BEC Session 2 Flashcards
What is the chain of survival?
- Early recognition and call for help - to prevent cardiac arrest
- Early CPR - to buy time
- Early defibrillation - to restart the heart
- Post resuscitation care - to restore quality of life
If any step in the chain missed out, cannot proceed to next step
What are causes of a blocked airway?
- Bodily fluids
- Foreign body
- Tongue
- Inflammation
- Infection
- Trauma
- Spasm
How do you assess the airways? (ABCDE)
- Sounds (snoring, gurgling, wheeze, stridor)
- Use of accessory muscles
- Seesaw respiration (paradoxical breathing)
What can be done to open the airways?
- Head tilt chin lift
- Jaw thrust for cervical spine injury
- Suction
- I-Gel
What is done once airway is open? (Patient has a pulse)
- Give 15 litres of oxygen to patients via non-rebreathing mask (keep Sats 94-98%)
- For COPD patients, keep Sats at 88-92%
What are causes of breathing problems?
- Decreased LOC
- Respiratory depression (hypoventilation)
- Muscle weakness
- Exhaustion
- Asthma
- COPD
- Infection/inflammation
- Pulmonary oedema
- Pulmonary embolus
How do you assess breathing?
- Look - rate (<10 or >20), symmetry, effort, SpO2, colour (cyanosis)
- Listen - talking (sentences, phrases, words), auscultation (wheeze, silent, added sounds)
- Feel - chest expansion, percussion
What can be done to treat breathing problems in an emergency?
- Ventilation with bag/valve/mask if respiratory rate <10
- Position upright if struggling to breathe
- Specific treatment e.e. B agonist (salbutamol inhaler for severe asthma)
What can be done to assess circulation?
- Look at colour (cyanosis)
- Feel temperature of peripheries
- Take pulse
- Capillary refill time
- Blood pressure
What are normal blood pressure values of different pulses?
- Central (carotid) pulse - systolic pressure of approx 60 mm Hg
- Femoral pulse - systolic pressure of approx 70 mm Hg
- Radial pulse - systolic pressure of approx 80-90 mm Hg
What is shock?
Inadequate tissue perfusion
What are causes of shock?
- Loss of volume - hypovolaemia
- Pump failure - cardiac causes
- Vasodilation - sepsis, anaphylaxis
What can be done to treat circulatory problems in an emergency?
- Position supine with legs raised (left lateral tilt in pregnancy)
- IV access - 16G
- SpO2 monitoring
- Keep patient warm
- Loosen tight clothing
- Reassure
What are causes of disability of the CNS?
- Inadequate perfusion of the brain
- Sedative side effects of drugs
- Low blood sugar
- Toxins and poisons
- Stroke
- Epilepsy
What can be done to treat disability in an emergency?
- Optimise airway, breathing and circulation
- Recovery position
- Treat underlying cause e.g. low blood sugar - glucagon injection, sugary drinks
- Control seizures - buccal Midazolam
- Call 999
What is done when exposing the patient in an emergency?
- Examine clothed patient head to toe, front and back
- Keep warm
- Maintain dignity
- Monitor vital signs regularly
What is SBAR?
- Situation
- Background
- Assessment
- Recommendation
What should be done during handover?
- What happened - SBAR
- What you found on ABCDE and AMPLE
- What you have done
What is the treatment for an unconscious patient who is breathing and has a pulse?
Recovery position
How is a spinal fracture cared for?
Immobilisation
What are signs and symptoms of a fracture?
- Visible fracture
- Deformity
- Pain
- Swelling
- Discolouration
What does management of the fracture involve?
- ABCDE
- Immobilisation of affected area
- Keep patient still and support the injury
- Sling can be made for arm fractures
- Open fractures - control the bleeding
- Monitor limb circulation
- Get help
What is a Colle’s Fracture?
Distal fracture of the radius in the forearm with posterior displacement of the wrist
In burns, what does the ability of the skin to repair depend on?
The depth of the burn
What are the 3 classifications of burn?
- Superficial burns
- Partial thickness burns
- Full-thickness burns
What are superficial burns?
- Involves only epidermis
What are some features of superficial burns?
- Red
- Painful - tender
- Blanches under pressure
- Possible swelling, no blisters
- Heals in ~7 days
What are partial thickness burns?
- Extend through epidermis into dermis
What are some features of partial thickness burns?
- Salmon pink
- Moist/shiny
- Painful
- Blisters usually present
- Heals in 7 - 21 days
What are full thickness burns?
- Through epidermis, dermis into underlying structures
What are some features of full thickness burns?
- Thick, dry
- Pearly grey or charred black
- May bleed from vessel damage
- Painless
- Require skin grafts to heal
How are burns and scalds managed?
- Monitor ABC as shock is likely
- Pour cool running water over affected area for 10 minutes (has cooling effects, stops burning process)
- Remove clothing and jewellery (if able)
- Burnt area should be covered with clingfilm
- Airway burns/smoke inhalation (intubation)
Why should cool water be poured over burns for 10 mins?
