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Year 2 > OMED 1400 - Advanced Skills Paramedic Practice > Flashcards

OMED 1400 - Advanced Skills Paramedic Practice Flashcards

1
Q

How to Open the Airway by Performing a Head-Tilt/Chin Lift?

A

To Open the Airway, move the Person on to his/her Back on a Firm Surface. Place one hand on the Forehead and Three fingers under the Chin.
Applying Pressure with your Fingers under the point of the Chin, lift the Chin as you move the Head back, opening the Airway. Look, Listen and Feel for normal Breathing, taking no longer than 10 seconds for this Assessment.

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2
Q

How to Open the Airway using a Jaw Thrust?

A

Where there is a Suspected Cervical Spine Injury, you may try to Open the Airway using a Jaw Thrust. First Place the Fingers under the Angle of the Jaw on Either Side.
Once your Fingers are in place, Lift the Jaw vertically to open the Airway. This Movement will lift the Tongue off the back of the Throat and Airway.
If Needed, you can use your Thumbs to Open the Mouth. Maintaining a Jaw Thrust can take much more effort than Opening the Airway in a Usual Fashion.
If the Attempt to Perform a Jaw Thrust is Unsuccessful, then use just Enough Head-tilt, a Small amount at a time, to Clear the Airway. Establishing a Patent Airway, Oxygenation and Ventilation takes Priority over Concerns about potential C-Spine Injuries.
(Resuscitation Council UK - 2015).

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3
Q

How to Open an Airway with a Oropharyngeal Airway?

A

An OP or Guedal Airway will keep the Airway open without having to Lift the Head and is therefore useful in a Suspected Spinal Injury where MILS or a Neck Collar is Applied. The Correct adult size Must be used. It is always put in Upside Down with the Open end Facing the Roof of the Mouth, Then turned as it is pushed into place. When the Person regains Consciousness, he or she will Cough or Spit the Airway out.

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4
Q

What are the Different IGel Sizes and Colours?

A

Yellow is a Size Three - Small Adult (30-60kg)
Green is a Size Four - Medium Adult (50-90kg)
Orange is a Size Five - Large Adult (90+kg)

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5
Q

What is the Recommended Insertion Technique of an IGel?

A

Grasp the Lubricated I-Gel firmly along the Integral Bite block. Position the Device so that the I-Gel Cuff outlet is facing towards the Chin of the Patient.
The Patient should be in the ‘Sniffing the Morning Air’ Position with head extended and neck flexed. The Chin should be gently Pressed down before proceeding to insert the I-Gel.
Introduce the Leading soft tip into the Mouth of the Patient in a Direction towards the Hard Palate.
Glide the Device Downwards and Backwards along the Hard Palate with a Continuous but Gentle push until a Definitive Resistance is left.

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6
Q

What is the Pathophysiology of Shock?

A

Life Threatening, Generalised Form of Acute Circulatory Failure with Inadequate Oxygen Delivery to, and Consequently Oxygen Utilisation by, the Cells. (BMJ, 2022)

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7
Q

What are the Factors that Affect O2 Demand?

A

Exertion
- Increased need for O2
- Increased need to Remove Waste
Increased Metabolic Demand
- Injury
- Infection
- Disease

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8
Q

What are the Factors that Affect O2 Supply?

A
  • Ventilation and Perfusion (VQ)
  • Cardiac Output
  • Haemoglobin
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9
Q

What can Ventilation and Perfusion lead to?

A

Can lead to Respiratory Failure
T1 - Hypoxic and Normocapnic
T2 - Hypoxia and Hypercapnia
Respiratory Failure can affect Blood Gases:
PAO2, PACO2, pH
Hypoventilation —> Hypercapnia —> Acidosis (<pH)
Hyperventilation —> Hypocapnia —> Alkalosis (>pH)

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10
Q

What is Cardiac Output?

A

Blood that Leaves the Heart per Minute
HR x SV
Important Role in Maintaining Blood Pressure
BP = CO x SVR (Systemic Vascular Resistance)
CO or SVR adjust to Maintain Homeostasis
BP = CO x SVR
Therefore if BP drops:
- CO can Increased (either HR/SV or Both)
- OR SVR can Increase (Vessels Tighten)
NOT SUSTAINABLE LONG TERM

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11
Q

What is the Pathophysiology of Haemoglobin?

