Development Meeting 2 Flashcards
Define anaphylaxis & what are the acute symptoms that may be present for this condition to be considered?
Anaphylaxis is a life threatening condition requiring urgent treatment.
Anaphylaxis can be defined as:
Any acute onset illness with typical skin features
(urticaria or erythema/flushing AND/OR angioedema)
PLUS involvement of respiratory AND/OR cardiovascular AND/OR persistent severe gastrointestinal symptoms”
OR
Any acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is considered possible, even if skin features are not present
Outline the treatment for anaphylaxis.
- IM adrenaline
- Oxygen
- Sodium chlor (10-20mL per kg)
- Posture supine & remove allergen if possible
- If no CCP, consider QAS clinical consult (adrenaline infusion)
After 3 x IM adrenaline:
If upper airway obstruction, consider NEB adrenaline .
If persistent hypotension/shock present, consider sodium chloride bolus + glucagon.
If persistent wheeze present, consider salbutamol NEB
What are the vital sign parameters that may indicate that a patient has sepsis?
ADULT:
- Respiratory rate greater than 25 breaths/min
- Systolic BP less than 90 mmHg (or a drop of greater
than 40 mmHg from normal)
- Heart rate is equal to or greater than 130 beats/min
- Needs oxygen to maintain SpO2 greater than 92%
- Non-blanching rash/mottled/ashen/cyanotic
- Deterioration in mental status (from normal)
- Recent chemotherapy
- Anuria in last 18 hours OR significantly reduced
urine output
PAEDIATRIC
- Severe tachycardia or bradycardia
- Severe respiratory distress/tachypnoea/apnea
- Needs oxygen to maintain SpO2 greater than 92%
- Hypothermia
- Non-blanching rash/mottled ashen/cyanotic
- Altered GCS/AVPU
RISK ASSESSMENT
- Re-presentation to a health care professional
within 48 hours
- Age less than 3 months OR greater than 65 years
- Recent trauma or surgery/invasive procedure/wound within last 6 weeks
- Indwelling medical devices (e.g. IDC)
- Immunocompromised/asplenia/neutropenia/unimmunised
- Parental/family/health care professional concern
for the patient
- Aboriginal or Torres Strait Islander/Pacific Islander/Maori cultural backgrounds
Detail the risks of managing a patient with APO and COPD. What medical hx markers may indicate APO as opposed to COPD?
- pts with COPD already have compromised lung function thus, APO would further impair gas exchange and increase WOB
- APO requires supplemental O2 however, administering high flow oxygen in COPD can lead to hypercapnia (CO2 retention) and thus worsen respiratory acidosis
- consider comorbidities
- differences in pharmacological management e.g giving Salbutamol in APO has the potential to worsen fluid shift and increase cardiac workload
Points to consider in order to differentiate:
- pts with COPD may have a hx of chronic respiratory symptoms including a cough, sputum production, dyspnoea & wheeze (usually gradual worsening during an exacerbation)
- pts with APO may have a hx of cardiac failure, ischaemic heart disease, hypertension, orthopnoea (difficulty breathing whilst laying flat), peripheral oedema & onset is usually sudden
- APO may present with crackles (rales) on auscultation signifying pulmonary congestion
Outline the management principles for a patient presenting with croup (stridor at rest).
- Use Westley Croup score to assess severity by assessing the patients LOC, cyanosis, stridor, air entry & chest wall retractions
If MILD - treat with Dexamethasone (glucocorticoid medication)
If MODERATE - treat with Dexamethasone + consider Adrenaline NEB
If SEVERE - treat with Adrenaline NEB & Dexamethasone
What vital signs would indicate that a paediatric patient is compensating?
- Increased HR
- Increased RR
- Decreased BP
- Fever
- Prolonged CRT >2 sec
- Decreased SPO2
- ALOC
What is BRUE & what are the management principles?
Brief resolved unexplained event - is defined as a self-limiting episode of unexpected deterioration in a young paediatric that is characterised by aberrancy in breathing, muscular tone, colour or level of consciousness.
Often witnessed by a parent, “describe a short-lasting (less than one minute) event of acute haemodynamic disturbance followed by a prompt return to the patients baseline health status. ”
Prehospital management includes conducting a thorough hx assessment and reassessing the pt regularly.
Why is a patient with sepsis a risk when managing an acute behavioural disturbance
Physical or chemical restraint (sedation) can lead to the following complications:
1. Haemodynamic instability
2. Difficult fluid resuscitation
3. Risk of hypoxemia
4. Metabolic derangement
Sedation in a patient experiencing an ABD carries risk - what are 4 risks that can be mitigated using the sedation checklist?
- Roles are allocated - ensures a team effort and ensures dedicated person to monitor patient vital signs and identify any potential issues in a timely manner
- Ensures monitoring and resuscitation equipment is nearby and ready
- Ensures DTP and contraindications are checked
- Ensures other organisations e.g. QPS have also been adequately briefed
Why might reduced dosages of Midazolam be recommended in patients who are of low body weight, frail or who have chronic disease?
Reduced dosages of Midazolam are recommended in these patient cohorts to reduce the risk of excessive sedation and adverse affects. This is due to multiple factors including:
1. Decreased metabolic weight (Midazolam is metabolised by the liver via cytochrome P450 enzymes and thus frail/low body weight individuals may metabolise the drug more slowly)
2. Reduced volume for distribution (smaller distribution volume = stronger concentration in the bloodstream)
3. Decreased clearance (prolonged half-life = further accumulation and effects
4. Increased risk of adverse effects (respiratory depression, haemodynamic instability)
5. Age related changes (decreased hepatic & renal function
Outline the preferred positioning for the following patients:
1. Toxicology
2. Head injury
3. Conscious patient with a partial airway obstruction
- Toxicology - semi recumbent/lateral recovery position if vomiting
- Head injury - head up 30° to assist with venous return and prevent increased ICP
- Conscious patient with a partial airway obstruction - sitting position/forward leaning
Outline risks of naloxone administration in an unconscious patient with opioid toxicity & how can these risks be mitigated?
- Increased risk of agitation & violence post naloxone administration
Risk reduction:
- QPS assistance
- physical restraint
- sedation
