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Guideline Questions Flashcards

1
Q

Other than analgesia, what 5 other interventions can contribute to pain control?

A 
Splinting
Posture
Oxygenation
Reassurance
Temperature Control
(SPORT)
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2
Q

When managing pain, the aim is:
A. Complete Relief
B. Reduce to a tolerable level

A

B. Reduce to a tolerable level

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3
Q

How long until IV Morphine reaches Maximal Effect?

A 
15 Minutes
(Significant variation among individuals)
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4
Q

How long until IN Fentanyl reaches Maximal Effect?

A 
5 Minutes
(Significant variation among individuals)
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5
Q

For pain that is going to be difficult to control with paramedic limits of morphine, what can/should you do?

A

Request Clinical Support

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6
Q

When delivering Narcotics, What should also be administered?

A

Oxygen

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7
Q

What are 6 adverse effects of Morphine?

A 
Hypotension
Respiratory depression
Interactions with Other CNS Depressants
Nausea and Vomiting
Itchiness
Constipation
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8
Q

Before administering any pain relief, what subjective finding should be assessed?

A

Pain score

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9
Q

What 2 type of pain can Paramedics administer Morphine to?

A

Musculoskeletal Injuries

Burns

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10
Q

What are the 2 main clinical findings that must be met before administering Morphine?

A

SPB > 100mmHg

GCS 15

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11
Q

What is the IV dose for Morphine, and at what interval is it given?
What is the end point for these repeated doses?

A

2.5mg every 5 minutes until pain is controlled

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12
Q

What is the maximum number of doses of IV Morphine that we can give as Paramedics?

A

Until pain is controlled. There is no specific limit.

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13
Q

If Morphine is not controlling pain, can you administer Fentanyl?

A

No

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14
Q

What can you do if pain is not being controlled with IV Morphine?

A

Request Clinical support.

If that is not available, consult with the EOC Clinician

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15
Q

When can paramedics administer Fentanyl?

A

When Morphine is unable to be administered

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16
Q

What is the initial IN dose limit for Fentanyl?

A

180mcg

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17
Q

What is the dose limit for second and subsequent doses of IN Fentanyl?

A

90mcg

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18
Q

How does Fentanyl come?

What dose is in the vial?

A

600mcg in 2mL

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19
Q

What is the procedure for drawing up a 180mcg dose of Fentanyl?

A

> 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

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20
Q

What is the minimum interval for Fentanyl doses?

A

5 Minutes

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21
Q

What is the Maximum combined dose for IN Fentanyl?

A

360mcg

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22
Q

What pain relief can we administer to paediatrics?

A

Methoxyflurane

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23
Q

What can we do for paediatrics that pain has not been controlled by Methoxyflourane?

A

Request Clinical support

Consult with the EOC Clinician

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24
Q

Under what circumstances might you consider morphine for chest pain?
What do you need to do before administering Morphine for Chest Pain.

A

Long country transfer

Consult with the EOC Clinician

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25
Q

What is the max dose of Methoxyflurane for paramedics?

A

3mL

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26
Q

If receiving a patient from a volunteer crew, what dose of Methoxyflurane may have been administered under Volunteer guidelines

A

6mL

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27
Q

If given authority, what is the Paediatric dose for IV Morphine?

A

50mcg / kg

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28
Q

If given authority, what is the Paediatric dose for IN Fentanyl?

A

0-4yo - 30mcg
5-9yo - 60mcg
10-13yo 90mcg

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29
Q

In severe ACPO, what should be activated early?

A

Clinical support for CPAP

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30
Q

Aside from GTN, what 3 other interventions are useful in the treatment of ACPO?

A

Oxygen
Posture
CPAP

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31
Q

What clinical findings need to be assessed before administering GTN?

A 
Blood Pressure (Sufficient)
ECG  (Rate and Rhythm)
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32
Q

Other than clinical findings, what is a contraindication for administering GTN?

A

Use of:
Viagra / Levitra in past 24 hours
Cialis past 48 hours

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33
Q

What is the interval for repeat doses of GTN? (guideline)

A

5 minutes

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34
Q

What is the dose for SL GTN?

A

400mcg

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35
Q

What is the max combined dose for GTN?

A

PRN, There is no limit

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36
Q

What is the half life of GTN?

A

3 minutes

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37
Q

What is the time to peak plasma levels for SL GTN?

A

3 Minutes

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38
Q

True or False

A notification is required for ACPO patients

A

True

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39
Q

In Adult Cardiac arrest, what takes precedence over all other procedures?