A

Hb - Haemoglobin
Hb Molecules Transport Oxygen
- Requires Iron to Bond O2
The Affinity of O2 to Hb depends on many Factor

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12
Q

What is the Supply and Demand Issue in Shock?

A

Reduced Co —> Reduced BP —> Cell Death —> Organ Failure —> Increased Cell Wall Permeability
—> Reduced Venous Return.

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13
Q

What are the Different Types of Shock?

A

Hypovolaemic - Volume (Tank). Examples: Trauma, Internal Bleed, D&V
Cardiogenic - Heart (Pump). Examples: MI & Arrhythmia
Obstructive - Flow (Pump). Examples: PE, Tamponade, Pneumothorax.
Distributive - Vessels (Pipes). Examples: Sepsis, Anaphylaxis, Neurogenic

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14
Q

How to Assess Shock?

A

Take the History of the Patient/
Signs and Symptoms
Consider Tools such as NEWS-2

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15
Q

How to Manage Shock and all the Types?

A
  • Primary Survey
  • Secondary Survey
  • Manage Symptoms
  • Try to Identify the Cause
  • Appropriate Destination
    E.g. ED, PPCI (PRIMARY PERCUTANEOUS CORONARY INTERVENTION), HASU (HYPER ACUTE STROKE UNIT), MTC.
    Hypovalaemic - Fix the Leak, Fill the Tank back up.
    Cardiogenic - Fix the Pump
    Obstructive - Remove the Obstruction and Restore the Flow.
    Distributive - Fix the Leak, Fill the Tank back up.
    Increase Supply and Reduce Demand.
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16
Q

What is the Summary of Shock?

A

Is a State not a Diagnosis.
Earlier Identification - Better Outcomes
Assess and Manage Symptoms
Consider Root Cause
Consider more Appropriate Destination.

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17
Q

What are Some Facts and Figures on Trauma?

A

6,000,000 Trauma Deaths Worldwide every Year.
40,000,000 Suffer Lufe Threatening Injury with a Form of Disability after Major Trauma.
Head Injury and Bleeding are Leading Causes of Death in Trauma.
Every Day, 12 Under 16s Die from Shootings in US.

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18
Q

What’s the Difference between Trauma and Major Trauma?

A

Trauma means “Wound” in Greek.
Actual Definition of Major Trauma is to do with the “Injury Severity Score”. Can only be Calculated Retrospectively - not on Scene. Maximum is 75 Points. ISS 15 or Greater = Major Trauma.

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19
Q

What is the Lethal Triad of Trauma?

A

What kills our Trauma Patients?
Coagulpathy (Lactic Acidosis) —> Metabolic Acidosis (Decreased Myocardial Performance) —> Hypothermia (Halt Coagulation Cascade).

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20
Q

What is Meant by Tension Disease?

A

Cardiac Tamponade (Blockage) - Blood/Clotted Blood in the Pericardium.
Right Ventricle is Weak - Hardly any Muscle Mass.
When the Pressure in the Pericardium equals the Pressure of the Right Ventricle during Diastolic Phase it cannot fill with Blood = Pump Failure and Obstructive Shock.
Tension Pneumo (Air) or Haemo (Blood) or Pneumohaemothorax (Both)
Air gets Trapped in the Potential Space within the Lung, Forcing it to Collapse (Atelectasis).
This can Impact Respiratory Physiology Causing Hypoxia.
This can also worsen to Obstruct Heart’s Function.
The Tension Refers to Pushing Structures onto the Other side of the Chest.

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21
Q

What are the Signs of Tension Disease?

A

Releasing the Tension (Obstructive Shock)
- Dyspnoea
- Reduced Air Entry
- Chest Injury (Blunt and Blast Injury)
- Tachycardia
- Distended Neck Veins
- Hypotension
- Angor Animi: Fear of Death.

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22
Q

What Occurs in Hypotension?

