CPP Flashcards
- According to conscious state assessment, when is a pt not suitable for NEPT?
- Reduction in GCS by >2 points from pt normal CS within past 24hrs (unless mechanically ventilated with mp escort)
- Paed who is not alert without suitable escort
- According to PSA, when is a pt not suitable for NEPT?
- BP <100 unless normal (acute hypotension after dialysis is ok)
- HR <50 or >100 unless normal for pt (pt with temporary pacing wire for bradycardia is ok)
- According to the RSA, when is a pt not suitable for NEPT?
- Moderate or severe respiratory distress, unless normal for pt
- Respiratory distress which does not improve after rest or mx with breathing difficulties protocol
- When is a major trauma pt not suitable for NEPT?
- 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
- ARV pt (unless approved by consulting retrieval physician)
- PIPER pt - Undiagnosed spinal cord compression sx where the treating mp suspects SCI
- What are the parameters around when an ACD can be accepted in good faith?
Home-to-hospital, documentation may be sighted or accepted in good faith.
Inter-hospital or hospital-to-home, documentation must be provided.
- Anaphylaxis Rx
- 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
- Rx Mild/Moderate respiratory distress:
- 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
- Severe respiratory distress Rx:
- 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
- Which chest pain pts are unsuitable for NEPT?
- Pt over 20 with potential cardiac chest pain that remains unresolved after admin of usual medication
- Pts requiring immediate time critical transfer for coronary angiography/cardiac surgery.
- What are considerations for a pt who develops chest pain with known IHD during Tx?
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.
- Rx for Chest pain:
- 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
- When can hypoglycaemia be Rx by NEPT?
- Occurs in a pt with history of diabetes mellitus and hypoglycaemia is found on arrival or occurs during Tx
- Pt with diabetes mellitus presents with Sx at public event
- What is the Rx for hypoglycaemia?
- 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
- Rx for N/V:
Ondansetron 4mg, repeat once after 20/60 if Sx persist
- Inadequate perfusion four parts:
- Skin CPC
- HR <50 or >100
- BP 60-80
- Either alert and orientated to TPP or altered
- RSA components:
Appearance, Speech, Sounds, RR, Rhythm, Effort, HR, Skin, CS
- GCS
E: none, pain, voice, spontaneous
V: none, incomprehensible, intelligible single, confused, orientated
M: none, extension, abnormal flexion, normal flexion, localises, obeys
- MSA components:
Observe: Safety, Appearance, Behaviour, Affect (SABA)
Listen: Speech, Thought process, Cognition (STC)
Discuss: Thought content, Self-harm, Perceptions, Environment (PETS)
- Paed weights:
- Newborn
- 3 months
- 6 months
- 1 yo
- 1-9 yo
- 10-11 yo
- 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
- HR
- Newborn
- Small infant
- Large infant
- Small child
- Medium child
- Newborn - 110-170
- Small infant - 110-170
- Large infant - 105-165
- Small child - 85-150
- Medium child - 70-135
- RR
- Newborn
- Small infant
- Large infant
- Small child
- Medium child
- Newborn - 25-60
- Small infant - 25-60
- Large infant - 25-55
- Small child - 20-40
- Medium child - 16-36
- BP
- Newborn
- Small infant
- Large infant
- Small child
- Medium child
- Newborn >60
- Small infant >60
- Large infant >65
- Small child >70
- Medium child >80
- Initial Paediatric Assessment components:
- Appearance: tone, interactiveness, consolability, look/gaze, speech/cry - TICLS
- WOB: abnormal breath sounds, abnormal positioning, retractions, nasal flaring
- Circulation to skin: pallor, mottling, cyanosis
- Single and dual operator compression/ventilation rate for newborn, cpm and pause length for ventilations?
3 compressions : 1 ventilation, 90 cpm, 0.5s pause for ventilation
- Dual operator c/v rates for CPR infants and children?
15 c : 2 v
- When are the criteria for NEPT transport for suspected stroke?
Stroke sx and CS are stable and a registered mp has evaluated the pt
- For a pt with chest pain, what criteria would deem them suitable for NEPT?
- Pt with suspected coronary syndrome who has post PCI inflation pain only - not supported by enzyme rise/ECG
- Pt who normally self-administers GTN, and whose pain has fully resolved within 2 hours of the onset of pain
- Pt with identified non-urgent chest pain
- Pt with NSTEMI who has been haemodynamically stable for >2hrs and doesn’t require pain relief
- Criteria for NEPT transport for Headache?
- Normal headache presentation for this pt
- SAH has been ruled out
- Undiagnosed headache approved by mp for further testing
- Subdural or SAH where mp has assessed pt as haemodynamically stable
- Criteria for NEPT transport for pt with abdo and back pain (non-traumatic)?
- Back or abdominal pain in patient <60 years
- Pt over 60 years with acute abdominal pain (<24 hours) where a registered medical practitioner has excluded the diagnosis of an aortic aneurysm
- Pt>60 with acute abdo pain, but registered mp has approved NEPT to Tx for further testing
- Obstetric pts classification as emergency?
- A patient with vaginal bleeding in the third trimester
2. A patient in active labour.
- Pt in moderate respiratory distress:
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
- APGAR scores
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
- What patients suffering pain are not suitable for NEPT?
- Pt>60 with sudden onset (<24hrs) and severe abdominal pain where AAA has not been excluded by mp
- Pt with undiagnosed headache where treating mp suspects acute intracranial pathology
- Rx for pain
<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
- When are stroke pt not suitable for NEPT?
Acute onset of stroke sx within 4.5hrs - unless mp has evaluated pt as suitable
- 5 heads criteria
Blunt head injury with/without LOC and now GCS 13-15:
- Any LOC >5mins
- Skull fracture
- Vomiting more than once
- Neuro deficit (loss of function/sensation)
- Seizure
- Spinal immobilisation criteria:
Meets major trauma or
- Age >55
- Hx of bone disease
- ACS
- Intoxicated
- Distracting injury
- Midline tenderness/pain
- Neuro deficit/changes
- Rx Paed Anaphylaxis
> 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