Introduction to Paramedic Practice - Week 1 + 2 (Cardiac arrest, communication, vital signs + Primary survey and infection control)

Question 1

WEEK 1 - Cardiac arrest, communication and vital signs

Resus theory - What is a cardiac arrest?

Answer 1

The cessation of effective cardiac output (Which is the amount of blood pumped around the body every minute). This means the patient’s heart has stopped, and is clinically ‘dead’.

Question 2

Cardiac arrest - NOTES (resus theory)

• A patient without a heart beat does not move blood and oxygen around the body
• This means tissues become hypoxic and begin to die
• The longer tissues go without oxygen the more cells will die
• The longer it takes to restart a heart the worse the patients prognosis will be

Question 3

Resus Theory- What signs might indicate a cardiac arrest?

Answer 3

• Bystanders doing CPR
• A pale or grey patient
• Central cyanosis (bluish colour due to lack of oxygen)

Question 4

Resus Theory - What does the ‘Thoracic pump theory’ describe?

Answer 4

• When you do CPR you aim to compress the chest by a third with every compression
• If you decrease the volume of the chest cavity you increase the pressure.
• That means the pressure on the heart increases forcing blood out the heart into circulation.
• Your circulatory system only flows one way – that how its built and you’ll cover it in human body systems
• When you release the compression the pressure returns to normal but now there is no blood filling the heart- so blood is drawn into the heart to fill the space: ready for the next compression.

Question 5

Resus Theory - What does the ‘Cardiac pump theory’ refer to?

Answer 5

• The heart is located between the spine and the sternum
• As you perform compressions you press the sternum towards the spine, consequently the heart is compressed between the two structures.
  As the heart gets compressed blood gets forced out and as you release the compression the heart refills.
• Remember it’s a one way system.
• Current thinking is that both mechanisms (this and thoracic pump theory) probably contribute to effective CPR

Question 6

Resus theory - Concept - Vectors: Notes

Force is a vector: it has both a magnitude and a direction
Contrast to a scaler such as height or speed
Adding vectors: Force in the same direction
Adding vectors Force in two directions

Question 7

Resus Theory - Application: Compressions:

Answer 7

First of all, arms straight and lock your elbows or you end up using your biceps and triceps too.

If you align your shoulders over the patient the force you apply goes directly down, into their sternum. You pivot on your hips.
As a bonus you get to add the weight of your own toros and shoulders to the compression meaning you don’t have to work as hard.

If you don’t align your shoulders above the torso, the force goes in at an angle, you don’t get the full benefit from your own body weight and you have to use more of your arm muscles to compensate. This gets tiring after a while and your compression quality starts to suffer.

Question 8

Resus Theory: Application (compressions) Does it even matter?

CPR is mainly performed by flexion and extension through the hip joint.
If you are not positioned properly you are not able to utilize some of your major muscle groups. If your not over the patient you cant engage your pectoralis major.
If you are kneeling too far back you don’t get to use your legs or your core.
Its not that you cant still do effective compressions, you can but you will tire more quickly and all the power has to come from your arms.
It takes about 30kg of pressure to compress a chest. As you tire your compressions become ineffective.

Question 9

Resus Theory: Concept: Rate of compressions

Answer 9

NZ resuscitation council recommends between 100 and 120 beats per minute. This is based on how many people survive out of hospital cardiac arrest and what rate seems to offer the best chance

We teach 110 beats per minute, right in the middle of that range. If you add one extra or skip one that gives you a little wiggle room rather than sitting on one extreme or another

Question 10

Resus theory - What is the acceptable depth of compressions?

Answer 10

5cm, or about 1/3 of the thoracic cavity

Question 11

Resus theory - Normal sinus rhythm: NOTES

Answer 11

Normal pathway of the electrical impulse
Originates in the Sino Atrial (SA) node
Intrinsic rate of 60-100 beats per minute
Do not defibrillate

(P wave, QRS complex, T wave)

Question 12

Resus Theory - Cardiac arrest arrythmias: What are the four arryhthmias focussed on in 1st year paramedicine?

Answer 12

1. Ventricular Tachycardia (VT)
2. Ventricular Fibrillation
3. Pulseless Electrical Activity (PEA)
4. Asystole

Question 13

Resus Theory - Cardiac arrest arrythmias: Ventricular tachycardia:

Shark tooth appearance
Fast heart rate (originates in the ventricles, not the atria)
Treatment; defibrillation

Question 14

Resus Theory - Cardiac arrest arrythmias:
Pulseless electrical activity:

Organised electrical activity with no detectable output
Do not defibrillate – The electrical activity is already working normally even though there is no cardiac output.
Treatment: look for and treat reversible causes

Question 15

Resus Theory - Cardiac arrest arrythmias:
Pulseless electrical activity:

What is the only way to differentiate a normal sinus rhythm from PEA?

Answer 15

To see if you can palpate a pulse (usually carotid or femoral). In the absence of a pulse, you know you are working with PEA over normal sinus rhythm.

Question 16

Resus Theory - Cardiac arrest arrythmias:
Asystole:

Complete absence of electrical activity (no pulse)
Poor prognosis
Do not defibrillate – This rhythm has no electrical activity, defibrillation will have no effect
Treatment: look for and treat reversible causes

Question 17

Resus Theory - What are the reversible causes of a cardiac arrest (4H’s and 4T’s)?

