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Clinical Care > Basic > Flashcards

Basic Flashcards

1
Q

What is important to do before or en-route to an emergency?

A

Any form of pre-planning e.g. calculate drug doses, pull up CPG’s etc

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2
Q

In what order should you conduct a patient assessment?

A

Primary - treat imminent threats
VSS
Secondary
Additional assessments

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3
Q

What is the purpose of primary assessment?

A

Quick assessment to rapidly determine imminent threats to life needing immediate treatment

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4
Q

What are the components of the primary survey?

A

Danger (risk assessment)
Response (AVPU)
Airway (clear + open)
Breathing (normal)
Circulation (pulse check)

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5
Q

In what situation might you rearrange the order of the primary survey?

A

If suspected cardiac arrest you can check circulation prior to airway and breathing

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6
Q

In what situation is it ok to abandon the primary survey and move onto the next assessment?

A

If the patient is fully alert and responsive as this indicates that they must be adequately breathing and well circulated

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7
Q

How do you assess a patients response in the primary survey?

A

Escalate attempts to provoke eye opening
A - alert with eyes open
V - eyes open to verbal cue
P - eyes open to pain stimulus (trapezium squeeze, eternal rub)
U - unresponsive/no eye opening

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8
Q

What assessment would need to follow an AVPU test if not on A level?

A

A GCS assessment

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9
Q

How do you assess the airway in the primary survey?

A

Check if clear - remove any fluid/secretion with suction, remove FB’s in mouth
Ensure open by look, listen and feel - may need jaw thrust or OPA

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10
Q

How do you assess breathing in the primary survey?

A

Look, listen, feel for normal breathing = rate 12-20 and adequate volume
Shallow, slow or agonal needs immediate care on completion of survey

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11
Q

How do you assess circulation in the primary survey?

A

Palpate for radial pulses —> carotid
If none = CPR
Carotid only = peripheral shut down

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12
Q

What special care is needed when palpating carotid pulse?

A

Only perform with patient lying down as can cause reflex bradycardia = drop in BP = syncope
Never palpate both at once = reduced cerebral perfusion

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13
Q

What are the steps to performing a pulse check?

A

Explain + consent
Palpate pulse for 30s and multiply by 2 (if irregular or slow/fast then do full minute)
Record

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14
Q

What might be the issue if pulses are different on each side of the body?

A

Coarctation (narrowed aorta), block or aneurysm

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15
Q

What 6 vital signs are taken?

A

BP
Pulse
Respirations
Temperature
Oxygen Saturations
BGL

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16
Q

What is the normal range for blood pressure?

A

Systolic: 100-150
Diastolic: 60-90

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17
Q

What factors affect systolic BP?

A

Contractility
Filling

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18
Q

What factors affect diastolic BP?

A

Blood volume
Vessel size / resistance

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19
Q

What is the cardiac output equation?

A

CO = HR x SV

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20
Q

What is the blood pressure equation?

A

BP = CO x PR

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21
Q

What is pulse pressure?

A

The difference between the systolic and diastolic blood pressure
We feel this when palpating a pulse

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22
Q

What is a narrow pulse pressure and what might cause it?

A

The systolic and diastolic BP are close together
Hypovolaemia, heart failure

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23
Q

What is wide pulse pressure and what might cause it?

A

The systolic and diastolic blood pressures are far apart
Anaphylaxis, septic shock, tamponade

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24
Q

What is the normal adult pulse rate?

A

60-100 bpm

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25
Q

How can we tell if the pulse pressure is narrow or wide?

A

Narrow = weak pulse
Wide = bounding pulse

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26
Q

What 3 factors should be documented regarding pulse VS?

A

Rate
Regularity
Strength

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27
Q

What is a normal respiratory rate?

A

10-20 breath/min

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28
Q

How do you assess the respiratory rate?

A

Count how many breaths are taken in 30s and multiply by 2
If time between breaths is >7s = hypoventilation
If time between breaths is 3-6s = normal
If time between breaths is <2s = hyperventilating

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29
Q

What is Kussmaul breathing?

A

Fast and deep regular breathing
Cause: usually metabolic acidosis

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30
Q

What is Cheyne-Stokes breathing?

A

Repeating cycles of hypopnoea - hyperpnoea - apnoea (small TV, rapid rate)
Cause: CHF, reduced brain perfusion

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31
Q

What is Biot’s breathing?

A

Alternating periods of hyperpnoea and apnoea (big TV)
Cause: brain injury

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32
Q

What is considered a normal temperature?

A

36-37.8 degrees

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33
Q

Define mild, moderate and severe hypothermia.

A

Mild: 36-35
Moderate: 35-33
Severe: <33 (disrrythmia, bradycardia, rigid, dilated pupils)

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34
Q

What is the general rule with rewarming?

