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AV - GAPPIES wear nappies > CWIs > Flashcards

CWIs Flashcards

1
Q 
Mod (5)
Pressure Bandage w/ Immobilisation
> Indications?
> CI's?
> Clinical Precautions?
A

> Indications:

  1. Susp. / reported SNAKE bite to limb
  2. Susp. / reported BIG BLACK SPIDER bite to limb
  3. Susp. / rep BLUE RINGED OCTOPUS bite to limb
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2
Q

Mod (5)
Pressure Bandage w/ Immobilisation
> Equipment Required?

A
  • Snake-bite bandage with indicator
  • Formable splint or traction splint
  • Crepe bandage (to secure formable splint)
  • 5 cm tape
  • Marker pen
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3
Q

Mod (5)
Pressure Bandage w/ Immobilisation
> Prepare Pt

A
  1. Reassure and inform patient.
  2. Lay patient flat.
  3. Remove and rings/watches/bracelets/anklets/etc. from
    the affected limb.
  4. Expose limb using shears to remove clothing.
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4
Q

Mod (5)
Pressure Bandage w/ Immobilisation
> Apply snake-bite bandage

A
  1. Apply snake-bite bandage beginning over the bite site.
  2. Make several turns at the bite site to anchor the
    bandage, stretching it so that the tension changes the shape of the rectangular indicators into squares.
  3. Mark the bandage on the outermost layer of the
    bandage with the marker pen.
  4. Continue to apply the bandage distal to the bite site,
    with each wrap of the limb covering half of the width of
    the previous wrap.
  5. Bandage distally down the limb to the digits, but ensure that the end of the digits remains exposed so that circulation can be assessed.
  6. Continue bandaging back up the limb in the same
    manner. Ensure that the indicators show the correct
    tension is being maintained.
  7. When the bite site is covered by the proximal
    bandaging, re-mark it with the marker pen on the
    outermost layer of the bandage.
  8. When the bandage reaches the main joint of the limb with the torso, secure it with 5 cm tape. Do not apply the tape circumferentially as it risks a tourniquet effect on the limb.
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5
Q

Mod (5)
Pressure Bandage w/ Immobilisation
> Re-assess
> Apply splint

A
  1. Check capillary refill in the digits. Loosen the bandage and re-apply if compromised.
  2. Apply either a formable or traction splint as per the
    relevant CWI.
  3. If using the formable splint, secure it to the limb with the crepe bandage, leaving the bite site exposed.
  4. If using the traction splint, note that it does not need the same amount of traction as for a fractured femur, as it is purely an immobilisation device in this context.
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6
Q

Mod (5)
Soft collar
> Indications?

A

> Indications:
• As per CPG A0804 Spinal injury
(also consider CPG A0701 Nausea and vomiting)

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7
Q

Mod (5)
Soft collar application
> Prepare Pt

A
  1. Explain the procedure and request that the
    patient keeps their head/neck as still as
    possible.
  2. Remove excess/bulky clothing and
    jewellery from the neck.
  3. If already supine, gently place the patient in
    the neutral position (Fig 1) or position of
    comfort.
    Neutral position (adult): Elevate the patient’s head
    with the aim of bringing the external auditory meatus to the level of the mid-clavicle (2 - 5 cm in
    most patients)
    Fig 1: Neutral position.
    Neutral position (paediatric): Due to prominent occiputs and short necks, paediatric patients may
    require thoracic elevation using blankets or towels to achieve a neutral head position.
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8
Q

Mod (5)
Soft collar application
> Prepare the collar

A
  1. Select appropriately sized collar.
    Note: The collar should extend from the base of the chin to the suprasternal notch when the
    patient is in the neutral position.
    This can be measured by comparing the front of the collar to the patient’s neck (Fig 3) or by using
    your fingers (Fig 4).
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9
Q

Mod (5)
Soft collar application
> Apply the collar

A
  1. If supine, slide the Velcro strap under the patient’s neck until it is visible
    Note: Ideally a second AV staff member should stabilise the head during application of the collar.
  2. Wrap the front of the collar around the neck and join the Velcro strips.
    Note:
    • The “C-Spine not cleared” label should sit over the midline
    • Larger patients: The ends of the collars may not touch once the Velcro strips are joined. This is appropriate if the collar remains comfortable. However, if they are more than 4 cm apart, the collar is not appropriately sized and should be removed.
    • Smaller patients: The ends may touch or overlap slightly. This is appropriate if the collar remains comfortable.
    • The chin should sit in the contoured dip in collar for increased comfort.
    • Loosen the collar slightly if it becomes uncomfortable or provokes the patient to move or pull
    at the collar.
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10
Q

Mod (5)
Pelvic splint application
> Indications?

A

• 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 state patient with significant 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.

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11
Q

Mod (5)
Pelvic splint application
> Contraindications?

A

• Impaled object preventing application.

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12
Q

Mod (5)
Pelvic splint application
> Clinical precautions?

A

• The pelvic splint should be appropriately sized for the patient. Smaller paediatrics may require a sheet/towel/pillow-case as a pelvic wrap.
• The following sizes should be considered for the SAM splint.
SAM splint size Hip circumference
Large 91 – 152 cm
Small 69 – 112 cm
• A traction splint to limbs should not be applied until after the pelvis has been stabilised.

