General knowledge Flashcards
Anaphylactic reaction definition
Any acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is considered possible, even if typical skin features are not present OR
Any acute onset illness with typical skin features (urticarial rash or erythema/flushing, and/or angioedema), PLUS involvement of respiratory and/or cardiovascular and/or persistent severe gastrointestinal symptoms, (ASCIA, 2010).
If allergic reaction is deemed to involve more than two body systems, and it is therefore no longer localised, anaphylaxis should be considered.
Paed weight calc
1-9 years: (Age + 4) x 2. 10-12 years: Age x 3.3
Asthma criticality conditions
2 I’s, 3 S’s, 4,3,2,1
Prior ICU admission
Prior intubation
Chronic use of steroids
Progressive symptoms in spite of aggressive treatment.
Patient unable to speak in sentences
Use of bronchodilators > every 4 hours
>3 ED visits in past year
>2 hospital admissions in past year
>1 bronchodilator canister used in past month
.
DOPES
D
Displacement
Check etCO2 value/waveform.
Look at tube position; does it look displaced?
Auscultate the chest and epigastrium. If gurgling is audible, withdraw ETT immediately
Assess/consider ETT cuff inflation, depth, or oesophageal intubation.
Check placement after any move.
O
Obstruction
Inability or severe resistance to ventilation is a very good indicator of obstruction.
Clear Foreign Body Airway Obstruction
P
Pneumothorax
Consider the signs and symptoms of pneumothorax/haemothorax.
Consider ventilator settings.
E
Equipment Failure
Consider failure of equipment starting from the oxygen cylinder straight through to the ETT and back again.
S
Secretions
Thick mucus might obstruct ETT.
Suction
Poisons info hotline number
13 11 26
SLUDGEBBB
Salivation
Lacrimation
Urination
Defecation
GI distress
Emesis
Bronchorrhea
Bradycardia
Bronchoconstriction
Tox animals PIT indication/contra
PIT = For All Australian Snake bites, sea snakes, funnel web Spiders, Blue-ringed octopus,
cone shell
Scales of hypothermia
Mild hypothermia (32-35C):
Decreased respiratory rate
Lethargy
Weakness
Slurred speech
Ataxia
Shivering may cease
Moderate hypothermia (30-32C):
Muscle rigidity
Poor reflexes
Dilated pupils
Hypotension
Bradycardia
Severe hypothermia (< 30C):
Flaccid muscles
Fixed pupils
Arrhythmias
Cardiac arrest
Respiratory distress scales
&components
Mild / Moderate / Severe-Life-threatening
Appearance / Pulse / Speech / WoB / Breath sounds / RR / Resp Rhythm
AEIOUTIPS
A – Alcohol / Abuse of substances / Acidosis (pH < 7.35)
E – Environmental / Epilepsy / Electrolytes / Encephalopathy / Endocrine disease
I – Infection
O – Overdose / Oxygen deficiency
U – Underdose / Uraemia (urea in blood - kidney failure)
T – Trauma / Tumor
I – Insulin
P – Psychogenic / Poisons
S – Stroke / Shock
CVA inclusion criteria
-Symptom onset < 9 hours
- Patient possesses full Activities of Daily Living (ADLs)
- BGL between 4 - 22mmol/L
Acute stroke centre locs and hours
Acute stroke centre
Sir Charles Gairdner Hospital
Fiona Stanley Hospital
Royal Perth Hospital
St. John of God - Midland
Joondalup Health Campus
Monday - Sunday, 24 hours a day
Acute neuroendovascular unit locs and hours
Acute neuroendovascular unit
Sir Charles Gairdner Hospital:
Monday - Sunday, 24 hours a day
Fiona Stanley Hospital:
Monday - Friday, 08:00 - 16:00
Arrival to ED must be within prescribed times
Status epilepticus
Convulsive status epilepticus is defined as any seizure activity that meets any of these three critiera;
A persistent seizure lasting greater that 5 minutes without return of consciousness
recurrent seizures (2 or more) without an intervening period of neurological recovery
Note that:
older definitions required seizure activity to continue for 30 minutes to be considered status epilepticus
most seizures terminate within 5 minutes and those that don’t are often prolonged
