CPGs Flashcards
Adrenaline Pharmacology
Alpha- and beta-adrenergic agonists
Beta 1: Increases HR, increases conduction velocity through AV node, increases myocardial contractility and increases irritability of the ventricles
Beta 2: Causes bronchodilatation
Alpha: Causes peripheral vasoconstriction
Contraindications and Precautions Adrenaline
Contra: Hypovolamic shock without adequate fluid replacement
Precaution: Elderly patients, pts with cardiovascular disease, pts on monoamine oxidase inhibitors, if pt beta blocked higher dosage may be required
Metabolism + Excretion of Adrenaline
By monoamine oxidase and other enzymes in the blood, in the liver and around nerve endings, and is excreted by the kidneys
Side Effects Adrenaline
Sinus tachycardia, supra-ventricular arrhythmia’s, ventricular arrhythmia’s, hypertension, papillary dilatation, may increase size of MI, anxiety / palpitations, muscle tremour
Aspirin Pharmacology
An analgesic, antipyretic, anti inflammatory and anti plate agent - which reduces platelet aggregation and inhibits synthesis of prostaglandins which has anti inflammatory actions
Metabolism and Excretion Aspirin
Converted to salicylate in the gut mucosa and liver, excreted mainly by the kidneys
Contraindications and Precautions Aspirin
Contras: hypersensitivity to aspirin / salicylates, actively bleeding peptic ulcer, bleeding disorders, suspected dissecting AAA, chest pain associated with psychostimulant overdose of BP >160
Precautions: peptic ulcer, asthma, on anticoagulants
Side effects aspirin
Heartburn, nausea, GI bleeding, increased bleeding times, hypersensitivity reactions
Why is aspirin contraindicated for use in active febrile illness for those under 12 years old?
It may lead to renal function impairment and Reye’s syndrome
Ceftriaxone Pharmacology
Cephalosporin Antibiotic
Ceftriaxone Metabolism and excretion
Excreted unchanged in urine and in bile
Contraindications Ceftriaxone and Precautions
Contra: Allergy to cephalosporin antibiotics
Precaution: Allergy to penicillin antibiotics
Side effects Ceftriaxone
Nausea and vomiting, skin rash
What alterations are made to ceftriaxone IM and IV administration?
IV: make up to 10ml per 1g and administer over 2 minutes
IM: Make up to 4ml per 1G and must be administered to lateral upper thigh.
Dexamethosone Pharmacology
A corticosteroid secreted by the adrenal cortex, it relieves inflammatory reactions and provide immunosuppresion.
Metabolism and excretion Dexamethasone
Metabolised by the liver and excreted predominantly by the kidneys
Contraindications and Precautions of dexamethasone
Contra: known hypersensitivity to dexamethasone or other corticosteroids
Precautions: usually only relevant with prolonged use and high dosages
Side effects Dexamethasone:
Except for allergens. adverse effects are usually only associated with prolonged use and high dosages
Diazapam Pharmacology
Member of the benzodiazapam family, inhibits anxiolytic, muscle relaxant and sedative effects. muscle- relaxant, a Most of these effects are thought to result from a facilitation of the action of GABA (The allosteric binding increases the frequency at which the chloride channel opens, leading to an increased conductance of chloride ions. This shift in charge leads to a hyperpolarization of the neuronal membrane and reduced neuronal excitability)
Metabolism / Excretion diazepam
Diazepam is metabolized in the liver to its active metabolite which is excreted in the urine as inactive metabolite
Contraindication / Precautions Diazepam
Contra: Known allergy to benzodiazapines and myasthenia gravis
Precaution: CNS depression or ingestion of CNS depressing agents, hypotension,
children and elderly, impaired renal or hepatic function, respiratory insufficiency
Define Myasthenia gravis
A chronic autoimmune, neuromuscular disease that causes weakness in the skeletal muscles
Side effects diazepam
Extrapyramidal reactions, drowziness, bradycardia, respiratory depression, hypotension
What are extra pyramidal reactions?
Drug-induced movement disorders aincluding dystonia, akathisia, and parkinsonism.
