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CPG Key points and treatment > Clinical approach > Flashcards

Clinical approach Flashcards

1
Q

Pre Arrival

A

Plan for case

Biases/human factors

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2
Q

Arrival

A

PPE
Dangers
Dynamic risk assessment

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3
Q

Rapid assessment for Adult and Paed

A

Adult
- skin
- Conscious state
- WOB

Paediatric
- APPEARANCE - Tone, interactiveness, consolability, look/gaze.speech/cry
WOB- Abodominal breathing, subcostal, nasal flarring,Abnormal breath sounds
CIRCULATION TO THE SKIN - pale, mottling, Cyanosis

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4
Q

Primary Assessment

A

If looks unwell
- Response
- Airway & C spine
- Breathing
- Circulation
- Disability
- Exposure & Hemorrhage
Immediate Mx and SITREP
Establish limitation of treatment

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5
Q

History (as appropriate)

A

Time line
Nature
Prodromal symptoms
History of similar episodes
Associated circumstances
Aggravating / relieving factors

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6
Q

Past history

A

R - Risk factors
A - Allergies
M - Medications
P - Past medical Hx
S - Social considerations

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7
Q

Assess

A

PSA
BP, GCS, HR, S

GCS
E 4, V 5, M 6

RSA
C,A,P,R,R,S,S

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8
Q

Adjuncts

A
  • Weight
  • Temp
  • ECG
  • BGL
  • SPO2
  • EtCO2
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9
Q

Focused Assessments

A

MASS
SIRS
RASH
AEIOUTIPS
Stroke mimics

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10
Q

Handover

A

IMIST - AMBO

  • I - Identification
  • M - Mechanism of injury / medical complaint
  • I - Injuries / Information related to complaint
  • S - Signs
  • T - Treatment and Trends
  • A - Allergies
  • M - Medication
  • B - Background history
  • O - Other information
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11
Q

Adequate Perfusion

A

Skin Pink Warm Dry
HR 60 - 100
SBP > 100
GCS 15 alert and orientated to date and time

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12
Q

Borderline perfusion status assessment =

A

Skin - Pale cool clammy
HR - 50-100
SBP 80-100mmhg
GCS 15

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13
Q

Inadequate perfusion assessment

A

Skin - Cool Pale Clammy
HR - <50 - >100
SBP - 60 - 80
GCS - Altered / 15

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14
Q

Extremely poor perfusion assessment

A

Skin - Cool pale clammy
HR - < 50 - > 110
SBP < 60
Altered conscious state or unconscious

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15
Q

RSA mild

A 
Appearance - Calm/anxious
Speech - full sentences 
Sounds - able to cough, Asthma= mild wheeze, LVF = some crackles
RR - 16-20 
Rhythm - asthma pt may have a prolonged exp phase 
WOB - slight increase 
HR - 60 -100 
Skin - normal 
GCS - 15
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16
Q

Moderate RSA

A

Appearance - distressed and anxious
Speech - short phrases
Sounds - still cough (Asthma + or - inspiratory and expiratory wheeze) (LVF crackles mid to lower fields )
Rate - > 20
Rhythm - Asthmatic pt long expiratory phase
WOB - marked chest movement + or - accessory involvement
HR 100-120
Skin - Pale and sweaty
GCS - mildly altered

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17
Q

Severe RSA

A

Appearance - anxious and fighting for breath potentially catatonic
Speech - single words or unable to speak
Sounds - unable to cough, (Asthma + or - inspo or expo wheeze or zero breath sounds) ( LVF full field crackles) upper airway obstruction = inspo stridor
RR - > 20 or bradypnoea < 8
Rhythm prolonged expiratory phase
WOB - full chest movement and all accessory muscles in use inc tracheal tug
HR >120 or Bradycardia is a late sign
Skin pale clammy sweaty and +- cyanosis
GCS altered or unconscious

18
Q

GCS eyes

A
    1. Opens (4) spontaneously
    1. Opens to voice (3)
    1. Opens to pain (2)
    1. None (1)
19
Q

Verbal GCS scoring

A
  1. Orientated (5)
  2. Confused (4)
  3. Inappropriate words (3)
  4. Inappropriate sounds (2)
  5. None (1)
20
Q

GCS Motor assesment

A
  1. Obeys commands (6)
  2. Localises to pain (5)
  3. Withdraws from Pain (4)
  4. Flexion to Pain (3)
  5. Extension to Pain (2)
  6. None (1)
21
Q

Clinical weights for Paed patient

A 
Newborn - 3.5kg 
3 month - 6 kg 
6 month - 8 kg 
12 month - 10 kg 
Above 1 is formula = Age x2 + 8 =
10 and 11 is x 3.3
22
Q

Paeds age parameters

A

Small infant < 3 months
Large infant 3-12 months
Small child 1-4 year old
Medium Child 5-11 year old

23
Q

Newborn (<24 hour) vitals

A

HR 110-170
SBP > 60
RR 25-60

24
Q

Small infant (upto 3 months)

A

HR 110-170
SBP > 60
RR 25 - 60

25
Q

Large infant (3-12 months)

A

HR 105 - 165
SBP > 65
RR 25- 55

26
Q

Small child (1-4 year old)

A

HR 85 - 150
SBP >70
RR 20-40

27
Q

Medium child (5-11)

A

HR 70 - 135
SBP >80
RR 16-34

28
Q

Secondary survey

A

Neuro
Cardiac
Respiratory
Git
Urinary
Skin
Trauma

29
Q

Secondary survey for Neuro

A

Dizzy
Headache
LOC
Pupils
Visual disturbance

30
Q

Secondary survey for Cardiac

A

Palpitations
Pain with breathing in

31
Q

Secondary survey for Resp

A

Px Cough
breathing difficulties

32
Q

Secondary survey for GIT

A

N&V
Soft to palpate
Distended
Pain to touch
BAs- Normal in freq, color, smell

33
Q

Secondary survey for Urinal

A

UTI symptoms
Pain when urinating
smell
color
Temps

34
Q

Secondary survey for Skin

A

Pale
Sweaty
Rash’s

35
Q

Secondary survey Trauma

A

Neuro Assessment
Limb Assessment
- P- Pain
- I - Irregularity
- L - Loss of movement of power
- S - Swelling
- D - Deformity
- U - Un natural movement
- C - Crepitus
- T - Tenderness
Neurovascular assessment

36
Q

MASS

A

Facial drooping
Bilateral grip push pull
Speech

37
Q

AEIOUTIPS

A

A- Alcohol
E - Epilepsy
I - Insulin
O - Overdose
U - Underdose
T - Trauma
I - Infection
P - Pain, Psychosis, Poison
S - Stroke

38
Q

RASH

A

Sudden onset of 2 or more of the following to a suspected exposure to a antigen (under 30 min upto 4 hr)
R - Respiratory distress
A - Abdomen symtoms
S - Skin
H - Hypotension

OR
Isololated respiratory distress with known exposure to a Known Antigen
OR
Isolated Hypotension SBP < 90 and exposure to a known antigen

39
Q

SIRS

A

2 of the following
Temp >38 or < 36
HR > 90
RR > 20
CO2< 32

40
Q

Stroke Mimics

A
  • Hyo/hyper glycaemia
  • Seizure
  • Migraine
  • Sepsis
  • Intoxication
  • Brain Tumor
  • Inner ear disorder (vertigo)
  • Subdural Haematoma
  • Syncope
  • Electrolyte disturbance
  • MS

CPG Key points and treatment (6 decks)

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