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NEPT > CPP > Flashcards

CPP Flashcards

1
Q
  1. According to conscious state assessment, when is a pt not suitable for NEPT?
A
  1. Reduction in GCS by >2 points from pt normal CS within past 24hrs (unless mechanically ventilated with mp escort)
  2. Paed who is not alert without suitable escort
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2
Q
  1. According to PSA, when is a pt not suitable for NEPT?
A
  1. BP <100 unless normal (acute hypotension after dialysis is ok)
  2. HR <50 or >100 unless normal for pt (pt with temporary pacing wire for bradycardia is ok)
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3
Q
  1. According to the RSA, when is a pt not suitable for NEPT?
A
  1. Moderate or severe respiratory distress, unless normal for pt
  2. Respiratory distress which does not improve after rest or mx with breathing difficulties protocol
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4
Q
  1. When is a major trauma pt not suitable for NEPT?
A
  1. Pt meets any criteria for major trauma (VSS, specific injuries, high risk criteria), unless assesses as suitable for NEPT transport by a mp and after consultation with ARV
  2. ARV pt (unless approved by consulting retrieval physician)
    - PIPER pt
  3. Undiagnosed spinal cord compression sx where the treating mp suspects SCI
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5
Q
  1. What are the parameters around when an ACD can be accepted in good faith?
A

Home-to-hospital, documentation may be sighted or accepted in good faith.
Inter-hospital or hospital-to-home, documentation must be provided.

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6
Q
  1. Anaphylaxis Rx
A
  • Epipen
  • O2 10-15L/min
  • Don’t walk or stand pt, if inadequate perf position supine with legs raised
  • Wheeze - treat as per breathing protocol
  • Repeat epipen after 5mins
  • Rx as cardiac arrest is unconscious/not breathing
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7
Q
  1. Rx Mild/Moderate respiratory distress:
A
  • Position upright
  • O2 8L/min
  • Wheeze/hx of asthma: Salbutamol 4-12 doses via pMDI OR 5mg neb and if pre-existing COPD add IB 500mcg
  • repeat salbutamol 5mg once and consult for further Rx
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8
Q
  1. Severe respiratory distress Rx:
A
  • Position upright
  • O2 8L/min
  • Wheeze/hx of asthma or COPD: Salbutamol 10mg neb and IB 500mcg
  • repeat salbutamol 5mg once and consult for further Rx
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9
Q
  1. Which chest pain pts are unsuitable for NEPT?
A
  1. Pt over 20 with potential cardiac chest pain that remains unresolved after admin of usual medication
  2. Pts requiring immediate time critical transfer for coronary angiography/cardiac surgery.
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10
Q
  1. What are considerations for a pt who develops chest pain with known IHD during Tx?
A

Where pain is not unusual, can Rx with GTN, up to 3 doses. If pain is no resolved after GTN admin or pt develops instability of VSS or cardiac rhythm, or pain significantly worse than normal - emergency ambulance should be called.

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11
Q
  1. Rx for Chest pain:
A
  • Apply cardiac monitor and prepare for deterioration
  • Aspirin 300mg if not already administered in previous 24/24
  • GTN: 300mcg if not previously administered or 600mcg
  • Repeat GTN at 5/60 until pain free
  • Rx with methoxy if pain persists/GTN C/I
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12
Q
  1. When can hypoglycaemia be Rx by NEPT?
A
  1. Occurs in a pt with history of diabetes mellitus and hypoglycaemia is found on arrival or occurs during Tx
  2. Pt with diabetes mellitus presents with Sx at public event
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13
Q
  1. What is the Rx for hypoglycaemia?
A
  • Responds to commands - Glucose past 15g
  • Doesn’t respond to commands - Glucagon 1mg IM if pt ≥25kg, 0.5mg if <25kg
  • If unimproved and BGL<4, Glucagon IM if not already admin
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14
Q
  1. Rx for N/V:
A

Ondansetron 4mg, repeat once after 20/60 if Sx persist

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15
Q
  1. Inadequate perfusion four parts:
A
  1. Skin CPC
  2. HR <50 or >100
  3. BP 60-80
  4. Either alert and orientated to TPP or altered
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16
Q
  1. RSA components:
A

Appearance, Speech, Sounds, RR, Rhythm, Effort, HR, Skin, CS

17
Q
  1. GCS
A

E: none, pain, voice, spontaneous
V: none, incomprehensible, intelligible single, confused, orientated
M: none, extension, abnormal flexion, normal flexion, localises, obeys

18
Q
  1. MSA components:
A

Observe: Safety, Appearance, Behaviour, Affect (SABA)
Listen: Speech, Thought process, Cognition (STC)
Discuss: Thought content, Self-harm, Perceptions, Environment (PETS)

