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SAAS CPGs > Medical > Flashcards

Medical Flashcards

1
Q

What is the guideline for mild/moderate allergy?

A

Consider
* oral fexofenadine 180 mg (pt ≥ 12 yrs)
* transport
* refer or self-care

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2
Q

What is the treatment for suspected anaphylaxis in adults?

A

IM adrenaline 10 microg/kg
up to 500 microg (every 5 mins prn)
Consider clinical support

**If bronchospasm **
- administer bronchodilators and ventilatory support as per asthma CPG

If upper airway angiodema
- Nebulised adrenaline 5mg/5ml

If hypotension
- IV saline 250ml aliquots up to 20ml/kg

If persistent wheeze
- Oral prednisolone 50mg

If persistent itch after systemic symptoms resolved
- Oral fexofenadine 180mg (pt>=12)

Prompt transport with early notification

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3
Q

What is the treatment for suspected anaphylaxis in pediatrics?

A

IM adrenaline 10 microg/kg
up to 500 microg (every 5 mins prn)

Mandatory clinical support

**If bronchospasm **
- administer bronchodilators and ventilatory support as per asthma CPG

If upper airway angiodema
-Pt >=6mo - neb adrenaline 5mg/5ml, or
- Pt <6mo - neb adrenaline 2.5mg/5ml (use 2.5ml saline)

If hypotension
- IV saline 10ml/kg aliquots (max 250ml) up to 20ml/kg

If persistent wheeze
- Oral prednisolone 1mg/kg up to 50mg

If persistent itch after systemic symptoms resolved
- Oral fexofenadine 180mg (pt>=12)

Prompt transport with early notification

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4
Q

What is the treatment for hypoglycemia in adults?

A

Use the least invasive therapy which restores BGL.

Consider any of
* Oral carbohydrates or oral glucose 15 g (if GCS allows)
* IM glucagon 1 mg,
* IV glucose 10% titrated against GCS and BGL
- first ensure IV patency with saline flush and follow infusion with IV saline 100 mL

If no return of normal neurological function despite treatment
* Consider clinical support/EOC consult
* Transport

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5
Q

What are the considerations for non-transport in adult hypoglycemia where normal GCS has been restored?

A

If considering non-transport, adult patients must have:
* Consumed complex carbohydrates
* BGL indicates a stable physiological range
* Been a previously stable diabetic
* An identified cause for the episode
* Residence in a suitable environment

Patients should be monitored by a responsible person until follow up medical assessment

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6
Q

What is the treament for hypoglycemia in pediatrics <25kg (< approx 6yrs)?

A

Consider
* Clinical support
* Oral carbohydrates or oral glucose 15 g (if GCS allows)
* Glucagon:
< 25 kg IM glucagon 0.5 mg

If glucagon ineffective or clinical support unavailable, consult EOC clinician who may advise:
* IV glucose 10% starting at 2 mL/kg
- ensure IV patency first with saline flush
- titrate against GCS and BGL
- total max dose 5 mL/kg
- follow infusion with IV saline 1 mL/kg
* Transport

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7
Q

What is the treament for hypoglycemia in pediatrics >=25kg (>= approx 6yrs)?

A

Consider
* Clinical support
* Oral carbohydrates or oral glucose 15 g (if GCS allows)
* Glucagon:
≥ 25 kg IM glucagon 1 mg

If glucagon ineffective or clinical support unavailable, consult EOC clinician who may advise:
* IV glucose 10% starting at 2 mL/kg
- ensure IV patency first with saline flush
- titrate against GCS and BGL
- total max dose 5 mL/kg
- follow infusion with IV saline 1 mL/kg
* Transport

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8
Q

What is the treament for hypoglycemia in neonates (BGL<2.5mmol/L) who are physiologically stable?

A
  • Universal care and life support
  • Assess BGL (sample from heel)
  • Gently dry buccal mucosa with dressing
  • Oral glucose gel 0.5 mL/kg dose using a 3 mL syringe
  • Avoid squirting directly into neonate’s mouth / OGT, instead gently massage buccal mucosa with gloved hand
  • Transport
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9
Q

What is the treatment for nausea/vomiting in adults?

A

Ondansetron 4mg ODT, IM or IV (slow push over >1min)
Repeat once prn
Max dose 8mg.

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10
Q

What is the treatment for adults with nausea/vomiting refractory to ondansetron?

A

If nausea and/or vomiting persist, consider:
IV droperidol 250 – 500 microg (slow push over ≥ 1 min)
- add droperidol (10 mg / 2 mL) to 100 mL saline bag
concentration created is 100 microg / mL
draw off required dose (2.5 – 5 mL)

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11
Q

What is the treatment for nausea/vomiting in pediatrics?

