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CPG'S Flashcards

1
Q

ACS Guide line (Adult)

A

Aspirin 300 mg nil repeat
GTN - 600mcg or 300mcg repeat @ 5 mins
GTN patch 50 mg (0.4mg) NIL repeat

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2
Q

When do you remove the GTN patch from a pt ?

A

When the pt BP < 90

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3
Q

The absence of ischaemic signs on the ECG does not exclude AMI. True or False ?

A

True

AMI is diagnosed by presenting history, serial ECGs and serial enzyme tests

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4
Q

Asthma (Adult)
Sever Guide Line
Management Pt with sever Asthma ?

A

Salbutamol 10mg (5mL) repeat @ 5mins 5mg (2.5mL)
Ipratropium Bromide 500mcg (2mL)
Dexamethasone 8mg/IV

Inadequate response

  • No response to Neb Therapy
  • Speaking single words or acute life threat

Adrenaline 500mcg IM (1: 1,000)
repeat 500mcg IM at 5- 10mins intervals

If no response to IM Adrenaline, consult the Clinician for IV Adrenaline if the thunderstorm asthma 20 mcg at 2 min intervals

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5
Q

Asthma Mild or Moderate Guide Line (Adult)

Management for a Pt with Mild Asthma ?

A

Salbutamol pMDI and spacer
Deliver 4- 12 doses at 20 Min intervals
4 breaths for each dose

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6
Q

COPD Guide Line (Adult)

Management Pt who has COPD ?

A

Salbutamol 10mg (5mL)
Ipratropium Bromide 500mcg (2mL)
Dexamethasone 8mg/IV

Inadequate response after 10 Mins
Distress and RR > 24
MICA
CPAP ( commence with 7.5cm H20 )

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7
Q

Nausea and Vomiting Guide Line (Adult)

Management for a Pt with Nausea and Vomiting

A

Undifferentiated nausea and Vomiting
- Ondansetron 4 mg ODT orally
repeat 4mg after 5 - 10 mins if symptoms persist ( max 8 mg ODT, IV or in combination)

  • Ondansetron 8 mg IV
  • if known allergy or C/I to Ondanetron and > = 21 years, Prochlorperazine 12.5mg IM
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8
Q

Over dose Guide line (Adult)

Management for a Pt having a Heroin Overdose ?

A

Assist maintain airway/ ventilation
Naloxone 1.6mg - 2mg IM

Inadequate response after 10 minutes
Tx without delay 
Consider airway 
- Mx CPG A0301 Supra - Glottic Airway
Consider MICA Intubation
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9
Q

Over dose Guide line (Adult)

Management Pt having a Opioids overdose ?

A

Assist and maintain airway/ ventilation
Naloxone 100mcg IV
-Repeat Naloxone 100 mcg IV every 2 Minutes ( max. 2mg) until Pt is adequately self- ventilating

  • If unable to insert IV- Naloxone 400mcg IM ( single dose only)
  • Consider airway Mx CPG A0301 Supra - Glottic Airway
  • Tx without delay
  • ConSider MICA Intubation
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10
Q

Over dose Guide line (Adult)
What do we have to STOP and make sure before entering the scene

What do we need to ASSESS on this pt before we treat for Opioid OD ?

A

Stop
Ensure Personal / crew safety
Scene may have concealed syringers

Assess
Exclude other causes of Altered consciousness
Confirm Clinical signs of Opioid OD
Assess most likely substances(s) involved

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11
Q

Seizures Guide line (Adult)

Pt having Generalised Convulsive SE. Management CPG

A

Manage airway and ventilation as required
If airway patent administer high-flow 02 as per O2 CPG
Midazolam 10 mg IM

  • Small (< 60kg ) frail or elderly Pt should be admin
    Midazolam 5 mg IM, repeat once at 5 Min interval if required

No response after 10 min
-If Pt had full dose initially ( not small / frail / elderly) repeat Midazolam 10 mg IM once only
Consult for further doses
Monitor airway / ventilation, conscious state and BP