- Has cooling effect
* Stops burning process
What is the rule of nines used to assess?
Percentage of total body surface area affected by burns
What is the burn percentage value of head, arms, front, back, genitals, legs and hands?
Head - 9% Arms - 9% each Front - 18% Back - 18% Genitals - 1% Legs - 18% each Hands - 1% each
By which routes can poisons enter the body?
- Inhalation through lungs
- Absorption through skin
- Ingestion through mouth
- Injection
How are poisons managed?
- ABC and ambulance
- Find out cause of poisoning
- If poison absorbed through skin, remove all clothing and irrigate
- Collect vomited material/medications
- Get time of poison ingestion
- Find out how much has been taken
- Rinse mouth
What should NOT be done in poison management?
DO NOT make casualty vomit to give fluids
What is hypovolaemic shock?
Shock caused by blood loss
What can cause hypovolaemic shock?
Haemorrhage
What are types of haemorrhage?
- Capillary bleed - oozing, bright red
- Venous bleed - darker red, steady
- Arterial bleed - bright red, spurting with arterial pulse
What should be done to manage haemorrhages?
PEPE
What is PEPE?
Used for haemorrhage control
- Position casualty
- Expose wound and check for foreign bodies
- Pressure applied followed by firm dressing
- Elevate limb if possible
- (Tourniquets if trained)
How can pressure be applied to a wound with a foreign object embedded?
I ring bandage can be placed around foreign object and pressure applied
What are symptoms of shock?
- Nausea and vomiting
- Thirst
- Rapid breathing
- Sweating
- Fast and weak pulse
- Pale, cold, clammy skin
- Reduced consciousness
- Confused and anxious
What are some examples of medical emergencies?
- Asthma
- Anaphylaxis
- Epilepsy
- Diabetes
- Chest pain
- Meningitis
What are signs and symptoms of asthma?
- Coughing
- Wheezing
- Shortness of breath
- Tightness in chest
What is the treatment for asthma?
- ABCDE
- Sit casualty down and reassure
- Ask the casualty to breathe slowly and deeply
- Get them to take a puff of their inhaler
- If symptoms do not improve in 5 minutes call 999 urgently
What are signs and symptoms of anaphylaxis?
- Collapse and unconsciousness
- Swelling of throat and mouth
- Difficulty in breathing
- Alterations in heart rate
- Drop in blood pressure
- Abdominal pain, nausea and vomiting
- Sense of impending doom
- Nettle rash (hives), urticarial rash
What is the treatment for anaphylaxis?
- ABCDE
- Remove source (trigger) of reaction
- If life threatening complications 999
- Oxygen if needed
- Position patient to relieve any breathlessness
- Raise legs if possible
- Administer auto-injector if they have one or 500mcg Adrenaline IM repeat every 5 mins if required
What is the treatment of epilepsy?
- Maintain airway
- Try to ease fall
- Loosen tight clothing
- Look for med alert tag
- Monitor time of seizure - if more than 5 minutes or first seizure call 999
What should not be done during an epileptic fit?
Do not put anything in the mouth
What are the symptoms of hypoglycaemia?
- Shaking
- Sweating
- Anxiety
- Dizziness
- Hunger
- Fast heartbeat
- Impaired vision
- Weakness, fatigue
- Headache
- Irritable
What are the symptoms of hyperglycaemia?
- Extreme thirst
- Frequent urination
- Dry skin
- Hunger
- Blurred vision
- Drowsiness
- Nausea
Why is hypoglycaemia an emergency?
It kills rapidly
What is the treatment for hypogylcaemia?
Glucose or glucagon
What is the treatment for hyperglycaemia?
Treat for shock/dehydration
insulin in hospital
What is acute coronary syndrome?
When coronary arteries that supply the heart muscle become blocked
What does partial blockage of coronary arteries cause?
Angina
What do fully blocked coronary arteries cause?
Myocardial infarction
What are signs and symptoms of acute coronary syndrome?
- Collapse, often without any warning
- Breathlessness and cyanosis
- Faintness and dizziness
- Pale, cold and clammy skin
- Nausea and vomiting
- Sense of impending doom
What is done to manage acute coronary syndrome?
- ABCDE
- 999
- Loosen clothing
- Oxygen if breathless
- GTN spray (angina)
- Aspirin
- Monitor and record vital signs
- Reassure and keep calm
What is the early treatment for a suspected MI?
MONA
- Morphine analgesia
- Oxygen (high flow)
- Nitroglycerin (sublingual)
- Aspirin (300mg)
What is meningitis?
An infection of the mininges
What are the symptoms of meningitis?
- Rash that does not fade under pressure (glass test)
- Fever, cold hands and feet
- Vomiting
- Confusion
- Severe muscle pain and headache
