Conditions Flashcards
What conditions can mimic hypovolaemia?
- TPT
- significant pain
- environmental exposure (heat/cold)
What is the treatment for haemorrhagic hypovolaemia with a SBP >/= 70mmHg?
- tolerate hypotension without fluid replacement for up to 2 hours
- prepare for deterioration
What is the treatment for haemorrhagic hypovolaemia with a SBP < 70mmHg?
- Normal Saline 250mL IV
- repeat 250mL (max 2000mL)
- titrate to SBP >/= 70mmHg
What are the signs of a simple pneumothorax?
Any of the following:
- Unequal breath sounds in spontaneously ventilating patient
- SpO2 <92% on room air
- subcutaneous emphysema
A patient can be considered to have a serious blunt head injury if:
- Loss of consciousness >5mins
- skull fracture (depressed, open or base of skull)
- vomiting more than once
- neurological deficit
- seizure
What are the airway actions for a traumatic head injury?
- If airway patent, do not insert NPA or OPA
- If airway not patent, position airway, suction and NPA
- If gag is absent insert SGA
What are the ventilation actions for traumatic head injury?
- Vt = 6-7mL/kg
- SpO2 > 95%
- EtCO2 = 30 - 35mmHg
What is the perfusion action for a traumatic head injury?
- Normal Saline IV (max 40mL/kg)
- Aim for SBP > 120mmHg
What is the ideal BP for Isolated SCI?
> 90mmHg
- normal saline 10mL/kg IV
What are the 7 modified nexus criteria for spinal immobilisation?
- Age >/= 65
- Hx of bone or muscle weakening disease/injury
- Altered conscious state
- Intoxication
- Significant distracting injury
- Midline pain/tenderness on palpation of the vertebrae
- Patient is unable to actively rotate neck 45* left or right without pain
What are the principles of pre-hospital management of fracture/dislocation?
- Control external haemorrhage
- Apply good splinting practices
- Resolve neurological or vascular compromise where possible
- Use judicious analgesia
What are the 3 symptoms that make up Beck’s Triad for diagnosing pericardial tamponade?
- Low arterial pressure
- Distended neck veins
- Muffled heart sounds
How much blood can be lost from injuries to each of the following areas:
- Radius/ulna
- Humerus
- Tibia
- Femur
- Pelvic #/ Abdo blunt injury
Radius/ulna = 400mL Humerus = 800mL Tibia = 1000mL Femur = 2000mL Pelvic #/abdo blunt injury = 5000mL
What are the 4 main subtypes of shock and what is their basic pathology?
Cardiogenic shock - the heart doesn’t pump correctly
Hypovolaemic shock - there isn’t enough blood to pump around
Obstructive - there is something blocking the path of blood through the cardiovascular system
Distributive shock - there is a problem with the vessels of the cardiovascular system
What are the 3 components of the lethal triad?
- Coagulopathy
- Acidosis
- Hypothermia
When can a suspected TPT be decompressed?
GCS <10 and BP <70
What does the SMART acronym stand for?
S = second intercostal space M = mid-clavicular line A = above rib below R = right angle to the chest T = towards spinal column
What is the management for a flail chest segment?
- pad and tape/bandage
- stabilise to chest wall
- stop paradoxical movement
- pain management
What are the S&S of airway burns?
- Evidence of burns to upper torso, neck and face
- Facial and upper airway oedema
- Sooty sputum
- Burns that occurred in an enclosed space
- Singed facial hair (nasal hair, eyebrows, eyelashes, beards)
- Respiratory distress (dyspnoea +/- wheeze and associated tachycardia, stridor)
- Hypoxia
What is the treatment for a patient >15yrs with partial or full thickness burns to >15% TBSA?
- Normal saline
- % TBSA x Pt weight (kg) = vol (mL)
- admin over 2 hrs from time of burn
- Pain relief
- Cool the burn and warm the patient
- Apply appropriate dressing
What is the treatment for a patient 12-15yrs with partial or full thickness burns to >10% TBSA?
