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GAP 2018 > CPGs- Value, time critical, clinical approach > Flashcards

CPGs- Value, time critical, clinical approach Flashcards

1
Q

How does pulse oximetry work?

A
  • emits 2 light waveforms, red and infrared.
  • detector on other side of probe measures amount of light passing through vascular bed.
  • both lights pulsate rapidly each second.
  • Hb absorbs more light than oxyHb therefore greater concentration of oxyHb, greater amount of red light received by detector.
  • both oxyHb and Hb absorb infrared equally which determines amount of Hb in arterial blood flow
  • infrared = total amount of available Hb
  • red light = saturated Hb
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2
Q

Limitations of Spo2

A
  • anaemia or hypovolaemia may give normal readings
  • poor perfusion can cause inaccuracy incl., cardiac arrest, shock, burns, PVD, oedema/hypothermia
  • movement
  • nail polish
  • skin pigmentation
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3
Q

Oxy-Hb Dissociation curve - explain

A

Represents affinity of Hb for o2 at different levels of partial pressure. As Pao2 reduces from 100, initially little effect on spo2
Leftward shift: increased pH, reduced paco2, increased temp
Rightward shift: decreased pH, increased paco2, increased exercise, increased altitude, catecholamine release

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4
Q

Ventilation - explain inspiration and expiration

A

Movement of air into and out of lungs due to pressure differences
Inspiration: air into lungs, pressure in lungs must be lower than atmospheric pressure. Pressure in lungs is lowered by increased volume. Muscles contract, expanding lungs.
Expiration: at end of resp phase, intrapulmonary pressure is already higher than atmospheric pressure causes air to follow pressure gradient = passive expiration

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5
Q

Why is intrapleural space negative?

A 
Parietal pleura (attached to chest wall), pulled outward.
Visceral pleura pulled inward by elastic recoil therefore constant pull in opposite directions caused 0 sub-atmospheric pressure hence preventing collapsed lung.
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6
Q

Types of hypoxia?

A

Stagnant - good oxygenation but decreased blood flow eg. cardiac arrest, shock, haemorrhage
Anaemia - decreased o2 carrying capacity, decreased Hb levels e.g. hypovolaemia
Histotoxic - good oxygenation of blood but o2 unable to dissociate due to cellular blocking agent e.g. cyanide
Hypoxic - decreased o2 in pulmonary vascular system e.g. atmospheric changes, APO

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7
Q

Assessment of Oxygen requiring patient

A 
Acute/chronic
Respiratory status
Spo2
Causes
Bleomycin and paraquat poisoning
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8
Q

Management of Adequate Spo2

A

greater than or equal to 92%

No O2 required, reassure pt

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9
Q

Management of Mild-mod hypoxaemia

A

85-91%
2-6L via nasal prongs or 5-10L via face mask
titrate to 92-96%

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10
Q

Management of severe hypoxaemia

A

less than 85% or critical illness:
-Arrest
-Trauma (head/major)
-Epilepsy
-Ketamine sedation
-Anaphylaxis
-Shock
-Sepsis
Non rebreather 10-15L/min - BVM if inadequate TV
Once pt haemodynamically stable, titrate to 92-96%
If deteriorates or Spo2 less than 85%, BVM 100%, consider SGA

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11
Q

Management of Chronic Hypoxaemia

A 
Kyphoscoliosis 
Neuromuscular disorders
Obesity 
COPD
Cystic fibrosis 
Bronchiecstasis 
-high concentration o2 may be harmful in COPD pts at risk of hypercapnic resp failure 
-titrate Spo2 88-92%
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12
Q

Management regardless of SPo2

A 
PPH
Inhalation (toxic)
Cord prolapse 
Cluster headache 
Decompression illness
Dystocia - shoulder 
-o2 via NRB 10-15l/min
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13
Q

Unwell patients include

A

unconscious/altered conscious
SOB
pale/sweaty

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14
Q

Definition of perfusion

A

The ability of the cardiovascular system to provide tissues with an adequate oxygenated blood supply to meet their functional demands at that time and to effectively remove associated metabolic waste products.

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15
Q

Perfusion can be affected by:

A

temp
anxiety
altered consciousness

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16
Q

When assessing perfusion, take into context:

A

presenting problem
pts meds
trends
response to mx

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17
Q

Adequate perfusion

A

Warm, pink, dry skin
Pulse 60-100
BP over 100
Alert

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18
Q

Borderline perfusion

A

Cool, pale, clammy
Pulse 50-100
BP 80-100
Alert

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19
Q

Inadequate perfusion

A

Cool, pale, clammy
Pulse less than 50 greater than 100
BP 60-80
Alert or altered

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20
Q

Extremely poor perfusion

A

Cool, pale, clammy
Pulse less than 50 greater than 110
BP less than 60
Altered or unconscious

21
Q

Normal respiratory status

A 
Calm appearance 
Clear speech 
Quiet chest 
RR 12-16 
Regular rhythm
Normal effort
Normal skin
Pulse 60-100
Alert
22
Q

