CWI Contras and Indications

Question 1

100 Application of a Rigid Cervical Collar

Answer 1

Indications:
• Major trauma patient following blunt force trauma to the head or trunk.
• Any awake patient complaining of traumatic pain to cervical area including neck and/ or upper thoracic area unable to be spinally cleared using the modified NEXUS criteria.
• Unconscious or altered conscious patient with a significant mechanism of injury.
• Neurological deficit or changes.

Contraindications:
• Vertebral column unable to be neutrally aligned due to disease or anatomical deformity.
• Application of the cervical collar causes an increase in pain or neurological symptoms.
• Unable to size appropriately.
• Patient non-compliant.

Question 2

156 Application of CT-6 Traction Splint

Answer 2

Indications:

• Middle third femur fractures, including compound
• Upper two-third tibia fractures, including compound

Contraindications
-Knee or ankle/foot trauma: may increase pain and worsen other injuries

Question 3

177 Application of Pelvic Splint

Answer 3

Indications:

• Suspected pelvic fracture
• An awake patient complaining of pain to pelvic area including lower back (sacroiliac joint), groin or hips
• An unconscious or altered conscious patient with specific mechanism of injury
• In the case of traumatic cardiac arrest, a pelvic splint should be applied as a matter of clinical priority if mechanism of injury is suggestive of a pelvic fracture

Contraindication:
- Impaled object preventing application

Question 4

178 Use of formable splint in limb injuries

Answer 4

Indications 
• Radius/ulna injury. 
• Humerus injury. 
• Lower leg/knee injury. 
• Ankle injury. 

Contraindications
• None in the above indications.

Question 5

179 Anatomical Splinting

Answer 5

Indications
• Suspected fractured neck of femur.
• Leg injuries that cannot be managed by a traction or formable splint.
• Finger or toe injuries.

Contraindications
• None in the above indications.

Question 6

059 IPPV with a Bag Valve Mask

Answer 6

Indications:
•Apnoea or significant hypoventilation
•Ventilation of adult patients with cardiac output should generally include the use of a positive end-expiratory pressure (PEEP) valve where accredited

Contraindications:
•PEEP valves are contraindicated in paediatric patients and any patient in cardiac arrest

Question 7

078 Medication Administered by Intra-Muscular Injection

Answer 7

Indications
•Medications that, as per the AV CPG’s, are required to be administered via the intra-muscular route

Contraindications
•Nil

Question 8

079 Placement of an In-Dwelling Safety Cannula in a Vein

Answer 8

Indications
•When intravenous medication administration is required, in line with the Ambulance Victoria CPG’s.

Contraindications
•None

Question 9

171 Haemorrhage Control using the combat application tourniquet (CAT)

Answer 9

Indications
• Uncontrolled haemorrhage from a limb despite direct pressure
• Multiple casualty scenes where patient numbers dictate that simple haemorrhage control measures cannot be individually applied

Contraindications
• Bleeding that can be controlled using basic first aid measures

Question 10

175 Haemorrhage Control Using Quickclot Haemostatic Wound Dressings

Answer 10

Indications:
•Uncontrolled haemorrhage from a non-compressible wound site
• Any traumatic haemorrhage that is not controlled by basic haemorrhage control measures such as direct pressure with a pad and bandage
•Severe limb wounds not controlled by two Combat Application Tourniquets
•Multiple casualty scenes where patient numbers dictate that simple haemorrhage control measures can not be individually applied

Contraindications:
•Bleeding that can be controlled using basic first aid measures•Ocular trauma
•Haemostatic dressings are not to be used for haemorrhages where they are unlikely to contact the point of bleeding such as PV or PR haemorrhage, or posterior epistaxis

Question 11

169 Tension Pneumothorax decompression with Air release system (ARS) or IV cannula

Answer 11

Indications:
• Suspected tension pneumothorax including in Traumatic Cardiac Arrest.

Contraindications
• The Air Release System (ARS) may not be appropriate for paediatric/small patients (use 14G or 16G decompression needle depending on patient’s size).

Question 12

020 Oropharyngeal Airway insertion

Answer 12

Indications
•Unconsciousness patient where there is a need to actively maintain airway patency by displacing the tongue anteriorly.
•Bite block to support ETT placement (not SGA placement).

Contraindications
•Trismus
•Gag reflex present
•Any patient suspected of having neurological injury out of concern for inducing a gag response

Question 13

021 Insertion of a Nasopharyngeal Airway (NPA)

Answer 13

Indications
•Unconscious patient presenting with trismus, where an OPA cannot be inserted

Contraindications
•Middle third facial fractures–possibility of intrusion into brain tissue
•Significant nasal trauma–May induce undesirable gag increasing ICP so use must be essential
•Traumatic brain injury or neurological event where airway is patent and tidal volume is adequate despite trismus–may induce undesirable gag reflex increasing intracranial pressure

Question 14

126 Insertion of “I-Gel” Supraglottic Airway

Answer 14

Indications: 
N/A  
FROM CPG: 
- Unconscious Pt  without gag reflex
- Ineffective ventilation with BVM and basic airway MX 
->10 minutes assisted ventilation 
-Unable to intubate

Contraindications:
•Intact gag reflex or resistance to insertion
•Strong jaw tone and/or trismus
•Suspected epiglottitis or upper airway obstruction
•The use of sedation to either assist placement of, or maintain placement of I-Gel is contraindicated

Question 15

173 Merit Medical Replaceable Pressure Infusor Bag

Answer 15

Indications:
- The PIB may be used in any situation necessitation the rapid infusion of fluid

Contraindications:
-None

Question 16

168 Intranasal Medication Administration via Nasal Actuator Device

Answer 16

Indications:
- Management of moderate or sever pain as per CPG Pain reliefs (adults and paeds)

Contraindications:
-Facial Trauma