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Approach Flashcards

1
Q

What are the steps of the primary survey?

A

-Dangers
-Response
-Send for help
-Airway
-Breathing
-Circulation
-Defibrilation

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2
Q

Dangers,
What needs to be done?

A

-Assess for hazards
-Standard precautions
-Remove patient from harm

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3
Q

Response,
Questions?

A

Can you hear me?
Open your eyes
What’s your name?
Squeeze my hand

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4
Q

Conscious state survey?

A

Alert
Voice
Pain
Unresponsive

Glasgow coma score

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5
Q

If patient responsive, what next?

A

Main presenting problem
Vital sign survey
History
2nd survey

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6
Q

Airway, What to check and do?

A

Check airway is open and clear

-place patient in supine position with a slight head tilt
-don’t delay
-Spinal care!

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7
Q

Primary survey, Breathing

A

-Look, listen and feel

-abnormal, agonal breathing is ineffective

-if normal, recovery position

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8
Q

Primary survey

Circulation, what to check for and action

A

-assess for carotid pulse

-if pulse is present but ineffective breathing, help patient breath

-if no pulse and ineffective breathing, immediately commence chest compressions!

-If effective breathing with pulse, manage as per Acute Altered Consciousness

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9
Q

Defibrillation

A

-electrodes on upper right and lower left

-call for help

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10
Q

Initial approach, after primary survey?
Vitals

A

Assess
-main presenting problem
-perfusion assessment
-Conscious state assessment
-respiratory assessment
-time critical assessment

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11
Q

Heart rate, what to check for ?

A

Rate, rhythm, strength

Normal adult rate, 60-100

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12
Q

Heart rate, where to take and when?

A

Carotid- unconscious
Radial - conscious
Brachial - infants, blood pressures

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13
Q

vital signs
Respiratory rate, what to check for?

A

Rate, rhythm, effort

12-16 normal rate

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14
Q

During Vital sign assessment which vitals are checked?

A

Heart rate
Respiratory rate
Blood pressure
Oxygen saturation (sp02)
Temperature
Blood glucose level

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15
Q

What is blood pressure?

A

Pressure exerted on the arteries by the blood

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16
Q

What are the 2 measurements of blood pressure?

A

Systolic- pressure when heart contracts

Diastolic- pressure when heart is at rest

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17
Q

What are the 2 ways to measure blood pressure?

A

Palpated- fingers (systolic only)

Auscultated- stethoscope (systolic & diastolic

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18
Q

What is the normal systolic blood pressure range of an adult?

A

100-140/palp

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19
Q

What is oxygen saturation?

A

Percentage of oxygen saturating a red blood cell

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20
Q

What can affect SPO2 accuracy?

A

Nail polish and dirty fingers

Extremities that are cold or have reduced circulation

Carbon monoxide poisoning

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21
Q

What is a normal SPO2 measurement?

A

> 92%

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22
Q

What is a normal body temperature?

A

36-37.5c

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23
Q

How is temperature checked?

A

Tympanic (from the ear)

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24
Q

What is blood glucose?