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13
Q

Mod (5)
Pelvic splint application
> Equipment req’d?

A

• SAM pelvic splint device
OR
• Sheet, towel, blanket, 50mm tape

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14
Q

Mod (5)
Pelvic splint application
> Prepare Pt

A
  1. Either cut off all outer clothing or remove all objects from pockets.
  2. Assess patient’s pain score. Analgesia may be required prior to this procedure.
  3. Ensure the patient is lying supine where possible.
  4. Commence reduction of pelvic fracture by realigning legs to neutral position.
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15
Q

Mod (5)
Pelvic splint application
> Position SAM splint

A
  1. Feed black belt up through the orange locking clip and return it toward the patient’s right hip.
  2. Slide splint underneath the patient’s thighs with orange locking clip on left side.
  3. Shift and adjust position so that the orange clip sits offset toward left hip.
  4. Locate the greater trochanters on each side.
  5. Slide the splint into position over the trochanters.
  6. If necessary, have an assistant gently lift the hips to allow for correct positioning.
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16
Q

Mod (5)
Pelvic splint application
> Fasten SAM splint

A
  1. Feed black belt up through the orange locking clip and return it towards the patient’s right hip
  2. One operator should position themselves on the patient’s left hip and hold orange handle.
  3. The second operator should position on the right side and hold the black handle on the black strap.
  4. Both operators should pull simultaneously in opposite directions until the buckle clicks and the belt is locked.
  5. Do not release tension on the black handle. Attach the Velcro side of the black handle to the splint.
  6. Do not re-adjust the tension once the buckle clicks.
17
Q

Mod (5)
Pressure Bandage w/ Immobilisation
> CI’s?

> Clinical Precautions?

A

> CI: Nil

> Clinical Precautions: Nil

18
Q

Mod (5)
Soft collar
> Contraindications?

A

> Contraindications:
• Surgical airway
• Penetrating neck trauma
• Unable to achieve neutral position*
*Due to resistance to movement, torticollis (lateral twisting or tilting of the head or neck
to one side with limited range of motion), pain, disease, anatomical deformity, size or
non-compliance. Never move the neck if the patient is unwilling or resists the movement.

19
Q

Mod (5)
Soft collar
> Contraindications?

A 
> Contraindications:
• Surgical airway
• Penetrating neck trauma
• Unable to achieve neutral position*
*Due to resistance to movement, torticollis (lateral twisting or tilting of the head or neck to one side with limited range of motion), pain, disease, anatomical deformity, size or non-compliance. Never move the neck if the patient is unwilling or resists the movement.
20
Q

Mod (5)
Pelvic splint application
> Using sheet wrap (Pt 1 of 2)

A
  1. Fold the sheet smoothly in half along its longest edge. Repeat folding as necessary until the shorter width is approximately 30 cm (adult). For paediatrics fold till an appropriate width is attained.
  2. Slide one end of the sheet under the knees/thighs and pull through to the other side. Ensure equal lengths remain on either side of legs.
  3. Slide sheet gently back and forward and progressively upward until the patient’s greater trochanters are centrally located within the width of the sheet.
21
Q

Mod (5)
Pelvic splint application
> Using sheet wrap (Pt 2 of 2)

A
  1. Gather each end of the sheet and bring them evenly together so that they are taut and directly above the patient (be careful to not lift legs with movement).
  2. Tightly roll the sheet towards the patient using both hands until the roll sits against the patient legs.
  3. Continue to roll sheet tighter using alternating hands.
  4. With either hand firmly tightened, maintain grip whilst applying 50mm tape from the hip closest to the person rolling right across to the other hip.
  5. Repeat tightening and taping position for other hand.
  6. If necessary, repeat tightening process one more time for each hand. Do not remove original tape: rather replace with third and fourth strip.
22
Q

Mod (5)
Pelvic splint application
> Post-splinting care

A
  1. Place towel or blanket between the knees.
  2. Tie a broad fold bandage around both legs just above the knees.
  3. Tie a figure of eight around the ankles to hold the feet together.
  4. Slightly flex the knees and support with a rolled blanket or in position of comfort.
23
Q

Mod (5)
Pelvic splint application
> Reassess Pt

A
  1. Reassess patient’s pain level.
  2. Assess for any pressure points produced in splinting.
  3. Reassess peripheral perfusion of limbs.
24
Q

Mod (5)
Pelvic splint application
> Removal of splint

A
  1. Once applied, a pelvic splint should only be removed by an Emergency Physician. DO NOT CUT.
  2. Pull black handle from the Velcro attachment on right hip.
  3. Whilst maintaining tension, slowly allow sling to loosen.
  4. Leave sling underneath patient and reapply if
    haemodynamic stability cannot be achieved.
  5. If using a sheet wrap, grasp roll in same manner as when tightened. Cut or remove tape once securely grasped.
  6. Leave sheet underneath patient and reapply if
    haemodynamic stability cannot be achieved.

AV - GAPPIES wear nappies (26 decks)

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