A

Ondansetron:
* ODT; 2 mg (2 to 5 yrs - half tablet) or 4 mg (≥ 6 yrs), or
* IM/IV ondansetron (1 - 15 yrs) 150 microg/kg to single max dose 4 mg
- If IV, slow push over ≥ 1 min
* Consult EOC Clinician for < 1 yr
* Transport or referral as required

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12
Q

What are the contraindications for ondansetron?

A

Absolute

Relative
* Prior hx of dystonic reaction to any drug
* Hx of hypersensitivity to any 5HT3-receptor antagonists

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13
Q

In which patients is ondansetron likely to be ineffective?

A

Ondansetron is inffective for motion sickness / vertigo.
May be ineffective in cannabinoid hyperemesis syndrome patients.

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14
Q

What are the goals in sepsis treatment?

A

Early identification
Optimal oxygenation
Targeted fluid resuscitation
Early hospital notification

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15
Q

What is qSOFA and when is it used?

A

In the presence of suspected infection, qSOFA (quick Sequential Organ Failure Assessment) is an adult screening tool for organ dysfunction.

qSOFA does not define sepsis, but the presence of at least two of the three qSOFA criteria is a predictor of increased mortality and ICU stays of more than three days.

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16
Q

What are the components of the qSOFA assessment?

A

Mneumonic = HAT
* Hypotension (SBP<100)
* Altered mentation / GCS
* Tachypnoea (RR>22)

If 2 or more present, qSOFA is positive.

17
Q

What are the red flags for sepsis in pediatrics?

A

The child with sepsis may be recognised by history or signs of infection, along with:

  • Temperature > 38.3°C or < 36°C (normal temperature does not exclude sepsis)
  • High respiratory rate relative to age
  • Altered mentation, decreased level of consciousness, or seizures
  • Decreased tone in infants
  • Signs of dehydration or discoloured skin
  • Oliguria (or no wet nappy) for several hours
  • Persistent vomiting, not feeding
18
Q

What is septic shock and how do we identify it?

A

Septic shock is a subset of sepsis where profound circulatory, cellular and metabolic abnormalities are associated with a higher risk of mortality than with sepsis alone.
Septic shock patients are identified by:
* a requirement for vasopressors (despite adequate volume resuscitation) to maintain a mean arterial pressure (MAP) of 65 mmHg or greater,
* serum lactate > 2 mmol/L

In the absence of reliable MAPs and lactate measurement, septic shock patients can be identified by sepsis with profound hypotension.

19
Q

What is the treatment for adults with suspected sepsis and adequate BP?

A
  • Use sepsis screening tool (qSOFA) to assess for sepsis
  • Administer high-flow oxygen
  • if reliable SpO2 obtained, titrate to achieve SpO2 94-98%
  • Priority transport to appropriate facility and notify:
    stating “suspected sepsis”
20
Q

What is the treatment for adults with suspected sepsis and MAP ≤ 65 mmHg or SBP ≤ 100 mmHg?

A
  • Use sepsis screening tool (qSOFA) to assess for sepsis
  • Request early clinical support
  • Treatment should not delay extrication or transport
  • Administer high-flow oxygen
    if reliable SpO2 obtained, titrate to achieve SpO2 94-98%
  • Rapid IV saline 250 mL aliquots up to 20 mL/kg:
    regularly assess response to fluid therapy
    aim to achieve/maintain MAP > 65 mmHg or SBP > 100 mmHg (cease saline if signs of fluid overload)
  • Consult EOC clinician if unable to achieve adequate perfusion with saline 20 mL/kg:
  • IV saline up to 30 mL/kg may be required
  • Priority transport to appropriate facility and notify:
    stating “suspected sepsis or suspected septic shock”
  • Handover total volume infused
21
Q

What is the treatment for paediatrics with suspected sepsis and poor perfusion?

A
  • Use sepsis screening tool (pediatric) to assess for sepsis
  • Request early clinical support
  • Early EOC Clinician consult recommended
  • Treatment should not delay extrication or transport
  • Rapid IV saline 10 mL/kg aliquots (max 250 mL) up to 20 mL/kg:
  • regularly assess response to fluid therapy
    aim to achieve/maintain SBP in lower end of normal range as per RDR. Cease saline if signs of fluid overload
  • Consult EOC clinician if unable to achieve adequate perfusion with saline 20 mL/kg: IV saline up to 30 mL/kg may be required
  • Priority transport to appropriate facility and notify:
    stating “suspected sepsis or suspected septic shock”
  • Handover including total volume of fluids infused
22
Q

What is the treatment for suspected meningococcal septicaemia in patients >=40kg?