Answer 17

• Toxins
• Tension pneumothorax (air in pleural space)
• Thrombosis (blood clot in vessel)
• Tamponade (compression of heart due to blood/fluid in heart cavity/pericardial space)
• Hypoxia (lack of oxygen)
• Hypokalemia (potassium based)
• Hypo/erthermia (temp)
• Hypovolemia (volume of blood in circulation)

Question 18

Resus Theory - Primary vs Secondary Arrest:

What is a primary cardiac arrest?

Answer 18

When the heart stops beating due to a mechanical or electrical failure of the heart. A heart attack or dysrhythmia causing cardiac arrest would be examples of primary cardiac arrest

Question 19

Resus theory - Primary vs Secondary arrest:

What is a secondary cardiac arrest?

Answer 19

Any non-cardiac problem which causes the heart to cease functioning is a secondary cardiac arrest. If a person drowns or chokes or asphyxiates, they will be unable to inspire oxygen. A lack of oxygen will cause a lack of ATP which will eventually cause the heart to stop beating. Stabbings, poisonings and drownings are all examples of secondary cardiac arrest

Question 20

Resus Theory - Primary Vs Secondary arrest:

Additional NOTES

Primary Arrest
- Cardiac Cause
- Priority is defibrillation and compressions
- Ratio of 30:2

Secondary Arrest
- Non – Cardiac Cause
- Priority is ventilations
- Look for reversable causes
- Ratio of 15:2

Question 21

Resus Theory - Cardiac arrest

• ‘Pit crew’ approach:

Use defined roles
Team leader
Airway/ breathing clinician
Chest compressions
Clear communication
Flattened hierarchy

Question 22

What are the three overt signs of a cardiac arrest?

Answer 22

• Unconscious
• Abnormal or NO breathing
• Absence in signs of circulation (central cyanosis or pale/grey in colour)

Question 23

What is the average amount of blood pumped around the body per minute (at rest)?

Answer 23

5 litres a minute

Question 24

Vital signs: Respiratory rate - What is respiratory rate?

Answer 24

The amount of times someone breathes in one minute

Question 25

Vital signs: Respiratory rate - How can a respiratory rate be measured?

Answer 25

By observing, palpating or listening to a patient's breathing, and counting each breath

Question 26

Vital signs: Respiratory rate - When would you prioritize taking a shorter albeit less accurate respiratory rate (i.e over the course of 15 seconds x4 rather than over the span of 1 minute)?

Answer 26

If the patient is extremely unwell. In this case speed may be prioritised over accuracy

Question 27

Vital signs: Respiratory rate - What is the normal healthy respiratory rate for a healthy adult patient?

Answer 27

12-20 breaths per minute

Question 28

Vital signs: Respiratory rate - What is a slow/fast respiratory rate called?

Answer 28

Slow = under 12 breaths per minute (bradypnea) Fast = over 20 breaths per minute (tachypnea)

Question 29

Vital signs: Respiratory rate - When measuring a respiratory rate, what other things should you be looking out for?

Answer 29

Consider the depth of respiration (deep or shallow), and the effort required to inhale and exhale)

Question 30

Vital Signs: Oxygen saturation and delivery - What is the oxygen flow rate for nasal prongs?

Answer 30

1-4 L per minute

Question 31

Vital Signs: Oxygen saturation and delivery - What is the oxygen flow rate for a simple oxygen mask? (also called acute or hudson mask)

Answer 31

6 L per minute

Question 32

Vital Signs: Oxygen saturation and delivery - What is the oxygen flow rate for a nebuliser mask?

Answer 32

8 L per minute

Question 33

Vital Signs: Oxygen saturation and delivery - What is the oxygen flow rate for a reservoir mask? (also may be called a non-rebreather mask)

Answer 33

10 L per minute

Question 34

Vital Signs: Oxygen saturation and delivery - What is the oxygen flow rate for a manual ventilation bag? (also called bag valve mask or IPPV - intermittent positive pressure ventilation

Answer 34

10 L per minute

Question 35

Vital signs: Oxygen What do red blood cells contain?

Answer 35

Haemoglobin

Question 36

Vital signs: oxygen What is haemoglobin? What does it do?

Answer 36

Haemoglobin is a protein found in red blood cells. Oxygen binds reversibly to haemoglobin, enabling it to be transported around the body. It also binds reversibly to carbon dioxide, to transport this gas out of the body.

Question 37

Vital signs: Oxygen How much blood does it take to dissolve: - 0.3ml of oxygen

Answer 37

100mls of blood

Question 38

Vital signs: Oxygen - How much oxygen can be carried in the haemoglobin of 100mls of blood?

Answer 38

About 20.1 mls

Question 39

Vital Signs: Oxygen - Pulse Oximetry: What is a normal Spo2 reading for most people?

Answer 39

94% or higher

Question 40

Vital signs: oxygen - Pulse Oximetry: What does a pulse oximetry measure?

Answer 40

- A pulse oximeter shines both red light and infrared light through a patients finger and detects how much light has been absorbed - This is displayed as a percentage of how many haemoglobin molecules in the blood have an oxygen bound to them This comes as oxygenated haemoglobin absorbs more infared light than deoxygenated haemoglobin, and deoxygenated haemoglobin absorbs more red light than oxygenated haemoglobin.

Question 41

Vital Signs: Oxygen - Pulse oximetry: What are the main limitations of Spo2?

