Adult CPG

Question 1

Perfusion status assessment

Answer 1

A WPD, 60-100, >100SBP, A+O to time and place
B - CPC, 50-100, 80-100SBP, A+O to time and place
I - CPC, <50 or >100bpm, 60-80SPB, either A+O or ACS
Ex poor - CPC, <50 or >100bpm, <60SBP, altered or unconscious
No perfusion - CPC, no pulse, unrecordable BP, unconscious

Question 2

Resp status

Answer 2

appearance
speech
sounds and auscultation
resp rate
resp rhythm
wob
HR
skin
conscious state

Question 3

GCS

Answer 3

Eyes- opening - spont, to voice, to pain, none
Verbal - orientated, confused, inappropriate words, incomprehensible sounds, none
motor - obeys commands, localises to pain, withdraws to pain, flexion to pain, extension to pain, none

Question 4

Trauma time critical

- Vital signs major trauma criteria

Answer 4

HR <60 or > 120
RR <10 or >30
SBP <90mmHg
SpO2 <90%
if >or = 16 years - GCS <13
if < or = 15 years - GCS <15

Question 5

Trauma time critical

- specific injuries meeting potential major trauma criteria

Answer 5

Blunt injuries
- serious injury to a single body region such that specialised care or intervention may be required or such that life, limb or ling-term quality of life may be at risk
- significant injuries involving one or more body region
Specific limb injuries
- limb amputation or limb threatening injury
- suspected SCI or spinal #
- burns >20% TBSA (>10% if =15) or suspected resp tract burn
- high voltage (>1000v) burns injury
- serious crush injury
- major compound # or open dislocation
- # to 2 or more of femur/tibia/humerous
- # pelvis

Question 6

Time critical guideline

- high risk criteria for major trauma

Answer 6

assess for MOI 
- motor/cyclist impact > 30kmph
- high speed MCA >60kmph
- pedestrian impact
- ejection from vehicle
- prolonged extrication
- fall from height >3m
- struck on head by object falling >3m
explosion
and co-morbidities
age<12 or >55, OR
pregnant, OR
significant underlying medical condition

Question 7

Mental health assessment

Answer 7

observe - safety, appearance, behaviour, affect(mood)
Listen - speech, thought process, cognition
Discuss - thought content, self harm, perceptions, environment (risk factors)

Question 8

Clinical flags

- red flags

Answer 8

HR  >120
RR >30
SBP <90
SpO2 <90% - unless chronic hypoxaemia
GCS <12 (<15 if age = 15 years)

Question 9

Clinical flags

-specific conditions

Answer 9

stridor
first presentation seizure
anaphylaxis (including resolved, possible anaphylaxis or post adrenaline)
acute coronary syndrome (even resolved)
ectopic pregnancy
primary obstetric issue
stroke/TIA
sudden onset headache
unable to walk (when usually able to walk)
post-tonsillectomy bleeding (of any amount) up to 14 days post-op
** clinician must be contacted where pt refuses transport**

Question 10

Clinical flags
- yellow flags

• pt meeting this criteria must be advised to attend hospital or GP within two hours via own transport arrangements

Answer 10

• ongoing pt or carer concern
• infection not responding to community based care
• immunocompromised with suspected infection
• surgical procedure within past 14 days
• significant unexplained pain
• syncope (asymptomatic, normal VSS, normal ECG)
• abdominal pain
  AND pt must:
• have capability to attend hospital
• be read referral advice script

Question 11

Oxygen therapy

- Severe hypoxemia or critical illness

Answer 11

severe - SpO2 < 85%
critical illness
- cardiac or respiratory arrest 
- major trauma/head injury
- shock 
- severe sepsis 
- anaphylaxis
- status epilepticus
- ketamine sedation
manage 10-15L NRB/ BVM (inad tidal vol), titrate to 92-96% once pt is haemodynamically stable
- consider SGA if SpO2 remains <85%

Question 12

Chronic hypoxaemia

Answer 12

COPD (high O2 may be detrimental due to hypercapni resp failure) 
Neuromuscular disorders
cystic fibrosis 
bronchiectasis
severe kyphosis
obesity
--> titrate O2 flow to SpO2 of 88-92%

Question 13

Regardless of SpO2

Answer 13

toxic inhalation exposure 
decompression illness
cord prolapse
postpartum haemorrhage shoulder dystocia
cluster headaches
-->NRB 10-15L/min

Question 14

SGA contraindication

Answer 14

• intact gag reflex or resistance to insertion
• strong jaw tone or trismus
• suspected epiglottitis or upper airway obstruction
  Size 3 - 30-60kg
  Size 4 - 50-90kg
  Size 5 - 90+kg

Question 15

SGA precautions

Answer 15

inability to prepare the pt in the sniffing position
pts who require high airway pressures
paediatric pts who may have enlarged tonsils
vomit in the airway
- side effects - correct placement does not prevent passive regurgitation or gastric distension

Question 16

Indications for IFS

Answer 16

Indication GCS <10
- hyperglycaemia with BGL reading “high”
- frail or elderly resp failure - COPD/APO
- pts with GCS <10 and requiring intubation but contraindicated for suxamethonium and AAV support is unavailable
CI:
- clinical situations where difficult airway guideline is not possible
- non functional capnography
- traumatic brain injury

Question 17

Indications for RSI

Answer 17

GCS <10 with
- TBI
- Non TBI - CVA or sub-arachnoid haemorrhage
hypoxic brain injury - post hanging, near drowning, ROSC
- resp failure unless frail or elderly - young asthmatic
- Suspected airway burns
OD with any of:
- Suspected TCA OD
- difficult extrication
- prolonged Tx time (>30/60)
- SpO2 unable to be maintained >90%
severe hyperthermia - >39.5 despite 10/60 active cooling
Status epilepticus
other indications:
- severe pain that is unable to be mangaged, irrespective of GCS
- GCS >10 with suspected airway burns (consult)