significant neuronal injury occurs well before 30 minutes
STEMI Transmission indications
Monitor reads “ACUTE MI” or “Meets STEMI criteria” OR
ST elevation 1mm in 2 contiguous limb leads OR
ST elevation in 2mm in 2 contiguous chest leads OR
Symptomatic acute left bundle branch block
STEMI inclusion criteria
Symptom onset < 12 hours
Mobile and independent ADLs
GCS15
P wave, PR interval, QRS, intervals (inc squares), t wave
P wave <0.12 (3 small squares)
PR interval 0.12-0.2 (3-5 small squares)
QRS 0.04-0.12 (1-3 small squares)
T wave <0.5mm
ECG interpretation steps
P wave
PR interval
QRS
Rate
Regularity
T wave
IMPACT CPR principles
- Create an overview position if possible
- Create or move to a good working space
- Standardised equipment placement
- High quality focussed compressions with minimal interruptions
- Use feedback and quality CPR devices
- Swap compressor every loop (2 minutes)
- BVM oxygenation/controlled ventilation
- Calm, quiet & coordinated scene
- Closed loop/functional language
Hs and Ts
Hypoxia, hypothermia, hyperkalemia, hypovolemia.
Tamponade, tension pneumothorax, toxins, thrombosis
TOR
- The presenting rhythm is Asystole, not SJA witnessed, and remains in Asystole after 20 min of maximally directed resuscitation
OR - The presenting rhythm is shockable, not SJA witnessed, and progresses quickly and remains in, Asystole OR wide, slow PEA (<40/min) after 20 – 30 mins with NO other favourable signs of response to efforts (e.g. high EtCO2)
OR - The destination ED is > 15 minutes away from the arrest location, 20 minutes or more of maximal BLS/ALS has been applied, ROSC has not been achieved at any stage and there are no special circumstances or other compelling reasons to continue.
OR - A specifically authorised SJA clinician makes a reasonable decision based upon prognostic futility either on scene or via the Clinical Support Desk or ASMA.
OR - Prolonged CPR in Blunt Traumatic Cardiac Arrest after reversible causes have been addressed is almost never associated with a good outcome. If delivery to an ED cannot be achieved within 25 minutes from arrival on scene, it is reasonable to terminate resuscitation if NO ROSC is achieved after 10 minutes, and Determination of Death criteria are met.
ROLE
- No Central Pulses at all and
- Asystole for >30 seconds[1] and
- Fixed and Dilated pupils with NO corneal reflexes at all and
- No signs of Breathing at all and
- No Auscultated Heart Sounds (if in scope of practice)
withholding criteria
- Prolonged Cardiac Arrest (i.e. estimated downtime greater than 15 minutes) and
- Generally unwitnessed and First assessed rhythm is Asystole and
- Not received a defibrillation shock and
- No compelling reasons or special circumstances to continue
**Expected Deaths / Advanced Directives;
*** There is credible evidence that death was expected as a result of terminal illness - The individual has taken the Voluntary Assisted Dying substance
- It is the patient’s wishes not to be resuscitated and have previously been clearly communicated and this seems reasonable to attending St John staff. It is not necessary to sight an advanced directive[2]
**Residential Care Facility[3] patients who;
***Are aged 80 years or over and - Obviously frail (Frailty Score 7, 8 or 9).
- Patients in the Community with ALL the following
- Aged 80 or over with
- Asystole as the presenting rhythm, and
- Clearly frail (Frailty Score 7,8 or 9) - most will have life-limiting co-morbidities e.g.
Chronic Renal Failure, Advanced Dementia or Cerebrovascular disease, Hemiplegia,
Advanced COPD, Chronic Cardiovascular disease.
major trauma - mechanism
- MVA= > 60kmh/h with injuries
-Ejection from a vehicle - Fatality on scene whereby the patient was in the same vehicle
- MBA > 30km/h with injuries
- Pedestrian op cyclist with the speed impact >25km/h
- Fall >3m
- Penetrating injury to head, neck, torso or proximal extremities