A

The amount of sugar in the blood available for the body to use

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25
What is a normal blood glucose level
4-8mmol
26
What 4 factors are looked at for perfusion assessment?
Skin Pulse BP Conscious state
27
Adequate perfusion
Warm, pink & dry skin Pulse 60-100 BP =>100mmhg systolic Alert and orientated in time and place
28
Less than adequate perfusion
Cool, pale, clammy skin Pulse <50 or >100 BP <100mm Hg systolic May be alert or conscious state altered
29
No perfusion
Cool, pale, clammy Absence of palpable pulse BP Unable to record Unconscious
30
What is looked at during respiratory assessment?
Rate Rhythm Effort Appearance ability to Speak Noises
31
Normal respiratory assessment
Rate, 12-16/min Rhythm, regular and even Effort, Little Appearance, Calm Speech, Clear and steady Noises, quiet
32
Respiratory rate in distress
>20 or <8
33
What are some noises that may be heard by a person in distress during respiratory assessment?
Cough Wheeze, asthma Crackle (indicates fluid), heart failure or infection Strider sound, airway obstruction
34
3 definitions for Time Critical assessment
Actual Emergent Potential
35
Time critical, actual
At the time the vital signs survey was taken, the patient was in actual physiological distress I.e. altered conscious state, inadequate perfusion, respiratory distress
36
Time critical, emergent
At the time the vital signs survey was taken, the patient was not physiologically distressed, but does have a “pattern of actual injury/illness” which is known to have a high probability of deteriorating to actual physiological distress
37
Time critical, potential
At the time the vital signs survey was taken, the patient was not physiologically distressed, and there was no significant “pattern of actual injury/illness”, but there is a “mechanism of injury/illness” known to have the potential to deteriorate to actual physiological distress.
38
Actual time critical distress vitals
Pulse- >120 or <60 Respiratory- <10 or >30 Hypotension- <90mm Hg systolic Conscious state- GCS <13
39
A paediatric is defined as?
A person under 12 years
40
Paediatric assessment triangle
Appearance Breathing Circulation
41
History taking, what do you need to know?
Ample -Allergies -Medications (current) -Past medical history -Last meal -Event that prompted the call for an ambulance
42
If patient is experiencing a traumatic injury, what should you do?
Expose the patient and conduct a nose to toes survey, also called a secondary survey
43
Secondary survey, for pain
D escription O nset L ocation O ther R elief
44
Primary survey Main presenting problem Vital signs Secondary survey What next?
Provide Situation Report
45
Situation report format
I- Identification M- Mechanism/ medical complaint I- Injuries/information related to the complaint S- Signs T- Treatment and trends
46
How to determine treatment?
-Patient should fall into one of the appropriate protocols -if in doubt call the ambulance clinician -use “pay off” and manage for best outcome
47
Oxygen, 8 Primary emergency indications
-Treatment of hypoxia/hypoxaemia (SpO2 <92% -cardiac arrest or resuscitation -major trauma/head injury -carbon monoxide poisoning -shock/anaphylaxis -severe sepsis -decompression illness -seizure
48
Oxygen, dose
-Moderate concentration(40-60%) via face mask at 8L per minute -High concentration (60-95%) via bag valve mask (bvm) device with reservoir bag at 8-15L per minute
49
Oxygen, side effects
Drying of mucous membranes of upper airway
50
Oxygen, special notes
The minimum oxygen flow through a face mask is 6L per minute The maximum oxygen flow through nasal prongs is 3L per minute
51
Bag valve mask?
-Delivers 100% oxygen -Use with 15L/min or demand head(oxygen kit) -Resuscitation or unresponsive patients -Adult, paediatric and neonate sizes
52
Non-rebreather mask
-Delivers >90% oxygen -use with 10-15L/min -Hypoxic (SpO2 <90%) or other primary indications -Adult & paediatric size
53
Hudson mask
-Delivers 60% oxygen -Use with 8-10L/min -Supplement oxygen delivery -Adult and paediatric size
54
Nebuliser mask
-Delivers 60% oxygen -use with 8-10L/min -Nebulised medication administration -Adult and paediatric size
55
Nasal Cannula
-Delivers 60% oxygen -use with 3-4L/min -Supplement oxygen administration -One size
56
What is suction equipment for?
Removal of blood, vomit & other fluids that can interfere with the maintenance of a clear airway
57
Suction equipment, manual clearance
-Lateral positioning (recovery position) -First preference for airway clearance
58
Suction equipment, Yankauer catheters
-hard and rigid -1 size
59
suction equipment, Y suction cathethers
-soft and flexible -FG6 to FG18
60
Suction rules
-only suction as far as you can see -Suction on the way out -Suction max 10 seconds at a time
61
Airway devices
-Oropharyngeal Airway (OPA) -Laryngeal mask airway (Igel)
62
Contraindications of Igel
-Intact gag reflexes or resistance to insertion -strong jaw tone/trismus -Suspected epiglottits or upper airway obstruction
63
Igel sizes and colours
-5 Larger adult, orange -4 normal adult, green -3 small adult, yellow

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