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Paramedicine > General > Flashcards

General Flashcards

1
Q

Ipratropium bromide

A

Indications:

  • Moderate bronchospasm (unresponsive to QAS salbutamol)
  • Severe bronchospasm

Contraindications:

  • Allergy/adverse
  • <1yr

Dosage (≥6 yrs):

  • 500mcg (NEB)
  • 500mcg, 20min
  • 1500mcg MAX Dosage

Dosage (1-5 yrs):

  • 250mcg (NEB)
  • 250mcg, 20min
  • 750mcg MAX

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Ipratropium%20bromide.pdf

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2
Q

Methoxyflurane

A

Indications

  • Pain

Contraindications

  • Allergy/adverse
  • <1yr
  • Malignant hperthermia
  • Significant renal/hepatic disease

Dosage (ADULT)

  • 3mL
  • 20min
  • 6mL

Dosage (PAEDIATRIC)

  • 3mL
  • NIL RPT

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Methoxyflurane.pdf

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3
Q

Oxytocin

A

Indications:

  • Active management of 3rd stage of labour & prevention of PPH
  • Management of uncontrolled primary and secondary PPH

Contraindications:

  • Allergy/adverse
  • Undelivered foetuses

Dosage (active management):

IM

  • 10 IU
  • NIL RPTS

Dosage (uncontrolled primary/secondary PPH):

Loading dose:

IV (2-3 min slow push)

  • 10 IU
  • NIL RPTS

Maintenence dose (CCP)

  • 10 IU (IV INF)

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Oxytocin.pdf

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4
Q

GCS

A

ADULT:

Eye opening

  • 4 - Spontaneous
  • 3 - Open to voice
  • 2 - Open to pain
  • 1 - No response

Verbal

  • 5 - Orientated to time and place
  • 4 - Confused
  • 3 - Innappropriate
  • 2 - Incomprehensible
  • 1 - No response

Motor

  • 6 - Obeys commands
  • 5 - Localised to pain
  • 4 - Withdraws from pain
  • 3 - Flexion (decorticate) response
  • 2 - Extension (decerebrate) response
  • 1 - No response

CHILD:

Eye opening

  • 4 - Follows objects
  • 3 - Open to voice
  • 2 - Open to pain
  • 1 - No response

Verbal

  • 5 - Babbles and coos
  • 4 - Irritable/crying
  • 3 - Crying to pain
  • 2 - Grunts/groans
  • 1 - No response

Motor

  • 6 - Spontaneous
  • 5 - Localised to pain
  • 4 - withdraws from pain
  • 3 - Flexion (decorticate) response
  • 2 - Extension (decerebrate) response
  • 1 - No response
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5
Q

Respiratory assessement

A

ASS Vag Pussy Boobs Legs

  • Appearance
  • Speech
  • Skin
  • Ventilatory (rate, rhythm, effort)
  • Pulse
  • Breath sounds
  • LOC
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6
Q

Paracetamol

A

Indications:

  • Mild to moderate pain
  • Fever causing distress

Contraindications:

  • Allergy/adverse
  • <1 month

Dosage (Adult):

PO

  • 500 - 1000mg
  • 4hrs
  • 4mg MAX/DAY

Dosage (Child):

PO

  • 15mg/kg
  • NIL RPTS

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Paracetamol.pdf

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7
Q

Neurological assessment

A
  • Pupils
  • Sensory
  • Motor
  • VSS
  • LOC
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8
Q

A pt presents with a 3 hour Hx of SOB. What are some differentials?

A

Differentials:

  • COPD
  • FBAO
  • Chest infection
  • Anxiety
  • Allergic reaction/anaphylaxis
  • Croup (age-dependent)
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9
Q

Fentanyl

A

Indications:

  • Significant pain
  • Sedation
  • Induction for RSI
  • Autonomic dysreflexia (with SBP> 160)

Contraindications:

  • Allergy/adverse

Dosage (≥ 70yrs):

IV

  • 25mcg
  • ≤25mcg, 5min
  • 100mcg MAX

IM

  • 25 - 50mcg
  • ≤50mcg, 10min
  • 100mcg MAX

NAS

  • 25 - 50mcg
  • ≤50mcg, 10min
  • 100mcg MAX

Dosage (<70yrs):

IV

  • 25 - 50mcg
  • ≤50mcg, 5min
  • 200mcg MAX

IM

  • 25 - 100mcg
  • ≤50mcg, 10min
  • 200mcg MAX

NAS

  • 50 - 100mcg
  • ≤100mcg, 10min
  • 200mcg MAX

Dosage (Child):

IV

  • 1mcg/kg (25mcg MAX SINGLE)
  • 0.5mcg, 5min
  • 2mcg/kg MAX

IM

  • 1-2mcg/kg (50mcg MAX SINGLE)
  • 2mcg/kg MAX

NAS

  • 1.5mcg/kg (50mcg MAX SINGLE)
  • 1mcg/kg, 10min
  • 100mcg MAX
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10
Q

Salbutamol

A

Indications:

  • Bronchospasm
  • Suspected hyperkalaemia

Contraindications:

  • Allergy/adverse
  • <1 yr

Dosage (adult):

MDI

  • 1200mcg (12 puffs)
  • 10 min
  • NO MAX

NEB

  • 5mg
  • PRN
  • NO MAX

Dosage (1 - 5 yrs):

MDI

  • 600mcg (6 sprays)
  • 10 min
  • NO MAX

NEB

  • 2.5mg
  • PRN
  • NO MAX

Notes:

  • MDI preferred route where possible to reduce aerosolised particles

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Salbutamol.pdf

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11
Q

What is autonomic dysreflexia, and how would we determine autonomic dysreflexia in the prehospital setting?