- Normal saline
- 3x %TBSA x Pt weight (kg) = vol (mL)
- admin over 24hrs from time of burn
- admin half of fluid over first 8hrs
- Pain relief
- Cool the burn and warm the patient
- Apply appropriate dressing
What is the treatment for a stable (GCS = 15) patient with a suspected diving related emergency?
- Position pt supine or lateral
- Mx nausea and vomiting
- Admin 10-15L O2 via non-rebreather
- Avoid rapid increase in body temp
- Tx to recompression chamber
- If adequately perfused and clear chest admin NS 1000mL over 15-20mins
- Continue NS every 4hrs
-If less than adequate perfusion, admin NS titrated to patient response (max.40mL/kg)
What is the treatment for an unstable (GCS < 15) patient with a suspected diving related emergency?
- Mx as per GCS 15
- Be aware of chest injuries
- Consider distance to recompression chamber
- If adequately perfused and clear chest admin NS 1000mL over 15-20mins
- Continue NS 1000mL every 4hrs
-If less than adequate perfusion, admin NS titrated to patient response (max. 40mL/kg)
What is the general care for patients with hypothermia?
- Shelter from wind in heated environment
- Remove all damp or wet clothing
- Gently dry patient with towels/blankets
- Wrap in warm sheet/blanket (cocoon)
- Cover head with towel/blanket (hood)
- Use thermal/space/plastic blankets above and below the patient if available
- Only warm frostbite if there is no chance of refreezing prior to arrival at hospital
- Assess BGL if altered conscious state
What are the ranges for mild, moderate and severe hypothermia?
- Mild = 32-35
- Moderate = 28-32
- Severe = <28
What is the treatment for a patient suffering from hypothermia?
- Normothermic NS 10mL/kg IV
- - Repeat NS 10ml/kg (max 40ml/kg)
What is the treatment for a patient suffering from hyperthermia with a temp of <40?
- Usually managed with basic cooling techniques alone such as:
- Shelter/remove from heat source
- Remove all clothing except underwear
- Ensure airflow over Pt
- Apply tepid water using spray bottle or wet towels
What is the treatment for a patient with significant dehydration and poor perfusion as the result of hyperthermia?
- Titrate NS to VSS and temp (max. 40mL/kg)
- If temp >40 use cool fluids (8 degrees)
- If cool fluids initiated, return to ambient temp once Pt temp is <39
- Rx low BGL
- Airway and ventilation support with O2 as required
What is the criteria for a suspected TPT?
- Increased resp distress
- Increased HR
- Increased JVP
- Increased peak inspiratory pressure (stiff bag)
- Decreased SpO2 despite being on oxygen
- Decreased conscious state
- Decreased BP
- Decreased EtCO2
- Tracheal shift
Which venomous animals require PBI?
- All land and sea snakes
- Funnel web spiders
- Blue-ringed octopus
- Cone shells
What is the treatment for all other species of spider?
- Ice packs for pain relief
- Simple analgesia for pain (paracetamol)
- Anti venom for redbacks (if systemic symptoms or severe pain)
What is the treatment for Stonefish and Lionfish envenomation?
- Wash and clean site
- Treat with hot water for pain relief (approx 20mins for up to 2hrs)
- Simple analgesics
- If analgesics and hot water do not have desired effect then antivenom should be administered
What is the treatment for bluebottle jellyfish stings?
- Wash site with seawater
- Remove tentacles with gloved hands
- Immerse in hot water for 20 mins
- NO vinegar
What is the treatment for an adult suffering from a crush injury?
- High flow O2
- Pain relief
- 20mL/kg/hr NS (open up IV just prior to release)
- Prepare for cardiac arrest after release
- Apply tourniquets if applicable and tighten just prior to release
What is the treatment for an elderly patient suffering from a crush injury?
- High flow O2
- Pain relief
- 10mL/kg/hr NS (open up IV just prior to release)
- Prepare for cardiac arrest after release
- Apply tourniquets if applicable and tighten just prior to release