Droperidol Pharmacology
Antipsychotic - inhibits dopamine mediated neurotransmission in the cerebrum and basal ganglia, also inhibits the chemoreceptor trigger zone in the medulla
Contraindications / Precautions Droperidol
Contras: Known allergy, parkinsons disease, previous dystonic reaction to droperidol, patients under 8 years old
Precautions: Concomitant use of CNS depressants
Metabolism / Excretion Droperidol
Hepatic metabolism with bilary / renal excretion as inactive metabolites
Side effects Droperidol
Extrapyramidal reactions,
Fentanyl Pharmacology
A synthetic narcotic analgesic. IT binds to opioid receptors, especially the mu opioid receptor, which are coupled to G-proteins. Activation of opioid receptors causes GTP to be exchanged for GDP on the G-proteins which in turn down regulates adenylate cyclase, reducing concentrations of cAMP. Reduced cAMP decreases cAMP dependant influx of calcium ions into the cell. The exchange of GTP for GDP results in hyperpolarization of the cell and inhibition of nerve activity. Decreased conduction velocity of AV node
Side effects Fentanyl
Sedation, respiratory depression, apnoea, rigidity of diaphragm and intercostal muscles, bradycardia
Fentanyl metabolism / excretion
Metabolised by the liver and excreted by the kidneys
Contras / Precautions Fentanyl
Contras: Known hypersensitivity, active labour, epistaxis or occluded nasal passages (IN admin), Patients <1 years olf
Precautions: Eldery Patients, resp depression (eg COPD), current asthma, known addiction to narcotics, Monoamine Oxidase inhibitors
Glucagon Pharacology
A hormone normally secreted by the pancreas. Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose. Has weak chronitropic and inotropic effect.
Glucagon metabolism
Metabolized by the liver, the kidneys and in the plasma.
Contras / precaution s glucagon
NIL of significance
Side effects glucagon
Nausea and vomiting
Glucose solution 10% Pharmacology
A slightly hypertonic crystalloid solution composed of 10% dextrose and 90% water
Metabolism glucose solution 10%
Glucose is broken down in most tissues, and stored in the liver and muscles as glycogen
Contras / precautions glucose 10% solution
NIL of significance
Glyceryl trinitrate GTN pharmacology
A vascular smooth muscle relaxant. Venous dilatation premotes venous pooling and reduces venous return to the heart (reduces preload). Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces afterload)
GTN metabolism
In liver
GTN contras / precautions
Contras: known hypersensitivity, Sys BP <100 for buccal, sys BP <120 for IV, Viagra, levetra in past 24 hours or cialis past 4 days, HR >150, HR <50 (excluding autonomic disreflexia, VT, right ventricular infarct
Precautions: No previous admin, elderly pts, recent AMI, inferior STEMI with sys BP <160, avoid skin contact with concentrated solution, always reduce BP slowly rather than aggressively
Side effects GTN:
Tachycardia, hypotension, headache, skin flushing, bradycardia
Ibuprofen Pharmacology
Non-selective NSAID that inhibits the synthesis of prostoglandins and COX. This results in analgesia, anti-inflammatory and antipyretic effects
Metabolism / excretion ibuprofen
Metabolised by liver and excreted by the kidneys
Contras / Precautions Ibuprofen
Contras: heart failure / cardiovascular disease, pregnancy 3rd trimester, pts taking anticoags, renal disease, current bleed GI bleeding or peptic ulcer, severe renal impairment, children <3 months
Precautions: asthma, previous hx GI bleeding or peptic ulcers, dehydration / hypolvolamia / diuretic treatment, elderly, chicken pox
Side effects ibuprofen
nausea, dyspepsia, GI bleeding, dizziness
Ipratropium bromide Pharmacology
Anticholinergic bronchodilator. Allows bronchodilation by inhibiting cholinergic bronchomotot tone (blocks vagal reflexes which mediate bronchocontriction)
Metabolism and Excretion Ipratropium Bromide
Metabolised in the GI tract, excreted by the kidneys
Contras / Precautions Ipratropium Bromide
Contras: Allergies to atropine or its derivatives
Precautions: Glaucoma, avoid contact with eyes
Side Effects Ipratropium Bromide
Headache, nausea, dry mouth, skin rash, tachycardia, palpitations, acute angle closure glaucoma secondary to direct eye contact
Lignocaine Hydrochloride Pharmacology
A local anaesthetic agent. Prevents initiation and transmission of nerve impulses causing local anaethesia
Metabolism Lignocaine Hydrochloride
Metabolised 90% liver, excreted 10% unchanged in the kidneys
Contraindications / Precautions Lignocaine
Contras: Known hypersensitivity, bradycardia with inadequate perfusion, evidence of a second or third degree heart block