A

Last Gasp act of Mammalian Homeostasis is to Maintain Blood Pressure.
Catacholinergic Cardiovascular Changes
Lost - Low Output State in Trauma.
NOT ALL HYPOTENSION IS BLEEDING.

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23
Q

How to Deal with Open Fractures?

A

Analgesia
Stabilise
Photo (with IPAD)
Reduce and Splint (Wound may Change)
Wet Gauze over Wound
JRCALC states do not Irritate Open Fractures (This Happens in Hospital within 24hrs, Fixation and Cover within 72hrs).
Antibiotics ASAP - BOAST Guidelines.

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24
Q

How to Deal with Eye Injuries and Types?

A

Light/Flash Injury
Direct Heat/Foreign Body Injury/Chemicals
Police Incapacitant
Analgesia and Reassurance
Irrigate Eye (Saline and Giving Set/Nasal Cannula)
Occipital Compartment Syndrome.
HEMS Lateral Canthotomy.

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25
Q

What are the Different Neck Injuries?

A

Bones Injury
Airway Injury
Vascular Injury
Cord/Neurological Injury
Thymus/Endocrine Injury

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26
Q

What is Flail Chest?

A

2 or More Ribs in 2 or More Places. “Stoved in Chest”
Costosternal Ligaments
Pneumothorax or Chest Wall Failure?

27
Q

What is an Aorta Injury?

A

Ligamentous Arteriousum
Sits near the Left Brachiocephalic Juntion
Very Strong.

28
Q

What is an Eviseration Physiology?

A

Reduced Intra-Abdominal Pressure
Diaphram Failure
Respiratory Failure
Haemorrhage and Sepsis.

29
Q

What does the Acronym SCENE Mean?

A

Safety
Casualties
Event and Mechanism
Needs
Equipment

30
Q

What Injuries Kill Quickly?

A

Haemorrhage
Airway Problems
Tension Pneumothorax/Haemothorax
Tamponade
Hypoxia
Brain Injury

31
Q

What is the Acronym MARCH?

A

Massive Haemorrhage
- Stop the Bleed
Airway
- Head Tilt Chin Lift/Jaw Thrust
- Adjuncts/I-Gels
Respiratory Physiology
- Ventilate and Oxygenate (THINK HYPOXIA, but also Low CO2 = Cerebral Vascular Constriction)
Circulatory Physiology
- Blood, Warm
- Avoid Adding Coagulopathy
Hypothermia and Head Injury
- If Possible, 30 Degrees Head up
- Keep Patient Warm
- Driving Affects ICP.

32
Q

What Results in the Most Successful Outcomes in Traumatic Cardiac Arrest?

A

Plugging the Holes (Correcting HYPOVALAEMIA), Improving the OXYGENATION and Correction TENSION DISEASES.

33
Q

How to Stop the Bleeding?

A

Cat Tourniquets, Packing Wounds of Lost Tissue (with CELOX), Pressure Bandaging, Pelvic Binders, Warmth and Avoiding Crystalloid.
After the Initual +Ve Feedback Mechabism of Clotting, we Like to get rid of our Clots. This is Called Fibrinolysis.
Tranexamic Acid (1g) within the First 4 Hours of Injury has Proven to Dramatically Increase Survival in Major Trauma Patients.
Tranexamic Acid is an Anti-Fibrinolytic
JRCALC - 1g/10 Mins.

34
Q

What is the Opinion of Giving Pre-Hospital Blood?

A

Doesn’t Help with Cardiac Dysfunction.
Scarce Resources and Blood Chemistry Changes in Storage.

35
Q

What is the Opinion in Giving Saline?

A

Cold
Acidic (pH 5.0)
Dilutes Clotting Factors and Stuff that Actually Carries Oxygen.

36
Q

How to Optimise Oxygenation?

A

Reliefs on Excellent Airway Management (Thinking about Positioning)
High Flow O2 until you know.
Excellent BVM Technique.
EtCO2 really Important to Consider in Major Head Injuries. (Low CO2 causes Cerebral Vasoconstriction and Makes Brain Injuries Worse)

37
Q

How to Correct Tension Disease?