A

Do it slowly
Don’t apply heat directly to skin (slow circulation = burn)
Warm blankets in a warm environment ideal

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35
Q

What is pulse oximetry and the normal range?

A

% of Hb saturated with O2
96-100%

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36
Q

What is the normal BGL?

A

4-8mmol/L

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37
Q

What is a significant difference between the way adult and paediatric vital signs present?

A

Adults compensate with visibly changing vital signs
Paediatric continue to function with normal VS until suddenly can’t cope and deteriorate quickly

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38
Q

What makes up the secondary survey?

A

History taking using SAMPLE and OPQRST
Vital signs
Physical head to toe assessment

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39
Q

What method can be used to perform the physical secondary survey on a medical patient?

A

TRIP DOCS
Temperature
Rash
Injection marks
Pulses
Diaphoresis
Oedema
Colour
Smell

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40
Q

What method can be used to perform the physical secondary survey of a trauma patient?

A

DCAP BTLS
Deformities
Contusions
Abrasions
Puncture
Burns
Tenderness
Lacerations
Swelling

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41
Q

What are the components of an abdominal physical assessment during secondary survey?

A

IPPA
Inspect: signs of injury, scars, distension
Palpate: rolling palm to finger in each region for lumps, pain
Percussion: tap first finger against each region to hear hollow vs solid organs
Auscultate: listen for bowel sounds in all quadrants

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42
Q

How do you perform auscultation for an IPPA assessment?

A

Start at 3-5cm above umbilicus (1200) and repeat at 0300, 0600 and 0900

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43
Q

What organs are in the upper right quadrant?

A

Liver
Stomach
Gallbladder
Duodenum
Right kidney
Pancreas
Transverse colon

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44
Q

What organs are in the upper left quadrant?

A

Liver
Stomach
Left kidney
Pancreas
Spleen
Transverse colon
Small intestine

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45
Q

What organs are in the lower right quadrant?

A

Large and small intestine
Appendix
Reproductive and urinary organs (not kidney)

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46
Q

What organs are in the lower left quadrant?

A

Large and small intestine
Sigmoid colon
Reproductive and urinary organs (not kidney)

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47
Q

What organs are in the right hypochondriac region?

A

(Top R)
Liver
Kidney
Gallbladder
Small + large intestine

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48
Q

What organs are in the epigastric region?

A

(Top middle)
Liver
Stomach
Spleen
Duodenum
Adrenals
Pancreas

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49
Q

What organs are in the left hypochondriac region?

A

(Top L)
Liver
Stomach
Pancreas
Kidney
Spleen
Large + small intestine

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50
Q

What organs are in the right lumber region?

A

(Middle R)
Ascending colon
Small intestine
Kidney

51
Q

What organs are in the umbilical region?

A

Duodenum
Small intestine
Transverse colon

52
Q

What organs are in the left lumbar region?

A

(Middle L)
Descending colon
Small intestine
Kidney

53
Q

What organs are in the right iliac region?

A

(Bottom R)
Appendix
Caecum
Ascending colon
Small intestine

54
Q

What organs are in the hypogastric region?

A

(Bottom middle)
Bladder
Sigmoid colon
Small intestine
Reproductive organs

55
Q

What organs are in the left iliac region?

A

(Bottom L)
Sigmoid colon
Descending colon
Small intestine

56
Q

What is used to complete a thorough neurological assessment?

A

Glasgow coma score

57
Q

What is the Glasgow coma score?

A

Assesses eye opening (4), verbal response (5) and motor control (6) to give a score between 3-15

58
Q

What is important to consider when assessing GCS?

A

What their normal response would be e.g may have dementia, syndrome etc

59
Q

What mnemonic is used to perform a respiratory assessment?

A

CAPERSSS
Consciousness: AVPU
Appearance: tripod, anxious, pale etc
Pulse: normal/bounding/flat
Effort: strain - accessory muscle, tug
Rate: 10-20 normal
Rhythm: regular, TV, pause
Skin: colour, sweaty, cyanosis
Speech: talk in full sentences
Sounds: auscultation

60
Q

What is airway wheeze?

A

High pitched whistle
Cause: constricted airway

61
Q

What is airway crackles/rales?

A

Bubbling/popping/clicking noise
Can be moist/dry and fine/coarse
Cause: fluid in small airways

62
Q

What is airway ronchi?

A

Low pitched rattling, snoring, gurgling or wheeze
Cause: blocked large airway

63
Q

What is airway strider?

A

High pitched variable sound involving upper airway
Cause: obstructed upper airway

64
Q

How is perfusion status assessed?

