Protocols Flashcards
(41 cards)
Arrest life threatening haemorrhage - DEAP
Direct pressure on bleeding site
Elevation
Apply tourniquet
Pelvic splint
Urgent transport for…..
Unrelieved Upper Airway Obstruction Examples include: burns, epiglottitis, foreign bodies
Severe Breathing Problems
Examples include: chest injuries with deterioration, severe pulmonary oedema, asthma or chronic obstructive pulmonary disease (COPD) and unresponsive to treatment
Severe Circulatory Problems
Examples include: uncontrollable haemorrhage, penetrating trauma (excluding isolated injury to hands and feet), severe shock of any type, dysrhythmias with poor perfusion, cardiac arrest, return of spontaneous circulation following cardiac arrest
Depressed LOC - If level of consciousness V, P or U. Examples include: head injuries, overdose unresponsive to naloxone, uncontrolled fitting
Emergency of Other Types
Examples include: maternal emergencies (including trauma), severe poisoning, uncontrolled severe pain, acute coronary syndrome, gastrointestinal haemorrhage, eye injuries, penetrating or chemical, stroke or sudden onset headache or neurological deficit, fever with lethargy, major trauma (Trauma Triage Tool criteria)
Informed consent requires what?
- Competency: the persons status to make a decision about their healthcare or treatment. they are not effected by chronic cognitive compromise i.e. Dementia, intellectual impairment
- Capacity: do they have the ability today to make an appropriate decision regarding their health. they are not incapacitated by circumstances such as - head injury, alcohol, drugs, hypo, mental illness
- Consent: do they have competency and capacity to give consent freely and voluntarily. content is specific and informed. can be expressed, written or implied or given by a person responsible.
When is consent not required
consent is not required in an emergency, where the patient is unable to give contest and the treatment is required immediately, to save the persons life, to prevent serious injury or under S20 of the mental health act.
Consent in young persons
Emergency treatment may be carried out on a person under 16 without any consent if the paramedic feels that the urgent treatment is required in order to save their life or prevent serious harm.
<14 yrs consent must be given by a responsible adult if non emergency care. If a child over the age of 14 yrs can prove competency and capacity they can make their own healthcare decisions.
Consent documentation must contain
Receive, do they have the ability to hear and concentrate to receive the information.
Believe, can they understand the information and accept and believe it.
Retain, can they remember long enough o analyse the information.
Explain, can the patient explain the information back to you including risks involved.
5 R’s medication administration
right person right drug right time right dose right route
Pain Medication - 3 steps, >65yrs
Step 1 - Non pharmacological options i.e. ice, elevation, splinting Step 2 (mild/moderate) - oral medications ie paracetamol, ibuprofen, methoxyflurane. Step 3 (severe) - parenteral medications ie morphine, fentanyl, ketamine
Any patient over the age of 65 yrs MUST receive a half doses of any pain medications AND sedatives.
FBAO
Treatment
Patient care (A2) - Assess severity of FBAO
Ineffective cough - Severe FBAO
If the patient is conscious:
Administer up to 5 sharp back blows (position the patient with their head down to utilise gravity - Skill 101.12)
If back blows fail, administer up to 5 chest thrusts (Skill 101.13)
If both fail, administer oxygen if indicated and continue to alternate back blows with chest thrusts during transport
If the patient is unconscious:
Extricate the foreign body with a laryngoscope and Magill forceps
If this fails, commence CPR
Effective cough - Mild FBAO
Encourage coughing to expel foreign body
Administer oxygen if indicated
Urgent transport (A8) for patients with severe FBAO
Asthma treatment
Asthma
Treatment
Patient care (A2) Assess severity and Peak Expiratory Flow Rate (PEFR - Patients ≥ 8 years of age)
Check for pneumothorax/tension pneumothorax
Administer medication/s if indicated
Expiratory assistance if indicated (skill 102.7)
Urgent transport (A8) for all patients with severe/life threatening asthma
Regularly repeat and document ABCD physical examinations and physiological observations in order to identify trends in clinical deterioration
Protocol specific exclusions
Initial moderate or severe/life threatening presentation
Previous intubation/ICU admission for asthma
Initial PEFR < 75% predicted or known physiological value
Concurrent respiratory illness
Bilateral crepitation on auscultation
History of COPD or heart failure
Nil improvement in PEFR and/or symptomatic post treatment
No access to self-administered bronchodilator
Pregnancy
Asthma drug regime
Mild
Salbutamol (216) - via neb & O₂ 8L/pm
≥ 5 YO:
5mg (2.5mL), Repeat whilst indicated, No max
< 5 YO:
2.5mg (2.5mL), Repeat whilst indicated, No max
Moderate
Salbutamol as per mild plus
