MILS Flashcards
(29 cards)
Reversible Causes of Cardiac Arrest
Hypoxia- minimise the risk of hypoxia by ensuring the patients lungs are ventilating adequately with 100% oxygen.
Hypovolaemia- PEA is caused by severe blood loss due to the likes of trauma or gastrointestinal bleeding. Treatment is to restore the intravascular volume rapidly and urgent surgical referral to stop haemorrhage.
Hypo/hyper kalaemia- Metabolic disorders will be detected by biomedical tests and the patients medical history i.e. renal failure.
Hypothermia.- Hypothermia should be strongly suspected in any drowning incident. Treatment is to rewarm the casualty accordingly.
Tension Pneumothorax- A Tension Pneumothorax is diagnosed clinically and the treatment is to rapidly decompress the chest followed by a chest drain.
Tamponade- A cardiac tamponade is difficult to diagnose because the clinical signs ( distended neck veins, hypotension) of this condition are obscured by the cardiac arrest itself. A cardiac tamponade should be strongly suspected if there is a penetrating chest trauma.
Toxins- poisoning maybe accidental or deliberate and the toxin may be a therapeutic or toxin substance. The treatment should be with the antidote to the substance in some cases it may just be supportive therapy.
Thromboembolic- the commonest cause is a massive pulmonary embolism. The treatment is to consider giving a thrombolytic drug as soon as possible.
Paediatric Normal Observation Parameters
Under 1 RR 30-40, Pulse 110-160
1-5 RR 25-30, Pulse 95-140
6-12 RR 20-25, Pulse 80-120
Common ECG Rhythms
Normal sinus rhythm – NSR
Ventricular Tachycardia – VT
Ventricular Fibrillation – VF
Pulseless Electrical Activity – PEA
Asystole
VT
Ventricular Tachycardia – VT
No visible P waves
Abnormal QRS
Will lead to VF if untreated
HR > 100 bpm
VT is a type of tachycardia or a rapid heart beat, that starts in the bottom chambers of the heart called ventricles.
Shockable
VF
Ventricular Fibrillation – VF
No rhythm or cardiac output
Fatal in 4 – 6 mins
Need to defib in < 8 mins
Uncoordinated contractions of cardiac muscle of the ventricles within the heart. This makes the ventricles quiver rather than contract properly.
The condition can be often reversed by electric discharge of direct current from a defibrillator.
Shockable
PEA
Pulseless Electrical Activity – PEA
Clinical absence of cardiac output despite electrical activity that would normally be expected to produce a cardiac output.
Normal Sinus Rhythm may be seen but no pulse will be palpable
Potentially treatable causes include severe fluid depletion or blood loss, cardiac tamponade, massive pulmonary embolism and tension pneumothorax
PEA is defined as organised electrical activity with no palpable pulse. There is often some myocardial contractions but they are too weak to produce a pulse or blood pressure.
Patients with PEA usually have poor outcomes.
Asystole
Asystole
Asystole for many patients is the result of a prolonged illness or cardiac arrest and prognosis is very poor. Few patients will likely have a positive outcome and successful treatment of cardiac arrest with asystole will usually involve identification and correction of an underlying cause if the asystole.
Failure of the ventricles of the heart to contract ( usually caused by VF) with consequent absence of the heartbeat leading to lack of oxygen and eventually death.
Ventricular standstill
Poor prognosis following VF or primary respiratory arrest
The lack of electrical activity in the heart muscle shows on an ECG as a flat line.
Non Shockable
Basic Theory of Defibrillation
The application of a DC electrical current across the myocardium
Depolarization of remaining responsive cardiac muscle
The natural pace making tissues in the SA node resume control
MLS Algorithm for Paediatrics
5 rescue breaths, 15:2 chest compressions to rescue breaths
Pathophysiology of Injuries to C Spine
The cervical spine is the upper part of the spinal column. It consist of seven vertebrae with attached muscles and ligaments surrounding a central spinal cord.
