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AV - GAPPIES wear nappies > AV - Adult - Precis Notes (O2, Pain relief, CVA/TIA, Agitation) > Flashcards

AV - Adult - Precis Notes (O2, Pain relief, CVA/TIA, Agitation) Flashcards

1
Q

A0001 - O2 Rx

Dot points?

A
  • Stop (4)
  • Adequate SpO2 (1)
  • Mild - moderate (1)
  • Severe (3)
  • Chronic hypoxaemia (3)
  • Regardless of SpO2 (2)
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2
Q

A0001 - O2 Rx

> Stop points?

A

> Stop

  • Reliant upon accurate pulse oximetry
  • Only for Pts >= 12 yrs
  • High concentration O2 may be harmful to Pts at risk of hypercapnic respiratory failure (COPD, severe asthma)
  • Suspect COPD if Pt > 40 AND a smoker / ex-smoker w/ SOBOE, chronic cough / sputum, family Hx of COPD
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3
Q

A0001 - O2 Rx

> Adequate SpO2?

> Mild - moderate?

A

> Adequate SpO2 (>= 92%)
- No O2 req’d

> Mild - moderate (85-91%)
- Titrate O2:
NC @ 2-6L OR
SFM @ 5-10L

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4
Q

A0001 - O2 Rx

> Severe?

Critical illness?

A

> Severe (< 85%) OR a Critical Illness
Initial Mx:
- NRBM @ 10-15L
- Consider BVM / IPPV / SGA

Once haemodynamically stable:
- Titrate O2 to SpO2 92-96%

Critical illness:

  • Cardiac Arrest / Resuscitation
  • Major Trauma / Head Injury
  • Anaphylaxis
  • Shock
  • Status epilepticus
  • Severe sepsis
  • Ketamine sedation
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5
Q

A0001 - O2 Rx

> Chronic hypoxaemia?

Chronic conditions?

A

> Chronic hypoxaemia
Titrate O2 w/ NC OR mask to SpO2 88-92%

If SpO2 < 85%, Rx as per > Severe

Chronic conditions:

  • Neuromuscular disorders
  • COPD
  • Cystic Fibrosis
  • Severe kyphoscoliosis
  • Obesity
  • Bronchiectasis
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6
Q

A0001 - O2 Rx

> Regardless of SpO2?

Conditions?

A

> Regardless of SpO2
O2 via NRBM @ 10-15L

Pts presenting with:

  • Decompression illness
  • Toxic inhalation exposure
  • Cluster headache
  • Shoulder dystocia
  • PPH
  • Cord prolapse
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7
Q

A0501 - Pain Relief

Aim?

A

To reduce pain to a level that the Pt is comfortable

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8
Q

A0501 - Pain Relief

What factors determine adequacy of analgesia?

A
  • Pt reporting comfort (most important)
  • distressed appearance
  • physiological signs of pain
  • verbal numerical rating
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9
Q

A0501 - Pain Relief

True or false:
Pts must be able to report or rate pain in order to be given analgesia (incl. pts w/ dementia, intellectual disability, neurodiversity, NESB)

A

False.

Where discomfort is evident, analgesia may be indicated

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10
Q

A0501 - Pain Relief

What (2) things should be considered in small, frail, or elderly pts?

A
  • dose reductions

- longer dose intervals

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11
Q

A0501 - Pain Relief

If a pt remains in pain and the maximum doses have been reached, what else can an ALS paramedic do?

A

Consult for IV ketamine +/- further doses of opioids

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12
Q

A0501 - Pain Relief

What is the preferred approach regarding quality analgesia?

Why?

A

Multi-modal approach (e.g. paracetamol, opioid, methoxyflurane) of smaller doses of multiple different agents.

The effect is usually improved pain and less adverse effects

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13
Q

A0501 - Pain Relief

True or false:
Ketamine may be given to treat chest pain in suspected acute coronary syndrome

A

False.

Option 1: Opioids IV
Option 2 (no IV access): Fentanyl IN
Option 3 (no IV or IN): Morphine or fentanyl IM
+/- methoxyflurane if req’d

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14
Q

A0501 - Pain Relief

What cohort of pts have potentially greater adverse effects from ketamine?

What are these medical conditions?

A

Adolescent / elderly / frail pts

Pts w/ Hx of anxiety / psychosis

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15
Q

A0501 - Pain Relief

What are the standard paracetamol doses?

What are they for S/F/E pts?

A 
Standard:
1000mg PO (2 x tabs)

small/frail/elderly/malnourished/liver disease:
500 mg PO (1 tab)

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16
Q

A0501 - Pain Relief

What are the standard morphine doses?

What are they for S/F/E pts?

A

Standard IV:
Up to 5mg
Rpt @ 5/60
Max: 20mg (consult for more)

Standard IM:
10mg
Rpt 5mg @ 15/60 PRN
Max: 15mg
S/F/E:
0.1mg/kg (e.g. 50kg = 5mg)
NO rpt dose
17
Q

A0501 - Pain Relief

What are the standard ketamine doses?

What are they for S/F/E pts?

