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Guidelines Flashcards

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1
Q

Adrenaline dose for cardiac arrest

A

1mg every 3 mins IV

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2
Q

LMA sizes

A 
Portex: 
Size 3: 30-50kg, 25ml 
Size 4: 50-70kg, 35ml 
Size 5: 70-140kg, 55ml 
Unique:
Size 3: 30-50kg, 20ml
Size 4: 50-70kg, 30ml 
Size 5: 70-140kg, 40 ml
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3
Q

ACS guidelines

Nitrates, antiplatelet, pain relief

A

Aspirin 300mg
GTN with BP >110 - 300mcg tablet or 600mcg if previous admin
GTN with BP >90 - 50mg patch (0.4mg/hour release)
Pain relief as per CPG

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4
Q

Pulmonary oedema

A

GTN as per ACS if mid to basal crackles

CPAP and suction

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5
Q

Pain relief

Morphine doses

A

IV up to 5mg, repeat every 5mins until max 20mg
IM: >60kg 10mg repeat 5mg after 15 mins (once)
less than 60kg 0.1mg/kg single dose only

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6
Q

Pain relief

Fentanyl doses

A

Elderly or less that 60kg 100mcg IN Max 200
Greater than 60kg 200mcg IN Max 400
repeat both up to 50mcg after 5 mins

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7
Q

Pain relief

Methoxyflurane doses

A

3ml repeat if required

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8
Q

Severe headache guideline

A

Methoxy 3ml, repeat if needed
Prochlorperazine 12.5mg IM
If after 15 mins no change and destination >15mins:
Morphine 2.5mg IV every 5 mins with max dose 20mg
If allergic to morph: 25mcg fentanyl IV every 5 mins with max of 200mcg
If IV unobtainable:
less than 60kg 50mcg IN Fentanyl repeat up to 25mcg every 5 mins max 100
greater than 60kg 100mcg IN repeat up to 25 mcg after 5 mins max 200

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9
Q

Actual medical time criticality

A

Moderate or severe resp distress
Oxygen saturation less than 90%
Less than adequate perfusion
GCS less than 13

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10
Q

Mild and moderate asthma

A

Salbutamol pMDI 4-12 doses every 4 mins 4 breaths each dose
Or
10mg nebulised repeat 5mg every 5 mins

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11
Q

Severe asthma

A

10mg nebulised and atrovent 500mcg
Repeat 5mg salbutamol after 5 mins
No response - 500mcg adrenaline IM
Repeat at 5-10mins max 1.5mg

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12
Q

COPD drug management

A

10mg salbutamol and 500mcg atrovent nebulised

Titrate spo2 to 88-92%

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13
Q

Nausea and vomiting

A

Assoc with chest pain etc 10mg metoclopramide IV/IM repeat after 10 mins max 20mg
Prochlorperazine 12.5mg IM as indicated

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14
Q

Hypoglycaemia

BGL less than 4 able to obey commands

A

Glucose 15g oral

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15
Q

Hypoglycaemia

BGL less than 4 doesnt obey commands

A

Dextrose 10% 15g 150ml IV repeat 10g after 3 mins
Normal saline 10ml flush
Or
1 unit of glucagon IM

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16
Q

Seizures

A

Manage airway and ventilate if required

Midaz 10mg IM repeat only once after 10mins

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17
Q

Causes of seizures

A 
Hypoglycaemia 
Hypoxia 
Head trauma 
Stroke 
Electrolyte imbalance 
Meningitis
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18
Q

Opioid overdose evidence

A 
Altered conscious state 
Resp depression 
Substance involved 
Exclude other causes 
Pin point pupils 
Track marks
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19
Q

Opioid overdose treatment

A

Naloxone 1.6-2mg IM
Assist and maintain ventilation
Repeat 0.8mg after 10 mins

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20
Q

Assessment of agitated patients

A 
Alcohol/drug use 
Epilepsy 
Insulin 
Overdose 
Underdose 
Trauma 
Infection 
Pain 
Stroke
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21
Q

Sedation of agitated pt

A

Midaz 5-10mg IM lower doses for eldery, frail, weight less than 60kg, BP less than 100, alcohol or drugs
Repeat after 10mins max total dose 20mg
Assess airway, ventilation, conscious state and BP

