Guidelines Flashcards

Question

Nausea - Prophylaxis for eye trauma, spinal injuries

Answer 1

Ondansetron 4mg IV/IM | Rpt: Once @ 10mins (max 8mg)

Answer 2

PROCHLORPERAZINE must not be given IV | Metoclopramide and Prochlorperazine must not be administered in the same episode of pt care.

Answer 3

BGL <4mmol/L, responds to commands: Glucose oral gel 15g Poor response, consider IM Glucagon or IV glucose BGL <4mmolL, doesn't respond: IV cannula in large vein. ENSURE IV PATENCY Glucose 10% 15g (150ml) IV. Normal Saline flush. If IV access unsuccessful: IM Glucagon 1mg Adequate response: Cease glucose Inadequate Response: Rpt Glucose 10% 10g @ 5 mins. Normal saline flush. BGL >4mmol/L Consider other causes of altered conscious states. (AEIOUTIPS)

Answer 4

ENSURE CORRECT DOSAGES Age <60yrs Midazolam 0.1mg/kg IM (max single dose 10mg) Continuous seizure after 10mins: Rpt: Single IM Midaz 0.1mmg/kg Age >60yrs Midazolam 0.05mg/kg IM (max single dose 10mg) Continuous Seizure after 10 mins: Rpt: Single IM Midaz 0.05mg/kg PAEDS: Midaz 0.15mg/kg IM Continuous Seizure after 10 mins: Rpt: Single IM Midaz 0.15mg/kg ICP ONLY IV Midaz first line Seizure activity after 5 mins, IV Midaz ``` Considerations: Protect Patient Airway and ventilations Other causes eg hypoglycaemia Patient's own management and Rx already given. ```

Answer 5

If pt Hx anaphylaxis and received treatment prior to AT arrival, pt MUST be transported to hospital for observation and follow up.

Answer 6

``` RASH Respiratory Distress Abdominal symptoms Skin/mucosal symptoms Hypotension or Altered Conscious State ``` OR Isolated hypotension/bronchospasm or upper airway obstruction with known antigen OR Single symptoms of R.A.S.H. with known contact with antigen and Hx anaphylaxis/severe allergic reaction

Answer 7

FLUID MODIFYING FACTORS Not for sepsis Normal Saline 20ml/kg IV ICP ONLY Rpt 20ml/kg Normal Saline Adrenaline Infusion Additional 20ml/kg Normal Saline

Answer 8

PPE Evidence of septicaemia -Typical purpuric rash -Headache, fever, joint pain, ACS, hypotension, tachycardia Ceftriaxone 2g IV - Dilate each 1g in 10ml normal saline - Administer slowly over 2 mins Ceftriaxone 2g IM - Dilute each 1g in 3.5ml Lignocaine HCl - Multiple injection sites Manage as per sepsis

Answer 9

ENSURE SAFETY - needles and sharps etc Evidence of narcotics overdose (GCS <12 and RR <8 - Altered conscious state - respiratory depression - substances involved - pin point pupils - track marks - exclude other causes eg head injury Assist and maintain airway/ventilation (NPA preference) -Consider LMA if ventilation >10mins Partial 100mcg in 1ml IV naloxone @ 1 min (total max 2mg) If no response after 1g, consider other causes and transport without delay. Complete 800mcg IM Naloxone Inadequate response - Rpt: 5 mins 800mcg naloxone IV/IM Final repeat 400mcg (max total 2mg)

Answer 10

Signs of TCA Toxicty: - Inadequate perfusion - Positive R wave >3mm in aVR, - Prolonged QT intervals. (more than half R-R intervala) - Wide QRS >0.12 indicated severe toxicity. - QTc >500msec indicated toxicity Management: - ICP Backup - Hyperventilate at 20-24/min, 100% O2 ICP ONLY Sodium Bicarb infusion Consider ET Tube EtCO2 target 25-30

Answer 11

``` Be safe. Monitor for aggressive behaviour Treat symptomatically -Acute Behavioural Disturbances -Seizures -Airway management -Chest pain as per ACS ``` Consider sedation if patient is hyperthermic

Answer 12

Sedation Assessment Tool (SAT) score ``` +3 Aggressive +2 Agitated +1 Anxious 0 Normal -1 Rouse to voice -2 Rouse to pain -3 No response ``` SAFETY Safety -- self, partner, bystanders, pt Aggression -- be aware of triggers Fix -- organic causes, deescilate Evaluate -- assess patient, PSA, RSA, NSA, SAT Tactical Communication -- Listen, empathise, rapport Yes to resources -- TASPOL, oforms, ICP, mental health teams etc ``` SAT +1 Diazapam PO 10mg <60yrs 5mg >60yrs RPT: 60 mins ``` ``` SAT +2 Droperidol IM 10mg if <60yrs or weight >50kg 5mg if >60yrs or <50kg RPT: Once after 15 mins (total max 20mg/10mg) ``` ``` SAT +3 Droperidol IV 5mg RPT: 10 mins ICP ONLY Midazolam IV once only ``` IF UNRESPONSIVE TO DROPERIDOL: ICP ONLY Ketamine IM IV midaz

