Development Meeting 1 - Technical Practice Focus Flashcards
Outline your approach to taking a medical history, inclusive of allergies, medications and events associated with the primary complaint. How do you retain important information from this history?
S - signs & symptoms (presenting complaint)
A - allergies (medical & environmental)
M - medications (also ask if the patient knows what they take them for)
P - past medical history
L - list of lasts (E.g. last time pt experienced same signs/symptoms, last bowel movement etc - anything pertinent to the case)
E - Events leading up
D - Advanced Heath Directives
Outline a pain assessment.
O - onset (what was the pt doing when the pain began)
P - provocation (does anything make the pain better or worse)
Q - quality (how does the pt describe the pain)
R - radiation (does the pain radiate anywhere)
S - severity (how bad is the pain out of 10 - is the pain constant or does it fluccuate)
T - timing (when did the pain start)
What are the components of performing a drug check?
Check the 5 rights of medication administration:
1. Right patient (check pt allergies & ensure they are indicated for the medication - no contraindications)
2. Right drug (check drug label and expiry date)
3. Right dose (calculate required dose)
4. Right time (ensure correct time between doses)
5. Right route
What is the intranasal dose for paediatric fentanyl & how do you calculate it?
1.5microg per kg
Weight = (age x3)+7
Required Dose = weight x 1.5
Amount of drug required = (what you want divided by what you got, times the stock volume)
Required dose / stock dose x volume
E.g. For a 4 yo
Pt weight: (4 x3) + 7 = 19kg
Dose required: 19 x 1.5 = 28.5 microg
Amount of drug required = 28.5/100 x 2mL
= 0.57mL
What are the contraindications for aspirin?
- Allergy/ADR to any NSAID
- Bleeding disorder
- Current GI bleeding/peptic ulcers
- Pt less than 18 years old
What are the contraindications for GTN?
- Allergy
- Acute CVA
- Recent head trauma
- HR less than 50 or greater than 150
- BP less than 100
- Phosphodiesterase 5 inhibitor medication (silenafio or vardenafil in past 24hrs OR tadalafil in previous 48hrs)
What are the contraindications for ondansetron?
- Allergy
- Congenital long QT symdrome
- Current apomorphine therapy for Parkinson’s disease
- Pt less than 2 years of age
Relative contraindication - 1st trimester of pregnancy (may only be administered for extreme and uncontrolled hyperemesis)
What is the preferred narcotic analgesia for pts presenting with pain & when are you contraindicated to use this medication?
Morphine is the preferred narcotic agent except in:
1. allergy or ADR
2. hymodynamic instability
3. known or suspected kidney disease
4. when NAS is the preferred route of administration
5. suspected ACS
The contraindications for morphine are:
1. Allergy/ADR
2. Kidney disease (renal failure)
What is the goal of analgesia in the prehospital setting?
To provide relief to the pt using the lowest appropriate dose of medication / without causing significant side effects.
What do you examine on a head to toe assessment?
- Espose necessary surfaces appropriate to pt condition
- Inspect, palpate & auscultate
- Look for signs of bleeding, brusing, swelling, deformity, rashes, wounds, oedema
What is the NEXUS criteria?
A criteria based off a study which can be used to assess pts indications for c-spine radiography.
Radiography is indicated in patients unless they meet ALL of the following crieria:
1. No midline tenderness
2. No evidence of intoxication
3. No ALOC
4. No focal neurological deficits
5. No distracting injury
Outline the management prinicples for a patient with central c-spine pain
- Apply spinal motion restrictions including MILS & cervical collar
- Consider neurogenic shock and potential for other injuries
- IV access for fluids, analgesia & antiemetic
Detail how a neurological assessment is completed.
- Level of conciousness (AVPU & GCS)
- Pupils (size & reactivity to light) also assess for any abnormalities including - deviation, poor tracking, nystagmus
- Motor function (muscle coordination, strength and tone) also assess for abnormal movements, tremors or posturing with or without painful stimuli
- Sensory function (hearing and ability to understand verbal communication & assess superficial sensation)
- Vital signs assessment - don’t forget temp & BGL
What are the indications for transport of a pt to a facility capable of large vessel occlusion retrieval - what assessment is required and what criteria must be met?
Suspected large vessle occlusion (LVO) stroke referral is mandatory for all pts woth symptoms suggestive of stroke who meet the following criteria:
Indications:
1. onset of stroke symptoms os less than 24hrs
2. NIHSS-8 or eight or more
3. Pre-morbid mRS of zero to 3
4. Pt located less than 60 mins transport time (from time of QAS assessment) to an ECR hospital
Contraindications:
1. Advanced terminal cancer with a life expectancy of less than 6 months
2. Seizure(s) at onset of symptoms
What are the indications of a fractured pelvis, femur, radius & ulna & what are the principals of management if identified?
General clinical features of fractures include:
* pain
* swelling
* bruising
* loss of function
* deformity
Additional specific clinical features include:
Pelvis - asymmetry, bruisng and/or numbness or tingling in groin, bruising in flanks, bleeding, decreased lower limb pulses/decreased sensation & haemodynamic instability (hypotension & tachycardia)
Femur - asymmetry, limb shortening, hypovolaemic shock
Radius/ulna - deformity (radius in line with thumb ie radial pulse) Colles fracture (hand displaced higher than forearm) or Smith fracture (hand displaced lower than forearm)
Management:
- pain relief
- IV access
- assess neurovascular status
- splinting then reassess
- consider CCP for procedural sedation/reduction