A

Assessment of circulation
Conscious level: AVPU
Pulse rate: 60-100
Radial pulse: present? >90mmHg which is needed to perfuse vital organs
Blood pressure: normal
Skin colour: warm, pink, dry

65
Q

How do you perform a history assessment?

A

SAMPLE
Signs/symptoms
Allergies
Medication - regular and today
Past medical history (surgery, disease)
Last in/out
Events leading up

66
Q

What tool is used to perform a pain assessment?

A

OPQRST
O: onset and origin (where, when, pattern)
P: palliation + provocation (what makes better + worse)
Q: quality (what it feels like)
R: radiation (pain spread)
S: severity (1-10)
T: time + treatment (what done to relieve and when)

67
Q

What pain score system is used to assess pain in adult, paed and infant?

A

Adult 1-10
Paed Wong-baker
Infant PLACC

68
Q

What assessment must be performed on a newborn at 1 and 5 minute mark?

A

APGAR
Appearance (colour)
Pulse rate
Grimace (irritability)
Activity (muscle tone)
Respirations

69
Q

What is the expected APGAR score?

A

Most babies will be 6-8 (out of 10) when first born but should improve to a 10 at the 5 minute mark
Any deteriorations indicate need for intervention

70
Q

What is an indication that a wound need stitches?

A

If the edges are gaping

71
Q

What is used to assess total body surface area of burns?

A

Rule of nines

72
Q

What is the Parkland formula?

A

An equation for how much fluid a burns patient needs
4ml x BSA% x weight
Give the first half of the volume in the first 8 hours and the remaining in the next 16 hours

73
Q

How much blood can be lost in a femur or pelvic fracture?

A

2L femur
4-6L pelvic

74
Q

What lead set is used in the ambulance and what is the placement?

A

4 lead
Ankles and wrists or chest and hips

75
Q

What is Einthovens Triangle?

A

Depicts what view of the heart is achieved over a 3 lead ECG
We use lead II from RA to LL

76
Q

What creates upright or downward ECG?

A

In Einthoven’s Triangle if the flow of electricity is - to + it’s upright but if it is flowing backwards then it is downward. Different leads on the ECG are +/-. Again this is why lead II is best

77
Q

What is the 6 step method to interpreting ECG?

A

Rate
Regularity
P waves
PR interval
QRS complex
Everything else

78
Q

How do you assess rate on an ECG paper?

A

300 method
300 large boxes per 1 minute so count how many large boxes are between QRS and divide by 300 to get beats per minute

79
Q

How do you assess regularity on an ECG paper?

A

Use spare paper to mark first 3 QRS and line up with remaining complexes
Up to 1 small square variation is acceptable

80
Q

How do you assess P waves on an ECG paper?

A

Look for presence, rounded and upright before each QRS

81
Q

How do you assess PR interval on an ECG paper?

A

Start of P to start of QRS
Should be <5 small boxes

82
Q

How do you assess QRS complexes on ECG paper?

A

Should be narrow and 2-3 small boxes

83
Q

What is the everything else part of assessing ECG paper?

A

Looking for missed or additional beats
Strange looking complexes

84
Q

What are the only instances where you can stop CPR?

A

If an appropriate level paramedic or doctor calls death
If you are too exhausted

85
Q

What do you do if patient vomits during CPR?

A

Pause, turn on side and clear the airway. Restart CPR

86
Q

What is airway dead space?

A

The air not participating in gas exchange (e.g. everything outside of alveolar)
About 350ml in an adult so the TV needs to be more than this

87
Q

How much oxygen and nitrogen in air?

A

21% oxygen
79% nitrogen

88
Q

How do you size an NPA?

A

Nostril to tragus

89
Q

What are the rules of airway suctioning?

A

Short bursts to avoid oxygen depletion
Don’t suction beyond where you can see

90
Q

What is the flow rate and indication for nasal cannula?

A

2-4L/min
Maintenance of SpO2 or when SpO2 still >91%

91
Q

What is the flow rate and indication for Hudson mask?

A

6-10L/min
Moderate hypoxia and when nasal cannula not enough

92
Q

What is the flow rate and indication for a non-rebreather mask?

A

10-15L/min
Severe hypoxia

93
Q

What is the flow rate for a nebuliser?

A

6-8L/min

94
Q

What is important about treatment of digestive system complaints?

A

Almost always transport as too hard to diagnose

95
Q

What is important to note about pain patterns with abdominal issues?

A

Irritation of the peritoneum an cause generalised or referred pain (e.g. pancreatitis causes shoulder tip pain)
Distension can be obstruction or haemorrhage

96
Q

What is cord prolapse?

A

Umbilical cord comes out before baby
Gets compressed and reduced oxygen and nutrient flow to baby

97
Q

What is the treatment principles for cord prolapse?

