!
62
A 1 hour old baby is classified as a ________.
| Newborn/ neonate/ infant/ paediatric
Newborn
| 0 - 2 hours
63
A neonate's age ranges from _______ to _______.
2 hours to 4 weeks.
64
A 9 month old baby is classified as a _________.
| Newborn/ neonate/ infant/ paediatric
Infant.
| 4 weeks - 1 year
65
What are the age ranges for a paediatric?
1 - 14 years
66
During Child Delivery, what are 6 key things to remember?
```
Don't drop it
Do Dry it
Record Time of birth
Exclude cord Compression
Hamburger hands
Massage the Fundas, then hands off (!)
```
67
What do we get if we deliver a newbown to the WCH that is normothermic?
A Bottle of wine
68
What is considered normal blood loss during child delivery?
<500mL
69
After delivery of a child, what 3 things do we need to check on the MOTHER?
>Check the Fundas for firmness (indicating contractillity)
>Obs - including blood loss, pereneal tears
>Check for a second Baby
70
After delivery of a child, what 3 things do we need to check on the NEWBORN?
>APGAR
>Stimulate and Rub
>Cord Care (clamp and cut)
71
What 4 reasons do we place newborns on the mother's chest with skin to skin contact?
Decrease heat loss
Begin Bonding
Increase mother's hormones that stimulate breast feeding
Increase Uterine contraction
72
During newborn care/ resuscitation, only aspirate secretions if:
The airway is compromised.
73
The 5 Components of APGAR are:
```
Appearance
Pulse Rate
Grimace
Activity
Respirations
```
74
```
How many points towards an APGAR score does this newborn get:
Generally pink with blue hands
HR 110
Grimacing a bit, but not coughing/crying
Some arm activity
Slow, Irregular respirations
```
6
75
When should an APGAR be done?
1 minute after delivery
| 5 minutes after delivery
76
At what point would you ventilate a newborn, and at what rate?
Inadequate respiration after 30 - 60 seconds.
| Ventilate at 40 - 60 /minute
77
When would you give a newborn oxygen? (2)
- After 5 minutes of ventilating with air.
or
- HR <100
78
In a newborn, what 2 conditions need to be met to begin compressions?
At least 30 seconds of ventilation
| HR <60
79
In a newborn arrest, what is the ratio for compressions / ventilations?
3:1
80
What are the reasons that you may not commence CPR?
-The patient is in the terminal phase of a terminal illness.
AND
An advanced directive is in place
or
Medical agent exercises Power of attorney
- Rigor Mortis
- Clear, unmistakable dependent lividity
- Injuries incompatible with life
- Pulseless, not breathing, fixed dilated pupils, unresponsive with no CPR for 30 mins (all of these)
- Crew placed in significant danger to do CPR
- MCI triaging
81
Under what conditions can a Person be taken into care and control under the MHA?
```
Has/appears to have a MH Illness
AND
Has / risk of Harm to self/ others/ property
or
requires medical exemination
```
82
In a behavioural emergency that looks like sedation will be required, what should you consider early?
Clinical support for IV midazolam.
83
In mild anaphylaxis, where bronchospasm is the main complaint, what is the treatment guideline?
Slabutamol (10mg) + Atrovent (500mcg) Neb
| Fexofenadine 180mg PO in adults with rash/itchiness.
84
What are the three main clinical findings to suspect severe anaphylaxis?
Hypotension
Severe Bronchospasm
Respiratory distress due to angioedema
85
In severe anaphylaxis, what is the route, dose and interval of Adrenaline?
300mcg IM, 5 minute intervals PRN
86
In severe paediatric anaphylaxis, what is the dose and interval of Adrenaline?
10mcg IM, 5 minute intervals PRN
87
In severe anaphylaxis, do paramedics need to consult to give adrenaline to paediatrics?
No, but you could consider clinical support.
88
What is the dose for oral glucose paste?
15g
89
What is the adult dose for IM Glucagon?
1IU
90
What is the paediatric dose for IM Glucagon?
<8 yo = 0.5 IU
| ≥8 yo = 1IU
91
If glucagon is ineffective in increasing BGL in a paediatric, what are your options?
Request Clinical support for IV Glucose.
| Consult the EOC Clinician for IV Glucose
92
If given authority, what is the paediatric dose for Glucose?
Glucose 10% 5mL/ kg titrated to effect
93
Immediately before, and immediately after administering IV Glucose, what must you do?
100mL Saline flush (less for paediatrics)
94
The best management for hypoglycaemia is:
The least invasive therapy that increases BGL.
