Hs and Ts Conditions Hypoxaemia Hypovolaemia Hypo/Hyperkalaemia & metabolic disorders Hypo/Hyperthermia Tension pneumothorax Tamponade Toxins/poisons/drugs Thrombosis - pulmonary/coronary

Newborn CPR 30 breaths via BVM on room air with OPA (1-2 breaths per second) Reassess pulse, breathing No pulse - CPR - 3 chest pumps:1 breath, oxygen at 15L for 1 min or until responsive and then reassess

Mum Haemorrhaging external pressure on vagina (tears etc) external aortic compression (fist on groin on either side - if no femoral pulse it is working) internal aortic compression (fist on inside of vagina - as well as fist on top)

Shoulder Dystocia delivering sideways shoulder gets stuck on pubic bone turtle necking (crowing and then goes back in) To help: Gaskin manoeuvre (get mum on all 4s) McRoberts Manoeuvre (mum on back with knees on chest - can be held by partner etc) Ruben 1 (push down on baby's shoulder behind mum's pubic bone) Ruben 2 (Ruben 1 plus 2 fingers internally on baby's shoulder) Woodscrew and Return Woodscrew (towel around shoulders and twist and turn gently)

Nuchal Cord Cord wrapped around baby's neck To help: Get pinky under cord and try to push over bub's head Push cord over shoulders and deliver baby through it Backflip - turn baby's head towards mum's inner thigh and summersault baby out, keeping head as close to mum as possible

Theory Flashcards by Terri Brown

SAMPLE

History taking:

S - signs and symptoms

A - allergies

M - medications

P - past medical Hx

L - last ins and outs

E - events leading to the incident/issue

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OPQRST

Pain assessment - part of secondary survey:

O - origin and onset (Where did it start and what were you doing?)

P - palliation/provocation (What makes it better or worse?)

Q - quality (crushing, stabbing, throbbing etc)

R - radiation (does it move anywhere?)

S - severity (on a scale of 0 - 10)

T - time and treatment (how long and have you taken anything?)

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AVPU

Level of consciousness

A - alert

V - voice

P - pain

U - unresponsive

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IMISTAMBO

Patient handover:

I - identification - pt’s name and age

M - mechanism - what is the mechanism or presenting problem

I - injuries/information - pt assessment and Hx relevant to complaint

S - signs - vital signs and GCS

T - treatment and trends - interventions and response

A - allergies - what the pt is allergic to

M - medications - regular medications and are they present

B - background - medical Hx

O - other issues - scene, social situation, advanced care directives, belongings/valuables, cultural and religious considerations, interpreter

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APGAR

Newborn assessment conducted at 1 min and 5 mins post delivery. Usually at 6-8 at 1 min and 10 at 5 mins. Each item scored between 0 - 2.

Includes:

Appearance (skin colour)

Pulse

Grimace (muscle tone)

Activity

Respirations

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Glascow Coma Scale

Eye Opening:

Spontaneous 4

To Voice 3

To Pain 2

None 1

Verbal Response:

Oriented 5

Confused 4

Inappropriate Words 3

Incomprehensible Sounds 2

Silent 1

Motor Response:

Obeys Commands 6

Localised Pain 5

Withdraws 4

Abnormal Flexion 3

Abnormal Extension 2

No Movement 1

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Hs and Ts

Conditions that may precipitate cardiac arrest or decrease chances of successful resuscitation

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Hs and Ts Conditions

Hypoxaemia
Hypovolaemia
Hypo/Hyperkalaemia & metabolic disorders
Hypo/Hyperthermia
Tension pneumothorax
Tamponade
Toxins/poisons/drugs
Thrombosis - pulmonary/coronary

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Effect of Toxins

Death caused by airway obstruction and respiratory arrest secondary to a decreased conscious level after self-poisoning (benzodiazepines, opioids, tricyclic antidepressants, local anesthetics, beta-blockers, and calcium channel blockers).

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Main Cause of Paediatric Cardiac Arrest

Respiratory issue

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Obstetric Emergencies - Breech

Complete Breech = cross legged
Frank Breech = legs up on chest
Kneeling Breech = knees first
Footling Breech = legs first

How to help:

Use pinkies to untangle legs
Loveset Manoeuvre - wrap towel around bubs hips and twist gently back and forth
Catch newborn with index finger and thumb around chin
Pop onto mum’s belly - skin to skin (helps with post natal depression)
Clamp umbilical 1 fist from bub, second fist from bub and then half way between these
Cut umbilical between 1st and 2nd clamp

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Newborn CPR

30 breaths via BVM on room air with OPA (1-2 breaths per second)
Reassess pulse, breathing
No pulse - CPR - 3 chest pumps:1 breath, oxygen at 15L for 1 min or until responsive and then reassess

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Mum Haemorrhaging

external pressure on vagina (tears etc)
external aortic compression (fist on groin on either side - if no femoral pulse it is working)
internal aortic compression (fist on inside of vagina - as well as fist on top)

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Shoulder Dystocia

delivering sideways
shoulder gets stuck on pubic bone
turtle necking (crowing and then goes back in)

To help:

Gaskin manoeuvre (get mum on all 4s)
McRoberts Manoeuvre (mum on back with knees on chest - can be held by partner etc)
Ruben 1 (push down on baby’s shoulder behind mum’s pubic bone)
Ruben 2 (Ruben 1 plus 2 fingers internally on baby’s shoulder)
Woodscrew and Return Woodscrew (towel around shoulders and twist and turn gently)

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Nuchal Cord

Cord wrapped around baby’s neck

To help:

Get pinky under cord and try to push over bub’s head
Push cord over shoulders and deliver baby through it
Backflip - turn baby’s head towards mum’s inner thigh and summersault baby out, keeping head as close to mum as possible

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Newborn Heart Rate

Normal = 150bpm = score 2

100 - 140bpm = score 1

< 100bpm = score 0

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Paediatric Weight Calculation

(age x 3) + 7 = weight

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Paediatric Joules Calculation

weight x 4 joules

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Paediatric Adrenalin Dose Calculation

weight x 100 = .ml

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Paediatric Amiodarone Dose Calculation

weight / 10 = ml

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Paediatric Medication Formula

(dose - mcg,mg,g / meds mcg,mg,g) x meds ml = . mls needed

Paediatric ALS Respiration Rates

BVM - 15:2
LMA - 1 breath every 4 seconds

Tension Pneumothorax Symptoms

resistance on bagging
tracheal deviation
jugular distension
diminished chest sounds (gets worse lower in the lungs)
Subcutaneous emphasaema

Preferred ACS Analgesic

Fentanyl

Pinpoint Pupils Drug

Pinpoint Pupils Drug Naloxone (Narcan)

Tension Pneumothorax Needle

Tension Pneumothorax Needle 14 gauge

Amiodarone Administration Round

Amiodarone Administration Round 3rd round if shockable rhythm

Vital Signs Survey

Vital Signs Survey * BGL * Temp * Pupils * Pulse * Respiratory rate * Sats * Blood pressure * Capillary refill * Glasgow Coma Scale * Chest auscultation * ECG

5 Moments of Hand Hygiene

5 Moments of Hand Hygiene 1. Before touching a pt 2. Before a procedure 3. After a procedure or body substance exposure risk 4. After touching a pt 5. After touching a pt's surroundings Note: hand hygiene must be performed after the removal of gloves.

Pulse/Heart Rate

Pulse/Heart Rate Number of beats per minute, normal is 60-100bpm, often seen in the lower half of the range.

Respirations

Respirations Number of breaths per minute, normal is 12-20rpm (1 breath every 4-5 seconds).

Blood Pressure

Blood Pressure Combination of cardiac output and peripheral resistance. Normal range for an adult is: Systolic 100 - 150 Diastolic 60 - 90

Temperature

Temperature Normal is between 36.5 and 37.5 degrees

Blood Glucose Level (BGL)

Blood Glucose Level (BGL) The level of millimoles of glucose in each litre of blood. * Hyperglycaemic = \>8mmol/L * Normal = 4-8mmol/L * Hypoglycaemic = \<4mmol/L

Pulse Oximetry

Pulse Oximetry % of oxygen carrying haemobglobin that is saturated with oxygen. Normal range is 96% - 100% but don't treat unless under 93%

Perfusion Status Assessment

Perfusion Status Assessment Assesses blood flow to tissues and organs Includes assessment of: * level of consciousness * capillary refill time * BP * skin colour

Access

Access = Getting in * safety first * access challenges, eg locked doors * terrain for equipment * once inside, identify exits early * how many people are on scene * pt presentation * selecting correct extrication equipment

Rule of Nines

Rule of Nines * front and back of head and neck = 9% * front and back of each arm and hand = 9% * chest = 9% \* Stomach = 9% * Upper back = 9% * lower back = 9% * front and back of each foot and leg = 18% * genital area = 1%

PERRLA

PERRLA Pupils Equal - both should be the same size Round - should be perfectly round Reactive - to light and accommodation Light - pupils should shrink when exposed to light Accommodation - should be able to focus close up and far away

TILE

TILE T - task - type of manual handling activity, eg pushing, pulling, lifting, carrying etc I - individual - the capabilities of the person carrying out the manual handling activity L - load - size, shape, surface type and weight of the object being moved E - environment - the area in which the object is being moved

METHANE

METHANE Major incident management M - major incident confirmation E - exact location T - type of incident H - hazards identified A - access via N - number of pts, adult/paed, nature and priority E - emergency services/resources required

IPPA

IPPA Abdomen assessment I - inspect - look and observe - distended/swollen/bruising P - palpate - touch/feel with open hand - rolling palm to fingers P - percuss - tapping of fingers A - auscultate - listening with a stethoscope

Prone

Prone Lying face down

Supine

Supine Lying face up

Diaphoretic + grey =

Diaphoretic + grey = Acute Coronary Syndrome

OPA Measurement

OPA Measurement Side of mouth to base of ear

NPA Measurement

NPA Measurement Septum (centre of nose) to base of ear Long edge to outside when inserting Right nostril is a little straighter and bigger

Double Airway Manoeuver

Double Airway Manoeuver Jaw thrust Mouth opening

Triple Airway Manoeuver

Triple Airway Manoeuver Jaw thrust Mouth opening Head tilt

Suction Time

Suction Time 5-10 seconds

6 Rights of Medication

5 Rights of Medication * Right pt * Right drug * Right dose * Right route * Right time * Right documentation