Answer 41

- Poor perfusion may reduce the amount of blood flow to the extremities. In this case, if less blood flow (and therefore oxygen) reaches the Spo2 probe, it may give a low reading - Dark nail polish/dark pigmentation may inhibit the probes ability to detect light absorption - Carbon monoxide binds ALMOST irreversibly to haemoglobin. It absorbs similar levels of light to oxygen, resulting in an erroneous reading. - Remember all the pulse oximeter does is measure the percentage of haemoglobin with oxygen attached, SO if there are few red blood cells but all of them have an oxygen bound to them, the SpO2 will be 100% - Haemoglobin contains iron. Anaemia or low iron levels inhibit haemoglobin production. - Bleeding patients have a reduced blood volume but may have a normal SpO2 reading

Question 42

Vital Signs: Oxygen - Pulse oximetry: What does Spo2 actually stand for?**

Answer 42

Peripheral oxygen saturation S = saturation P = Peripheral O2 = Oxygen

Question 43

Vital Signs: Oxygen - What is cyanosis?

Answer 43

Blueness of the skin resulting from a deficiency of oxygen in the circulating blood... The oxygen deficiency turns the haemoglobin a reddish-violet colour, which is lightened to blue-violet as it shows through the white dermal collagen. - Cyanosis is a sign of severe hypoxia, and is most commonly seen in the lips or extremities

Question 44

Vital Signs: Oxygen - What are the four main types of hypoxia?

Answer 44

1. Hypoxic hypoxia (not enough oxygen is being inhaled). Caused by a decrease in inhaled oxygen An example would be a patient with an inadequate respiration rate 2. Pulmonary hypoxia (ventilation perfusion mismatch). Caused by a mismatch in ventilation (the amount of oxygen reaching the alveoli) and perfusion (the amount of blood reaching the alveoli). An example would be an embolism or blockage of blood vessels perfusing the lungs resulting in blood which was unable to reach the lungs to get reoxygenated. This might result in deoxygenated blood returning to circulation. 3. Stagnant hypoxia (oxygen is not being transported to the lungs). Occurs when there is abnormally low blood flow to the lungs. An example would be cardiac arrest where the heart muscle is unable to pump blood 4. Cellular hypoxia (oxygen can't bind to haemoglobin). Occurs when heamoglobin is not able to bind with oxygen This can occur in carbon monoxide poisoning

Question 45

Vital Signs: Oxygen - Indications: NOTES - Oxygen should usually only be administered if the patient has an SpO2 less than 92% on air, airway obstruction, or a specific indication as described within these guidelines (CPG1.16) - In some conditions such as carbon monoxide poisoning oxygen may be specifically indicated - Oxygen is administered for poor perfusion, dyspnoea or hypoxia. - A normal SpO2 does not indicate a lack of need for oxygen

Question 46

Vital Signs: Oxygen - Contraindications NOTES - There are no contraindications for oxygen - Oxygen is a drug and should only be given when needed - High flow oxygen may cause vasoconstriction particularly in smaller arteries which can impede blood flow into tissues - Hyperoxia may also enhance inflammatory processes

Question 47

Vital Signs: Oxygen What is hypercarbia?

Answer 47

- High levels of carbon dioxide CO2. - This can lower the Ph of the blood, causing it to become too acidic (*as it links with water creating carbonic acid)* - Normally high carbon dioxide levels cause a person to inhale. Some patients normally have a higher than usual carbon dioxide level. These patients are incentivised to inhale by oxygen levels. - Providing high flow oxygen to these patients may decrease their respiration rate.

Question 48

Vital Signs: Oxygen - Hypercarbia NOTES - Patients with Chronic Obstructive Pulmonary Disorder (COPD), morbid obesity or who are on home oxygen are at risk of developing hypercarbia when given high flow oxygen These patients normally have an SpO2 of 88-92% - Oxygen administration should be titrated to keep the patient in this range or to whatever their normal SpO2 is (if known

Question 49

Vital Signs: Oxygen - Confined Spaces NOTES Oxygen administration in a confined space increases atmospheric oxygen concentration Oxygen promotes combustion Increasing the concentration of oxygen from 21% to 24% may significantly increase the risk to staff from fire or explosion

Question 50

Vital Signs: Oxygen - What is bleomycin? How does it affect oxygen sensitivity?

Answer 50

Bleomycin is a chemotherapy drug. It causes lifelong sensitivity to high concentrations of oxygen High flow oxygen may cause lung damage to patients who have previously been treated with bleomycin Titrate the oxygen administered to maintain an Spo2 reading of between 88-92%

Question 51

Vital signs - Oxygen: What is the point of a nebuliser mask? What is its flow rate of oxygen per minute?

Answer 51

The point of a nebuliser mask is to deliver aerolised medications using oxygen to deliver them. It has a flow rate of 8 L per minute of oxygen.

Question 52

Vital Signs - Capnography: What is capnography used for?

Answer 52

To detect carbon dioxide which is exhaled by a patient. This can provide additional information on the depth and rate of respiration. Capnography measures a patients end tidal carbon dioxide and displays it as a graph against time (waveform) This can be used to provide real time feedback on airway and breathing interventions and can assist in diagnosing some diseases

Question 53

Vital signs - Capnography: What is a normal end tidal of carbon dioxide?

Answer 53

35-45mmHg (millimetres of mercury)

Question 54

Vital Signs - Capnography When is capnography recommended/mandatory?

Answer 54

- recommended if: A bag valve mask is used to ventilate a patient - mandatory if an endotracheal tube has been placed

Question 55

Vital Signs - Capnography What is ETCO2?

