Section 6 CPGs

Question 1

Altered level of consciousness - Adult

Answer 1

V, P, or U on AVPU scale
-Maintain airway
-Was the nature if injury trauma
-If it was trauma, consider cervical spine
-If it was not trauma, place patient in the recovery position
-If the patient is not P or U on the AVPU scale, consider paramedic
-If the patient is P or U on the AVPU scale, request ALS
-Obtain SAMPLE history from patient, relative or bystander
-ECG and SpO2 monitoring
-Check temperature, check pupillary size and response, check fro skin rash
-Check for medications or medical alert jewellery carried
-Check blood glucose levels
-determine possible cause of ALOC
-Possible causes include, Anaphylaxis, Submersion incident, Head injury, Hypothermia, Poisons, seizures, symptomatic bradycardia, glycaemic emergency, shock from blood loss, abnormal work of breathing, post resuscitation care, stroke, in each case go to appropriate CPG
-Determine differential diagnosis
-Transport

Question 2

Pain management - Adult

Answer 2

Pain
-Preform a pain assessment
-Consider non pharmacological pain management techniques, splinting, psychological support, heat or cold therapy, positioning
-Determine if this was an adequate relief of pain
-If it was an adequate pain relief or the best achievable, go to originating CPG
-If it was not an adequate relief of pain, implement pharmacology strategy at appropriate level on pain ladder
-If pain management not resolved, request ALS

ANALOGUE OR VISUAL PAIN SCALE (0 = NO PAIN, 10 = WORST PAIN IMAGINABLE)

PHECC PAIN LADDER
MILD PAIN;
1G PARACETAMOL PO
OR
400MG IBUPROFEN PO

MODERATE PAIN;
1G PARACETAMOL AND 600MG IBUPROFEN
AND/OR
NITROUS OXIDE AND OXYGEN INH
OR
METHOXYFLURANE 3ML INH

SEVERE PAIN;
ALS

REPEAT METHOXYFLURANE INH ONCE PRN

Question 3

Seizure/convulsion

Answer 3

Seizure/convulsion
-Protect from harm
-oxygen therapy
-determine seizure status, are they seizing currently or is this post seizure
-Seizing currently, request ALS, support head, check blood glucose levels
-If blood glucose levels are less than 4mmol/L go to glycemic CPG
-If blood glucose levels are above 4mmol/L, reassess
-Is the patient still seizing, transport to emergency department if requested by ambulance control
-If the patient is not still seizing proceed to post seizure assessment
-Post seizure, consider ALS, Determine if the patient is alert
-If the patient is alert, check blood glucose levels
-If the patient is not alert, place patient in recovery position, airway management, check blood glucose levels
-If blood glucose levels are less than 4mmol/L go to glycemic CPG
-If blood glucose levels are above 4mmol/L reassess, transport

CONSIDER OTHER CAUSES OF SEIZURES
MENINGITIS
HEAD INJURY
HYPOGLYCAEMIA
ECLAMPSIA
FEVER
POISONS
ALCOHOL/DRUG WITHDRAWAL

TIME SEIZURE FROM ONSET

Question 4

Stroke

Answer 4

Acute neurological symptoms
-Complete a FAST assessment
-Maintain airway
-Oxygen therapy
-Check blood glucose
-If blood glucose levels are less than 4mmol/L or more than 20mmol/L proceed to glycemic GPG
-If blood glucose levels are more than 4mmol/L and less than 20mmol/L, monitor ECG and SpO2 levels
-Consider paramedic
-Transport

F-Facial weakness, Can the patient smile? has their mouth r eye drooped? which side?
A- Arm weakness, can the patient raise both arms and maintain for 5 seconds?
S-Speech problems, Can the patient speak clearly an understand what you say?
T- Time of onset