Precaution: Only IM admin due to potential CNS complications
Methoxyflurane pharmacology
Inhalational analgesic agent at low concentrations. CND depressant
Methoxyflurane Contras / Precautions
Contras: Prexisting renal disease / impairment, concurrent use of tetracycline antibiotics, exceeding total dose of 6ml in 24 hours or 15 ml in seven days, family history or anesthetic induced malignant hyperthermia
Precautions: Must be handheld by pt, preeclampsia
Side Effects methoxyflurane
Drowziness, decrease in BP and HR (rare), exceeding maximum dose may lead to renal toxicity
Metoclopromide Pharmacology
Metoclopramide is an antiemetic and dopamine receptor antagonist. Accelerates gastric emptying and peristalsis
Metabolism / Excretion Metoclopromide
Metbolised by the liver and excreted by the kidneys
Contras / Precautions Metoclopromide
Contras: GIT haemorrage, obstruction or perforation, known sensitivity or intolorance, <16 years of age
Precautions: Undiagnosed abdominal pain
Side Effects metoclopromide
Drowziness, lethargy, dry mouth, muscle tremour, hypotension / Hypertension. extrapyramidal reactions, lowers the seizure threshold
Midazolam Pharmacology
CND depressant of the benzodiazapine class. Benzodiazepines enhance the inhibitory action of the amino acid neurotransmitter gamma-aminobutyric acid (GABA). Antianxiolytic, sedative and anti-convulsant properties.
Contras / Precautions Midazolam
Contras: Known hypersensitivity to benzodiazapines
Precautions: reduced dosage may be required for the elderly, chronic renal failure, CCF or shock, The CND deppressants effects are enhanced in the presence or narcotics or alcohol, can cause severe resp depression in pts with COPD, pts with mysthenia gravis
Side effects midazolam
Depressed level of consciousness, resp depression, loss of airway control, hypotension
Morphine Pharmacology
A narcotic analgesic.
Morphine binding to opioid receptors blocks transmission of nociceptive signals, signals pain-modulating neurons in the spinal cord, and inhibits primary afferent nociceptors to the dorsal horn sensory projection cells.
Contraindications / Precautions Morphine
Contras: Known hypersensitivity, labour
Precautions: Elderly, hypotension, resp depression, current asthma, resp tract burns, known addiction to narcotics, acute alcholism, pts on monoamine oxidase inhibitors
Morphine metabolism / excretion
Metabolised by the liver and excreted by the kidneys
Morphine Side Effects
CNS effects: Drowziness, resp depression, euphoria, N+V, pin-point pupils, addiction
CV effects: Hypotension, bradycardia
Naloxone Pharmacology
A narcotic antagonist. It is a competitive inhibitor of the opioid receptor. Naloxone antagonizes the action of opioids, reversing their effects.
Metabolism Naloxone
Metabolised in the liver
Contras / Precautions Naloxone
Contras: Nil
Precautions: If pt is dependant on narcotics they may become combative after admin, neonates
When should naloxone not be administered?
Following a narcotic assoiciated cardiac arrest or following a head injury
Ondansatron Pharmacology
A seretonin 5-HT3 receptor antagonist. Effects are on both central and peripheral nerves. It reduces the activity of the vagus nerce, thereby inhibits the vomiting centre in the medulla oblongata, and also blocks serotonin receptors in the chemoreceptor trigger zone
Contras / Precautions Ondansatron
Contras: Known hypersensitivity, children <2 years old
Precautions: impaired hepatic function, elderly, pregnancy, lactation
Metabolism / Excretion Ondansatron
Metabolised by liver and excreted by the kidneys
Side Effects Ondansatron
Headache, skin flusing, extrapyramidal effects, arrhythmia
Pharmacology Normal Saline
An isotonic crystalloid solution
Contras / Precautions oxygen admin
Contras: Known paraquat poisoning, lung disease secondary to bleomycin therapy
Precautions: Prolonged admin to neonates, high concentrations given to COPD patients, FIre and or explosive hazard
Paracetamol Pharmacology
An analgesic aand antipyretic agent. Exact mechanism unclear but thought to inhibit prostaglandin synthesis in the CNS
Metabolism / Excretion Paracetamol
Metabolised by the liverand excreted by the kidneys
Contras / Precautions Paracetamol
Contras: Known hypersensitivity, children <1 month of age, paracetamol admin within past 4 hours, Total paracetamol within past 24 hours >4G adult of 60mg/kg child, chest pain in suspected ACS
Precautions: Hepatic or renal dysfunction, elderly / frail, malnourised
Side Effects Paracetamol
Hypersensitivity reactions or hematological reactions (both rare)
Prochlorperazine Pharmacology
Antiemetic which acts on several central neuro-transmitter systems.