Answer 55

- End tital carbon dioxide - This measures the carbon dioxide that is exhaled with each breath

Question 56

Vital signs - Capnography How does a capnograph work?

Answer 56

Carbon dioxide absorbs infrared light. A capnograph shines an infrared light across the exhaled air. The amount of light which was absorbed will indicate the amount of carbon dioxide in the breath APPLICATION: Capnography can be measured via nasal capnography or a probe may be attached to a breathing tube

Question 57

Vital Signs: Capnography - selected waveforms (e.g on a graph see ppt)

Answer 57

- Respiratory baseline (should be 0) - Expiratory upstroke - Alveolar plateau - Measured ETCO2 (point at top right on graph) - Inspiratory downstroke

Question 58

Vital Signs - Capnography: Sudden loss of waveform NOTES If you are ventilating a patient and notice a sudden absence of a capnography waveform you need to check on your patient urgently This means that carbon dioxide is not reaching the sensor This may be caused by a break in the circuit between your patient and the sensor If there is no break your patient may have gone into cardiac arrest

Question 59

Vital Signs - Capnography: CPR When a person is receiving ventilation during CPR you will often see a normal looking waveform with a lower ETCO2 Low ETCO2 values can be a predictor of mortality during CPR as ETCO2 under 10mmHg after 20 minutes of CPR are associated with poor rates of survival

Question 60

Vital Signs - Capnography: ROSC NOTES A sudden increase in ETCO2 during CPR may predict a Return Of Spontaneous Circulation (ROSC) Compressions should continue until the next rhythm analysis where palpation of a pulse may confirm that ROSC has occurred

Question 61

Vital Signs - Capnography: Uses of capnogrpahy NOTES

Answer 61

If you are ventilating a patient and the ETCO2 is increasing, consider increasing your ventilation rate to compensate for this If an endotracheal tube or supraglottic airway has been inserted capnography can be used to confirm it has been correctly placed A sudden drop in ETCO2 and a loss of waveform may indicate poor ventilation technique when using a bag valve mask to ventilate a patient When resuscitating a patient a sudden increase in ETCO2 may indicate a return of spontaneous circulation

Question 62

Vital Signs - Heart Rate: What is considered a normal heart rate in adults?

Answer 62

60-100BPM

Question 63

Vital Signs - Heart Rate: What are the terms used to describe either low or high heart rate?

Answer 63

Tachycardia - Fast heart rate (over 100BPM) Bradycardia - Slow heart rate (under 60BPM)

Question 64

Vital signs - Heart Rate: What else should you determine when palpating a heart pulse (other than number of beats)?

Answer 64

The regularity. Is it regular, irregular, or regularly irregular

Question 65

Vital Signs - Capillary Refill Time (CRT): What is CRT used to measure?

Answer 65

A persons perfusion

Question 66

Vital Signs - Capillary Refill Time (CRT): Where is a CRT usually measured on a patient?

Answer 66

A finger, but this can be done on a patient's toes, forehead or sternum also

Question 67

Vital Signs - Capillary Refill Time (CRT): How do you measure a CRT?

Answer 67

Compress an area of tissue for about 5 seconds, until the tissue turns pale. Measure the amount of time taken for colour to return to the tissue. - NOTE: In a healthy adult this should be under two seconds. - A prolonged CRT indicates poor perfusion

Question 68

Vital Signs - Blood pressure: - Mostly intuitive, see slideshow for notes if required

Question 69

Vital Signs - Three lead ECG: NOTES: An electrocardiogram (ECG) is a graph of the electrical activity of the heart against time. This can be detected through defibrillator pads or through ECG leads (see back of flashcard)...

Answer 69

ECG leads can measure the electrical activity of the heart but cannot deliver a shock to the patient. ECG leads can be attached to the wrists and ankles of a patient. Alternatively they can be attached on the left and right of the thorax below the clavicle and on the left and right side of the lower abdomen. Leads must be placed either on the limbs or the thorax not a combination of the two

Question 70

Vital Signs - Three Lead ECG: What is important about the placement of ECG leads?

Answer 70

The combination of leads (e.g LL, RL, RA, LA) must be placed either on the limbs or on the thorax of the body; not a combination of the two. e.g the RA can be placed either on the wrist or below the clavicle on the thorax, and the LL lead can be placed either on the ankle or lower left abdomen

Question 71

Vital Signs - GCS: What does the glasgow coma scale measure?

Answer 71

The level of a patient's consciousness

Question 72

Vital Signs -GCS: How many components make up the GCS scale? What are they?

Answer 72

Three: 1. Eye opening (scored out of 4) 2. Verbal response (scored out of 5) 3. Motor skills (scored out of 6) - When recording a GCS scale, it is important to incnlude the total GCS score (out of 15), as well as the scores assigned to each component specifically.

Question 73

Vital Signs - GCS: (eye opening) What are the four possible categorical outcomes of 'eye opening' on the GCS scale? *one being the worst*

Answer 73

4. Spontaneous 3. To speech 2. To pain 1. None

Question 74

Vital Signs - GCS: (verbal response) What are the five possible categorical outcomes of 'best verbal response' on the GCS scale? *one being the worst*

Answer 74

5. Oriented 4. Confused 3. Inappropriate 2. Incomprehensible 1. None

Question 75

Vital Signs - GCS: (motor skills) What are the six possible categorical outcomes of 'motor skills' on the GCS scale? *with one being the worst*

Answer 75

6. Obeying 5. Localising (*person moves purposefully towards the source of pain - indicating a higher level of brain function rather than pure reflexive movement) 4. Withdrawal (*person pulls away but does not try to stop it - not as purposeful*) 3. Flexing (* in response to pain person flexes/BENDS arms, clenches fists, flexes arms and extends legs, abnormal movement indicating brain damage) 2. Extending (in response to pain, person EXTENDS arms and legs - severe brain damage*) 1. None - (*indicated deep unconsciousness or death)

Question 76

Vital Signs - Blood Glucose Level (BGL): What is the device that measures blood glucose called?