A

Defibrillation (if indicated)

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40
Q

In Adult Cardiac arrest, once an advanced airway is in situ, ventilate:
>rate/minute
>ratio/compressions
> ? second intervals

A

Ventilate:
6/minute
15:1 to compressions
Every 10 seconds

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41
Q

What are the reversible causes of Cardiac Arrest?

4Hs & 4Ts

A

Hypoxia
Hypovalemia
Hyper/hypothermia
Hyper/hypokalemia

Tension Pneumothorax
Tamponade
Toxins
Thrombosis (STEMI/PE)

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42
Q

What legal consideration must be considered before commencing/continuing CPR?

A

End of life considerations/NFRs

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43
Q

In Cardiac arrest, at what point is IV Adrenaline given for:
> Shockable rhythms?
> Non Shockable rhythms?

A

> Shockable rhythms
after second shock, then every second loop
Non Shockable rhythms
Stat, then every second loop

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44
Q

In a persistent VT, VF or PEA arrest, what is the minimum amount of time you should spend attempting resuscitation?

A

30 Minutes

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45
Q

In a persistent asystole arrest, what is the minimum amount of time you should spend attempting resuscitation?

A

10 Minutes

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46
Q

In an arrest, what needs to happen before ceasing resuscitation?

A

Discussion with all clinicians and interested parties at the scene

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47
Q

After ceasing resuscitation, when can you consider removing invasive equipment?

A

Expected death
Scene Management
Cultural Considerations
Note the reason in PCR

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48
Q

What 6 things should be done post ROSC?

A 
Re-evaluate ABCDE
Advanced Airway
Evaluate Oxygenation / Ventilation
12 lead ECG (if does not delay transport)
Treat precipitating causes
Transport/Notify
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49
Q

What 4 concurrent clinical findings are required to declare life extinct?

A 
Nil for 1 minute:
Heart Sounds
Pulse
Respirations
Pupil reactions
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50
Q

Why do we give aspirin to Chest Pain?

A

Reduce platelet aggregation around the thrombus.

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51
Q

Chewable aspirin begins to be detected in blood after _____minutes.

A

20 minutes

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52
Q

Peak serum levels for aspirin are _______minutes.

A

180 minutes (3hours)

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53
Q

Why can we give aspirin to patients already on Warfarin?

A

Warfarin is an anticoagulant that works on a different pathway than aspirin.

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54
Q

If chest pain is unrelieved with GTN and Oxygen, what can we do as Paramedics?

A

Clinical Support

Consult with the EOC Clinician

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55
Q

In Unrelieved Chest Pain, and if permitted, what is the IV dose and frequency of Morphine?

A

1 - 2.5mg IV every 5 minutes RPN

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56
Q

In paediatrics, cardiac arrest is usually due to:

A

Hypoxia

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57
Q

In Paediatric Cardiac Arrests, the Compression/Ventilation ratio is:

A

15:2

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58
Q

In Cardiac arrest, what is the paediatric dose for DCCS?

A

4J / Kg

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59
Q

In a paediatric Cardiac Arrest, what ages can be cannulated, and what are the options for gaining access?

A 
>1yo = cannulate
<1yo = request Clinical support for IO access. If no support, consider cannulating.
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60
Q

What is the Paediatric dose of adrenaline in Cardiac Arrest?

A

10mcg / kg

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61
Q

Do paramedics need to consult for Adrenaline in Paediatric Cardiac Arrest?

A

Yes!

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62
Q

A 1 hour old baby is classified as a ________.

Newborn/ neonate/ infant/ paediatric

A

Newborn

0 - 2 hours

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63
Q

A neonate’s age ranges from _______ to _______.

A

2 hours to 4 weeks.

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64
Q

A 9 month old baby is classified as a _________.

Newborn/ neonate/ infant/ paediatric

A

Infant.

4 weeks - 1 year

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65
Q

What are the age ranges for a paediatric?

A

1 - 14 years

66
Q

During Child Delivery, what are 6 key things to remember?

A 
Don't drop it
Do Dry it
Record Time of birth
Exclude cord Compression
Hamburger hands
Massage the Fundas, then hands off (!)
67
Q

What do we get if we deliver a newbown to the WCH that is normothermic?

A

A Bottle of wine

68
Q

What is considered normal blood loss during child delivery?

69
Q

After delivery of a child, what 3 things do we need to check on the MOTHER?

A

> Check the Fundas for firmness (indicating contractillity)
Obs - including blood loss, pereneal tears
Check for a second Baby

70
Q

After delivery of a child, what 3 things do we need to check on the NEWBORN?