A

Relieve pressure with gravity or manually:
-Transport in a position that relieves pressure on the cord (knee to chest or exaggerated sims)
-Physically create space for the cord
The cord must continue to pulsate
Be careful when touching as may cause cord to spasm - use a swab

98
Q

What are the treatment principles for a miscarriage?

A

Transport
Analgesia
Fluid
Keep any tissues/clots for labs

99
Q

What is placental abruption?

A

Placenta detaches from uterine wall prior to delivery
Risk of haemorrhage or reduced blood flow to baby

100
Q

What are the treatment principles for placental abruption?

A

Transport
Fluid
Analgesia
Antiemetic
TXA
Position to reduce aortic compression

101
Q

What is placenta previa?

A

Placenta grows over vagina opening
Patient should have booked C/S but if early labour risk of haemorrhage and difficulty

102
Q

What are the treatment principles for placenta previa?

A

Transport
Fluid
Antiemetic

103
Q

What is pre-eclampsia?

A

Occurs in second half of gestation
Hypertension >140, oedema and proteinuria (headache, seizure)

104
Q

What is a primary PPH?

A

<24hours after delivery
TX: transport, fluid, fundal massage, manual compression

105
Q

What is a secondary PPH?

A

> 24hours and <6weeks of delivery
TX: transport, fluid, antiemetic, analgesia

Often feel progressively worse over time, continued bleeding, reduced lactation
Usually retained product causing bleeding and infection

106
Q

What are the 4 T’s of PPH?

A

Tone
Tissue
Trauma
Thrombus

107
Q

What is nuchal cord?

A

Cord wrapped around baby neck

108
Q

What are the treatment principles of nuchal cord?

A
  1. Try to unloop
  2. Try to stretch over shoulders to deliver through it
  3. Curve baby so somersaults out
  4. Apply 2 clamps and cut in the middle but will need urgent delivery

Careful not to cause spasming or trauma to cord

109
Q

What occurs in first stage of labour?

A

Contractions and dilation increasing in strength and frequency until fully dilated
Ruptured membranes can occur
TX: non-narcotic pain relief (only midwives and doctors check dilation)

110
Q

What occurs in second stage of labour?

A

Pressure in pelvis creates urge to push and baby is born
Bloody show occurs
Encourage pushing, move skin around crowning head, support head as emerging - check clear airway and cord
Perineum may tear

111
Q

What things do you need to do when baby is born?

A

Note gender and time
Stimulate if needed to cry and wrap
Place face down over mothers thighs to drain airway secretions (consider suction)
Conduct APGAR
Assess cord

112
Q

What is involved with assessing the cord after the baby is born?

A

If pulsating then allow skin to skin
Once no longer pulsating clamp at 10cm, 15cm and 20cm and cut between the 15 and 20 clamp

113
Q

What occurs during third stage of labour?

A

Delivery of the placenta
May take up to an hour
Allow to occur naturally, contractions and pushing may occur
Collect in bag for hospital check

114
Q

What is the treatment principles with a snakebite?

A

Pressure bandage to crush lymph vessels from transporting venom to the blood and circulating around the body
Immobilise to prevent skeletal muscle movement from pumping lymph vessels

115
Q

How do you apply a C-spine collar?

A

Need two medics: one to stabilise
Size by neck width
Slip back Velcro piece under neck and feed through
Line up front chin notch and secure velcro

116
Q

How do you remove a helmet?

A

Keep on unless patient panicking, airway compromised or need to access to stop bleeding

Patient in supine position
One medic to stabilise head
One medic slowly pull helmet from above

117
Q

How do you apply an arterial tourniquet?

A

Put around affected limb as high as possible
Secure the initial velcro strap
Twist to tighten until bleeding stops and secure twist piece
Note time of applicaiton

118
Q

Approximately where does a pelvic binder get applied at?

A

At the greater trochanter level (about buttocks)

119
Q

What is transport critical?

A

Patient needs TX outside your scope of practise e.g. stroke

120
Q

What is actual time critical?

A

Patient needs immediate TX on scene e.g. cardiac arrest
Transport still high priority

121
Q

What is emergent time critical?

A

Patient has a pattern of injury or illness with a high chance of deterioration
E.g. penetrating injury, pelvic injury, AAA, snakebite

122
Q

What is potential time critical?

A

Patient with a mechanism of injury or past history with a high chance of sudden deterioration
E.g. fall >5m, MVA >60kph, blast injury, asthma with previous ICU

123
Q

What considerations need to be given as to what hospital you will transport to?

A

Facilities patient needs
Distance/time/traffic
Contingency if deteriorate
Your skill level and equipment

124
Q

What is mandatory reporting?

A

If you think a child is not having their needs met (education, food, shelter, abuse, medical care, subject to behaviour causing psychological harm) then it must be reported

Clinical Care (2 decks)

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