Metabolism / Excretion Prochlorperazine
Metabolised by the liver and excreted by the kidneys
Contras / Precautions Prochlorperazine
Contras: Circulatory collapse, CNS depression, previous hypersensitivity, children <2 years of age
Precautions: Hypotension, epilepsy, Pts effected by alchohol or on anti-depressants
Side Effects prochlorperazine
Drowzinessm blurred vision, hypotension, sinus tach, skin rash, extrapyramidal reactions, tardic dyskinesia may develop in pts on antipsychotic drugs
Salbutamol Pharmacology
A synthetic beta-adrenergic stimulant, with primarily beta 2 effects
Salbutamol Metabolism / Excretion
Metabolised by the liver and excreted by the kidneys
Salbutamol contras / Precautions
Contras: Nil
Precautions: Diabetes, cardiac disease, pregnancy / lactating mothers, between doses oxygen must be administered continuously, large doses of IV salbutamol have been reported to cause metabolic acidosis
Salbutamol Side Effects
SInus tachycardia, muscle tremour
Weight ranges for igels (5,4,3,2.5,2,1.5,1
5: >90 kg
4: 50 -90kg
3: 30-60kg
2.5: 25-35kg
2: 10-25kg
1.5: 5-12kg
1: 2-5kg
Contraindications igel
Intact gag reflex or resistance to insertion.
Strong jaw tone and/or Trismus.
Suspected epiglottitis or upper airway obstruction
Precautions iGel
Inability to prepare the patient with the external auditory meatus aligned with
the sternal notch.
Patients who require high airway pressures e.g. morbid obesity, pregnancy,
decreased pulmonary compliance (stiff lungs due to pulmonary fibrosis) or
increased airway resistance (severe asthma).
Significant volume of vomit in airway
Indications iGel
Cardiac Arrest.
Unconscious patients without gag reflex.
Ineffective oxygenation with bag valve mask and basic airway management.
Unable to intubate/difficult intubation.
Assisted ventilation required for > 10 minutes.
Indications Modified Valsalva
Haemodynamically stable Supraventricular Tachyarrhythmia’s i.e. SVT in line
with CPG A0403
Contraindications Modified Valsalva
Haemodynamically unstable requiring immediate synchronised cardioversion
(Systolic BP <90 mmHg)
AF/A Flutter
Third Trimester Pregnancy
AMI
Aortic stenosis
Coronary artery stenosis
Precautions Modified Valsalva
Syncope
Prolonged hypotension may occur
What occurs in 4 phases of modified Valsalva
o Phase one – a transient increase in aortic pressure and a compensatory decrease in heart rate, due to increased intrathoracic pressure generated during forced exhalation against resistance.
o Phase two – the end of the transient period, with a decrease in aortic pressure as a consequence of reduced venous return and hence cardiac output, with baroreceptor response leading to increased heart
rate.
o Phase three – the end of the strain phase of the Valsalva manoeuvre, with further decrease in aortic pressure and compensatory rise in heart rate.
o Phase four – increased venous return accentuated by raising legs leading to increasing aortic pressure and compensatory decrease in heart rate, with subsequent return to resting heart rate.
Effects of modified valsalva
The Valsalva manoeuvre increases vagal tone, slow conduction through the
atrioventricular (AV) node and prolongs the AV nodal refractory period,
leading to a reduction in heart rate and reversion of supraventricular
tachycardia.
Indications and sites IO
For adult and paediatric (>1y) patients in cardiac arrest where vascular access
is difficult to obtain or there will be a delay in obtaining.
o Adult insertion sites: Proximal humerus, proximal tibia or distal tibia.
o Paediatric insertion sites: Proximal humerus, proximal tibia, distal tibia or distal
femur.