A

> APGAR
Stimulate and Rub
Cord Care (clamp and cut)

71
Q

What 4 reasons do we place newborns on the mother’s chest with skin to skin contact?

A

Decrease heat loss
Begin Bonding
Increase mother’s hormones that stimulate breast feeding
Increase Uterine contraction

72
Q

During newborn care/ resuscitation, only aspirate secretions if:

A

The airway is compromised.

73
Q

The 5 Components of APGAR are:

A 
Appearance
Pulse Rate
Grimace
Activity
Respirations
74
Q 
How many points towards an APGAR score does this newborn get:
Generally pink with blue hands
HR 110
Grimacing a bit, but not coughing/crying
Some arm activity
Slow, Irregular respirations
75
Q

When should an APGAR be done?

A

1 minute after delivery

5 minutes after delivery

76
Q

At what point would you ventilate a newborn, and at what rate?

A

Inadequate respiration after 30 - 60 seconds.

Ventilate at 40 - 60 /minute

77
Q

When would you give a newborn oxygen? (2)

A
  • After 5 minutes of ventilating with air.
    or
  • HR <100
78
Q

In a newborn, what 2 conditions need to be met to begin compressions?

A

At least 30 seconds of ventilation

HR <60

79
Q

In a newborn arrest, what is the ratio for compressions / ventilations?

80
Q

What are the reasons that you may not commence CPR?

A

-The patient is in the terminal phase of a terminal illness.
AND
An advanced directive is in place
or
Medical agent exercises Power of attorney

  • Rigor Mortis
  • Clear, unmistakable dependent lividity
  • Injuries incompatible with life
  • Pulseless, not breathing, fixed dilated pupils, unresponsive with no CPR for 30 mins (all of these)
  • Crew placed in significant danger to do CPR
  • MCI triaging
81
Q

Under what conditions can a Person be taken into care and control under the MHA?

A 
Has/appears to have a MH Illness
AND
   Has / risk of Harm to self/ others/ property
   or
   requires medical exemination
82
Q

In a behavioural emergency that looks like sedation will be required, what should you consider early?

A

Clinical support for IV midazolam.

83
Q

In mild anaphylaxis, where bronchospasm is the main complaint, what is the treatment guideline?

A

Slabutamol (10mg) + Atrovent (500mcg) Neb

Fexofenadine 180mg PO in adults with rash/itchiness.

84
Q

What are the three main clinical findings to suspect severe anaphylaxis?

A

Hypotension
Severe Bronchospasm
Respiratory distress due to angioedema

85
Q

In severe anaphylaxis, what is the route, dose and interval of Adrenaline?

A

300mcg IM, 5 minute intervals PRN

86
Q

In severe paediatric anaphylaxis, what is the dose and interval of Adrenaline?

A

10mcg IM, 5 minute intervals PRN

87
Q

In severe anaphylaxis, do paramedics need to consult to give adrenaline to paediatrics?

A

No, but you could consider clinical support.

88
Q

What is the dose for oral glucose paste?

89
Q

What is the adult dose for IM Glucagon?

90
Q

What is the paediatric dose for IM Glucagon?

A

<8 yo = 0.5 IU

≥8 yo = 1IU

91
Q

If glucagon is ineffective in increasing BGL in a paediatric, what are your options?

A

Request Clinical support for IV Glucose.

Consult the EOC Clinician for IV Glucose

92
Q

If given authority, what is the paediatric dose for Glucose?

A

Glucose 10% 5mL/ kg titrated to effect

93
Q

Immediately before, and immediately after administering IV Glucose, what must you do?

A

100mL Saline flush (less for paediatrics)

94
Q

The best management for hypoglycaemia is:

A

The least invasive therapy that increases BGL.

95
Q

After adult reversal of hypoglycaemia, what 4 components are required to leave a patient at home?

A
  1. Consumed carbohydrates
  2. BGL is stable
  3. The patient was a previously stable diabetic
  4. A cause for the episode can be identified
96
Q

In a hypothermic arrest, when may CPR be ceased?

A

Core body Temp >35`C

97
Q

In a hypothermic VF/VT arrest, how many shocks should me delivered in total?

98
Q

When moving or handling a hypothermic patient, what special considerations should you take?

A

Minimal movement/stimulation

99
Q

How can a hypothermic patient be warmed?

A

Dry the Patient
Remove wet clothing
Remove from contact with cold/windy environment
Insulate with linen and space blankets

100
Q

How much fluid should be given to a hypothermic patient?

