Criterias Flashcards
Richmond Agitation Sedation Scale (RASS)
4 - Severely agitated: overtly combative, violent, immediate danger or threat
3 - Very agitated: aggressive behaviour, unreasonable
2 - Agitated: frequent, excessively anxious, loud outbursts
1 - Restless: mildly anxious, non-aggressive, talkative
0 - alert & calm
-1 - drowsy: sustained awakening to voice (>10s)
-2 - Light sedation: Awakens briefly to voice with eye contact (<10s)
-3 - Moderate sedation: Movement or eye opening to voice. no eye contact
-4 - Deep sedation: Movement or eye opening response to physical stimulus
-5 - Cannot be roused: Unresponsive to vice or physical stimulus
Stroke inclusion criteria
- time of onset <9hrs (woke w/ symptoms but asymptomatic prior to sleep, time starts at waking)
- pt possess full ADLs
- BGL 4-22mmol/L
Stroke Hospitals
FAST +ve RACE <=4
- Charlie’s
- FSH
- Royal Perth
- Midland
- Joondalup
FAST +ve RACE >=5
- Charlie’s 24/7
- FSH Monday - Friday 0800-1600 (arrival must be w/in times)
STEMI Inclusion Criteria
- symptom onset < 12hrs
- mobile and independent ADLs
- GCS 15
STEMI Indications for transmission
- monitor reads “ACUTE MI” or “Meets STEMI criteria
- ST elevation >=1mm in 2 contiguous limb leads
- ST elevation >=2mm in 2 contiguous chest leads
- symptomatic acute LBBB
TBI Goals
- SATs >90%
- BGL >4mmol/L
- head at 30 degrees
- BP >110 sys
Determination of Death
- No central pulses at all and
- asystole for >30secs and
- fixed and dilated pupils w/ NO corneal reflexes at all and
- no signs of breathing at all and
- no auscultation heart sounds (if in scope of practice)
IMPACT 7
- working space
- standardise equipment placement
- high quality compressions
- swap compressor every 2 mins
- create overview
- maintain calm, coordinated scene
- ventilation
PPCI Hospital
- FSH
- royal perth
- Charlie’s
- St John of god Murdoch
Stroke Hospitals (Not NIISWA)
- FSH
- Royal Perth
- st John midland
- Charlie’s
- Joondalup
STROKE NIISWA
- FSH (0800-1600 Mon-Fri)
- Charlie’s 24/7
Obvious Signs of Death
- decomposition, larval infestation or putrefaction OR
- signs of Rigor Mortis or gravitational dependent post-Mortem hypostatis in association w/ determination of death criteria OR
- major traumatic injuries incompatible w/ life; for example:
= decapitation, significant cranial destruction, significant truncal destruction
= hemicorporectomy / trans-lumbar amputation
= obvious injuries w/ exsanguination or profound blood loss inconsistent w/ life
= document ALL relevant findings carefully
OR - major incidents / multi casualty situations where clinical resources are overwhelmed, and applied triage pack guidelines indicate death/futility of victim w/ no signs of life
Withholding Resus
1) prolonged cardiac arrest (I.e. estimated downtime >15mins) and generally unwitnessed and first assessed rhythm is asystole and not received a defibrillation shock and no compelling reasons or special circumstances to continue
2) expected death / advanced directives: there is credible evidence that death was expected as a result of terminal illness; the individual has taken the voluntary assisted dying substance; it is the patients wishes not to be resuscitated and previously been clearly communicated and this seems reasonable to attending St John staff. It is not necessary to sight an advanced care directive
3) Residential care facility: aged 80 or over and obviously frail (score 7, 8 or 9)
4) patients in the community w/ all the following: 80 or over w/, asystole as presenting rhythm and clearly frail (7,8,9) most have co-morbidities
Termination of Resus
- the presenting rhythm is Asystole, not SJA witnessed, and remains in Asystole after 20min of maximally directed resuscitation
OR - the presenting rhythm is shockable, not SJA witnessed and progresses quickly and remains in, Asystole or wide, slow PEA (<40/min) after 20-30mins w/ no favourable signs of response to efforts
OR - the destination ED is >15mins away from the arrest location, 20mins or more of maximal BLS/ALS has been applied, ROSC has not been achieved at any stage and there are no special circumstances or other compelling reasons to continue
OR - a specifically authorised SJA clinician makes a reasonable decision based upon prognostic futility either on scene or via the clinical support desk or ASMA
OR - prolonged CPR in blunt traumatic cardiac arrest after reversible causes have been addressed is almost never associated with/ good outcome. If delivery to an ED cannot be achieved w/in 25 mins from arrival on scene, it is reasonable to terminate resus if NO ROSC is achieved after 10 mins, and determination of death criteria are met
Sedation Warnings
- sedation is high risk (don’t listen to police)
- positive RASS doesn’t mean auto sedate
- age <16 ASMA consult
- ETOH /Intoxication
- repeat & maintenance dose
- monitoring (SpO2 and EtCO2 below RASS -2)
- positioning (lateral position)
- airway and breathing
- restraint (not prone and/or handcuffed)
- RASS scores agreed and documented
- weight (agreed and documented)