What is the first line pharmacotherapy for autonomic dysreflexia?

A

What is it?

  • In individuals with SCI above T6, where a precipitating factor (eg. bladder irritation, skin infection, bowel compaction, sexual activity) triggers a dysregulationo of sympathetic input.
  • Parasympathetic response cannot reach below level of inury (nreves originate above SCI). Often bradycardia coupled with systemic hypertension as a result

Recognition:

  • Bradycardia
  • Hypertension
  • Diaphoresis
  • Pounding headache
  • Nasal stuffiness

Pharmcotherapy:

  • GTN (400mcg) = first line
  • Morphine (consider alongside GTN)
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12
Q

Morphine

A

Indications:

  • Significant pain
  • Sedation
  • Autonomic dysreflexia (SPB >160mmHg)

Contraindications:

  • Allergy/adverse
  • Kidney disease (renal failure)

Dosage (≥70yrs)

​IM

  • 2.5 - 5mg
  • 2.5mg, 10min
  • 10mg MAX

IV

  • 2.5mg
  • 2.5mg, 5min
  • 10mg MAX

Dosage (<70yrs):

IM

  • 2.5 - 10mg
  • 5mg, 10min
  • 20mg MAX

IV

  • 2.5 - 5mg
  • 5mg, 5min
  • 20mg MAX

Dosage (CHILD):

IM

  • 100 - 200mcg/kg (5mg single max)
  • 100mcg/kg, 10min
  • 200mcg/kg MAX

IV

  • 100mcg/kg (2.5mg single max)
  • 50mcg/kg, 5min
  • 200mcg/kg MAX
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13
Q

Midazolam

A

Indications:

  • Focal or generalized seizure (GCS≤12)
  • Behavioural disturbances (With SAT≥, unresponsive to max dose droperidol)
  • Sedation

Contraindications:

  • Allergy/adverse

Dosage (Adult):

Seizure

IV

  • 5mg
  • 5min
  • 20mg MAX

IM/NAS

  • 5mg
  • 10min
  • 20mg MAX

Behavioural disturbance

  • CONSULT

Dosage (Child):

IM/NAS

  • 200mcg/kg (5mg SINGLE MAX)
  • Half initial dose, 10min (2.5mg SINGLE MAX)
  • 10mg MAX

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Midazolam.pdf

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14
Q

Ondansetron

A

Indications:

  • Significant Nausea/vomiting

Contraindications:

  • Allergy/adverse
  • <3 yrs
  • Long QT syndrome
  • Current apomoprhine therapy

Dosage (adult):

IV/IM/PO

  • 4-8mg
  • 8mg MAX

Dosage (Child):

PO (≥5yrs)

  • 4mg
  • NIL RPT

PO (2-4yrs)

  • 2mg
  • NIL RPT

IV

  • 100mcg/kg (MAX 4mg)
  • NIL RPT

IM

  • 100mcg/kg, round to nearest 5kg (MAX 4mg)
  • NIL RPT

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Ondansetron.pdf

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15
Q

Perfusion assessment

A

London PBS

  • LOC
  • Pulse
  • BP
  • Skin
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16
Q

How would we clear a C-spine in the prehospital setting?

A

Nexus criteria

  • Midline C-spine tenderness
  • Intoxication
  • ALOC
  • Focal neurological deficit
  • Distracting injury
17
Q

GTN

A

Indications:

  • ACS
  • ACPO
  • Autonomic dysreflexia (SPB ≥ 160)
  • Irukandji syndrome (SPB ≥ 160)

Contraindications:

  • Head trauma
  • CVA
  • SBP <100
  • HR <50 or >150
  • Phosphodiesterase past 24hrs

Dosage (Adult):

  • 400mcg (SUBLING)
  • 5min, NO MAX

Dosage (Paeditric):

Irukandji/autonomic dysreflexia:

  • CONSULT

ACS/ACPO:

  • CONTRAINDICATED

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Glyceryl%20trinitrate.pdf

18
Q

Adrenaline

A

Indications:

  • Severe allergic reaction/anaphylaxis
  • Severe life-threatening bronchospasm
  • Croup with stridor at rest
  • Cardiac arrest

Contraindications:

  • NIL

Dosage (Adult):

