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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
Q

What is a normal blood glucose level

A

4-8mmol

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26
Q

What 4 factors are looked at for perfusion assessment?

A

Skin
Pulse
BP
Conscious state

27
Q

Adequate perfusion

A

Warm, pink & dry skin
Pulse 60-100
BP =>100mmhg systolic
Alert and orientated in time and place

28
Q

Less than adequate perfusion

A

Cool, pale, clammy skin
Pulse <50 or >100
BP <100mm Hg systolic
May be alert or conscious state altered

29
Q

No perfusion

A

Cool, pale, clammy
Absence of palpable pulse
BP Unable to record
Unconscious

30
Q

What is looked at during respiratory assessment?

A

Rate
Rhythm
Effort
Appearance
ability to Speak
Noises

31
Q

Normal respiratory assessment

A

Rate, 12-16/min
Rhythm, regular and even
Effort, Little
Appearance, Calm
Speech, Clear and steady
Noises, quiet

32
Q

Respiratory rate in distress

A

> 20 or <8

33
Q

What are some noises that may be heard by a person in distress during respiratory assessment?

A

Cough

Wheeze, asthma

Crackle (indicates fluid), heart failure or infection

Strider sound, airway obstruction

34
Q

3 definitions for Time Critical assessment

A

Actual
Emergent
Potential

35
Q

Time critical, actual

A

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
Q

Time critical, emergent

A

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
Q

Time critical, potential

A

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
Q

Actual time critical distress vitals

A

Pulse- >120 or <60
Respiratory- <10 or >30
Hypotension- <90mm Hg systolic
Conscious state- GCS <13

39
Q

A paediatric is defined as?

A

A person under 12 years

40
Q

Paediatric assessment triangle

A

Appearance
Breathing
Circulation

41
Q

History taking, what do you need to know?

A

Ample

-Allergies
-Medications (current)
-Past medical history
-Last meal
-Event that prompted the call for an ambulance

42
Q

If patient is experiencing a traumatic injury, what should you do?

A

Expose the patient and conduct a nose to toes survey, also called a secondary survey

43
Q

Secondary survey, for pain

A

D escription
O nset
L ocation
O ther
R elief

44
Q

Primary survey
Main presenting problem
Vital signs
Secondary survey
What next?

A

Provide Situation Report

45
Q

Situation report format

A

I- Identification
M- Mechanism/ medical complaint
I- Injuries/information related to the complaint
S- Signs
T- Treatment and trends

46
Q

How to determine treatment?

A

-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
Q

Oxygen, 8 Primary emergency indications

A

-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
Q

Oxygen, dose

A

-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
Q

Oxygen, side effects

A

Drying of mucous membranes of upper airway

50
Q

Oxygen, special notes

A

The minimum oxygen flow through a face mask is 6L per minute
The maximum oxygen flow through nasal prongs is 3L per minute

51
Q

Bag valve mask?

A

-Delivers 100% oxygen
-Use with 15L/min or demand head(oxygen kit)
-Resuscitation or unresponsive patients
-Adult, paediatric and neonate sizes

52
Q

Non-rebreather mask

A

-Delivers >90% oxygen
-use with 10-15L/min
-Hypoxic (SpO2 <90%) or other primary indications
-Adult & paediatric size

53
Q

Hudson mask

A

-Delivers 60% oxygen
-Use with 8-10L/min
-Supplement oxygen delivery
-Adult and paediatric size

54
Q

Nebuliser mask

A

-Delivers 60% oxygen
-use with 8-10L/min
-Nebulised medication administration
-Adult and paediatric size

55
Q

Nasal Cannula

A

-Delivers 60% oxygen
-use with 3-4L/min
-Supplement oxygen administration
-One size

56
Q

What is suction equipment for?

A

Removal of blood, vomit & other fluids that can interfere with the maintenance of a clear airway

57
Q

Suction equipment, manual clearance

A

-Lateral positioning (recovery position)
-First preference for airway clearance

58
Q

Suction equipment, Yankauer catheters

A

-hard and rigid
-1 size

59
Q

suction equipment, Y suction cathethers

A

-soft and flexible
-FG6 to FG18

60
Q

Suction rules

A

-only suction as far as you can see
-Suction on the way out
-Suction max 10 seconds at a time

61
Q

Airway devices

A

-Oropharyngeal Airway (OPA)
-Laryngeal mask airway (Igel)

62
Q

Contraindications of Igel

A

-Intact gag reflexes or resistance to insertion
-strong jaw tone/trismus
-Suspected epiglottits or upper airway obstruction

63
Q

Igel sizes and colours

A

-5 Larger adult, orange
-4 normal adult, green
-3 small adult, yellow

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