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CMT1 PHEC Flashcards > PHEC Disability > Flashcards

PHEC Disability Flashcards

(62 cards)

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1
Q

Lobes of the Brain

A

Frontal , Parietal, Temporal and Occipital

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2
Q

Epileptic / Fitting Casualty Definition

A

A fit is a term used to describe an episode relating to a seizure of the brains electrical activity. Can be partial or Generalised

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3
Q

Causes of Seizures

A

Mental illness
Battle shock
Drugs intoxication
Hyperventilation
Hypothermia
Hypoglycaemia
Grand mal epilepsy
This list is not exhaustive

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4
Q

Seizures Recognition

A

Quick History:
Witness report
Past history of fits
Associated conditions
Have they had their medication?
Preceding aura/visual disturbances
Sudden collapse with generalised/localized fitting
May be drowsy or asleep following fit
May have urinated

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5
Q

Seizure Management

A

Get a history
Protect patient from harm
Allow fit to subside
Primary survey
Oxygenation
Identify & treat cause if possible
Ensure seen by MO if first episode
Packaging/evacuate

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6
Q

Poisoning Definition

A

Any substance that if taken in sufficient quantity can cause harm

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7
Q

Poisoning Types

A

Opiates
Prescribed medicines
Toxins/solvent
Alcohol
Carbon monoxide
Garden organophosphates

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8
Q

Poisoning Recognition

A

Puncture marks
Drowsiness
Smell of alcohol
Burns/blisters around mouth, nose and throat
Tachycardia
Nasal bleeding
Excessive sweating

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9
Q

Poisoning Management

A

Initial assessment and primary survey
Give an antidote if available or if cause known
Evacuate and take any evidence of the poison with you

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10
Q

Bites and Stings Treatment

A

Lay patient down/make comfortable
Assess and record: When and where bitten, Description of snake/scorpion, Any symptoms, BP & GCS/AVPU
Circumference Of Affected Limb
Mark Area Of Oedema/Discolouration
Document Spontaneous Bleeding
Look For And Document Paralysis
Check Tetanus Status

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11
Q

Bites and Stings Dos

A

Pressure immobilisation
Splint limb
Gain IV access
Arrange transfer
If respiratory distress give oxygen

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12
Q

Bites and Stings Do nots

A

Feed patient
Allow patient to walk around
Elevate limb
Wash the limb – so they can take a sample

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13
Q

Hypoglycaemia Definition:

A

Abnormally low blood sugar: <4mmols

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14
Q

Hypoglycaemia Pre-Disposing Factors:

A

Missed meals
Excessive use of insulin
Changes in insulin therapy
Unaccustomed or excessive physical exercise

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15
Q

Hypoglycaemia Signs and Symptoms

A

History of diabetes
Sweating
Tachycardia
Dizziness/weakness
Tremors
Anxiety
Irritable/aggressive
Uncoordinated
Reduced level of consciousness

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16
Q

Hypoglycaemia Management

A

Ascertain levels of consciousness
Ensure ABC stable
Ascertain blood glucose levels
Recovery position
Initial assessment and primary survey
Rapid evacuation

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17
Q

Diabetic Coma Definition

A

Collapse or acute illness caused by Hypo/Hyperglycaemia

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18
Q

Diabetic Coma Treatment

A

As for diabetes but if cause unknown treat for Hypoglycaemia
Evacuate

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19
Q

Head Injury Classifications

A

Skull fractures
Brain injuries
Scalp wounds
Primary injury – penetrating/ blunt trauma
Secondary injury – continual haemorrhage, prolonged hypoxia

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20
Q

Head Injury Signs and Symptoms

A

Traumatic, temporary loss of consciousness/ ALOC
Inability to remember events before the injury – usually temporary
Anxiety – repetitive questions
Aggression
Headache
Nausea, vomiting
Dizziness

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21
Q

Basal Skull Fractures Signs and Symptoms

A

Bleeding from the ear
Rhinorrhoea and/or Otorrhea –Fluid from nose/ears
Blood staining of the whites of the eye
Periorbital haematoma - racoon eyes
Bruising over the mastoid process - battle signs

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22
Q

Three ICP Locations

A

Subdural haematoma
Subdural haematoma a tear in a blood vessel below the dura mater. (shown in pictures)
Extradural haematoma
Epidural is the same as Extradural. This is a collection of blood that form between the inner surface of the skull and the outer layer of the dura.
Subarachnoid haemorrhage