Cardiac arrest

IV

  • 1mg
  • 3-5min
  • NO MAX

Anaphylaxis/severe allergic reaction

IM

  • 500mcg
  • 5min,
  • NO MAX

NEB (only for upper airway obstruction unresponsive to 3xIM injections)

  • 5mg
    • NIL RPTS

Bronchospasm

IM

  • 500mcg
  • 5min
  • NO MAX

Dosage (Paediatric):

Croup

NEB

  • 5mg
  • NIL RPTS

Cardiac arrest

IV

  • 10kg (≥1yr)
    • 10mcg/kg
    • 3-5 min
    • NO MAX
  • <10kg
    • 100mcg
    • 3-5 min
    • NO MAX
  • Newborn
    • 50mcg
    • 3-5 min
    • NO MAX

Anaphylaxis/severe allergic reaction

IM

  • ≥6yrs
    • 300mcg
    • 5 min
    • NO MAX
  • 1 - 6 yrs
    • 150mcg
    • 5 min
    • NO MAX
  • 6mths - 1yr
    • 100mcg
    • 5 min
    • NO MAX
  • <6mths
    • 50mcg
    • 5 min
    • NO MAX

NEB (only for upper airway obstruction unresponsive to 3xIM injections)

  • 5mg
  • NIL RPTS

Bronchospasm

IM

  • ≥6yrs
    • 300mcg
    • 5 min
    • NO MAX
  • 1 - 6 yrs
    • 150mcg
    • 5 min
    • NO MAX
  • 6mths - 1yr
    • 100mcg
    • 5 min
    • NO MAX
  • <6mths
    • 50mcg
    • 5 min
    • NO MAX

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Adrenaline.pdf

19
Q

Aspirin

A

Indications:

  • ACS
  • ACPO

Contraindications:

  • Allergy/adverse to aspirin or any other NSAID
  • <18 yrs
  • GI bleeding or peptic ulcers
  • Chest pain due to psychostimulant overdose
  • Clotting disorders

Dosage:

PO

  • 300mg
  • NIL RPT

Notes:

  • Should be administered in suspected ACS or ACPO even if pain free
  • Should be administered after initial dose of GTN in setting

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Aspirin.pdf

20
Q

Glucose 10%

A

Indications:

  • Symptomatic hypoglycaemia (unable to self-adminster oral glucose)

Contraindications:

  • NIL

Dosage (Adult):

  • 15g (150mL)
  • 10g boluses, 5min,
  • Until BGL >4

Dosage (child):

  • 250mg/kg (2.5mL/kg)
  • 100mg/kg (1mL/kg) boluses, 5 minutes
  • Until BGL >4

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Glucose%2010.pdf

21
Q

Mental status assessment

A

BAAPTISM

  • Behaviour
  • Appearance
  • Affect
  • Perceptions
  • Thought form & content
  • Insights/judgements
  • Speech
  • Mood
22
Q

Briefly overview management plan for pt with #to L) humerus

A

Primary survey

  • Clear airway, breathing and circulation

Assessments:

  • Pain
  • Head to toe
  • Perfusion (particularly distal to humerus)
  • Neurological
    • At least assess neurological function in affected limb
    • possibly full neuro if MoI sufficient to suspect TBI/SCI

Interventions:

  • Analgesia
    • Methoxy
    • ?morphine/fentanyl?,
    • Paracetamol since synergistic with other analgesia) -
  • Splinting (?sling?)
  • Transport
23
Q

What are some associated symptoms with ACS?

A
  • Headache
  • Nausea
  • Diaphoresis
  • Dizziness/lightheadedness
  • Anxiety, apprehension, restlessness
24
Q

Glucose Gel

A

Indications:

  • Hypoglycaemia

Contraindications:

  • Difficulty swallowing
  • ALOC/unconscious
  • <2yrs

Dosage (adult):

  • 15g (PO)
  • 15g, 15min
  • 30g MAX

Dosage (child):

  • 15g (PO)
  • NIL RPT

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Glucose%20gel.pdf

25
Q

Droperidol

A

Indications:

  • Acute behavioural disturbance (with SAT≥2)

Contraindications:

Absolute:

  • Allergy/adverse
  • <8 yrs
  • Parkinson’s disease
  • Known Lewy body dementia
  • Previous dystonic reaction to droperidol

Relative:

  • Suspected sepsis (consult)

Dosage (≥65 yrs, CONSULT)

IM/IV

  • 5mg
  • 15 min
  • 10mg MAX

Dosage (16 - <65yrs)

IM/IV

  • 10mg
  • 15 min
  • 20mg MAX

Dosage (8 - 15yrs, CONSULT):

IM/IV

  • 100 - 200mcg/kg (max 10mg)
  • 15 min
  • 20mg MAX

https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Droperidol.pdf

26
Q

Outline the NIHSS-8

A
  1. Level of consciousness
  2. LOC questions
  3. Commands
  4. Facial Palsy
  5. Best gaze
  6. Motor arm
  7. Dysarthria
  8. Extinction/neglect

https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Stroke%20and%20Transient%20ischaemic%20attack.pdf

Paramedicine (2 decks)

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