A

Needle Chest Decompression.
Largest Cannula, 10ml Syringe and 2mls of NaCL
2nd Intercostal Space, Midclavicular Line OR
5th Intercostal Space, Anterior Axillary Line

38
Q

Where do the Different ECG Stickers go?

A

V1 + V2 - 4th Intercostal Space
V4 - 5th Intercostal Space - Mid Clavicular Line
V3 - Between V3 + V4
V5 - Anterior Axillary Line
V6 - Mid-Axillary Line

39
Q

What do the Limb Leads Show?

A

Views: I, II, III, aVR, aVL, aVF.
Ride Your Green Bike.

40
Q

What are Common Neurological Condtions?

A
  • Stroke/TIA
  • Epilepsy/Seizures
  • Headaches/Migraines
  • Alzheimer’s/Dementia
  • Neuromuscular Disorders (Parkinson’s, MS< Muscular Dystrophy)
  • Neurological Infection
  • Brain Tumours
  • TBI
  • Raised ICP
  • Spinal Cord Trauma
41
Q

What are Some Statistics about Strokes and Different Types?

A
  • Stroke Strikes every 5 Minutes
  • 100,000 People have a Stroke Each Year
  • 1.3 Million Stroke Survivors in the UK
    DIFFERENT TYPES OF STROKE
  • Ischaemic Stroke
  • Haemorrhagic Stroke
  • Transient Ischaemic Attack
42
Q

What are the Differences between CVA and TIA?

A

CVA - (CEREBRAL VASCULAR ACCIDENT) Ischaemic and Haemorrhagic
Interruption in the Flow of Blood to Cells in the Brain. When the Cells in the Brain are Deprived of Oxygen, they die.
TIA - (TRANSIENT ISCHAEMIC ATTACK - Mini Stroke) is a Serious condition where the Blood Supply to your Brain is Temporarily Disrupted. Usually Caused by a Clot Blocking the Blood Supply to the Brain.
SIGNS AND SYMPTOMS
- Face Drooping to One Side
- Not being Able to Lift your Arms & Slurred Speech

43
Q

What is the Assessment and Management for a Stroke?

A
  • Assess GCS
  • Measure and Record RR
  • Measure and Record Pulse
  • Monitor SPO2 and Provide O2 to Achieve Saturations of >94%
  • Measure and Record Blood Pressure (Consider Fluids if Indicated)
  • Measure and Record Blood Glucose
  • Measure and Record Temperature
  • ECG? - Do Not Delay Transfer
  • Pain Assessment
  • Time Critical Transfer and Pre-Alert
44
Q

What Occurs after the Patient is Conveyed to Hospital?

A

Imaging ASAP
Thrombolysis - Alteplase (Within 4.5 Hours and Once Haemorrhagic Stroke Ruled out)
Aspirin (Within 6 Hours)
Thrombectomy
- To be Considered for pt’s with a Pre-Stroke Modified Rank Scale Score <3 & a Score >5 on the National Institute of Health Stroke Scale.
- Within 6 Hours pt’s with Acute Ischaemic Stroke and Confirmed Occlusion of Proximal Anterior Circulation).
- Between 6-24 Hours (inc Wake-up Strokes) for the Above Patients if there is the Potential to Salvage Brain Tissues.

45
Q

What is the Modified Rankin Scale?

A

0 - No Symptoms
1 - No Significant Disability. Able to Carry out all usual Activities, Despite Some Symptoms.
2 - Slight Disability. Able to Look after own affairs without Assistance, but Unable to Carry out all Previous Activities.
3 - Moderate Diability. Requires some help, but able to walk Unassisted.
4 - Moderate Severe Disability. Unable to Attend to Own Bodily Needs without Assistance, and Unable to Walk Unassisted.
5 - Severe Disability. Requires Constant Nursing Care and Attention, Bedridden, Incontinent.
6 - Dead.

46
Q

What is the Difference Between Bilateral Tonic Clonic Seizures and Psychogenic Non-Epileptic Seizure?