Answer 76

A glucometer

Question 77

Vital Signs - Blood Glucose Level (BGL): What is the range of a normal bgl reading?

Answer 77

between 3.5-7mmolL

Question 78

What is someone with too little BGL or too high a BGL called?

Answer 78

Too low - (below 3.5mmol/L = Hypoglycaemic) Too high - (above 7mmol/L) = HJyperglycaemic)

Question 79

Vital Signs - Stroke assessment: When does a stroke occur?

Answer 79

When blood flow to the brain has been disrupted. This can be caused by bleeding or a blockage in the blood vessels that supply the brain.

Question 80

Vital signs - Stroke assessment:

Question 81

Vital Signs - Stroke assessment: What does the FAST acronym used to summarise the stroke signs stand for?

Answer 81

F - Face (check patient for asymmetry or facial droop. They may have altered sensations or numbness to one side) A - Arms (Ask the patient to raise both arms and keep them elevated for 10 seconds with their eyes closed. If an arm drifts downwards, or there is a reduce in sensation or power to one side, it may be a stroke) S - Speech (The patient may have lost the ability to speak, speech may be slurred or difficult to understand. They may struggle to identify the words they want to say, or know which words but may be unable to use them) T - TIME

Question 82

Vital Signs - Pupils What is the average span of a pupil in size?

Answer 82

Between 2-5mm

Question 83

Vital Signs - Pupils What are small or constricted pupils called? What can cause this?

Answer 83

Miosis - They may be caused by bright lights, parasympathetic stimulation, some kinds of brain injury, or some medications such as opiates

Question 84

Vital Signs - Pupils What are large or dilated pupils called? What can cause this effect?

Answer 84

Mydriasis - They may be caused by darkness, sympathetic stimulation, some brain injuries and some medications such as anticholinergic's or methanphetamine

Question 85

Vital Signs - Pupils What can uneven pupil sizes indicate?

Answer 85

Severe brain injury - particularly in the presence of a head injury

Question 86

Vital Signs - Pupils What is the consensual pupillary reflex?

Answer 86

- When a light is shone into the eye the illuminated pupil should constrict. This is the direct pupillary reflex. - Both pupils should constrict even though only one is illuminated. The ability of both pupils to constrict in response to the illumination of only one eye is called the consensual pupillary reflex

Question 87

Vital Signs - What can a slow or 'sluggish' constriction of the pupil in resposne to light indicate?

Answer 87

Increased intracranial pressure + potentially brain damage, particularly in repsonse to brain trauma

Question 88

Vital Signs- Temperature NOTES: A patient with a high temperature may have an infection or hyperthermia. A patient with a low temperature may have hypothermia. In an adult patient temperature is normally measured using a tympanic thermometer. In a healthy patient a temperature should be between 36.5 and 37.5 degrees Celsius.

Question 89

COMMMUNICATION SECTION: mainly intuitive, go back to notes if need to ****

Question 90

WEEK 2: Primary Survey: What is the purpose of doing a primary survey when we first arrive to a patient?

Answer 90

To ascertain how sick our patient is. It allows you to quickly identify a cardiac arrest, or whether the patient is time critical. Ideally a primary survey should be completed within 90 seconds. To help us do this in complex and high-stress situations, we use a structured approach using a 'Find-It, Fix-It, Move-On' algorithm.

Question 91

Primary survey - What does the ABC stand for in the primary survey table?

Answer 91

Airway Breathing Circulation

Question 92

Primary survey - What is the find it, fix it, move on for airway in a primary survey?

Answer 92

Find it: Look, listen, jaw tone Fix it: Back blows, chest compressions, position, suction, adjuncts, head tilt, jaw thrust Move on: Patent, noiseless, self maintained, with or without supported with clinical assistance

Question 93

Primary survey - What is the find it, fix it, move on for breathing in a primary survey?

Answer 93

Find it: Rate, colour, Spo2 Fix it: Positioning, oxygen, ventilation Move on: Adequate volume, rate, with or without supported with clinical assistance

Question 94

Primary survey - What is the find it, fix it, move on for circulation in a primary survey?

Answer 94

Find it: Rate, colour, CRT, pulse strenght Fix it: Positioning, Autotransfusion Move on: Adequate perfusion and rate with or without clinical assistance

Question 95

What is the full acronym for a primary survey? What does it mean?