101
Q

In haemorrhagic or obstructive shock, what is the limit for fluid in adults before consulting?

102
Q

In haemorrhagic or obstructive shock, what is the end point of fluid administration?

A

Maintain a palpable peripheral pulse and stable GCS

103
Q

In haemorrhagic or obstructive shock in a paediatric, what are your options for fluid administration?

A

Request clinical support

Consult the EOC Clinician

104
Q

What can we do for patients with symptomatic dehydration with hypotension?

A

Request Clinical support for Fluid

Treat hyperthermia with active cooling

105
Q

For hypovolaemia secondary to sepsis, what are our options?

A

Request clinical support

Call EOC Clinician for fluid

106
Q

What 2 ways does Benzylpenicillin come?

A

600mg or 1200mg vials

107
Q

What is Benzylpenicillin reconstituted with, and how much is used?
What concentration do you have once reconstituted?

A

600mg - add 1.6mL water
1200mg - add 3.2mL water
Both vials are then 300mg/ mL

108
Q

Upon initial suspicion of meningococcal, what is the FIRST thing you should consider.

109
Q

What 4 clinical findings need to be present for paramedics to immediately administer Benzylpenicillin for Meningococcal?

A

Febrile
GCS <15
Evidence of sepsis
Purpuric rash

110
Q

What is the dose and route for benzylpenicillin for paediatrics and adullts.

A

<1 yo - 300mcg
1-9 yo - 600mcg
10+ yo - 1200mcg

111
Q

If meningococcal is suspected, but there is no purpuric rash what are your treatment options?

A

Contact EOC Clinician for ASMO consult

112
Q

When reversing a narcotic overdose in an ADULT, what are the 2 main aims?

A

Re establish:
Airway control
Effective ventilation

113
Q

When reversing a narcotic overdose in an CHILD, what is the aim?

A

Complete reversal

114
Q

What is the adult dose of Naloxone IN?

A

120mcg IN PRN

115
Q

What is the adult dose of Naloxone IV?

A

100mcg IV PRN

116
Q

What is the adult dose of Naloxone IM?

A

400mcg IM PRN

117
Q

What is the maximum total dose for Naloxone in: Adults?

Paediatrics

A

Adult: No limit
Paediatrics: 1600mcg

118
Q

What is the route / dose of naloxone in paediatrics:
>6yo
<6yo
Newborns

A

> 6yo = 400mcg IM PRN
<6yo = 200mcg IM PRN
Newborns with respiratory depression due to maternal narcotic use = consult with EOC Clinician

119
Q

Odansetron should be used cautiously in patients with previous dystonic or other reaction to _______ receptor agonists.

120
Q

What is the adult dose range for Ondansetron?

A

4 - 8mg IM or IV

121
Q

When administering IV Ondansetron, over how long should it be administered?

A

Slow push over 5 minutes, watch for dystonic reactions

122
Q

What is the paediatric dose of Ondansetron?

A

100 mcg / kg Max dose 4mg

123
Q

Within what timeframe do CVA patients need to arrive at a Stroke Unit from onset of symptoms?

124
Q

Which hospitals have a stroke unit?

What hours are they open?

A

FMC, RAH and QEH - 24/7

Lyell McEwin - 0800 - 1600 Now 7 days

125
Q

When considering treatment options for a suspected CVA patient, but does not fit the criteria for thromolysis at a stroke unit, what are your options?

A

Consider transporting to a hospital with a stroke unit, or if this would create an excessive travel time, transport to nearest hospital.

126
Q

When transporting a suspected CVA patient to a stroke unit, what is the max travel time allowable?

127
Q

If transporting a suspected CVA patient to a stroke unit, what else should you consider in preparation for the stroke unit?

A

Bilateral 18G IVA
12 Lead ECG
(As long as transport time is not delayed)

128
Q

On a ROSIER scale, what 2 items can contribute to a negative score?

A

LOC/syncope

Seizure activity

129
Q

On a ROSIER scale, what 5 items can can contribute to a positive score?

A

New, Acute:

  • asymmetrical facial weakness
  • asymmetrical arm weakness
  • asymmetrical leg weakness
  • speech disturbance
  • visual field defect
130
Q

Before completing a ROSIER score, what needs to be checked first? (and treated if necessary?

131
Q

Other than clinical findings, what also needs to be ascertained before a CVA patient can be considered for thrombolysis at a stroke unit?

A

Their pre-morbid independence.

