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Ambulance Tasmania Guidelines > Guidelines > Flashcards

Guidelines Flashcards

1
Q

Cardiac Arrest - Shockable

A

Commence CPR
Ratio 30:2

Defibrillate 200J Biphasic - repeat @ 2 mins

VF/VT Persists:

  • Adrenaline 1mg IV Rpt: @ 4 min
  • ICP ONLY Amiorderone

Insert Igel
- CPR Ratio 15:1 uninterrupted

Reversible Causes (H’s and T’s)

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2
Q

Cardiac Arrest - Non-shockable

A

Commence CPR
Ratio 30:2

Do not shock - status check repeat @ 2 mins

Adrenaline 1mg IV Rpt: @ 4 min

PEA Persists
-20ml/kg Normal Saline

Insert Igel
- CPR Ratio 15:1 uninterrupted

Reversible Causes (H’s and T’s)

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3
Q

Cardiac Arrest - Hypothermic (>32, 30-32, <30)

A

> 32
Normal Management

30-32
Double dosage intervals
DO NOT warm above 33 with ROSC

<30
Continue CPR until warmed above 30*
One shock only
Single dose adrenaline
Single dose amiodarone
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4
Q

Cardiac Arrest - Traumatic

A 
HOTT
Hypovolaemia
-Tourniquets for arterial haemorrhage
-TPOD for pelvic injuries
-Straighten long bone fractures

Oxygenation

  • Establish airway
  • High flow O2

Tension Pneumothorax
-ICP ONLY Bilateral Needle Decompression

Tamponade
- Needle Thoracentesis (in hospital only)

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5
Q

Foreign Body - Choking (Incomplete and Complete Obstruction)

A

ACDC
Incomplete Obstruction:
Encourage Coughing
Transport

Complete Obstruction:
5x Back blows
5x Chest Thrusts
REPEAT until unconscious

Unconscious:
Manual Clearance
Laryngoscope and Magill’s

Unsuccessful - Commence CPR

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6
Q

ACS - Mx

A

FONA
Fentanyl (Pain Relief)
-Analgesia to reduce workload on the heart

Oxygen
-Normocytic therapy 94-98%

Nitrates
-0.4mg SL GTN @ 5 min if BP >100mmHg

Antiplatelet Rx
-Aspirin 300mg PO

Antiemetics if required:
Ondansatron

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7
Q

Bradycardia

A

BLS management

ICP ONLY Atropine

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8
Q

Tachycardia - Narrow Complex (SVT)

A

Asymptomatic:

  • BLS
  • 12 lead
  • IV access
  • Modified Valsalva Manoeuvre
  • -Semi Recumbent
  • -Pressure - syringe. Sudden Release
  • -Supine - Legs up

Symptomatic:

  • Modified Valsalva Manoeuvre
  • No reversion - ICP Adenosine

Unstable:
ICP ONLY
Cardioversion
Adenosine

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9
Q

Tachycardia - Broad Complex

A

ICP MANAGEMENT ONLY
Torsarde de Pointes:
Mg Infusion

Stable:
Amiodarone

Unstable:
Caradioversion

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10
Q

AIVR - Accelerated Idioventricular Rhythm

A

Adequate Perfusion:
BLS

No Perfusion:
CPR - PEA

Inadequate Perfusion:
ICP MANAGEMENT ONLY

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11
Q

Pain Management - Mild

A

Consider NEED for pain relief.

Paracetamol 1000mg PO if not taken in past 4 hours.
-Not to be used to treat suspected ACS.

If not controlled or rapid relief required, elevate to moderate pain management.

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12
Q

Pain Management - Moderate

A

Consider paracetamol as per mild pain relief.

IV access Available:

  • Morphine or Fentanyl IV as per severe pain.
    • 0.05mg/kg MORP or 0.5mg/kg FENT
IV access unavailable or >10min delay:
IN FENT up to 100mcg (total max dose 400mcg)
or
MXF 3ml (total max dose 6ml)

If unable to administer IN FENT or MXF:
0.1mg/kg IM Morphine or IM Fentanyl. (max single dose 10mg or 100mcg)
Rpt: Once after 20 mins.