Answer 95

DRC-ABC D - Danger (check if there is any danger to the scene, and whether it is safe to proceed) R - Response (check AVPU scale for initial level of consciousness) - is patient in cardiac arrest RESUS C - Catastrophic breathing (CONTROL). Use pressure and tourniquets to stop bleeding A - Airway - Use positioning/manoeuvres, suction and airway adjuncts B - Breathing - Use masks, oxygen therapy and ventilation equipment C - Circulation - use positioning/autotransfusion (elevated legs)

Question 96

Primary Survey - Response: NOTES

Answer 96

- The Glasgow Coma Scale (GCS) is a means of determining a patients level of consciousness which is covered in the vital signs content. - In the primary survey we need a more rapid tool to quickly identify if a patient is conscious or unconscious. - We use the AVPU tool to make this assessment. This is faster but less comprehensive than the GCS. Using the AVPU scale a patient will fall into one of four categories: Alert: The patient is not unconscious. Their eyes open spontaneously, they may react or speak as you approach. They could be completely oriented or very confused. If they appear aware of their environment they are alert. Voice: The patient is not alert. They make no response to your approach. Their eyes do not open spontaneously. They could be asleep or unconscious. If the patient responds to your voice whether it is a normal speaking voice or a shout they are considered responsive to voice. Pain: The patient is not alert and has not responded even to a shout. The next step is the application of a painful stimulus. This is normally applied using a firm pressure to squeeze the trapezius muscle. If the patient responds to this stimulus they are considered responsive to pain Unresponsive: If the patient has not reacted at all to voice or painful stimulus they are considered unresponsive. This indicates a profoundly unconscious person.

Question 97

Infection Control: What are allergens?

Answer 97

The body's own immune response mistakes a substance as harmful, releasing chemicals such as histamine in response, this leads to an allergy response, and the severity of the response is variable and can range from minor irritation to anaphylaxis.

Question 98

Infection Control: What are Zooneses? What are common diseases associated with types of zooneses (bacterial, viral, parasitic)...

Answer 98

Infections that are transmitted from animals to humans. These can be bacterial, viral, or parasitic. Zoonotic diseases are very common. - Bacterial diseases include leptosiprosis, brucellosis and anthrax - Viral diseases include zika virus or Q fever - A parasitic example would be a tapeworm

Question 99

Infection Control: What are Prions? What are they responsible for?

Answer 99

- Misfolded proteins which have the ability to transmit their shape onto normal variants of the same protein. - They are responsible for many degenerative brain diseases in humans and animals including Creutzfeld-Jacob disease or bovine spongiform encephalopathy

Question 100

Infection Control: What are ectoparasites? What are some examples?

Answer 100

- A parasite that lives on the outside of its host Examples include: - Scabies (use topical lotion) - Fleas (can carry tapeworms, but will only infect humans if an infected flea is swallowed. Fleas are sepcific to their host, e.g cat fleas, human fleas etc. Fleas can be transferred via bedding or clothing). - Bed Bugs (feed on blood, don't live on humans, and usually live 2-3 metres from where humans sleep. Not likely to transmit disease but bites can be uncomfortable, cause allergic reactions in some people, and allow for secondary skin infections. The bugs can travel into new environments via infested material e.g bedding clothing bags etc).

Question 101

Infection control: What are some indirect modes of transmission?

Answer 101

- Surfaces - Food or water - Vector insect - Vector animal

Question 102

Infection control: What are some direct modes of transmission?

Answer 102

- Airborne - Person to person contact

Question 103

Infection Control: What does direct person to person transmission require?

Answer 103

- Physical contact between an infected person and a susceptible person - Transfer of pathogens can occur through touching, sexual contact or contact with body fluid or lesions. - Healthcare workers are at relatively high risk of direct person to person infection if exposed to blood or bodily secretions.

Question 104

Infection Control: When does Indirect transmission occur?

Answer 104

When there is an intermediary between the infected person/animal to the susceptible person. These include surfaces, food or water, insect or animal vectors.

Question 105

Infection Control: Droplet/Airborne contamination NOTES -

Answer 105

- Can be from human or environmental sources. - Mucus secretions present in coughs or sneezes can be more contagious than infectious agents spread by direct contact, droplets can travel more than a meter in the air before entering the respiratory tract, diseases that are transmitted this way include measles, tuberculosis as well as cold and flu viruses. - Environmental sources can include soil or water and be the source of respiratory diseases such as legionella.

Question 106

Infection Control: Vector borne diseases: NOTES

Answer 106

- A vector is an organism that carries disease, carrying microorganisms from one host to another, this can increase the range and spread of the disease, anthropod vectors, especially blood sucking insects can transmit a variety of disease including parasitic (malaria) or viral (dengue fever) - Animal vectors (infected animals) can transmit zoonotic disease through various means, infected cat faeces can carry the parasite - Toxoplasmosis gondii (potentially harmful during pregnancy

Question 107

Infection Control: Risk Factors - The risks of infectious biological hazards depend on... Virulence, Infectivity, and Survivability What do these terms refer to?

Answer 107

Virulence - How much damage the pathogen can do to its host. Infectivity - How transmissible the pathogen is, the ability of the pathogen to produce, establish an infection and how frequently it spreads from host to host. Survivability - This refers to the ability of the pathogen to survive outside of a host, some pathogens will survive for hours (HIV, Hep B), some can survive for days depending on the surface (COVID-19)...

Question 108

Infection Control: EXTRA NOTES... Occupations at increased risk from biological hazards: - Outdoor workers, greater contact with a range of microorganisms, animals, plants and fungi. People who work with animals- increased biological hazards including zoonotic disease. People exposed to human blood and bodily fluid.- Includes Medical and hospital workers. People in caring roles.-Includes Medical and hospital workers. At risk workers: - Immunocompromised workers or those with chronic health conditions. - Those who work across multiple workplaces (different sites) Inexperienced workers.

