Section 2 CPGs Flashcards
FBAO - Adult
-Ask are you choking
-Determine the severity
-If the patient can cough, it is mild
-If the patient cannot cough it is severe
-If severe and the patient is unconscious, request ALS, complete 1 cycle of CPR, in ineffective complete one more cycle of CPR, if ineffective again proceed to BLS Adult CPG
-If severe and the patient is conscious, preform 1-5 back blows follow by 1-5 abdominal thrusts, if ineffective and the patient remains conscious repeat 1-5 back blows and 1-5 abdominal thrusts until object becomes dislodged or patient becomes unconscious
-If CPR is effective or object becomes dislodged ensure adequate ventilation
-If there is adequate ventilation, consider oxygen therapy
-If there is not adequate ventilation, preform positive pressure ventilation, a maximum of 10 per minute and provide oxygen therapy
-transport
-AFTER EACH CYCLE OF CPR OPEN PATIENT’S MOUTH AND CHECK FOR OBJECT IF VISIBLE MAKE ONE ATTEMPT TO REMOVE
Advanced airway management - Adult
ADULT CARDIAC ARREST
-Is the patient able to ventilate
-If the patient is not able to ventilate consider FBAO
-If the patient is able to ventilate, consider option of an advanced airway
-If you cannot consider option of an advanced airway, proceed to BLS adult CPG
-If you can consider option of an advanced airway, insert Supraglottic airway,
-If successful insertion, check supraglottic airway placement after each patient movement or if any patient deterioration and continue ventilation and oxygenation
-If unsuccessful insertion, make one more attempt at insertion
-If unsuccessful 2nd insertion, revert to basic airway management
-continue ventilation and oxygenation
-go to appropriate CPG
-MINIMUM INTERRUPTIONS OF CHEST COMPRESSIONS, MAXIMUM HANDS OFF TIME IS 10 SECONDS
-MAINTAIN ADEQUATE VENTILATION AND OXYGENATION THROUGHOUT PROCEDURES
-FOLLOWING SUCCESSFUL ADVANCED AIRWAY MANAGEMENT, VENTILATE AT 8 TO 10 PER MINUTE, UNSYNCHRONISED CHEST COMPRESSIONS CONTINUOUS AT 100 TO 120 BEATS PER MINUTE
-EMTS MAY USE CUFFED SUPRAGLOTTIC AIRWAYS SUBJECT TO MAINTAINING COMPETENCE AND MEDICAL DIRECTOR AUTHORISATION
Abnormal work of breathing -Adult
respiratory distress
-Is the airway patent and protected
-If the airway is not patent and protected, proceed to airway CPG
-if the airway is patent and protected, check SpO2 levels, preform oxygen therapy, and request ALS
-Preform a patient assessment
-Preform positive pressure ventilations a maximum of 10 per minute
-potential brain insult, proceed to stroke CPG or head injury CPG
-potenial substance intake, proceed to poisons CPG
-other, consider pain, posture and neuromuscular disorders
-potential respiratory failure, preform a respiratory assessment
-Bronchospasm/known asthma, go to asthma CPG, go to allergy/anaphylaxis CPG, go to COPD CPG
-Crepitations, go to sepsis CPG
-Asymmetrical breath sounds, consider collapse, consolidation and fluid, if suspected tension pneumothorax (ALS must treat), if none suspected, transport
-Other, consider shock, cardiac/neurological/systemic illness, pain or psychological upset, transport
-IF REDUCED SpO2 LEVELS CONSIDER ASSISTED VENTILATION
-IF NORMAL SpO2 LEVELS ENCOURAGE DEEP BREATHS
-100% O2 INITIALLY UNLESS PATIENT HAS KNOWN COPD, TITRATE O2 TO STANDARD AS CLINICAL CONDITION IMPROVES
Exacerbation of COPD
Dyspnea
-Is there a history of COPD
-If no history of COPD, proceed to abnormal work of breathing CPG
-If there is a history of COPD preform oxygen therapy
-ECG and SpO2 monitor
-Administer salbutamol, 5mg, via Nebuliser
-If patient begins to deteriorate/unstable request ALS and ensure adequate ventilation, if adequate ventilation transport, if no adequate ventilation proceed to abnormal work of breathing CPG