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22
Q

Autonomic dysreflexia

A 
Remove any stimulus 
If BP still >160 GTN 300mcg or 600mcg s/l 
Repeat after 10 mins until: 
Symptoms resolve 
Onset of side effects 
BP less than 160
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23
Q

Stroke mimics

A 
Intoxication/drugs 
Hypo/hyperglycaemia 
Seizures 
Brain tumour 
Syncope 
Middle ear disorder 
Migraine 
Subdural haemorrhage 
Sepsis 
Electrolyte disturbances
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24
Q

Stroke co morbidities

A

Dementia

Significant pre existing disability

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25
Stroke treatment
Assess facial droop, slurred speech, hand grip, BGL Maintain adequate airway and ventilation Manage symptomatically
26
Stroke transport
Stable with no comorbidities onset time less than 4.5 hours and transport time greater than 1 hour then transfer to the nearest hospital with thrombolysis Not stable: transport to closest hospital
27
Hypothermia temperatures
Mild 32-35 degrees Moderate 28-32 Severe less than 28
28
Hypothermia treatment | Non cardiac arrest
Warmed saline 10ml/kg IV | Repeat to maintain perfusion
29
Hypothermia treatment | Cardiac arrest
>32 degrees normal guideline 30-32 double intervals between doses, do not rewarm above 33 if ROSC 30 one shock only, one dose adrenaline
30
Hyperthermia
Cooling techniques until temp less than 38 Normal saline 20ml/kg and reasses vitals and temp Continue admin if pt remains poorly perfused or dehydrated
31
Paediatric weights
``` Newborn 3.5kg 2 months 5kg 5 months 7kg 1 year 10kg 1-9kg age x 2 +8 10-14 age x 3.3 ```
32
Paediatric perfusion
Newborn 120-160 bpm Infant 100-160 bpm BP >70 Small child 80-120 bpm BP >80 Large child 80-100 bpm BP >90
33
Paediatric respiratory rates
Newborn 40-60 Infant 20-50 Small child 20-35 Large child 15-25
34
Paed pain relief
``` Fentanyl IN Large child > 25kg 50mcg Small child 10-24 kg 25mcg Repeat same dose after 5-10 mins max 3 doses Or methoxy 3ml Or morphine IM 0.1mg/kg single dose ```
35
Paed mild asthma
>6 years 4-12 doses pMDI salbutamol less than 6 years 2-6 doses Nebulised 10mg Salbutamol if needed, repeat every 5 mins
36
Paed moderate to sever asthma
Salbutamol 10mg nebulised Atrovent 250mcg nebulised Repeat salbutamol 5mg after 5 mins
37
Paed asthma ventilations
``` Infant 15-20 ventilations per min Small child 10-15 Large child 8-12 Adrenaline 10mcg/kg IM if no response Repeat after 20 mins as required max 30mcg/kg ```
38
Paed hypoglycaemia
If responding glucagon 15g oral | If not responding 25kg 1 unit of glucagon IM
39
Paed seizures
``` Manage airway and ventilations as required Large child >25kg 5mg IM Small child 10-24kg 2.5mg Infant 5-9kg 1mg Newborn less than 5 kg 0.5mg ```
40
Paed opioid overdose
Assist and maintain ventilations Naloxone 10mcg/kg IM max 2mg Repeat after 10 mins
41
Emergent time critical medical
ACS, acute stroke, severe sepsis, possible AAA, undiagnosed severe pain Need for hyperbaric treatment Hypo or hyperthermia
42
PEA causes
``` Hypoxia Exsanguintation Asthma Tension pneumothorax Anaphylaxis Airway obstruction ```
43
Causes of APO
``` LVF Nutritional deficiency Liver disease Renal disease Fluid overload ```
44
CPAP measurements
5-7cm water with 8liter bag | 10cm water with 12-13 liters of oxygen
45
Other causes of Seizures
``` Hypoglycaemia Hypoxia Head trauma Stroke Electrolyte disturbances Meningitis ```
46
Hypovolaemia modifying factors
``` SCI Chest injury Penetrating trunk injury AAA Uncontrolled external haemorrhage Gi haemorrhage ```
47
Hypovolaemia HR less than 100 BP greater than 100
Fluid not required unless dehydrated Dehydrated: Normal Saline up to 20ml/kg IV over 30 mins
48
Hypovalaemia isolated tachy HR greater than 100, BP greater than 100