Question 109

Infection Control: Pathogenic Microbial world - How are pathogens divided/classed as groups?

Answer 109

- Cellular and acellular Acellular: Viruses Cellular: Prokaryotic, Eukaryotic Prokaryotic - Bacteria, Archea Eukaryotic - Protozoa, Yeast, Fungi

Question 110

Infection Control: Pathogenic Microbial world - EXTRA NOTES

Answer 110

- Microorganisims are a large group of organisms, a small subset known as pathogens are capable of causing disease in humans. - There are four broad classes of microorganisms that can interact with humans- viruses, bacteria,fungi and parasites. - Acellular- Contains no cells. - Cellular- Consists of living cells - Prokaryotic: is a single-celled organism whose cell lacks a nucleus and other membrane-bound organelles. - Eukaryotic: organisms whose cells have a membrane-bound nucleus. All animals, plants and fungi are eukaryotes.

Question 111

Infection Control: Acellular Virus: How are viruses structured? What structures do they contain?

Answer 111

- Structures include a nucleic core containing either RNA or DNA, and this is surrounded by a protein layer called a capsid/nucleocapsid, some viruses have a second layer called an envelope.

Question 112

Infection control: Acellular Virus Where can viruses multiply?

Answer 112

- Viruses can multiply ONLY inside a living cell. An infected cell is forced to replicate thousands of copies of the virus, and these copies are then released from the cell (usually damaging/destroying the cell in the process).

Question 113

Infection Control - Acellular Viruses How can viruses be eliminated?

Answer 113

Viruses can be eliminated via hydrogen peroxide, alcohol, or by mechanical means (friction used during hand washing is an example of this...)

Question 114

Infection prevention and Control - Prokaryotic Bacteria: How do prokaryotic bacteria replicate? What is their structure?

Answer 114

Autonomously. - Prokaryotic bacteria lacks an organised nucleus, contains both RNA and DNA, and are surrounded by a cell membrane and a cell wall. The structure and synthesis of the cell wall determines the shape of the bacterium (e.g spherical/cocci, helical/spirilla, or elongated (bacilli)

Question 115

Infection prevention and Control - Prokaryotic Bacteria: NOTES

Answer 115

Bacteria can survive in a wide range of environments and are found everywhere, (in more environments and habitats than any other living thing) some need oxygen and some thrive without it, in the right conditions bacteria can replicate itself rapidly. Survival time outside the body is variable but E. faecium (which is found in the G.I tract abut also causes meningitis/endocarditis) has survived for 4 weeks on a range of surfaces.

Question 116

Infection prevention and Control - Eukaryotic- Fungi yeasts and mould - What are the cell walls of these made up of? What do they not contain?

Answer 116

- Made up of cellulose and chitin - Does not contain chlorophyll

Question 117

Infection prevention and Control - Fungi What are fungi?

Answer 117

Relatively large eukaryotic microorganisms that grow as either single cellular yeasts (spheres), or multi celled moulds (filaments or hyphae)

Question 118

Infection prevention and control - How do yeasts create ATP?

Answer 118

Through aerobic respiration. (Anaerobes)

Question 119

Infection prevention and control - NOTES Environment for survival Moulds are aerobic and live in a variety of environments, yeasts are facultative anaerobes – produce ATP using aerobic respiration. They are able to grow in a wide range of environmental conditions. Common contaminants found on surfaces and food

Question 120

Infection Control - Eukaryotic Fungi, yeasts and mould: What are some elimination techniques? What do they involve?

Answer 120

- Virkon: (disinfectant) This technique oxidises sulfur bonds in proteins and enzymes disrupting the cell membrane, ultimately rupturing the cell wall. Can be used on surfaces, equipment, vehicles, aerial disinfection and water delivery. - Hydrogen Peroxide: Oxidises sulfur bonds in proteins and enzymes, disrupting the cell membrane and ultimately rupturing the cell wall. Best on non-porous surfaces. It cannot penetrate porous material such as wood , drywall etc.

Question 121

Infection Control - Eukaryotic Fungi, Yeasts and moulds: Eukaryotic Protozoa What are Protozoa? How do they obtain nutrients?

Answer 121

A diverse group of unicellular Eukaryotic organisms, many of which are motile. They have a tough outer cell membrane instead of a cell wall, they have mitochondria and can obtain nutrients by ingesting solid particles of food. This is digested by enzymes and transported into the cytoplasm. Most common protozoa include: Malaria parasites (plasmodium), and giardiasis (amoeba).

Question 122

Infection Control - Protozoa NOTES They are unicellular, usually motile, (capable of movement) and lack a cell wall, but they occur in a number of shapes, sometimes within the life cycle of a single type. Many live independently, some live on dead organic matter, and others are parasites living in or on another living host. As in other microbial classifications, protozoa are divided into a number of subcategories.

Question 123

Infection control: Eukaryotic Protozoa What is a good environment for survival for Protozoa?

