Section 5 CPGs

Question 1

Decompression illness (DCI)

Answer 1

Scuba diving within 48 hours
-Complete primary survey, commence CPR if appropriate
-Treat in supine position
-Oxygen therapy 100% O2
-Request ALS
-Determine if the patient is conscious
-If the patent is not conscious, maintain airway, breathing and circulation, determine if pain relief is required
-If the patient is breathing, determine if pain relief is required
-If pain relief is required, go to pain management CPG (Entonox is absolutely contraindicated)
-If pain relief is not required, determine if the patient is nauseous
-If the patient is nauseous, (ALS must treat)
-If patient is not nauseous, monitor ECG and SpO2
-Notify control of query DCI and alert emergency department (ED)
-Transport is completed at an altitude of less than 1000ft above incident site or aircraft pressurised equivalent to sea level

-CONSIDER DIVING BUDDY AS POSSIBLE PATIENT ALSO
-TRANSPORT DIVE COMPUTER AND DIVING EQUIPMENT WITH PATIENT, IF POSSIBLE

Question 2

Glycaemic emergency - Adult

Answer 2

Abnormal blood glucose level
-If blood glucose level is more than 20mmol/L request ALS, consider ketone measurement, transport
-If blood glucose level is less than 4mmol/L determine if patient is conscious and able to swallow
-If patient is conscious ad able to swallow, administer 10-20g glucose gel buccal and/or a sweetened drink, allow 5 minutes to elapse following administration of medication
-If patient is not conscious and/or unable to swallow, administer 1mg glucagon IM, allow 5 minutes to elapse following administration of medication
-Reassess
-If blood glucose level is above 4mmol/L advise carbohydrate meal (sandwich), transport
-If blood glucose level is less than 4mmol/L, request ALS and administer 10g-20g glucose gel buccal CONSIDER 1MG OF GLUCAGON IF NOT ALREADY ADMINISTERED
-reassess, transport
-If blood glucose level is 11-20mmol/L, consider ketone measurement, transport

Question 3

Sickle cell crisis - Adult

Answer 3

Sickle cell crisis
-oxygen therapy
-determine if pain management is required
-If pain management is required, go to pain CPG
-If pain management is not required, measure patient’s temperature
-If temperature is elevated go to sepsis CPG
-If temperature is not elevated, and if patient is cold ensure that he/she is warmed to normal temperature
-Encourage oral fluids
-Determine if the patient is dehydrated and unable to take in oral fluids
-If patient is dehydrated and unable to take in oral fluids, request ALS and monitor SpO2 levels and ECG
-If patient is not dehydrated and able to take in oral fluids, monitor ECG and SpO2 levels
-Transport

DURING OXYGEN THERAPY, ADMINISTER 15L OXYGEN VIA NON-REBREATHER FACEMASK
CONSIDER PATIENT’S CARE PLAN