A

BILATERAL TONIC CLONIC SEIZURES:
- Begins with Stiffening of the Muscles
- Start in a Limited Area on One Side of the Brain and Spread to Involve Both Sides.
PSYCHOGENIC NON-EPILEPTIC SEIZURE:
- Look like Epileptic Seizures but are not caused by Abnormal Brain Electrical Discharges.
- Psychological Conflict or Accompany an Underlying Psychiatric Disorder.

47
Q

What are Indications for IO Access?

A

Anytime in Which Vascular Access is Difficult to Obtain in Emergent, Urgent or Medically Necessary cases for up to 24 Hours or 72 Hours (CE indicated Markets Only).
Adults:
Proximal Humerus
Proximal Tibia
Distal Tibia
Paediatrics:
Distal Femur
Proximal Humerus
Proximal Tibia
Distal Tibia

48
Q

What are the Contraindications of IO Access?

A

Fracture in Target Bone
Infection at Area of Insertion
Excessive Tissue (Severe Obesity) and/or Absense of Adequate Anatomical Landmarks.
IO Access or Attempted IO Access in Target Bone within Previous 48 Hours.
Previous, Significant Orthopaedic Procedure at the Site, Prosthetic Limb or Joint.

49
Q

What are the Four Easy Steps of Intraosseous Vascular Access System?

A

01 - Select
02 - Prepare
03 - Access
04 - Deliver

50
Q

How to Select an Insertion Site?

A

Proximal Humerus - 3 Second to Heart with Medication/Fluids. Flow Rates Average 6.3L/hr. Under Pressure.
Less Pain Reported with Saline Flush.
Less Medication required for Pain Management during Infusion.
Distal Femur (Paeds Only), Proximal Tibia, Distal Tibia. (Insertion Success Rate of 98-100%). Flow Rates Average 1.0L/HR. Under Pressure.

51
Q

How to Choose the Needle Set?

A

Clinical Judgement should be Used to Determine Appropriate Needle Set Selection based on Patient Weight, Anatomy, and Tissue Depth Overlying the Insertion Site.
EZ-IO 15mm Needle Set: 3-39kg
EZ-IO 23mm Needle Set: >3kg
EZ-IO 45mm Needle Set: >40kg
End Tip = Cannula
Next = Hub
Last = Stylet

52
Q

What are Some Needle Set Selection Tips?

A

With the Tip of the Needle Set Touching Bone, at Least One Black Line must be Visible above the Skin.

53
Q

What is the Positioning and Insertion Angle for Proximal Humerus Site Identification?

A

Using Either Method, Adduct Elbow to Rotate Humerus Internally:
Place the Arm Tight Against the Body, Rotate the Hand so the Palm is Facing Outward, Thumb Pointing Down.
Place the Patient’s Hand over the Abdomen with Arm tight to the Body.
Insert Needle Set into the Greater Tubercle at an Approximately 45 Degree Angle, as if Aiming Towards the Opposite Hip.

54
Q

How to Identify the Proximal Tibia Site in Both Adults and Paeds?

A

Adults - Two Fingers Below the Knee
Paeds - One Finger Below the Knee.
Above the Two Fingers

55
Q

How to Identify the Distal Tibia Site in Both Adults and Paeds?

A

Insert Medially on the Flat, Center Aspect of the Bone.
On Ankle, Two fingers, Insert Above the Fingers.
In Paeds, One Finger, Above the Finger.

56
Q

How to Identify the Distal Femur Site in Paeds?

A

One Finger above the Patella, Insert Above the Finger.

57
Q

How to Insert an EZ-IO?

A

Driver:
Battery Indicator Light
Sealed Lithium Batteries
Trigger
Magnetic Shaft
Manual Insertion:
Rotate Clockwise/Counter Clockwise, While Applying Gentle to Moderate, Steady Downward Pressure.

58
Q

How to Care, Maintain and Remove an EZ-IO?

A

Flush:
Adults: 5-10mL
Infants and Small Children: 2-5mL.
Infusion and Medications:
For Optimal Flow, Infuse with Pressure.
IO Vascular Access is Equivalent to a Peripheral Line.
Care:
Assess Frequently, IO Access Patency, Repeat Flush as Needed, Monitor Site, Patient Comfort.
Removal:
Take Covering Off and use a Syringe to Pull Out.