95
After adult reversal of hypoglycaemia, what 4 components are required to leave a patient at home?
1. Consumed carbohydrates
2. BGL is stable
3. The patient was a previously stable diabetic
4. A cause for the episode can be identified
96
In a hypothermic arrest, when may CPR be ceased?
Core body Temp >35`C
97
In a hypothermic VF/VT arrest, how many shocks should me delivered in total?
3
98
When moving or handling a hypothermic patient, what special considerations should you take?
Minimal movement/stimulation
99
How can a hypothermic patient be warmed?
Dry the Patient
Remove wet clothing
Remove from contact with cold/windy environment
Insulate with linen and space blankets
100
How much fluid should be given to a hypothermic patient?
Minimal
101
In haemorrhagic or obstructive shock, what is the limit for fluid in adults before consulting?
1000mL
102
In haemorrhagic or obstructive shock, what is the end point of fluid administration?
Maintain a palpable peripheral pulse and stable GCS
103
In haemorrhagic or obstructive shock in a paediatric, what are your options for fluid administration?
Request clinical support
| Consult the EOC Clinician
104
What can we do for patients with symptomatic dehydration with hypotension?
Request Clinical support for Fluid
| Treat hyperthermia with active cooling
105
For hypovolaemia secondary to sepsis, what are our options?
Request clinical support
| Call EOC Clinician for fluid
106
What 2 ways does Benzylpenicillin come?
600mg or 1200mg vials
107
What is Benzylpenicillin reconstituted with, and how much is used?
What concentration do you have once reconstituted?
600mg - add 1.6mL water
1200mg - add 3.2mL water
Both vials are then 300mg/ mL
108
Upon initial suspicion of meningococcal, what is the FIRST thing you should consider.
PPE!
109
What 4 clinical findings need to be present for paramedics to immediately administer Benzylpenicillin for Meningococcal?
Febrile
GCS <15
Evidence of sepsis
Purpuric rash
110
What is the dose and route for benzylpenicillin for paediatrics and adullts.
<1 yo - 300mcg
1-9 yo - 600mcg
10+ yo - 1200mcg
111
If meningococcal is suspected, but there is no purpuric rash what are your treatment options?
Contact EOC Clinician for ASMO consult
112
When reversing a narcotic overdose in an ADULT, what are the 2 main aims?
Re establish:
Airway control
Effective ventilation
113
When reversing a narcotic overdose in an CHILD, what is the aim?
Complete reversal
114
What is the adult dose of Naloxone IN?
120mcg IN PRN
115
What is the adult dose of Naloxone IV?
100mcg IV PRN
116
What is the adult dose of Naloxone IM?
400mcg IM PRN
117
What is the maximum total dose for Naloxone in: Adults?
| Paediatrics
Adult: No limit
Paediatrics: 1600mcg
118
What is the route / dose of naloxone in paediatrics:
>6yo
<6yo
Newborns
>6yo = 400mcg IM PRN
<6yo = 200mcg IM PRN
Newborns with respiratory depression due to maternal narcotic use = consult with EOC Clinician
119
Odansetron should be used cautiously in patients with previous dystonic or other reaction to _______ receptor agonists.
5HT3
120
What is the adult dose range for Ondansetron?
4 - 8mg IM or IV
121
When administering IV Ondansetron, over how long should it be administered?
Slow push over 5 minutes, watch for dystonic reactions
122
What is the paediatric dose of Ondansetron?
100 mcg / kg Max dose 4mg
123
Within what timeframe do CVA patients need to arrive at a Stroke Unit from onset of symptoms?
4 Hours
124
Which hospitals have a stroke unit?
| What hours are they open?
FMC, RAH and QEH - 24/7
| Lyell McEwin - 0800 - 1600 Now 7 days
125
When considering treatment options for a suspected CVA patient, but does not fit the criteria for thromolysis at a stroke unit, what are your options?
Consider transporting to a hospital with a stroke unit, or if this would create an excessive travel time, transport to nearest hospital.
126
When transporting a suspected CVA patient to a stroke unit, what is the max travel time allowable?
1 hour
127
If transporting a suspected CVA patient to a stroke unit, what else should you consider in preparation for the stroke unit?
Bilateral 18G IVA
12 Lead ECG
(As long as transport time is not delayed)
128
On a ROSIER scale, what 2 items can contribute to a negative score?
LOC/syncope
| Seizure activity
129
On a ROSIER scale, what 5 items can can contribute to a positive score?