Contraindications IO
- Fracture of the targeted bone.
- Previous, significant orthopaedic procedures at insertion site (e.g. prosthetic limb or joint).
- IO in the targeted bone within the past 48 hours.
- Infection at area of insertion.
- Excess tissue or absence of adequate anatomical landmarks.
What landmarks do you align pelvic binder with
Align the top edge of the Belt at the level of the iliac crest.
Alternatively the Belt can be cantered at the level of the
greater trochanters.
Contras CT7
- Knee or ankle/foot trauma: May increase pain and worsen other injuries.
Precautions CT7
- Pelvic trauma: Pelvic splinting is a higher clinical priority than splinting of limb factures.
Traction splints may apply pressure on the pelvis in order to achieve traction, potentially
worsening an injury. Legs should be realigned as part of open book fracture management.
Splinting can still be used in pelvic trauma/fracture without gross deformity though anatomical
splinting may be better depending on pelvic injury and severity. - Compound fractures: Open fractures with exposed bone should be irrigated with a sterile
isotonic solution prior to realignment and splinting.
Define Primary and Secondary Post Partum haemorrage
Primary: 600ml within the first 24 hours
Secondary: Excessive haemorrhage from 1 day to 6 weeks post partum
Signs and Symptoms of Preeclampsia
Hypertension BP sys >140 and dias >90
headache
visual disturbances
nausea and or vomiting
dizziness
At what temperature is cardiac arrhythmia associated with hypothermia
33 degrees and below
How to handle and position hypothermic patients
Handle gently and position flat or lateral. Avoid head up position
Warmed fluid for hypothermia should be what temperature
Between 37 and 42 degrees
Temperatures for mild, moderate and severe hypothermia
Mild:32-35
Moderate: 28-32
Severe: <28
Fluid therapy for hypothermia patients <32 degrees
Warmed fluids 10ml/kg to max of 40ml/kg
Drug dosages alterations for hypothermic cardiac arrest
> 32 normal
30-32 double dosage intervals + do not warm above 33 if ROSC
<30 continue CPR and warming until tempt >30, one defib and one adrenaline only
BP and HR aims in fluid therapy for hypovolaemia
HR <100 BP >100
Fluid therapy for pts with isolated neurogenic shock
500ml Normal saline bolus only
Aim of fluid therapy for pt with penetrating trunk injury, suspected AA or uncontrolled haemorrage
Accept palpable carotid pulse with adequate conscious state
Fluid dosage for hypovolamic patient with either isolated tachycardia or hypotension BP <100
HR>100: 20ml/kg
BP<100: 20ml/kg
What is the narcotic drug of choice for traumatic brain injury
Fentanyl
Fluid dosage for partial of full thickness burns >10%
2ml/kg x % burn over first 8 hours
Wallace rule of 9s burns
Head and Neck: 9% (Front and back of the head each account for 4.5%)
Upper Limbs (Each Arm): 9% (Front and back of each arm each account for 4.5%)
Chest: 18% (Front of the chest and abdomen each account for 9%)
Back: 18%
Lower Limbs (Each Leg): 18% (Front and back of each leg each account for 9%)
Genitalia: 1%
Crush syndrome management less than 30 mins and over 30 mins
Less than 30 mins or involving torso and head immediately remove
More than 30 mins establish IV access 500ml normal saline and cardiac monitor prior to removal
Barotrauma / Gas Embolis
Arrises from gas expansion in body cavities
Assess for CAGE (Cerebral Artery Gas Embolis) - sudden LOC or other CNS symptoms after rapid ascent
Decompression Sickness
More gradual onset usually post dive. 0-36 hours post diving
Symptoms: generalsied aches, headache. SON, rash, joint pain, parethesia, paralysis, seizures, unconcious
Management diving emergency
Keep pt supine, normal saline 1000ml then medical consult, tx avoid high altitudes.