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23
Q

Raised ICP Definition

A

Raised ICP is a life threatening complication where there is excess fluids such as cerebrospinal fluid (CSF), blood etc inside the skull which increases the pressure on the brain

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24
Q

ICP Signs and Symptoms

A

Hypertension & bradycardia
Reduction in conscious levels
Abnormal posturing
Abnormal respiratory patterns

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25
Level 1 ICP
BP rises, pulse slows Pupils constricted but reactive Abnormal respiratory patterns Initially, may localise and remove painful stimuli Later, will only withdraw from painful stimuli Signs of decorticate posturing – flexion Usually reversible with prompt surgical intervention
26
Level 2 ICP
BP continues to rise with a decreasing pulse Pupils may become fixed or react to light sluggishly Abnormal respiratory pattern Decereberate posturing – extension
27
Level 3 ICP
One or both pupils may become dilated or fixed Ventilation may become ataxic Unresponsive to painful stimuli Casualty becomes flaccid BP drops, pulse rapid and irregular
28
ICP Management
Initial assessment and primary survey Suspect C-spine Give oxygen Monitor regularly Treat what you can see Evacuate ASAP
29
Components of the CNS
Cerebrum Midbrain Pons Medulla Oblongata Cerebellum Spinal Cord
30
Causes of Unconsciousness – FISHH-SHAPED
Fainting Infections (not all) Shock Head Injury Heart attack Stroke Hypoxia Abnormal Body Temp Poisoning Epilepsy Diabetes
31
Disability Assessment - 3x Methods
AVPU, PEARLA, GCS
32
PEARLA Assessment
Equal and (compare to other eye) React to light Shape and Size (mm) Comparison and Reaction Accommodation – ability to focus
33
PEARLA - If Pupils Bilaterally fixed & dilated
Dead Hypoxia Hypovolemic shock Atropine and Ecstasy An extreme fear response
34
PEARLA - Unilaterally fixed & dilated
Brain injury Stroke
35
PEARLA - Bilaterally Pinpointed
Opiate Overdose
36
PEARLA - Irregular Pupil
Trauma Eye operation Stigmatism
37
Unconscious Casualty Considerations
Witnessed fit Suspicion of drug abuse Sugar levels Check Temp Obvious Trauma Don’t jump straight to trauma, consider the other options
38
Brain Anatomy
Epidural space - space outside the outermost covering on the brain, under the skull (there are 3 layers, the dura mater is the toughest one) Subdural space – space that can be opened by the separation of the arachnoid mater from the dura mater as the result of trauma, pathologic process, or the absence of cerebrospinal fluid Periosteum – Dense fibrous membrane covering the skull Meninges - the three membranes that envelop the brain and spinal cord Dura mater - thick membrane that is the outermost of the three layers of the meninges that surround the brain and spinal cord Arachnoid Layer/Mater - between the two other meninges, the more superficial and much thicker dura mater and the deeper pia mater, from which it is separated by the subarachnoid space Pia mater - delicate innermost layer of the meninges Frontal lobe - contains most of the dopamine-sensitive neurons in the cerebral cortex. The dopamine system is associated with reward, attention, short-term memory tasks, planning, and motivation. Dopamine tends to limit and select sensory information arriving from the thalamus to the forebrain Parietal lobe - integrates sensory information, including spatial sense and navigation (proprioception), taste, temperature and touch, writing and maths skills Temporal lobe - mainly revolves around hearing and selective listening. It receives sensory information such as sounds and speech from the ears. It is also key to being able to comprehend, or understand meaningful speech. In fact, we would not be able to understand someone talking to us, if it wasn't for the temporal lobe Occipital lobe - important to being able to correctly understand what your eyes are seeing. These lobes have to be very fast to process the rapid information that our eyes are sending
39
Analgesia - Prior to Administration Ascertain
What is the pain like How bad is the pain (scale 1-10/0-3) How long they have had the pain Does anything make it better or worse Always check AVPU and PEARLA
40
Analgesia - 3 Ps
Physical: Splintage, Cooling burns Pharmacological: Controlled Drugs, Analgesia, Fentanyl Operational Analgesia, Entonox, Penthrox, Oral Analgesia Psychological: Reassurance
41
Oral Analgesia
Used to treat mild to moderate pain Paracetamol Ibuprofen Aspirin
42
Penthrox - What is it
Penthrox- 536 Module ( Ambulance Module) Penthrox contains the active substance methoxyflurane. It is a medicine which is used to reduce pain. It is inhaled through the custom-built Penthrox Inhaler. Penthrox is intended to reduce the severity of pain, rather than stop it completely.