59
Q

What are the Three Stages of Labour?

A

First Stage:
Painful and Regular Contractions
Dilation of the Cervix until it is Fully Open/Dilated (-10cm).
Foetal Head Descends and Rotates as it Passes through the Maternal Pelvis.
Second Stage:
From time that Cervix is Fully Dilated until it’s Delivered.
Third Stage:
Delivery of Placenta.

60
Q

What are the Different Mechanisms of Labour?

A

Descent - Here the Baby Decends through the Pelvic Inlet towards the Pelvic Floor.
Descent Occurs due to:
- Uterine Contractions
- Amniotic Fluid Pressure
- Abdominal Muscle Contraction.
Engagement - Occurs when the Largest Diameter of the Fetal Head fits into the Largest Diameter of the Maternal Pelvis.
As the Fetal Head Engages, the Head Moves towards the Pelvic Brim in either the Left or Right Occipto-Transverse Position.
This Allows the Widest part of the Fetal Head to fit through the Widest Part of the Pelvic Inlet.
Flexion - As the Fetal Head comes into Contact with the Pelvic Floor, Cervical Flexion Occurs.
This Allows the Presenting Part of the Fetus to be Sub-Occipito Bregamic.
In this Position, the Fetal Skull has a Smaller Diameter, which Assists Passage through the Pelvis.
Internal Rotation - The Pelvic Floor has a Gutter Shape, with a Forward and Downward Slope.
This allows the Head to Rotate from a Left or Right Occipito-Transverse Position to an Occipito-Anterior Position.
Extension - The Occiput slips beneath the Suprapubic Arch as the Head extends and the Nape of the Neck is Pivoting against the Arch.
External Rotation and Restitution - The Head externally Rotates to Face the Right or Left Medial-Thigh of the Mother.

61
Q

What is the ABCDE Assessment in Maternal Emergencies?

A

If any Time Critical Features are Present, manage these and Begin Transfer to Nearest ED with an Obstetric Unit if Safe to do so.
Identify Gestation from Mother/Maternal Notes.
- Consider Viability
Assess for:
- Operculum
- Ruptured Amniotic Fluid Sac (Waters Broke)
- Contraction
- Bleeding
ANY OF THE ABOVE ARE PRESENT THEN ASSESS FOR
- Contraction Interval
- Urge to Push Down
- (If Contractions <2 mins apart) Crowning / Top of Baby’s Head / Breech Presentation Visible at Vulva.
If no Primary Survey Concerns and None of the Above Present:
- Ask for Maternity Notes if not Already Present.
- Discuss with Woman’s Booked Obstetric Unit.

62
Q

What are the Initial Considerations for Maternal Emergencies?

A

Operculum = Mucus Plug
- Jelly-Like Appearance, Generally Clear/Off White
- May be Blood Stained.
Amniotic Fluid Rupture = Waters Broken
- In the Majority of Births the Amniotic Rupture during Labour.
- Appearance: Clear / Straw Coloured/
- Consider Meconium if Yellow/Green.

63
Q

What are the Differences in Convulsions During Maternity?

A
  • Lateral Position to <IVC Pressure
  • Anti Convulsant after 2-3 Mins.
64
Q

What is Maternal Bleeding <20 Weeks?

A

Miscarriage - ‘Spontaneous Loss of Pregnancy before Baby Reaches 24 Weeks Gestation’.
- Can only be Confirmed by Ultrasound.
Suspect Miscarriage in any Pregnant Person with any / Multiple of the Following.
- Bleeding
- Pain
- Signs of Pregnancy Subsiding
Time Critical (Pre-Alert) Features:
- Clinical Signs of Hypovalaemic Shock
- Maternity Pad Soaked within 30 Mins (-50ml)
- Total Blood Loss >500ml
Significantly Concerning Signs/Symptoms (E.g. Hypotension, Bradycardia).
- Signs/Symptoms of Ectopic Pregnancy.

Year 2 (15 decks)

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