General Treatment Principles

Question 1

What steps should be followed when verifying death?

Answer 1

1. if clear and obvious signs of death (decomp, rigor m.,injuries incompatible w life) = yes
2. if no ssx breathing for 1 min/no central pulse/no audible hr/pupils dilated and unreactive = wait 10min
3. If no ssx RR for 1 min/no central pulse/no audible HR/pupils dilated unreactive/3 lead ECG shows asystole

Question 2

When should oxygen be administered?

Answer 2

SPO2 <94% on air (except CORD/high risk)
Airway obstruction
Respiratory distress
Shock
Severe TBI
CO poisoning
Smoke inhalation
Decompression illness
Condition requiring sedation

Question 3

What are high risk pts re oxygen and how should they be treated with oxygen?

Answer 3

CORD/ morbidly obese/on home O2/CPAP or BiPAP/neonates

• high risk adult titrate to known normal SPO2 or 88-92%
• if neonates titrate to 90-95% 10 mins after birth

Question 4

What are grounds for believing a pt is not competent?

Answer 4

1. unable to understand information
2. unable to understand consequences of their decisions
3. unable to remember information
4. Has attempted suicide
5. Has made a gennuine or significant threat to commit suicide

Question 5

Treatment may be provided against a patients will if what?

Answer 5

1. Pt is believed not competent
2. Treatment is believed to be in pt best interest
3. Risks assoc ttmt < risks assoc not ttmt
4. ttmt non contracting a valid advanced directive

Question 6

What are the analgesia indications for mild/moderate/severe pain?

Answer 6

Mild - paracetamol and maybe ibuprofen
Moderate - paracetamol and maybe ibuprofen, tramadol and inhaled analgesia - call for paramedic backup if pain not controlled
Severe - maybe inhaled analgesia call for paramedic backup for pain relief

Question 7

What are contras and cautions for paracetamol?

Answer 7

Contras: paracetamol poisoning
Cautions: 
dose last four hours/
adominal pain/
severe liver disease

Question 8

What are contras and cautions for ibuprofen?

Answer 8

Contras: 3rd trimester pregnancy
Cautions: 
dose last four hours
abdo pain
age >= 75
dehydration/shock
renal impairment
bleeding disorder
clinically significant bleeding
bronchospasms with NSAIDS
taking warfarin
pregnancy

Question 9

What are contras and cautions for tramadol?

Answer 9

Contras: <12 yo
Cautions: 
tramadol last 4
abdo pain
age >=75
confusion
pregnancy

Question 10

What are contras and cautions for entonox?

Answer 10

Contras:
scuba last 24
decompress illness
bowel obstruction
pneumothorax
Caution
confined space
chronic pain and frequent ambulance use

Question 11

What are contras and cautions for methoxy?

Answer 11

Contras:
hx or family hx of malignant hyperthermia
unable to obey commands
known renal impairment
had methoxy in last week

Caution:
confined spaces
pre-eclampsia (hypertension in pregnancy)
age >=75