Normal Saline 20ml/kg HR less than 100: no further fluid HR greater than 100: repeat 20ml/kg
49
Hypovolaemia BP less than 100
Normal Saline 20ml/kg HR less than 100: no further fluid HR greater than 100: repeat 20ml/kg
50
Contras for CPAP
``` GCS less than 13 Facial trauma Pneumothorax Active vomiting Life threatening arrhythmias Pts requiring airway management Hypo ventilation ```
51
Adult perfusion
HR: 60-100, 50-100, less than 50 greater than 100, less than 50 greater than 110 BP: greater than 100, 80-100, 60-80, less than 60
52
Paed resp rates
40-60 20-50 20-35 15-25
53
Paed perfusion
HR: 120-160, 100-160, 80-120, 80-100 BP: na, less than 70, 80, 90
54
Actual Time Critical Trauma
``` RR less than 12 or greater than 24 BP less than 90 HR greater than 124 GCS less than 13 Spo2 less than 90% ```
55
Emergent Time Critical Trauma
Penetrating or blunt injuries to head, neck, chest, abdo, pelvis, axilla, groin Specific injuries: amputations, suspected spinal injury, burns greater than 20%, serious crush injury, major compound fracture, fractured pelvis
56
Potential Time Critical Trauma
Ejection from vehicle, motor/cyclist impact greater than 30km/kr, fall greater than 3m, struck by object greater than 3 m, explosion, high speed MVA greater than 60km/hr, pedestrian impact, prolonged extrication greater than 30mins
57
Hypovoaemia modifying factors
SCI, chest injury, penetrating trunk injury, AAA, uncontrolled external haemorrhage, GI haemorrhage
58
Hypovolaemia guideline
20ml/kg if: | significantly dehydrated, HR >100 BP>100, BP
59
Chest Injuries
Supp oxygen if required, pain relief, position pt upright if possible unless perfusion is less than adequate, alterned conscious, associated barotrauma or potential spinal
60
Pneumothorax
Simple if: unequal breath sounds in spontaneously ventilating pt, low Spo2 on room air, subcutaneous emphysema TPT if increased peak insp pressure, reducedd EtCO2, poor perfusion or increased HR and or reduced BP, increased JVP, reduced consicous state in awake pt, tracheal shift, low Spo2 on supp O2
61
Traumatic Head injury
Airway: do not insert NPA or OPA if airway patent, insert NPA is not patent, LMA if no gag and cannot intubate Ventilation: ensure adequate ventilation 10ml/kg, maintain Spo2 greater and 95% Perfusion: manage as per hypovolaemia, aim for SBP greater than 120, after 40ml/kg reassess General Care: treat seizures, hypoglycaemia, consider time criticality
62
Considered a significant head injury if:
with or without loss of consciousness and GCS 13-15: any loss of consciousness exceeding 5 mins skull fracture vomiting more than once neurological deficit seizure
63
Spinal injury
Provide spinal immobilisation if any of the following present: increased injury risk - over 55yo, history of bone disease or muscular weakness difficult pt assessment - unconciousness, drug or alcohol affected, significant distracting injury actual evidence of structural injury - spinal column pain/bony tenderness actual evidence of spinal cord injury - neuro deficit or changes
64
Signs and symptoms of TNT
``` Chest trauma Resp distress Absent breath sounds Poor perfusion Increasing jugular vein distension Subcutaneous emphysema Tracheal shift ```
65
Decompression of chest
``` Second intercostal space Mid clavicular line Above third rib Right angle to chest Towards vertebrae ```
66
Cushings triad
Bradycardia - affected CNS X vagus nerve Hypertension - sympathetic response to bradycardia, hence increased pulse pressure or compensatory response due to bleeding or swelling in brain Altered resps - neural control of breathing is compromised, therefore resp only in response to lower brain stem stimulus
67
CPP
MAP-ICP
68
MAP
DP + 1/3 pulse pressure
69
When ICP increases ...
CPP decreases

Clinical Prac (4 decks)

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