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12
Q

Seizures Guide line (Paed)

Management Generalised Convulsive SE

A

Mx airway and ventilation as required
If airway patent, admin High-flow 02
Midazolam IM
- Medium Child ( 5- 11 years) Midazolam 2.5- 5 mg IM
-Small child ( 1- 4 years ) Midazolam 2.5mg IM
- Small & Large Infant ( <12 months) Midazolam 1 mg
-Newborn Midazolam 0.5mg
Contine to montitor airway, Ventilation, conscious state and BP

Seizure activity continues > 10

  • Repeat original Midazolam IM dose once only
  • Consult for further doses
  • Continue to monitor air way, ventilation conscious state and BP
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13
Q

Seizure
General notes
Status Epilepticus (SE) refers to

A

Either = > 5 minutes of continuous seizure activity OR multiple seizures without full recovery of consciousness (ie back to baseline )between seizures

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14
Q

Seizure ( General notes )

Consider other causes e.g

A 
Hypoglycaemia,
Hypoxia,
Head Trauma, 
Stroke ? ICH,
Electrolyte disturbance, 
Meningitis
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15
Q

Croup Guide Line

Moderate

A

Dexamethasone 600mcg/ Kg Oral ( Max 12 mg)

  • Tx
  • Rx and Severe if deteriorates
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16
Q

Croup Guide Line

Pt with Severe croup mx

A
  • Adrenaline 5mg ( 5mL) Nebulised (1:1,00)
  • Dexamethasone 600mcg/ kg Oral ( Max 12 mg)

If unimproved

  • Repeat Adrenaline as above at 5 min intervals until improvement
  • Continue to Monitor Pt
  • Tx
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17
Q

Croup Severe Signs

A
  • Increasing respiratory distress
  • Increasing Lethargy
  • Decreasing stridor
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18
Q

Tricyclic Antidepressant Signs and Symptoms Of TCA Toxicity

Severe toxicity

A
  • Coma
  • Respiratory depression / hypoventilation
  • Conduction delay
  • PVCs
  • SVT
  • VT
  • Hypotension
  • Seizures
  • ECG changers

This could lead to aspiration, hyperthermia, rhabdomyolysis and APO

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19
Q

Hypoglycaemia Guide Line : (Adult)

BGL < 4 Not responding to commands

A 
Actions
-IV cannula in large vein
-Dextrose 10% 15g (150mL) IV
  - Normal Saline 10mL flush
If GCS or BGL not returned to normal after 5- 10 min:
  • Dextrose 10% 10g (100mL) Iv titrating to effect
    If unable to insert IV:
    -Glucagon 1 IU IM
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20
Q

Hypoglycaemia Guide Line : Adult

Why do we need to insure IV is patent before administering Dextrose ?

A

Extravasation of Dextrose can cause tissue necrosis

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21
Q

Hypoglycaemia Guide Line : Adult

All IVs should be well flushed before and after Dextrose administration. Whats the minimum amount ?

A

10mL Normal Saline

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22
Q

Hypoglycaemia Guide Line : Adult

The median time to restoration of normal conscious state after the administration of Dextrose IV can vary from ?

A

5 to 15 minutes. A slow response exceeding 15 minutes can also occur occasionally

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23
Q

Hyperglycaemia Guide Line : Adult

Diabetic ketoacidosis signs

A

Any Pt with

  • a pre-existing Hx of diabetes
  • BGL > 11 mmol/L, and
  • Clinical features of DKA (e.g. confusion, signs of dehydration, Kussmaul’s breathing) should be transported to hospital for further investigation
24
Q