Mild respiratory distress

A 
Mildly anxious appearance
Speaking sentences 
Sounds- mild exp wheeze, fine basal crackles, able to cough
Rate 16-20
Rhythm prolonged expiratory
Effort slightly increased
Skin normal 
Pulse 60-100
Alert
23
Q

Moderate respiratory distress

A 
Distress/anxious appearance
Speaking in phrases
Sounds - expiratory +/- inspiratory phase, basal to midzone crackles, able to cough 
Rate over 20 
Rhythm prolonged expiratory 
Effort increased and accessories 
Skin pale and sweaty
Pulse 100-120
Altered conscious
24
Q

Severe respiratory distress

A

Distressed, fighting to breath, catatonic appearance
Speaking words only or none at all
Sounds - inspiratory and expiratory wheeze, full field crackles, unable to cough, UAO: inspiratory stridor
Rate over 20 or less than 8
Rhythm prolonged expiratory
Effort increased and accessories, intercostal retraction, tracheal tugging
Skin pale/sweaty/cyanosed
Pulse over 120
Altered or unconscious

25
Q

GCS purpose

A

an objective measure of scoring level of consciousness and identifying trends

26
Q

GCS criteria

A

Eyes: spontaneous, to voice, to pain, none
Verbal: orientated, confused, inappropriate words, incomprehensible sounds, none
Motor: Obeys, localizes, withdraws, abnormal flexion, abnormal extension, none

27
Q

AVPU

A

Alert 15
To voice 10-14
To pain 7-9
Unresponsive less than 7

28
Q

Trauma time critical guidelines VSS

A 
HR less than 60 or greater than 120
RR less than 10 or greater than 30 
SBP less than 90 
Spo2 less than 90 
if 16 or over, GCS less than 13 
if 15 or younger, GCS less than 15
29
Q

Trauma time critical guidelines specific injuries

A
  • All penetrating injury
  • Blunt injuries: to single region where loss of life or quality is at risk, or significant to more than 1 region
  • Specific injuries: fractured 2 or more long bones, fractured pelvis, crush injury, compound fracture/open dislocation, burns over 20% or resp tract, limb amputation, suspected SCI
30
Q

Trauma time critical guidelines high risk factors

A
  • pedestrian impact
  • ejection from vehicle
  • explosion
  • fall over 3m
  • struck by object over 3m
  • motor/cyclist impact over 30km/hr
  • prolonged extrication over 30mins
  • MVA over 60k/hr
31
Q

Trauma time critical guidelines co-morbidities

A

age less than 12 or greater than 55
pregnant
significant underlying medical condition

32
Q

Medical time critical guidelines ACTUAL

A

RSA - moderate or severe distress
PSA- less than adequate perfusion
GCS - less than 13
Spo2 - less than 90% RA or 93%o2 or 88% chronic

33
Q

Medical time critical guidelines EMERGENT

A 
AAA
Acute stroke
ACS
Sepsis
Suspected meningococcal
Severe undiagnosed pain 
Hyperbaric treatment
Hypothermia
Hyperthermia
34
Q

Mental status Assessment

A 
Safety 
Appearance
Behaviour
Affect
Speech
Cognition
Thought process
Thought content
Self-harm
Environment
Perceptions
35
Q

PILSDUCT

A

pain, irregularity, loss of function, swelling, deformity, unnatural movement, crepitis, tenderness

36
Q

5HEDS

A

5/60 LOC, head fracture apparent, emesis greater than 1, neuro deficit, seizure

37
Q

Paediatric Assessment Triangle

A

Appearance - tone, interactive, consolable, look/gaze, speech/cry
Breathing - breathing sounds, posturing, retraction, nasal flaring
Circulation - pallor, mottling, cyanosis

38
Q

Newborn age and weight

A

up to 24hours 3.5kg

39
Q

Small infant age and weight

A

less than 3 months

3month old 6kg

40
Q

Large infant age and weight

A

3 to 12 months
6 month old 8kg
1yr old 10kg

41
Q

Small child age and weight

A

1-4yrs

1-9: age x 2 +8

42
Q

Medium child age and weight

A

5-11yrs

10-11: age x 3.3

43
Q

Newborn HR, BP and RR

A

HR 110-170
BP over 60
RR 25-60

44
Q

Small infant HR, BP and RR

A

HR 110-170
BP over 60
RR 25-60

45
Q

Large infant HR, BP and RR

A

HR 105-165
BP over 65
RR 25-55

46
Q

Small child HR, BP and RR

A

HR 85-150
BP over 70
RR 20-40

47
Q

Medium child HR, BP and RR

A

HR 70-135
BP over 80
RR 16-34

48
Q

Signs of respiratory distress in Paediatrics

A
  • tachypnea
  • chest wall retraction
  • use of accessory muscles
  • tracheal tugging
  • abdo protrusion
49
Q

Paediatric time critical guidelines VSS

A

small infant: HR less than 100 over 180, RR over 60, BO less than 50, SPo2 less than 90, GCS les than 15
Large infant: HR less than 100 over 180, RR over 50, BP less than 60
Small child: HR less than 90 over 160, RR over 40, BP less than 70
Medium child: HR less than 80 over 140, RR over 30, BP less than 80

GAP 2018 (13 decks)

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