A 
Standard IN:
75mg
Rpt 50mg @ 20/60
Max: none*
*CDA (clinical discretion advised)
S/F/E:
50mg
Rpt 25 mg @ 20/60
Max: none*
IV route: consult only
18
Q

A0501 - Pain Relief

What are the standard methoxyflurane doses?

A

3mL inhaled
Rpt 3mL @ 20-25/60
Max: 6mL / 24 hrs

19
Q

A0501 - Pain Relief

What are the standard IV fentanyl doses?

What are they for S/F/E pts?

A

IV fent:
Up to 50mcg
Rpt @ 5/60
Max: 200mcg (consult for more)

20
Q

A0501 - Pain Relief

What are the standard IN fentanyl doses?

What are they for S/F/E pts?

A 
IN fent:
200mcg
Rpt up to 50mcg @ 5/60
Max: 400mcg
S/F/E:
100mcg
Rpt up to 50mcg @ 5/60
Max: 200mcg
21
Q

A0501 - Pain Relief

What is the mx of significant respiratory depression due to opioids?

What dose and repeats?

Other considerations?

A

Titrate small doses of IV Naloxone until pt is adequately self-ventilating.

Dose: Naloxone 100mcg IV
Rpt 100mcg IV @ 2/60 
Max: 2mg
*no IV access: Naloxone 400mcg/mL IM
Single dose only

Consider SGA insertion and tx w/out delay

22
Q

A0501 - Pain Relief

What actions are required to mx ketamine side effects?

A

> Hypersalivation:

  • suction (sufficient on most occassions)
  • where this becomes difficult to mx and airway is compromised&raquo_space; MICA (Atropine IV/IM)

> Emergence reaction:
For significant or persistent reactions,
Midazolam 0.5 - 1mg IV (ALS consult)

23
Q

A0711 - Suspected Stroke / TIA

Dot points?

A
  • Stop (3)
  • Ax (3)
  • Non-urgent tx (1)
  • Non-ECR eligible stroke (3)
  • Possible ECR eligible stroke (5)
  • MICA (1)
24
Q

A0711 - Suspected Stroke / TIA

Stop points?

A
  • MASS
  • ACT-FAST
  • Excl. stroke mimics (incl. hypoglycaemia)
25
Q

A0711 - Suspected Stroke / TIA

Ax points?

A
  • Sx onset time
  • co-morbidities
  • ECG
26
Q

A0711 - Suspected Stroke / TIA

Non-urgent tx?

A

MASS pos. >= 12hrs AND
ACT-FAST neg.
OR
Susp. TIA:

  • Tx to closest thrombolysing stroke centre
27
Q

A0711 - Suspected Stroke / TIA

Non-ECR eligible stroke?

A

MASS pos. < 12hrs AND
ACT-FAST neg.:

  • IV access: 18G, large vein, reflux valve
  • Consider R/v w/ MSU (metro, M-F)
  • Tx to closest thrombolysing stroke centre w/ notification (name & DOB)
28
Q

A0711 - Suspected Stroke / TIA

Possible ECR eligible stroke?

A

MASS pos. < 24hrs AND
ACT-FAST pos. at time of loading:

  • IV access: 18G, large vein, reflux valve
  • Consider R/v w/ MSU (metro, M-F)
  • Tx to closest thrombolysing stroke centre w/ notification (name & DOB)
  • Consider tx to ECR centre if equivalent tx time
  • rural: tx to closest VST centre w/ notif.
29
Q

A0708 - Agitation

Dot points?

A
  • Stop (2)
  • Ax (3)
  • Mild agitation (2)
  • Mod. agit’n. (2)
  • Sev. agit’n. (3)
30
Q

A0708 - Agitation

Stop points?

A
  • Maintain safe enviro. for paramedics, pts, family, bystanders
  • Pts < 16, RCH consult PRIOR to sedation
31
Q

A0708 - Agitation

Ax points?

A
  • Ax with SAT tool
  • MX clinical causes
  • Consider grief / stress
32
Q

A0708 - Agitation

Mild agitation mx?

S/F/E/drug or alco affected?

A

SAT +1:
Olanzapine 10mg ODT
Rpt 10mg @ 20/60 if still SAT +1
Max: 20mg

S/F/E/drug or alco affected:
Olanz 5mg ODT
Rpt 5mg @ 20/60 if still SAT +1
Max: 10mg

33
Q

A0708 - Agitation

Moderate agitation mx?

S/F/E/SBP<100/drug or alco affected?

A

SAT +2:
Midazolam 5-10mg IM
Rpt 5-10mg @ 10/60 TTR
Max: 20mg

S/F/E/SBP<100/drug or alco affected:
Midaz 2.5-5mg IM
Rpt 2.5-5mg @ 10/60 TTR
Max: 10mg

34
Q

A0708 - Agitation

Severe agitation mx?

Plan if it doesn’t work?

A 
SAT +3
Ketamine IM (single dose):
- <60kg = 200mg
- 60-90kg = 300mg
- >90kg = 400mg
  • consult for more
  • consult for Midaz IM/IV if pt hyperthermic or increased muscle tone

AV - GAPPIES wear nappies (26 decks)

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