Treatment for N+V associated with cardiac chest pain, Iatrogenic secondary to narcotic analgesia, severe gastroenterteritis or previously diagnosed migraine
Metoclopromide 10mg IV/IM, repeat at 10 mins
AND/OR
Ondansatron 4mg IV/IM, repeat at 10 mins
Treatment prophylaxis for potential motion sickness or planned aeromedical evacuation
Prochlorperazine 12.5mg IM and Ondansatron 4mg IV
Treatment prophylaxis for eye trauma or patients with suspected spinal injuries who are immobilised
Ondansatron 4mg , repeat 10mins
Treatment BGL<4
If responding to comands 15G oral glucose
If not responding to commands or no response to oral glucose large bore cannula 15G / 150ml glucose with 10ml saline flush, repeat 10G / 100ml every 10 mins until BGL>4
OR Glucagon 1mg IU IM
What is DKA charactorized by
Hyperglycaemia
Ketosis
Metabolic acidosis
What is HHS characterized by
Hyperglycaemia
Hyperosmolarity
Severe Dehydration
What is euglycemic ketoacidosis
A condition where a patient blood glucose is normal but they have elevated ketones. Most likely to occur in pregnant patients, patients on low carb diets or patients taking SGLT2i medications (anti-hyperglycamic - dapagliglozin, empagliflozin, ertugliflozin).
Management of hyperglycemia
If ketones <0.6 - 20ml/kg fluid if pt is dehydrated, if ketones >0.6 - 20ml/kg fluid if pt is dehydrated. Pt with ketones over 0.6 must be transported.
Exclusion criteria for nonconvey diabetic emergencies
Post hypo and alone, unable / unwilling to eat post hypo, pregnancy, moderate/severe dehydration, no diagnosed hx diabetes, pt taking steroids, chronic alcoholics, blood ketone level >0.6
Blood ketone assessment guide
Normal <0.6
Normal 0.6-1.5
Moderate 1.6-3.0
Severe >3.0
Management continuous .recurrent seizures
> 60 years old: Midazolam 0.05mg/kg max single dose 10mg IM
<60 years old: Midazolam 0.1mg/kg max single dose 10mg IM
Repeat initial dose at 10 mins
Preferred location for IM admin of adrenaline in anaphylaxis?
Antereo-lateral mid-thigh due to improved absorption
Treatment for pts persistantly unresponsive to adrenaline (especially if taking beta blockers)
Consult for 1-2 IU of Glucagon IM or IV
Treatment for anaphylaxis
500mcg Adrenaline IM at 5 min intervals
10mg salbutamol neb with repeat 5mg @ 5 mins if required for bronchospasm
20ml/kg normal saline IV fluid resus
5mg nebulised adrenaline for upper airway oedema
What are the SIRs criteria
2 or more of:
Temp>38 or <36
HR>90
RR>20
BP<90
Suspected Sepsis Inadequate perfusion Treatment
Normal Saline 20ml/kg if poor perfusion
If prolonged transport time exists, consult for ceftriaxone and dexamethasone (dosage on consult)
Criteria for admin of ABX in Meningococcal disease
History suggestive of infection and any of:
Altered level of conciousness
Meningeal irritation (neck stiffness, photophobia)
Non blanching petechial rash
Treatment suspected meningococcal disease
If IV access: 2G Ceftriaxone administered over 2 mins (each G made up into 9.5ml of normal saline)
If no IV access: 2G Ceftriaxone (each G made up into 3.5ml Lignocaine HCl) admin into the upper lateral thigh or large muscle mass
What are the two goal vita sign targets for treating narcotic overdose
GCS>12 and RR>8 (with adequate tidal volume)
Treatment Narcotic OD
Partial reversal (preferred unless imminent arrest)
Naloxone 100mcg bolus IV every 60 seconds titrated to response (maximum 2mg)
Complete reversal
800mcg IM
Repeat 800mcg IV/IM at 5 mins if no response Repeat 400mcg IV/IM at 5 mins (max 2mg)
ECG changes indicated TCA overdose
Positive R wave in aVR >3mm, prolonged PR, QRS and QT intervals. If QRS widening over 0.12 secs - severe toxicity. QTc >500msec indicates toxicity
Treatment TCA overdose
Hyperventilate with 100% O2 at rate 20-24
What are the 4 general categories of ABD
Psychiatric disorders, substance related, organic disorders, situational
When may paramedics sedate and place a patient in protective custody?