43
Penthrox Indications
Dislocations Lacerations/wounds Fractures Burns/Scalds Chest/Abdominal Injuries Neck of Femur Fracture
44
Penthrox Contraindications
Shallow/Difficulty breathing Unconscious Liver damage Kidney impairment
45
Penthrox - How to use
Tilting the inhaler slowly poor the methoxyflurane into the base of the inhaler making sure you rotate backwards and forwards gently Penthrox inhaler is now ready for use. Place the wrist loop around the patient wrist and get the patient to breath gently for the first few breaths in and out of the mouthpiece For a stronger effect get the patient to place a finger on the diluter hole The maximum dose is two bottles containing 3 ml per administration. Do not inhale more than the maximum dose.
46
Entonox - What is it
Entonox – PHC Setting, Deployed Hosp Safe analgesic gas 50% nitrous oxide 50% oxygen Cold conditions – The mixture will separate below 6 degrees. With oxygen on top and nitrous oxide on bottom. Same with Flying with Entonox.
47
Entonox - Indications
Prior to applying traction or splints
48
Entonox - How to use
Self-administered Inhaling deeply in using facemask/mouthpiece Administer at least 2 minutes before attempting treatment
49
Entonox Contraindications
Chest injuries Severe Head Injuries Diving Injuries Intoxication Mental Illness or Psychiatric Disturbances
50
Entonox Short Term Side Effects
Nausea Vomiting Dizziness Euphoria
51
Fentanyl - What is it
Controlled drug. 800mcg Oral transmucosal fentanyl citrate Commonly known as the Fentanyl lozenge Absorbed through the buccal mucosa Currently for use on Overseas Exercises and Operations only 25% absorbed through the Buccal mucosa and 75% through GI
52
Fentanyl Contraindications
Hypersensitivity to Fentanyl or to any of the excipients Severe respiratory depression or severe obstructive lung conditions Children under 16
53
Fentanyl Considerations
Do not use without MO advice if patient has: A reduced level of response (e.g. drowsy, unconscious etc.) Difficulty breathing A head injury (Suspected ICP)
54
Fentanyl Side Effects
Very Common Side effects: Somnolence – Drowsiness or strong desire to fall asleep Dizziness Headache Nausea Vomiting Constipation Drowsiness Abdominal pain Common side effects: Confusion, anxiety, hallucinations, depression, emotional liability, respiratory depression, loss of consciousness, convulsion, vertigo, myoclonus, sedation, paraesthesia (including hyperaesthesia/circumoral paraesthesia), abnormal gait/incoordination, taste perversion, abnormal vision, dyspnoea, pruritus, sweating, rash Rare/uncommon: Euphoria, coma, slurred speech, vasodilatation
55
Fentanyl Practical Application
Fentanyl lozenge is self-administered Remove from packaging Placed in mouth, rubbed against cheek and twirled regularly Moisten mouth with small sip of water if dry Assess pain control regularly Monitor for side effects Mark casualty cheek with ‘F’ and time of administration using 24 hour clock Total dose is given over 15 minutes A second lozenge may be used if required 30 minutes after completing use of first lozenge A third lozenge may be administered under professional medical direction only.
56
Fentanyl DO NOTs
Allow the casualty to suck or chew lozenge Tape to casualty’s thumb or finger Use more than one at a time Use for children
57
Fentanyl Advantages
Rapid & simple use Patient has control of use Very few side effects Improved safety Improved pain control
58
Fentanyl Disposal
Fentanyl should be kept out of sight and reach of children A partially used lozenge may contain enough medicine to be harmful or life-threatening to a child Disposal – once used the handle (with any remaining residue) should be replaced in the ‘coffin’ package Do not flush partially used lozenge, handles or the blister pack down the toilet
59
Fentanyl and CBRN
In the CBRN ‘hot’ environment (Non Permissive environment) GSR should not be removed to administer Fentanyl lozenge In the warm (decon) zone (Semi-permissive environment) the GSR may be removed at the discretion of the Medic or Enhanced First Aider to facilitate the administration of the Fentanyl lozenge.
60
Naloxone Hydrochloride Indications
Naloxone hydrochloride (NARCAN 400mcg/ml) used for Opiate related overdose
61
Naloxone Hydrochloride Contraindications
Known hypersensitivity
62
Naloxone Hydrochloride Administration
IV: Initially 400mcg, then 800mcg for up to 2 doses at 1 minute IM: Every 2-3 minutes until consciousness regained

CMT1 PHEC Flashcards (11 decks)

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