New, Acute:
- asymmetrical facial weakness
- asymmetrical arm weakness
- asymmetrical leg weakness
- speech disturbance
- visual field defect
130
Before completing a ROSIER score, what needs to be checked first? (and treated if necessary?
BGL
131
Other than clinical findings, what also needs to be ascertained before a CVA patient can be considered for thrombolysis at a stroke unit?
Their pre-morbid independence.
132
In moderate paediatric croup, what is your treatment?
Basic care and oxygen
133
In severe paediatric croup, what is the dose/ route for adrenaline?
5mg nebulised
134
In severe paediatric croup, do you need to consult for adrenaline?
No, but you should consider requesting clinical support.
135
In severe paediatric croup, what is the duration of action for adrenaline? (range)
Minutes to Hours
136
What 3 reasons would you consider administering midazolam to a seizure patient?
Risk of:
- physical injury
- hypoxia
- aspiration
137
What 4 things potentiate the negative effects of Midazolam?
Hypoxia
Hypovolaemia
Extremes of age
Other CNS depressants
138
To control a seizure, what is the dose for midazolam?
100mcg / kg IM, up to 10mg
139
What is the recommended interval for IM Midazolam to control a seizure?
5 Minutes
140
If a seizure has not been controlled with IM Midazolam after 5 minutes, what should you consider (aside from repeat doses)
Request Clinical support
141
For any IM injection, what is the maximum volume that can administered in a site?
5mL
142
When treating an amputation, when should you consider a tourniquet?
Torrential haemorrhage unable to be controlled with direct pressure
143
When treating a burns patient, when can Hydrogel be considered?
When there is no running water.
144
When irrigating/cooling a burn, what needs to be considered, and closely monitored.
Hypothermia.
145
How long do the following burns need to be irrigated?
- Heat Burns
- Chemical Burns
- Heat Burns - Up to 20mins
| - Chemical Burns - At least 20mins
146
When cooling a burns patient, which 2 groups are more susceptible to hypothermia?
Young
| Elderly
147
How long can a Hydrogel dressing be left on for on the following groups:
- Neonates
- Young or elderly patients
- Burns >15% BSA
- All other patients
- Neonates - 10mins
- Young or elderly patients - 20mins
- Burns >15% BSA - 20 mins
- All other patients - no specific guideline
148
When assessing/ treating a major burns patient, other than pain and temperature, what is the most important thing to keep reassessing.
Airway burns/oedema
149
Where should a burns patient be transported if you are in or near the Adelaide metropolitan area and are passing primary survey?
RAH / WCH
150
When administering fluid to a traumatic hypovolaemic patient, what is the end point and limit for saline?
Gain & maintain a peripheral pulse, and stable GCS
| Max 1L
151
What are you treatment options for fluid in a hypovolaemic paediatric in trauma?
Request clinical support
| Consult with the EOC clinician
152
How much fluid can be given to a severely crushed patient?
Proportianal to the extent of the crush/ potential for hypotension.
153
For suspected / actual haemorrhage in a pregnant patient in 3rd trimester, how much fluid could be given?
1L even if a radial pulse is present.
154
When administering fluid to suspected / actual haemorrhage in a pregnant patient in 3rd trimester, when might you slow to KVO rate?
- Normotensive and decreased heartrate
| - Becoming hypertensive
155
Where should you transport a traumatic pregnant patient to in the Adelaide area if passing their primary survey?
FMC
156
In patients with severe head injury, what MAP should be achieved?
90mmHg
157
In a severe head injury, what is the end point for fluid administration?
MAP of 90mmHg
158
For Paediatrics with severe head injury, what are you treatment options?
Request clinical support
| Consult with the EOC Clinician
159
When considering NOT applying spinal immobilisation, what 5 things need to be confirmed?
ALL of the following
- GCS 15 (no altered behaviour, ETOH, drugs, head injury/illness)
- No pain in neck / head / shoulders
- No pain / deformity on palp of neck shoulders
- No neurological dysfunctions at any stage
- No distractions - other pain, anxiety, distress
160
Who needs to assess a patient before trauma bypass?
ICP / Retrieval Officer
| NOT EOC Clinician
161
What 3 criteria needs to be in place for an IPC to authorise Trauma Bypass?
- Suitable for Paramedic transport
- Low potential for sudden deterioration
- Issues being adequately addressed (such as pain and fluid management)
162
If you are enroute and trauma bypassing, and your patient suddenly deteriorates, what should you do?
Divert to the closest trauma service. (closes hospital that can handle trauma)