19
Q
  1. Paed weights:
    - Newborn
    - 3 months
    - 6 months
    - 1 yo
    - 1-9 yo
    - 10-11 yo
A
  • Newborn - 3.5kg
  • 3 months - 6kg
  • 6 months - 8kg
  • 1 yo - 10kg
  • 1-9 yo - Age x 2+8
  • 10-11 yo - Age x 3.3
20
Q
  1. HR
    - Newborn
    - Small infant
    - Large infant
    - Small child
    - Medium child
A
  • Newborn - 110-170
  • Small infant - 110-170
  • Large infant - 105-165
  • Small child - 85-150
  • Medium child - 70-135
21
Q
  1. RR
    - Newborn
    - Small infant
    - Large infant
    - Small child
    - Medium child
A
  • Newborn - 25-60
  • Small infant - 25-60
  • Large infant - 25-55
  • Small child - 20-40
  • Medium child - 16-36
22
Q
  1. BP
    - Newborn
    - Small infant
    - Large infant
    - Small child
    - Medium child
A
  • Newborn >60
  • Small infant >60
  • Large infant >65
  • Small child >70
  • Medium child >80
23
Q
  1. Initial Paediatric Assessment components:
A
  • Appearance: tone, interactiveness, consolability, look/gaze, speech/cry - TICLS
  • WOB: abnormal breath sounds, abnormal positioning, retractions, nasal flaring
  • Circulation to skin: pallor, mottling, cyanosis
24
Q
  1. Single and dual operator compression/ventilation rate for newborn, cpm and pause length for ventilations?
A

3 compressions : 1 ventilation, 90 cpm, 0.5s pause for ventilation

25
Q
  1. Dual operator c/v rates for CPR infants and children?
A

15 c : 2 v

26
Q
  1. When are the criteria for NEPT transport for suspected stroke?
A

Stroke sx and CS are stable and a registered mp has evaluated the pt

27
Q
  1. For a pt with chest pain, what criteria would deem them suitable for NEPT?
A
  1. Pt with suspected coronary syndrome who has post PCI inflation pain only - not supported by enzyme rise/ECG
  2. Pt who normally self-administers GTN, and whose pain has fully resolved within 2 hours of the onset of pain
  3. Pt with identified non-urgent chest pain
  4. Pt with NSTEMI who has been haemodynamically stable for >2hrs and doesn’t require pain relief
28
Q
  1. Criteria for NEPT transport for Headache?
A
  1. Normal headache presentation for this pt
  2. SAH has been ruled out
  3. Undiagnosed headache approved by mp for further testing
  4. Subdural or SAH where mp has assessed pt as haemodynamically stable
29
Q
  1. Criteria for NEPT transport for pt with abdo and back pain (non-traumatic)?
A
  1. Back or abdominal pain in patient <60 years
  2. Pt over 60 years with acute abdominal pain (<24 hours) where a registered medical practitioner has excluded the diagnosis of an aortic aneurysm
  3. Pt>60 with acute abdo pain, but registered mp has approved NEPT to Tx for further testing
30
Q
  1. Obstetric pts classification as emergency?
A
  1. A patient with vaginal bleeding in the third trimester

2. A patient in active labour.

31
Q
  1. Pt in moderate respiratory distress:
A 
A: distressed/anxious
S: short phrases
S: exp wheeze +/- ins wheeze, base crackles-mid-zone
R: >20
R: Prolonged exp phase
E: Marked chest movement +/- accessory muscle use
P: 100-120bpm
S: Pale and sweaty
C: May be altered
32
Q
  1. APGAR scores
A

Appearance: 0 - blue/pale, 1 - body pink/extremities blue, 2 - pink
Pulse: 0 - absent, 1 - <100, 2 - >100
Grimace: none, 1 - grimaces, 2 - cries
Activity: limp, 1 - extremity flexion, 2 - active motion
Respiratory: absent, 1 - weak/gasping/ineffective, 2 - strong cry

33
Q
  1. What patients suffering pain are not suitable for NEPT?
A
  1. Pt>60 with sudden onset (<24hrs) and severe abdominal pain where AAA has not been excluded by mp
  2. Pt with undiagnosed headache where treating mp suspects acute intracranial pathology
34
Q
  1. Rx for pain
A

<4: Age<60 and weight>60 - paracetamol 1000mg, Age≥60 or weight≤60 500mg - if prolonged Tx and pain is not tolerable, treat as ≥4
≥4: Methoxy 3mL, repeat

35
Q
  1. When are stroke pt not suitable for NEPT?
A

Acute onset of stroke sx within 4.5hrs - unless mp has evaluated pt as suitable

36
Q
  1. 5 heads criteria
A

Blunt head injury with/without LOC and now GCS 13-15:

  1. Any LOC >5mins
  2. Skull fracture
  3. Vomiting more than once
  4. Neuro deficit (loss of function/sensation)
  5. Seizure
37
Q
  1. Spinal immobilisation criteria:
A

Meets major trauma or

  1. Age >55
  2. Hx of bone disease
  3. ACS
  4. Intoxicated
  5. Distracting injury
  6. Midline tenderness/pain
  7. Neuro deficit/changes
38
Q
  1. Rx Paed Anaphylaxis
A

> 5yrs/20kg - adult epipen
≤5yrs/20kg - epipen junior 150mcg - repeat after 5min
O2 15L/min
Supine with legs raised in inadequate perfusion
Treat as breathing difficulties if wheeze

NEPT (3 decks)

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