They may sedate a pt in protective custody when: they consider it necessary and prudent to do so, they have exhausted all other means of getting the pt to hospital in a less restrictive manner
They may place a person into protective custody if they reasonable believe that: the persona has a mental illness, the person needs to be assessed against assessment or treatment criteria, the persons safety or other persons is likely to be at risk if the person is not taken into protective custody.
ABD Sedation treatment
SAT +1
10mg oral diazapam (5mg if age>60 years), may be repeated at 60 min intervals to max of 40mg).
SAT +2 - +3 NO IV access
Droperidol 10 mg IM (5mg in age>60 or weight <50kg) Repeat once at 15 mins if SAT >0
SAT +2 - +3 IV access
Droperidol 5mg IV, may repeat same dosage at 10 mins if SAT>0
Max dose drop 20mg or 10mg if age>60 or weight under 50kg
What is the key word to look for on labels in suspected organophosphate poisoning?
Anticholinesterase
Treatment Autonomic dysreflexia
Treat possible cause (unkink catheter, manage pain ect)
400mcg GTN if BP >160 repeat 10 mins until symptoms resolve or onset of side effects or BP<160
How can shock be defined / identified (sepsis)
Septic shock defined as “a subset of sepsis with profound circulatory, cellular and metabolic abnormalities”
Shock can be identified by a vasopressor requirement to maintain systolic BP>100 if unresponsive to at least 1L of saline
qSOFA Criteria
2 of more of HAT:
Hypotension - sys BP<100
Altered concious state - any decrease from baseline
Tachypnoea - RR>22
Criteria for ABX admin in sepsis
Provisional diagnosis of sepsis, a positive qSOFA score + tranport time >60 mins
Fluid admin in sepsis
500ml IV repeated until BP >100 sys (max 3L
Treatment Bronchoconstriction
Mild or moderate:
Salbutamol pDMI 6 puffs at 5 mins or if no spacer 10mg salbutamol nebulised, repeat 5mg at 5 mins
Severe: Salbutamol pDMI 6 puffs at 5 minutes and Ipatropium bromide pDMI 8 x puffs no repeat or 10mg salbutamol nebulised, repeat 5mg at 5 mins and 500mcg ipatropium bromide no repeat
If requiring ventilation 5-8p/mi allowing for prolonged expiratory phase with gentle lateral chest pressure if required
If imminent arrest 300mcg adrenaline IM repeat at 20 minutes as required
Treatment COPD
Irrespective of severity: 10mg salbutamol nebulised, repeat 5mg at 5 mins and 500mcg ipatropium bromide no repeat nebulise titrate oxygen to 88-92%
If requiring ventilation 5-8p/mi allowing for prolonged expiratory phase with gentle lateral chest pressure
Management No cardiac output COPD / Asthma
Apnoea for 1 minutes
What are the specific indications for fentanyl?
Contraindication to morphine, short duration of action desired (e.g dislocations), hypotension, nausea and vomiting secondary to previous morphine admin
Pain relief for mild pain
1000mg Paracetamol oral AND OR 400mg Ibuprofen
Pain relief for moderate pain
Consider Paracetamol and Ibuprofen
Morphine 0.05mg/kg up to 5mg IV repeat up to no less than 5 mins or Fentanyl .50mcg/kg max 50 mcg repeat up to no less than 5 mins
Or if unable to gain IV access or delayed >10 mins
3ml methoxyflurane repeat 3 ml as required only once
OR
Fentanyl up to 100mcg IN repeat 50mcg at no less than 5 minutes max 400mcg
OR
Morphine 0.1mg/kg max 10 mg IM/SC or Fentanyl 1mcg/kg max 100mcg IM/SC Repeat dose once only at 20 minutes
Pain relief for severe pain
Morphine 0.05mg/kg up to 5mg IV repeat up to no less than 5 mins or Fentanyl .50mcg/kg max 50 mcg repeat up to no less than 5 mins
Treatment ACS
Aspirin 300mcg
GTN 400mcg 5 min intervals as long as systolic BP >100
Pain relief as per pain management
GTN for hypertension +/- symptoms 400mcg Evenry 5 minutes until Systolic BP<160 or diastrolic BP<100
Treatment SVT
If maintaining BP >100mg Valsalva maneuver
Treatment Acute Pulmonary Odema
Posture pt sitting upright
If systolic BP over 100 GTN 400mcg, repeat 400mcg at 5 mins as required
12-lead ECG STEMI Criteria
≥2.5mm ST elevation in leads V2-V3 Men under 40
≥2mm ST evelation in men over 40
≥1.5mm ST evelation in women
or
≥1mm ST evelation in other leads
≥0.5mm ST evelation in V7-V9
Where does a supraglottic airway sit
Low pressure seal around the posterior perimiter of the larynx, superior to the oesophageal sphrincter
Treatment VT / VF arrest
Defib 200J every 2 mins
Normal Saline TKVO
Adrenaline 1mg every 4 mins
Treatment PEA arrest
Normal saline TKVO
Adrenaline 1mg every 4 mins
If PEA persist Normal sALINE 20ML/kg
RSA Criteria
General appearance, speech, breath sounds, resp rate, resp rhythm, breathing effort, pulse rate, skin, concious state, oxygen sats
PSA Criteria
Skin, pulse, BP, concious state, cap refil
Paediatric ages and weight calc
Newborn: Birth to first few hours to life. 3.5kg.