Hyperglycaemia Guide Line : Adult

Evidence of possible hyperglycaemia . Signs and symptoms

A
  • Confusion
  • Tachypnoea
  • Polyuria (excessive or abnormally large amounts of urine)
  • Dehydration
  • Polydipsia (is excessive thirst or excess drinking)
  • Kussmaul’s breathing
25
Hyperglycaemia Guide Line : Adult | BGL >11 mmol/L
Normal Saline 20 mL/ kg Iv titrated to perfusion statues - Consult if further doses are required to maintain adequate perfusion - Consider reduced fluid volume for elderly or impaired renal / cardiac function - Consider antiemetic
26
Head injury Pt assessment
``` 5 - LOC > 5/60 H - Hematoma / bruising , Lac on head E - Emesis more than once A - Anticoagulants D - deficits, Neurological S - Seizure activity ```
27
Stroke Mimics
``` Migraine Electrolyte Disturbance Syncope Subdural Haematoma Intoxication Sepsis Hypo/ Hyperglycaemia Inner ear Disorder Tumour Seizures ```
28
COPD Guide Line (Adult) | Salbutamol repeat does and at what time
Nil repeat does | Inadequate response after 10 mins CPAP
29
COPD Guide Line (Adult) | Indications for CPAP (MICA)
-SP02 of < 90 % on room air (or < 95% on supplemental 02) MICA Skill
30
Over dose Guide line (Paed)
Assist and maintain airway /ventilation -Naloxone 10 mcg/kg (max 400 mcg) IM Inadequate response after 10 mins Repeat Naloxone 10 mcg/kg (max 400mcg) IM
31
Over dose Guide line (Pead) | Consideration of 3 other differentials?
Head injury Hypoglycaemia Polypharmacy OD
32
Nausea and Vomiting Guide line (Paed ) | Indications for giving an Anti- emetic
Nausea and vomiting Potential spinal injury Potential eye trauma
33
Nausea and Vomiting Guide line (Paed ) | Undifferentiated nausea and vomiting
Ondansetron ODT orally - Small child - 2mg - Medium child - 4mg
34
Nausea and Vomiting Guide line (Paed ) | Porphylaxis for
- Awake Pt ( GCS 13-15) with potential spinal injuries and immobilised - Eye trauma - e.g penetrating eye injury or hyphema . is a pooling or collection of blood inside the anterior chamber of the eye Ondansetron ODT orally - Small child - 2mg - Medium child - 4mg
35
Nausea and Vomiting Guide line (Pead ) | undifferentiated nausea and vomiting may include
- secondary to opioid analgesia - secondary to cytotoxic drugs or radiotherapy - severe gastroenteritis
36
Asthma Guide line (Paed ) | Severe
Nebulised Salbutamol -Small children 2-4 years Salbutamol 2.5mg (1.25mL) Nebulised -Medium Children 5-11 years Salbutamol 2.5mg - 5mg (1.25 - 2.5mL) Nebulised Repeat at 20 minute intervals if required Ipratropium Bromide 250 mcg (1mL) Nebulised
37
Asthma Guide line (Paed ) | Mild and Moderate
Salbutamol pMDI and spacer - 6 years and greater Salbutamol 4 - 12 doses - 2 - 5 years Salbutamol 2 - 6 doses - Pt to take 4 breaths for each dose - Repeat at 20 minute intervals if required
38
Asthma Guide line (Paed ) | Critical
Nebulised Salbutamol - All children (2 - 11 years) Salbutamol 10 mg ( 5mL) Neb - Repeat Salbutamol at 5 mins intervals if required Ipratropium Bromide 250 mcg (1mL) Neb Adrenaline 10 mcg/Kg IM (1:1000) -repeat at 5 - 10 mins intervals as required ( max 30 mcg/kg IM) Dexmethasone 600mcg/kg IV/ Oral ( max 12 mg)
39
Small Infant Values
< 3 Months HR 110 - 170 SBP >60 RR 25 - 60
40
Small Child Values
1-4 HR 85 -150 SBP > 70 RR 20 - 40
41
Pain relief guide line (Adult) Moderate pain Morphine IV, IM