Answer 13

Prenotification for patient is essential Where possible, remove contaminated clothes and wash skin with soap and water. Confirm evidence of suspected poisoning and excessive cholinergic effects - Anticholinesterase on the label - Salivation compromising airway or bronchospasm - Bradycardia with inadequate perfusion ICP ONLY Atropine IV

Answer 14

Pt Hx: Spinal chord injury T6 or superior Severe headache SBP <160 REMOVE STIMULUS bladder distension fractures, burns, pain, labour If SBP >160 remains GTN SL 0.4mg RPT: @ 10 mins until symptoms resolve or BP <160

Answer 15

Consider Modifying Factors: SCI, chest injury, trunk injury, AAA, uncontrolled haemorrhage HR <100, BP >100, Fluid not required Either HR >100 OR BP <100 20ml/kg normal saline ICP ONLY RPT: 20ml/kg Medical consult for further doses.

Answer 16

Supplemental oxygen if required Pain relief Position pt upright if possible. Flail Segment/Rib fractures: Ventilatory Support Splint to reduce paradoxal movement and further injury Open Chest Wound: 3 sided dressing or chest seal Pneumothorax ICP ONLY Needle decompression

Answer 17

Fentanyl drug of choice for head injuries AIRWAY: If airway is patent and ventilation adequate, DO NOT insert NPA OPA preferred in TBI VENTILATION: Maintain SpO2 >95% Ventilate if required Maintain EtCO2 35-40mmHg PERFUSION: Manage with normal saline as per inadequate perfusion. General Care: Treat sustained seizure activity with Midaz Measure BGL and maintain normal levels

Answer 18

Assess for major trauma guidelines ``` Meets Major Trauma Guidelines: Manage airway Provide spinal immobilisation Pain relief Immobilise and support fractures Manage hypovolaemia Transport without delay to major regional facility unless >60mins ``` ``` NOT Major trauma guidelines: NEXUS 1 Age >60yrs 2 Hx bone disease 3 Unconscious or altered conscious state 4 Drug or alcohol affects 5 Significant distracting injury 6 Neuro or motor deficit 7 Spinal column pain/tenderness 8 If all of the above negative, and no pain on rotation 45* left and right, spinal immobilisation not necessary. ``` IF IN DOUBT, IMMOBILISE

Answer 19

CAUTION - Airway burns, facial burns, hands, feet and genitals. Rule of 9's Initial Management: - Cool area. 20 mins. Running water if possible - --Avoid overcooling - Pain relief - Cover with a dressing - Monitor temperature Partial or full thickness burns >10% Normal saline 2ml/kg x TBSA over first 8 hours Elevate burn if possible Transport and pre-notify

Answer 20

Control external haemorrhage. Support the injured area. Immobilise the joint above and below fracture site. Evaluate and record NVO distal to fracture site. Pain relief and hypovolaemia management. Realign long bone fractures as close to normal position as possible. Open fractures with exposed bone should be irrigated with normal saline prior to realignment. Femoral shaft fractures and 2/3 proximal tib/fib fractures should be managed with traction splint. Pelvic fractures should have the legs splinted together, and pelvic splinting.

Answer 21

Definition: Compression injury >30mins If less than 30 mins, or involves torso or head, remove crush immediately. If >30 mins. Establish IV and commence 500ml normal saline. Pain relief ICP ONLY Widening QRS - Sodium Bicarb

Answer 22

MEDICAL CONSULT required to notify appropriate hospital. Lay patient flat. Antiemetics Normal Saline 1000mL Pain relief if required. AVOID HIGH ALTITUDES Decompression Sickness 0-36 hours post dive. Ache, headache, SOB, rash, joint pain, seizure, paralysis, paraesthesia.

Answer 23

Mild: 32-35 Moderate: 28-32 Severe: <28 Non Cardiac Arrest Warm normal saline 10ml/kg IV Repeat 10ml/kg (max 40ml/kg) Hypothermic Cardiac Arrest Alternative managment

Answer 24

Accurately access temperature. Cooling techniques: until temp <38* - Remove from heat source - Remove clothes except underwear - Ensure airflow - Apply tepid water using towels or spray bottles AVOID SHIVERING as this may increase heat. POOR RESPONSE AFTER 10 mins: Transport without relay.

