Guideline Questions Flashcards
Other than analgesia, what 5 other interventions can contribute to pain control?
Splinting Posture Oxygenation Reassurance Temperature Control (SPORT)
When managing pain, the aim is:
A. Complete Relief
B. Reduce to a tolerable level
B. Reduce to a tolerable level
How long until IV Morphine reaches Maximal Effect?
15 Minutes (Significant variation among individuals)
How long until IN Fentanyl reaches Maximal Effect?
5 Minutes (Significant variation among individuals)
For pain that is going to be difficult to control with paramedic limits of morphine, what can/should you do?
Request Clinical Support
When delivering Narcotics, What should also be administered?
Oxygen
What are 6 adverse effects of Morphine?
Hypotension Respiratory depression Interactions with Other CNS Depressants Nausea and Vomiting Itchiness Constipation
Before administering any pain relief, what subjective finding should be assessed?
Pain score
What 2 type of pain can Paramedics administer Morphine to?
Musculoskeletal Injuries
Burns
What are the 2 main clinical findings that must be met before administering Morphine?
SPB > 100mmHg
GCS 15
What is the IV dose for Morphine, and at what interval is it given?
What is the end point for these repeated doses?
2.5mg every 5 minutes until pain is controlled
What is the maximum number of doses of IV Morphine that we can give as Paramedics?
Until pain is controlled. There is no specific limit.
If Morphine is not controlling pain, can you administer Fentanyl?
No
What can you do if pain is not being controlled with IV Morphine?
Request Clinical support.
If that is not available, consult with the EOC Clinician
When can paramedics administer Fentanyl?
When Morphine is unable to be administered
What is the initial IN dose limit for Fentanyl?
180mcg
What is the dose limit for second and subsequent doses of IN Fentanyl?
90mcg
How does Fentanyl come?
What dose is in the vial?
600mcg in 2mL
What is the procedure for drawing up a 180mcg dose of Fentanyl?
> Draw up at least 0.7mL in a 1mL Luer Lock syringe
You have 30mcg / 0.1mL (neeed 0.6mL for 180mcg dose)
Attach the NAD, and prime it with at least 0.1mL or until you have reached 0.6mL
What is the minimum interval for Fentanyl doses?
5 Minutes
What is the Maximum combined dose for IN Fentanyl?
360mcg
What pain relief can we administer to paediatrics?
Methoxyflurane
What can we do for paediatrics that pain has not been controlled by Methoxyflourane?
Request Clinical support
Consult with the EOC Clinician
Under what circumstances might you consider morphine for chest pain?
What do you need to do before administering Morphine for Chest Pain.
Long country transfer
Consult with the EOC Clinician
What is the max dose of Methoxyflurane for paramedics?
3mL
If receiving a patient from a volunteer crew, what dose of Methoxyflurane may have been administered under Volunteer guidelines
6mL
If given authority, what is the Paediatric dose for IV Morphine?
50mcg / kg
If given authority, what is the Paediatric dose for IN Fentanyl?
0-4yo - 30mcg
5-9yo - 60mcg
10-13yo 90mcg
In severe ACPO, what should be activated early?
Clinical support for CPAP
Aside from GTN, what 3 other interventions are useful in the treatment of ACPO?
Oxygen
Posture
CPAP
What clinical findings need to be assessed before administering GTN?
Blood Pressure (Sufficient) ECG (Rate and Rhythm)
Other than clinical findings, what is a contraindication for administering GTN?
Use of:
Viagra / Levitra in past 24 hours
Cialis past 48 hours
What is the interval for repeat doses of GTN? (guideline)
5 minutes
What is the dose for SL GTN?
400mcg
What is the max combined dose for GTN?
PRN, There is no limit
What is the half life of GTN?
3 minutes
What is the time to peak plasma levels for SL GTN?
3 Minutes
True or False
A notification is required for ACPO patients
True
In Adult Cardiac arrest, what takes precedence over all other procedures?
Defibrillation (if indicated)
In Adult Cardiac arrest, once an advanced airway is in situ, ventilate:
>rate/minute
>ratio/compressions
> ? second intervals
Ventilate:
6/minute
15:1 to compressions
Every 10 seconds
What are the reversible causes of Cardiac Arrest?
4Hs & 4Ts
Hypoxia
Hypovalemia
Hyper/hypothermia
Hyper/hypokalemia
Tension Pneumothorax
Tamponade
Toxins
Thrombosis (STEMI/PE)
What legal consideration must be considered before commencing/continuing CPR?
End of life considerations/NFRs
In Cardiac arrest, at what point is IV Adrenaline given for:
> Shockable rhythms?
> Non Shockable rhythms?
> Shockable rhythms
after second shock, then every second loop
Non Shockable rhythms
Stat, then every second loop
In a persistent VT, VF or PEA arrest, what is the minimum amount of time you should spend attempting resuscitation?
30 Minutes
In a persistent asystole arrest, what is the minimum amount of time you should spend attempting resuscitation?
10 Minutes
In an arrest, what needs to happen before ceasing resuscitation?
Discussion with all clinicians and interested parties at the scene
After ceasing resuscitation, when can you consider removing invasive equipment?
Expected death
Scene Management
Cultural Considerations
Note the reason in PCR
What 6 things should be done post ROSC?
Re-evaluate ABCDE Advanced Airway Evaluate Oxygenation / Ventilation 12 lead ECG (if does not delay transport) Treat precipitating causes Transport/Notify
What 4 concurrent clinical findings are required to declare life extinct?
Nil for 1 minute: Heart Sounds Pulse Respirations Pupil reactions
Why do we give aspirin to Chest Pain?
Reduce platelet aggregation around the thrombus.
Chewable aspirin begins to be detected in blood after _____minutes.
20 minutes
Peak serum levels for aspirin are _______minutes.
180 minutes (3hours)
Why can we give aspirin to patients already on Warfarin?
Warfarin is an anticoagulant that works on a different pathway than aspirin.
If chest pain is unrelieved with GTN and Oxygen, what can we do as Paramedics?
Clinical Support
Consult with the EOC Clinician
In Unrelieved Chest Pain, and if permitted, what is the IV dose and frequency of Morphine?
1 - 2.5mg IV every 5 minutes RPN
In paediatrics, cardiac arrest is usually due to:
Hypoxia
In Paediatric Cardiac Arrests, the Compression/Ventilation ratio is:
15:2
In Cardiac arrest, what is the paediatric dose for DCCS?
4J / Kg
In a paediatric Cardiac Arrest, what ages can be cannulated, and what are the options for gaining access?
>1yo = cannulate <1yo = request Clinical support for IO access. If no support, consider cannulating.
What is the Paediatric dose of adrenaline in Cardiac Arrest?
10mcg / kg
Do paramedics need to consult for Adrenaline in Paediatric Cardiac Arrest?
Yes!
A 1 hour old baby is classified as a ________.
Newborn/ neonate/ infant/ paediatric
Newborn
0 - 2 hours
A neonate’s age ranges from _______ to _______.
2 hours to 4 weeks.
A 9 month old baby is classified as a _________.
Newborn/ neonate/ infant/ paediatric
Infant.
4 weeks - 1 year