Ipratropium bromide (223) - Mixed with salbutamol
≥ 6 YO:
500mcg (1mL), Repeat once, Max 2 doses
< 6 YO:
250mcg (1mL), Repeat once, Max 2 doses
Hydrocortisone (238) - 100mg vial reconstituted with 2mL normal saline 0.9% (50mg:1mL)
≥ 16 YO:
100mg IM/IV, No repeat, Max 1 dose
6 - < 16 YO:
4mg/kg Max bolus (100mg) IM/IV, No repeat, Max 1 dose
Severe/Life Threatening
Salbutamol, Ipratropium Bromide & Hydrocortisone (≥6 YO) as per moderate plus:
Arenaline (201) - IM into lateral aspect of thigh
≥ 16 YO:
500mcg (0.5mL) 1:1,000 IM, Repeat every 5 min whilst indicated, No max
100mcg (1mL) 1:10,000 IV bolus if unresponsive to IM injections, Repeat every min whilst indicated, No max
< 16 YO:
10mcg/kg (0.01mL/kg) 1:1,000 IM into lateral aspect of thigh, Repeat every 5 min whilst indicated, No max
10mcg/kg (0.1mL/kg) 1:10,000 slow IV bolus if unresponsive to IM injection, Repeat every 5 min whilst indicated, No max
Hydrocortisone (238) - 100mg vial reconstituted with 2mL normal saline 0.9% (50mg:1mL)
< 6 YO:
4mg/kg (Max bolus 100mg) IM/IV, No repeat, Max 1 dose
Management of Acute Severe Behavioural Disturbance
< 14 yrs - head injury: Midazolam (ALS, ICP)
- non head injury: Midazolam (P1 and above)
> 14 yrs - is the aetiology a head injury: Ketamine (ICP)
- non head injury: Droperidol
METHANE
M - declare major incident E - Exact location, specify if different to original location given T - Type of incient H - Hazards A - Access to loacation N - Number of casualties E - Emergency services required
Verification of Death Procedure
- No palpable pulse
- No heart sounds heard for 2 minutes
- No breath sounds heard for 2 minutes
- Fixed and dilated pupils
- No response to central stimulation
- No motor response/facial grimace to painful stimuli
- Identify and coronial checklist flags
- Support family and keep them informed of the situation and processes
Paediatric transport
any unwell paed must be transported in the DHS restraint. children who are well and returning home or to a lower acuity facility.
Abdominal pain treatment
- Patient care
- Pain management
- Treat associated conditions - Dehydration, Medical hypo perfusion/hypovolaemia, nausea and vomiting, abdominal trauma.
4 Urgent transport for hypovolaemic shock and unrelieved pain especially in children
FBAO
ffective cough: Indicated by patients who are able to speak, cough and breathe. An effective cough indicates a mild airway obstruction. Patients should be encouraged to continue coughing to expel the foreign material. Transport patient to hospital if unable to remove foreign body, administer oxygen (221) if indicated
Ineffective cough: Indicated by patients who are unable to speak, breathe effectively and/or have wheezy/noisy breathing. Attempts at coughing may be silent or have little air movement. An ineffective cough indicates a severe FBAO and requires immediate treatment
Treatment
Patient care (A2) - Assess severity of FBAO
Ineffective cough - Severe FBAO
If the patient is conscious:
Administer up to 5 sharp back blows (position the patient with their head down to utilise gravity - Skill 101.12)
If back blows fail, administer up to 5 chest thrusts (Skill 101.13)
If both fail, administer oxygen if indicated and continue to alternate back blows with chest thrusts during transport
If the patient is unconscious:
Extricate the foreign body with a laryngoscope and Magill forceps
If this fails, commence CPR
Effective cough - Mild FBAO
Encourage coughing to expel foreign body
Administer oxygen if indicated
Asthma - treatment and meds
Assess severity and peak expiratory flow
check for pneumothorax/tension pneumothorax
administer medications
expiratory assistance
urgent transport
Mild-
salbutamol
Moderate-
salbutamol
Ipratropium Bromide
Hydrocortisone
Severe-
all meds as per moderate regime plus
adrenaline
Nausea and Vomiting
Patient care Medications (fors sever nausea/vomiting)- Ondansetron first line. metoclopramide if ondansetron is contraindicated or ineffective after 10 minutes. Treat associated conditions- dehydration gastroenteritis medical hypoperfusion/hypovolaemia
Croup
Patient care assess severity mild- transport moderate - oxygen severe- nebulised adrenaline urgent transport
Dehydration
Patient care assess severity mild - oral fluids moderate/severe - oral fluids and compound sodium lactate 10mls/kg, no repeats treat associated conditions if any determine referal options
Seizures
patient care protect patient from injury administer medications - Midazolam >5min treat associated conditions- hypoglycaemia hyperthermia traumatic injuries urgent transport if recurrent or continuous
Meningococcal
patient care - identify any rash and good history
compound sodium lactate if signs of hypovolaemia
if a rash - Benzyl Penicillin
urgent transport
Autonomic Dysreflexia
patient care -
posture pt with legs dependant
loosen any tight clothing
monitor blood pressure every 2-3 minutes
look for and rectify any reversible causes
administer meds - GTN
urgent transport for pets with altered loc, stroke symptoms or persistent symptoms despite treatment