A
  • Request early clinical support
  • If known hypersensitivity to penicillin, first consult SAAS Medical Practitioner via EOC Clinician
  • Administer benzylpenicillin 2400 mg (IV preferred but not essential):
  • Rapid IV saline 10 mL/kg aliquots (max 250 mL) up to 20 mL/kg: aim to achieve/maintain:
    adults: MAP ≥ 65 mmHg or SBP ≥ 100 mmHg
    paediatrics: SBP in lower end of normal range for age per RDR
  • IV saline should not delay extrication or transport
  • Regularly assess response to fluid therapy (cease saline if signs of fluid overload)
  • Consult EOC clinician if unable to achieve BP targets with 20 mL/kg saline: IV saline up to 30 mL/kg may be required
  • Priority transport to appropriate facility and notify:
    suspicion of meningococcal septicaemia
  • Handover total volume infused
23
Q

What is the treatment for suspected meningococcal septicaemia in patients <40kg?

A
  • Request early clinical support
  • If known hypersensitivity to penicillin, first consult SAAS Medical Practitioner via EOC Clinician
  • Administer IV or IM benzylpenicillin 60 mg/kg (single max dose 2400 mg) (IV preferred but not essential):
  • Rapid IV saline 10 mL/kg aliquots (max 250 mL) up to 20 mL/kg: aim to achieve/maintain:
    adults: MAP ≥ 65 mmHg or SBP ≥ 100 mmHg
    paediatrics: SBP in lower end of normal range for age per RDR
  • IV saline should not delay extrication or transport
  • Regularly assess response to fluid therapy (cease saline if signs of fluid overload)
  • Consult EOC clinician if unable to achieve BP targets with 20 mL/kg saline: IV saline up to 30 mL/kg may be required
  • Priority transport to appropriate facility and notify:
    suspicion of meningococcal septicaemia
  • Handover total volume infused
24
Q

What are the goals in the treatment of traumatic / hypoxic brain injury?

A

Maintenance of cerebral perfusion is critical in the management of traumatic brain injury.
This is achieved by
* maintaining adequate ventilation
* maintaining adequate blood pressure
* avoiding hypotension
* preventing any increases in intracranial pressure.

Maintaining an adequate blood pressure should take into account the potential loss of cerebral autoregulation.

25
Q

What are the preventable contributors to increases in ICP?

A
  • Straining or gagging / vomiting
  • Factors restricting venous drainage from the head such as abnormal neck position, gravitational resistance or external compression around the neck (tight collars and advanced airway device ties).
26
Q

Aside from TBI, which other patients may be treated using the TBI/hypoxic brain injury guideline?

A

Patients who have had sudden onset hypoxic brain injury (e.g. CVA, intracerebral bleed, post drowning, post hanging).
Consultation with SAAS medical practitioner strongly is recommended in these circumstances.

27
Q

What is the guideline for treatment of TBI / hypoxic brain injury patients?

A

Universal care, including monitoring of:
- GCS, ECG, BGL
- pulse oximetry, aim for SpO2 of > 94%
- EtCO2 (numbers may be unreliable in spontaneously breathing patients)

Consider clinical support i.e. ICP, MedSTAR
Consider EOC clinician consult for:
advice on treatment plans or liaison with SAAS Medical Practitioner

Establish IV access:
≥ 14 years: IV saline 250 mL aliquots up to 20 mL/kg,
aim to establish/maintain MAP ≥ 90 mmHg or SBP ≥ 110 mmHg
< 14 years: IV saline 10 mL/kg aliquots (max 250mL) up to 20 mL/kg, aim to establish/maintain normal SBP for age as per RDR

Exclude or treat other causes for altered behaviour (e.g. hypovolaemia, hypoglycaemia, alcohol/psychostimulant OD, psychosis)

Optimise cerebral venous return where possible:
posture 30 degrees head up if patient condition permits neck position, constrictive clothing, tight collars, tight airway ties

Provide rapid transport and notify as per either:
* Major Trauma Triage Tool
* Destination Triage Tool
* Local regional arrangement

28
Q

What is the general approach to fluid resuscitation in medical energencies for adults?

A
  • Regularly assess response to treatment and cease if signs of fluid overload present
  • IV saline 250 mL aliquots up to 20 mL/kg
  • Consult EOC Clinician if unable to improve perfusion with 20 mL/kg
  • Prompt transport
29
Q

What is the general approach to fluid resuscitation in medical energencies for pediatrics?

A
  • Regularly assess response to treatment and cease if signs of fluid overload present
  • IV saline 10 mL/kg aliquots (max 250 mL) up to 20 mL/kg
  • Aim to achieve/maintain SBP in lower end of normal range as per RDR
  • Consult EOC Clinician if unable to improve perfusion with 20 mL/kg
  • Prompt transport

SAAS CPGs (5 decks)

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