More flexible and less protected than other parts of the spine so is more at risk of greater injury
If injured, it is likely that the spinal cord carrying the nervous pathways between the brain and the body will also be damaged resulting in paralysis, may affect the lower or all four limbs dependent on what level the injury is at
Spinal cord damage can be either complete or incomplete, incomplete may recover but is susceptible to further injury if casualty is mismanaged
Those at risk of a C-Spine Injury
Unconscious from head injury or unknown cause
Rapid acceleration/deceleration event (e.g. RTC or sports injuries)
Multiple blunt injuries/significant blunt injury above clavicle
Conscious and complaining of neck pain/loss of motor and/or sensory function
Blast injuries
Penetrating neck wounds
Fall from height
Head injury or from an unknown cause (intoxication or drugs)
Management of Spinal Cord Injury
Primary survey - manual immobilisation
Packaging – cervical collar & manual immobilisation
Evacuation – long board and head blocks
Manual Stabilisation of the C-Spine
Safest position is supine
C-spine in neutral position
Take control ASAP
THINK SPINAL PRECAUTIONS
NOT SPINAL IMMOBILISATION
100% immobilisation is not possible in the field, delays transport, rarely needed.
Cervical Collars
Sized using manufacturer’s instructions
Does not completely immobilise the cervical spine
Hands support the head, not the collar
(Collars are implicated in worsening head injuries and increasing ICP)
Semi-rigid collars at best only immobilise the c-spine by 30%. All ill fitting collar may cause airway obstruction
This is part of packaging, aim is to take weight of head off the injured C-Spine and restrict, flexion, extension and rotation of the neck
Reduces some sideways movement, does not fully prevent rotation, hands do
Self-extrication, Where possible has been PROVEN to limit Spinal movements and REDUCE ON-SCENE TIMES
Problems that may endanger the airway
Head injury and other causes of decreased level of consciousness – tongue
Max–Fax injuries – vomit/blood, swelling
Neck injuries – bleeding internally, trauma, swelling
Burns to the face and airway
Onset of Airway Complications
Immediate
Delayed – occurring minutes or hours after injury
Insidious – slow deterioration is easily overlooked
Obstructed Airway Signs
Cyanosis
Choking
Agitation
A LOC
Noisy breathing
Airway adjuncts - NPA
Casualties who will not tolerate an OPA, have jaw injuries or are clenching of their teeth (trismus), may require insertion of a NPA.
A NPA has the advantage of being less likely to become dislodged during evacuation.
The NPA is size by comparing the length from the centre of the nose to the angle of the jaw / earlobe. Typical sizes: 6.0 mm, 6.5 mm, 7.0 mm, 7.5 mm
Differing manufacturers use different sizing and numbering. The NPA size for adults is usually a 7 for males and a 6 for females.
Airway Adjuncts NPA Contraindications
Severe nasal trauma
With caution, baseline fracture of the skull
Nasal polyps
Airway Adjuncts OPA
Oropharyngeal Airway (OPA)
Works by holding the tongue down and forward.
Prior to insertion the OPA should be correctly sized centre of mouth to the angle of the jaw.
LARGE ADULT is a No 3 OPA
Airway Adjuncts OPA Contraindications and Considerations
Contraindications
Lock jaw
Conscious casualty
Severe facial trauma
Considerations:
May induce vomiting
Too short, no tongue support
Too large may close the glottis and block airway
I-GEL
Supraglottic Airway device
3 - small adult 30-60kg
4 - Medium Adult 50-90kg
5 - Large Adult 90kg+
Lube the sides, back and tip, not the face
Insert until you feel resistance or until the teeth reach the black line
Sizes of O2 Cylinders
CD – 460 ltrs
D – 340 ltrs
F – 1360 ltrs
HX – 2300 ltrs
O2 Universal Points
Cylinders not subjected to extreme high temps
Removed from immediate vicinity of patient during defibrillation
Secure in-transit
Empty & full cylinders kept separate
Store away from combustibles
Position cylinders so that it prevents interference with delivery system
No smoking - Smoking O2 Clip
Avoid oil and grease
Replace when ¼ full
Close valve when not in use
Avoid dropping or damaging
Clip - Sheared Valve
Vehicles may be required display compressed gas sign