-If patient does not deteriorate and is stable ensure adequate ventilation, if adequate ventilation, transport, if not proceed to abnormal work of breathing CPG
-IF NO IMPROVEMENT SALBUTAMOL MAY BE REPEATED AT 5 MINUTE INTERVALS
-OXYGEN THERAPY;
1.IF O2 ALERT CARD ISSUED FOLLOW INSTRUCTIONS
2. IF NO ALERT CARD, COMMENCE THERAPY AT 28%
3.ADMINISTER O2 TITRATED TO SpO2 92%
AN EXACERBATION OF COPD IS DEFINED AS;
AN EVENT IN THE NATURAL COURSE OF THE DISEASE CHARACTERISED BY A CHANGE IN THE PATIENT’S BASELINE DYSPNEA, COUGH AND/OR SPUTUM BEYOND DAY TO DAY VARIABILITY SUFFICIENT TO WARRANT A CHANGE IN MANAGEMENT
Asthma - Adult
Asthma/bronchospasm
-Assess and maintain airway
-Respiratory assessment
-For mild asthma, 5mg of salbutamol can be administered via a nebuliser or 100mcg via metered dose inhaler who can be repeated up to 11 times
-If this resolves or improves the asthma, transport
-If this does not improve or resolve the asthma, monitor ECG and SpO2 levels, administer oxygen therapy and request ALS
-moving into moderate asthma, administer 5mg of salbutamol via nebuliser
-If this resolves or improves the asthma, transport
-If this does not improve or resolve the asthma, administer another 5mg of salbutamol via nebuliser
-If this improves or resolves the asthma, transport
-If this does not resolve or improve he asthma, move into severe asthma and administer another 5mg of salbutamol via nebuliser
-If the asthma improves or resolves, transport
-If this does not improve or resolve the asthma, move into life-threatening asthma
-Administer 5mg of salbutamol via nebuliser every 5 minutes prn and transport
-CONSIDER PEFR (Peak Expiratory Flow Rate) PRIOR TO SALBUTAMOL ADMINISTRATION
-IF NO IMPROVEMENT SALBUTAMOL 100MCG MAY BE ADMINISTERED UP TO 11 TIMES AS REQUIRED VIA MDI
Emergency tracheostomy management
Tracheostomy or laryngostomy present
-Respiratory distress or breathing complaint
-If there is no respiratory distress or breathing complaint, go to appropriate CPG
-If there is respiratory distress or breathing complaint, consider ALS and assess ventilation at mouth and stoma
-If the patient is breathing, apply high flow O2 to both face and neck, and assess tracheostomy/stoma patency, remove the stoma cover, speaking valve or cap (if present), remove inner tube (if present) - may need to be replaced. DO NOT REMOVE A TRACHEOESOPHAGEAL PUNCTURE (TEP) PROSTHESIS.
-If patient is not breathing, assess tracheostomy/stoma patency, remove the stoma cover, speaking valve or cap (if present), remove inner tube (if present) - may need to be replaced. DO NOT REMOVE A TRACHEOESOPHAGEAL PUNCTURE (TEP) PROSTHESIS.
-If suction catheter is not passable deflate the cuff (if present) and assess breathing adequately
-If suction is passable, the tracheotomy/stoma is patent; preform tracheal suction, ventilate via neck if not breathing, continue ABCDE assessment, remain alert as it may be a partial obstruction, continue to breathing adequately
-If patient is breathing adequately, tracheostomy tube/stoma is partially obstructed or displaced, Continue ABCDE assessment and go to appropriate CPG
-If patient is not breathing adequately, remove the tube (if present) ad assess the breathing at mouth and stoma, consider saline Neb
-if patient is breathing, continue ABCDE assessment and proceed to appropriate CPG
-If patient is not breathing, consider either tracheotomy or laryngectomy/uncertain
-If tracheotomy cover the stoma (with hands or swabs) attempt to ventilate via mouth
-If successful, commence CPR if no pulse present
-If unsuccessful, commence stoma ventilation - use paediatric face mask over the stoma and commence CPR if no pulse present
-If laryngectomy/uncertain commence stoma ventilation - use a paediatric face mask over the stoma and commence CPR if no pulse present
USE ETCO2 IF PRESENT, A POSITIVE READING INDICATES A PATENT OR PARTIALLY PATENT AIRWAY