Answer 123

- Can live on dead organic matter, or on living hosts (parasitic), or remain dormant (cysts) - Can live in water, soil and moist environments, including extreme environments - Extreme adaptive resistance

Question 124

Infection Control: Eukaryotic protozoa - NOTES Survival time – surfaces etc Some have life stages including proliferative and dormant cysts. As cysts, protozoa can survive harsh conditions, such as exposure to extreme temperatures or harmful chemicals, or long periods without access to nutrients, water, or oxygen for a period of time. The ability of protozoa to thrive under extreme environments contributes to their ability to evade immune system responses, drug therapies and survive for prolonged periods of time before infection. Being a cyst enables parasitic species to survive outside of a host, and allows their transmission from one host to another. Cryptosporidium cysts can survive 2 weeks on innate surfaces at temperatures as high as 30°C, and as low as -20°C. Cryptosporidium cysts can survive for months in water and soil

Question 125

Infection Control: Eukaryotic Protozoa NOTES Transmission of Microbe: Direct Transmission: This involves the disease being passed on directly from an infected person to a healthy individual. It often occurs when parasites are passed on through faecal-oral routes or sexual contact Indirect - Plasmodium, the protozoan responsible for malaria, is transmitted indirectly through the bite of an infected mosquito, making it a vector-borne disease. On the other hand, Giardia, the parasite causing giardiasis, is often transmitted directly when an individual unknowingly consumes food or water contaminated with faecal matter containing the parasite.

Question 126

Infection Control: Eukaryotic Protozoa NOTES Elimination technique Protozoa are extremely difficult to eliminate due to their Extreme adaptative resistance Comprehensive approach – environment, food, hygiene and people Heat based – cysts inactivated by heat over 72 °C for more than 1 minute UV treatment – Damages genetic code of the cell, only effective at particular wave lengths Alcohol 70% (ethanol or methanol) disrupting the cell membrane

Question 127

INFECTION CONTROL AND PREVENTION: What is the hierarchy of controls for prevention of infection (1-5 with 1 being most effective)...?

Answer 127

1. Elimination (Physically remove the hazard, eliminate potential exposure risk) 2. Substitution (Replace the hazard) 3. Engineering controls (isolate or reduce exposure of healthcare workers and people from the hazard) 4. Administrative controls (change the way people work) 5. Personal Protective Equipment (PPE - Protect the worker with PPE)

Question 128

INFECTION CONTROL + PREVENTION: For Elimination technique of prevention of infection, what does this procedure involve?

Answer 128

Physically removing the hazard and eliminating potential exposure risk. - Triage - Risk control - Screening - Risk assessment

Question 129

INFECTION CONTROL + PREVENTION: For Substitution technique of prevention of infection, what does this procedure involve?

Answer 129

- Replacing the hazard - Find other ways to provide care that will reduce potential risk of transmission

Question 130

INFECTION CONTROL + PREVENTION: For Engineering controls technique of prevention of infection, what does this procedure involve?

Answer 130

- Isolating or reducing the exposure of healthcare workers and people from the hazard - Use of physical barriers and pathways - Remote triage areas, airborne infection isolation rooms and single patient spaces - Engineering controls also focus on maintaining the quality of the indoor air

Question 131

INFECTION CONTROL + PREVENTION: For the Administrative controls technique of prevention of infection, what does this procedure involve?

Answer 131

- Changing the way in which people work. - Involves effective policies and protocols designed to prevent and reduce the risk of exposure of exposure and transmission of infections - Implementation of IPC measures - standard of transmission based precautions, hand hygiene, vaccination programmes for staff and vulnerable patients, cleaning and disinfection - Education and training

Question 132

INFECTION CONTROL + PREVENTION: For the PPE technique of prevention of infection, what does this procedure involve?

Answer 132

- Protecting the worker with personal PPE) - Ensure that adequate supplies of PPE are available to staff, and that appropriate education and training is provided including regular refresher training. - Availability of PPE at point of care - Respiratory protection programme - Risk assess PPE recommendations for specific staff, activities and roles

Question 133

INFECTION PREVENTION AND CONTROL: - What are some basic precautions that should always be used for all patient interactions?

Answer 133

- Hand hygiene (This will usually involve heavy use of hand sanitiser as no hot water/soap on an ambulance- containing at least 60% alcohol) - use this before/after touching a patient, before or after aseptic procedures, and taking off or putting on PPE or touching patient surroundings - Select appropriate PPE (based on assessment of risk of exposure to bodily substances e.g gloves for bodily fluid, face mask/shield if splash is possible) - Respiratory hygiene and etiquette. - Safe use of disposable needles and other sharps - Aseptic 'non-touch' technique for all invasive procedures, including appropriate use of skin antiseptics - Patient care equipment - Clean, disinfect and reprocess reusable equipment between patients - Appropriate cleaning and disinfection of environmental and other frequently touches surfaces

Question 134

INFECTION CONTROL + PREVENTION: What are transmission based precautions? What are examples of these?

Answer 134

- Transmission based precautions are an addition to standard based precautions. They are used when patients may be infected. Transmission based precautions are contact, droplet and airborne. - Contact precautions: Required when interacting with people known/suspected to have infections or diseases that can be transmitted through either direct contact or indirect contact with people, objects or environmental surfaces that have infectious matter on them (wear single use non-sterile gloves, wear a disposable plastic apron or gown) Droplet Precautions: Required when interacting with people known/suspected to have infections or diseases that can be transmitted through droplets (Wear a medical mask upon room entry, wear eye protection eye mask/shield to reduce exposure to droplets by touching your eyes or a patient coughing/sneezing - Where possible, the patient should wear a medical mask along with strict adherence to respiratory hygiene and cough etiquette. - Airborne Precautions: Required when interacting with patients known to/suspected to have diseases spread by very small particles that can suspend in the air and be inhaled into the lungs (wear a P2/N95 mask respirator that you have fit checked before room entry. Where possible the patient should wear a mask along with strict adherence to respiratory hygiene and cough etiquette).