(C) APO CPG (A0406)

Question 1

APO.

Care Objectives

Answer 1

> Nitrates - symptomatic (C)APO

> CPAP - if unresponsive to nitrates / significant resp. failure

Question 2

APO.

w/ chest pain?

Answer 2

Mx as per ACS CPG (A0401)

Question 3

APO.

CPAP CI’s

Answer 3

• GCS < 13
• facial trauma
• secure airway needed
• active vomiting
• hypoventilation
• pneumothorax
• life-threatening arrhythmias

Question 4

APO.

Mx

Answer 4

? SOB & crackles
> GTN 300 mcg S/L (SBP > 110)
Repeat @ 5/60 - titrate to pain / side effects
> GTN patch 50 mg (0.4 mg / hr) to upper torso / arms
Remove patch if SBP < 90

? no improvement / full-field APO
> CPAP
> suction & assisted ventilation as req’d

** MICA **
> ETT intubation
> Furosemide administration

Question 5

COPD.

Suspected in…

Answer 5

Pts > 40 who have:

• smoking hx
• fam hx COPD
• dyspnoea worse w/ exercise
• chronic cough
• chronic sputum production

Question 6

COPD.

Exacerbation definitions

Answer 6

Increased:

• dyspnoea
• cough
• sputum production

Question 7

COPD.

Indications and CI’s

Answer 7

• Indication:
  Sp02 < 90% RA / Sp02 < 95% on O2 **
  **Why 95%? Shouldn’t COPD Pts have O2 titrated to 88-92% SpO2??

* CI's
Ineffective:
- cardiac / resp. arrest
- Pt agitation / mask intolerance
- nil improvement after 1/24 Rx
VS:
- HR < 50, SBP < 90
- LOC / GCS < 13
- decreasing SpO2
Active Pt risk
- loss of airway control
- copious secretions
- active vomiting
- paramedic judgement of clinical deterioration

Question 8

COPD.

Mx

Answer 8

All exac. COPD:
> Salbutamol 10 mg + Ipratropium 500 mcg NEB
> Dexamethasone 8 mg IV/PO

Adequate:
> titrate O2 to target 88-92%

Inadequate after 10/60:
** MICA **
> CPAP

Pt deteriorates:
> ventilate with 100% O2
** MICA **
> consider ETT intubation