Answer 25

Positioning ``` APGAR 1, 5 and 10 mins if needed. Appearance Pulse Grimace Activity Resps ```

Answer 26

>600mls Primary: First 24 hours Secondary: 1 day to 6 weeks Treat with inadequate perfusion with hypovolaemia ICP ONLY Medical consult for ergometrine

Answer 27

``` Pre-eclampsia: SBP >160mmHg DBP >90mmHg Peripheral/Generalised oedema GI disturbance ``` Eclampsia: Hx preeclampsia Seizure activity ``` Management: Preeclampsia: -Lateral position to avoid HTN -High flow O2 -Dark calm environment ``` Eclampsia - ICP Backup - If Mg infusion delay, manage as per seizures (0.1mg/kg IM MDZ) ICP ONLY Magnesium infusion

Answer 28

IN Fentanyl is first line agent for paediatric pain management Consider MXF if unable to administer IN FEN. (procedural pain relief) IM MOR is a last line agent. Mild: Paracetamol 15mg/kg PO Moderate: IN Fent <25kg: 25mcg IN FEN >25kg: 50mcg IN FEN RPT: @ minimum 5 mins (consider longer) Total max 3x doses Under 1 year (10kg) medical consult for pain relief. Severe: IM MOR 0.1mg/kg (max 5mg dose) RPT: medical consult only ICP: IV MOR IV FEN KETAMINE

Answer 29

Mild/Moderate: BLS Severe: Adrenaline 5mg in 5ml NEB If no improvement: RPT adrenaline 5mg/5ml NEB ICP ONLY Dexamethasone

Answer 30

ICP ONLY Ondansatron 0.1mg/kg IV/IM (max 4mg) Ondansetron and Stemetil contraindicated <2yrs Maxalon <8yrs contraindicated

Answer 31

BGL >7mmmol/L Pt unwell, requires medical assessment and treatment BGL>12mmol/L Normal saline bolus 250-500ml If shocked, treat as per Inadequate Perfusion with hypovolaemia.

Answer 32

No anaphylaxis: BLS Monitor for deterioration. ``` Anaphylaxis: Monitor for arrhythmias Adrenaline 500mcg IM repeat @ 5 mins. Treat bronchospasm as per asthma Consider fluid resuscitation Consider NEB adrenaline 5mg/5ml for upper airway obstruction ``` PAEDS: Adrenaline 10mcg/kg IM Repeat @ 5 mins Inadequate Response: ICP ONLY Adrenaline Infusion

Answer 33

qSOFA score <2 (HAT) - Supplemental O2 if required - Normal Saline - -500ml bolus repeated until BP >100 (max 3L) ``` qSOFA >=2 As above including: -ICP Backup -Ceftriaxone 2g if transport >60min -Pre-notify ``` ICP ONLY Adrenaline infusion

Answer 34

Spinal Cord Injury - Neurogenic shock given single 500ml bolus normal saline ONCE. Chest injury - Consider tension pneumothorax. Treat as per chest injury. Penetrating Trunk injury, suspected aortic aneurysm or uncontrolled haemorrhage (eg GI bleed) - Accept palpable carotid pulse with adequate conscious state and transport immediately.

Answer 35

``` Mild/Moderate: 6 sprays (600mcg) @ 5 mins ``` 5mg/2.5ml NEB Salbutamol if unable to use pMDI ``` Severe: Salbutamol MDI 6 sprays Ipratropium Bromide MDI: <6 yrs: 4 sprays >=6 yrs: 8 sprays ``` Salbutamol 5mg in 2.5ml NEB Ipratropium Bromide 500mcg in 1 ml NEB ICP ONLY Mg infusion Salbutamol IV Dexamethasone IV/IM

Answer 36

Responses to commands: 15g PO gel Unresponsive: Glucose 10% 5ml/kg Unable to gain IV access: <25kg - 0.5mg glucagon IM >25kg - 1mg glucagon IM ICP ONLY RPT glucose 10% IV 5mg/kg

Answer 37

Recurrent Seizures: 0.15mg/kg IM Midazolam ICP ONLY: IV MDZ If seizure continues after 10mins RPT: original IM MDZ once ICP ONLY IV Midaz RPT after 5 mins Intubation

Answer 38

As per adult except: Adrenaline 10mcg/kg IM RPT: @ 5 mins Consider nebulised adrenaline for upper airway swelling ICP: Consider IO access Adrenaline infusion

Answer 39

As per adult except: Ceftriaxone Dose: 50mg/kg IV/IM (max 2g) Manage as per Sepsis Normal Saline 10mg/kg RPT once after 15mins

Answer 40

As per adult except: No partial or complete Naloxone Dose: 10mcg/kg IM (max 400mcg) RPT: @ 10 mins total max 2mg