132
Q

In moderate paediatric croup, what is your treatment?

A

Basic care and oxygen

133
Q

In severe paediatric croup, what is the dose/ route for adrenaline?

A

5mg nebulised

134
Q

In severe paediatric croup, do you need to consult for adrenaline?

A

No, but you should consider requesting clinical support.

135
Q

In severe paediatric croup, what is the duration of action for adrenaline? (range)

A

Minutes to Hours

136
Q

What 3 reasons would you consider administering midazolam to a seizure patient?

A

Risk of:

  • physical injury
  • hypoxia
  • aspiration
137
Q

What 4 things potentiate the negative effects of Midazolam?

A

Hypoxia
Hypovolaemia
Extremes of age
Other CNS depressants

138
Q

To control a seizure, what is the dose for midazolam?

A

100mcg / kg IM, up to 10mg

139
Q

What is the recommended interval for IM Midazolam to control a seizure?

140
Q

If a seizure has not been controlled with IM Midazolam after 5 minutes, what should you consider (aside from repeat doses)

A

Request Clinical support

141
Q

For any IM injection, what is the maximum volume that can administered in a site?

142
Q

When treating an amputation, when should you consider a tourniquet?

A

Torrential haemorrhage unable to be controlled with direct pressure

143
Q

When treating a burns patient, when can Hydrogel be considered?

A

When there is no running water.

144
Q

When irrigating/cooling a burn, what needs to be considered, and closely monitored.

A

Hypothermia.

145
Q

How long do the following burns need to be irrigated?

  • Heat Burns
  • Chemical Burns
A
  • Heat Burns - Up to 20mins

- Chemical Burns - At least 20mins

146
Q

When cooling a burns patient, which 2 groups are more susceptible to hypothermia?

A

Young

Elderly

147
Q

How long can a Hydrogel dressing be left on for on the following groups:

  • Neonates
  • Young or elderly patients
  • Burns >15% BSA
  • All other patients
A
  • Neonates - 10mins
  • Young or elderly patients - 20mins
  • Burns >15% BSA - 20 mins
  • All other patients - no specific guideline
148
Q

When assessing/ treating a major burns patient, other than pain and temperature, what is the most important thing to keep reassessing.

A

Airway burns/oedema

149
Q

Where should a burns patient be transported if you are in or near the Adelaide metropolitan area and are passing primary survey?

150
Q

When administering fluid to a traumatic hypovolaemic patient, what is the end point and limit for saline?

A

Gain & maintain a peripheral pulse, and stable GCS

Max 1L

151
Q

What are you treatment options for fluid in a hypovolaemic paediatric in trauma?

A

Request clinical support

Consult with the EOC clinician

152
Q

How much fluid can be given to a severely crushed patient?

A

Proportianal to the extent of the crush/ potential for hypotension.

153
Q

For suspected / actual haemorrhage in a pregnant patient in 3rd trimester, how much fluid could be given?

A

1L even if a radial pulse is present.

154
Q

When administering fluid to suspected / actual haemorrhage in a pregnant patient in 3rd trimester, when might you slow to KVO rate?

A
  • Normotensive and decreased heartrate

- Becoming hypertensive

155
Q

Where should you transport a traumatic pregnant patient to in the Adelaide area if passing their primary survey?

156
Q

In patients with severe head injury, what MAP should be achieved?

157
Q

In a severe head injury, what is the end point for fluid administration?

A

MAP of 90mmHg

158
Q

For Paediatrics with severe head injury, what are you treatment options?

A

Request clinical support

Consult with the EOC Clinician

159
Q

When considering NOT applying spinal immobilisation, what 5 things need to be confirmed?

A

ALL of the following

  • GCS 15 (no altered behaviour, ETOH, drugs, head injury/illness)
  • No pain in neck / head / shoulders
  • No pain / deformity on palp of neck shoulders
  • No neurological dysfunctions at any stage
  • No distractions - other pain, anxiety, distress
160
Q

Who needs to assess a patient before trauma bypass?

A

ICP / Retrieval Officer

NOT EOC Clinician

161
Q

What 3 criteria needs to be in place for an IPC to authorise Trauma Bypass?

A
  • Suitable for Paramedic transport
  • Low potential for sudden deterioration
  • Issues being adequately addressed (such as pain and fluid management)
162
Q

If you are enroute and trauma bypassing, and your patient suddenly deteriorates, what should you do?

A

Divert to the closest trauma service. (closes hospital that can handle trauma)

Paramedic Intern (3 decks)

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