Infant: First few hours to one year. 5 moths 7kg, 1 year 10kg
Young child: 1-9 years. Age x 2 + 8kg
Older child 9-12 years. Age x 3.3kg
When to commence chest compressions paeds
No palpable pulse or
HR<60 infrants
HR< 40 children
Newborn non effective breathing treatment
Dry, stimulate, warm
If pulse<100 of inadequate breathing commence IPPV on room air (for 10 mins)
If after 30 seconds breathing remains inadequate and pulse <60 commence CPR 1:3
Defibrillation paeds calculation
4J/kg
Pain relief dosages paediatrics
Paracetamol 15mg/kg
Fentanyl IN small child (10-24kg): 25mcg 3 dosages @ 5 mins, large child(>25kg): 50mcg 3 x dosages 5 mins
Ibuprofen 10mg/kg
Methoxyflurane 3 ml repeat 3 ml as required max 6ml
Morphine IM 0.1mg/kg max 5mg. Medical consult for further dosage
When is nebulised adrenaline indicated for croup
Signs of agitation, distress, cyanosis, SPO2<92% on RA, marked use of accessory muscles
Adrenaline neb dosage paed upper airway obstruction
5mg/5ml neb. Repeat as required
Asthma treatment paeds
Sabulatamol pDMI 6 puffs every 5 mins
IB for <6 years 4 puffs, >6 yewars 8 puffs no repeat
Salbutamol ned 5mg and IB 500mch, repeat 5mg salbutamol @ 5 mins
Ventilation rates asthma paeds
Infant 15-20
Small child 10-15
Large child 8-12
all 7ml/kg
Treatment impending arrest asthma paed
Adrenaline 10mcg/kg IM repeat at 20 mins as required (total max 30mcg/kg)
Immediate treatment loss of cardiac output in asthma paeds
30 seconds apnoea with gentle lateral chest pressure
Hypoglycaemia paeds treatment dosages
15g oral gel
GLucose 10% 5ml/kg (500mg/kg)
Glucagon <25kg 0.5 IU >25kg 1IU
Hyperglycaemia treatment paediatrics
Normal saline 10ml/kg
Continuous / recurrent seizures paeds treatment
0.15mg/kg IM max dose 10mg repeat once at 10 mins if required
Adrenaline dosage paeds in anaphylaxis
10mcg/kg to max 500mcg @ 5 minutes
Ceftriaxone dosage meningococcal disease paeds
50mg/kg max dose 2G
Paeds sepsis fluid resus dose
Normnal saline 10ml/kg bolus, repeated once at 15mins max dose 20ml/kg
Naloxone dosage paeds
10mcg/kg (max 400mcg per dose) IM, repeat at 10 mins to max of 400mcg
Inadequate perfusion fluid dose paed
20ml/kg IV
Paeds isolated neurogenic shock fluid resus
5ml/kg nomral saline single bolus
Paediatric HR values
Newborn: 120-160
Infant: 100-160
Small Child: 80-120
Large Child: 80-100
Paediatric RR Values
Newborn: 40-60
Infant: 20-50
Small Child: 20-35
Large Child: 15-25
Paediatric BP vaules
Newborn: NA
Infant: >70sys
Small Child: >80sys
Large Child: >90 sys