Morphine up to 5mg IV - repeat up to 5mg at 5 intervals consult after 20mg IV ``` Severe pain IM 10 mg - repeat 5mg after 15 minutes if required ( once only) OR 0.1 mg/kg ( <60kg / frai / elderly) -No repeat dose ```
42
Pain relief guide line (Adult) Moderate pain Fentanyl IV, IN, IM
Fentanyl up to 50mcg IV ( if specifically indications) - repeat up to Fentanyl 50 mcg IV at 5 minute intervals (consult after 200mcg IV) Fentanyl 200 mcg IN -Repeat up to Fentanyl 50 mcg IN at 5 minute intervals (Max. 400 mcg IN) OR Fentanyl 100mcg IN (weight < 60kg or frail or elderly) -repeat up to 50 mcg IN at 5 minute intervals ( Max. 200mcg IV) IM - 100 mcg - repeat up to 50 mcg after 15 minutes if required ( once only) Or - 1 mcg/Kg ( < 60 kg / frail / elderly - No repeat dose
43
Pain relief guide line (Adult) | Ketamine
IN 75mg - Repeat 50 mg at 20 minute intervals - No max dose OR 50 mg ( <60 kg / frail / elderly ) - Repeat 25 mg at 20 minute intervals - No max dose
44
Agitated Patient Guide Line ( Adult) Mild agitation (SAT score +1)
Olanzapine 10mg ODT orally - Administer lower dose (5mg ODT orally) for frail.elderly weight <60kg, or significant effect from sedating drug /alcohol involvement - Repeat dose after 20 minutes if Pt remains .
45
Oxygen Therapy Guide Line ( Adult ) | Pt with a Critical illnesses that receive Oxygen
``` Cardiac arrest or resuscitation Major trauma / head injury Shock Severe sepsis Anaphylaxis Status epilepticus Ketamine sedation ``` Action Initial Mx -Initial dose nonrebreather mask 10-15L/min -If inadequateVt consider BVM ventilation with 100%O2 Once Pt haemodynamically stable and has reliable oximetry reading -Titrate O2 flow to SpO2 of 92 - 96% If Pt deteriorates or SpO2 remains <85% - BVM ventilation with 100% O2 - Consider SGA
46
Oxygen Therapy Guide Line ( Adult ) | Sever hypoxaemia Sp02 of ?
SpO2< 85%
47
Oxygen Therapy Guide Line ( Adult ) | Mild - Moderate Sp02 rage ?
85 - 91%
48
Oxygen Therapy Guide Line ( Adult ) | Chronic Hypoxaemia conditions
- COPD - Neuromuscular disorders - Cystic Fibrosis - Bronchiectasis - Sever Kyphoscollosis - Obesity
49
Oxygen Therapy Guide Line ( Adult ) | Pt with Chronic Hypoxaemia treat is as pre Oxygen cpg ?
``` -Titrate 02 flow to Sp02 of 88 -92 % If no critical illness presents -initial dose of 2-6L/min via nasal cannulae -Consider simple face mask 5 - 10 L/min If Pt deteriorates or Sp02 remains <85% -Rx as per severe hypoxaemia ```
50
Oxygen Therapy Guide Line ( Adult ) Oxygen for Pt Regardless of Sp02 %
- Toxic inhalation exposure - Decompression Illness - Cord Prolapse - Postpartum haemorrhage - Shoulder dystocia - Cluster headache (Headaches that occur in patterns or clusters Pain is severe on one side of the head, accompanied by symptoms such as nasal discharge or red or tearing eyes.) Action -O2 via nonrebreather mask 10 - 15
51
When is CPR indicted on an Infants when a HR is less than < 40 < 60 < 50
< 60
52
Pea reversible casuses
``` Tension pneumothorax Upper airway obstruction Exsanguination Asthma Anaphylaxis Hypoxia ```
53
6 year old 4 joules/kg
80j Round up to 85j
54
Paediatric cardiac arrest with NO ETT/ SGA what the Compression rate and Ventilations for 2 and 1 person crew
15 Compression 2 Ventilations | 30 Compression 2 Ventilations ( Single Officer )
55
Paediatric cardiac arrest with with ETT/ SGA what the Compression rate and Ventilations for 2 and 1 person crew
10 Ventilations pre minute | No pause for ventilation

CPG (2 decks)

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