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13
Q

Pain Management - Severe

A

IV access Available:

  • Morphine or Fentanyl IV as per severe pain.
    • 0.05mg/kg MOR or 0.5mg/kg FEN
  • -max single dose 5g MOR, 50mcg FEN
  • -Rpt: @ 5 mins.
  • -max 20mg MOR or 200mcg FEN

If IV access unavailable:
As per moderate pain relief

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14
Q

Bronchoconstriction - Asthma - Mild/Moderate

A

Salbutamol pMDI
6 puffs @ 5 mins until symptoms resolve. (600mcg)

If pMDI unavailable:
Salbutamol NEB 10mg in 5ml @ 5 mins as required.

No significant response after 10 mins, upgrade to Severe management.

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15
Q

Bronchoconstriction - Asthma - Severe

A

pMDI Salbutamol 6x 100mcg spray @ 5mins
pMDI Ipratropium Bromide 8x 21mcg spray once.
(Burst therapy can repeat after 20 mins, max 3 burst doses.)

If spacer unavailable or not tolerated:
Salbutamol NEB 10mg in 5ml with Ipratropium Bromide 500mcg in 2ml

Repeat Salbutamol @ 5 mins.

Further deterioration or no response:
ICP ONLY
Magnesium infusion
Dexamethasone
IV Salbutamol
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16
Q

Bronchoconstriction - COPD

A

Salbutamol 10mg in 5ml NEB with Ipratropium Bromide 500mcg in 2ml

Adequte Response:
Titrate O2 for normoxic (88-92%)

Inadequate Response:
Salbutamol NEB @ 5 mins

Altered Conscious State:
Ventilate 5-8/min with 7ml/kg tidal volume
Allow prolonged expiratory phase
Gentle lateral chest pressure during expiration

ICP ONLY
Dexamethasone
Consider intubation

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17
Q

Bronchoconstriction - Asthma - Altered Conscious State

A

REQUIRES IMMEDIATE ASSISTED VENTILATIONS
IPPV with 100% O2 with a rate of 5-8/min
Allow for prolonged expiration phase and lateral chest pressure if required.

Adequate response:
Mx as per severe asthma

Inadequate Response:
Adrenaline 0.3mg IM Rpt: 0.3ml @ 20mins

ICP ONLY:
Salbutamol IV
Magnesium
Adrenaline IV/IO
Normal Saline
ET Tube
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18
Q

Bronchoconstriction - Asthma - No Cardiac Output

A

Lose of cardiac output and BVM increasingly still

IMMEDIATE INTERVENTION:
Apnoea for 1 min

Output returns:
Treat as per Asthma/COPD

Carotid pulse, no BP:
ICP ONLY:
Adrenaline
Normal Saline

No return of output:
ICP ONLY
Bilateral Chest Decompression

Commence Cardiac Arrest

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19
Q

Nausea - Chest pain, Narcotics analgesia, Gastroenteritis, PMHx migraine

A

Metoclopramide 10mg IV/IM.
Rpt: Single @ 10mins

AND/OR

Ondansatron 4mg IV/IM
Rpt: Single @ 10mins

If dehydrated, manage as per Inadequate perfusion with hypovolaemia

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20
Q

Nausea - Prophylaxis Motion sickness, AMR

A

Prochlorperazine (Stemetil) 12.5mg IM
Ondansetron 4mg IV/IM

No repeat as per guidelines

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21
Q

Nausea - Prophylaxis for eye trauma, spinal injuries

A

Ondansetron 4mg IV/IM

Rpt: Once @ 10mins (max 8mg)

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22
Q

Nausea - Warnings

A

PROCHLORPERAZINE must not be given IV

Metoclopramide and Prochlorperazine must not be administered in the same episode of pt care.

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23
Q

Glycaemic Emergency - Hypoglycaemia

A

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)

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24
Q

Seizures - Continuous or Recurrent Seizures

A

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.
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25
Q

Anaphylaxis - Warnings

A

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

26
Q

Anaphylaxis - Indications

A 
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

27
Q

Inadequate perfusion - Non-cardiogenic/Non-hypovolaemic

A

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

28
Q

Meningococcal Septicaemia

A

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

29
Q

Overdose - Narcotics (Partial and Complete)

A

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)

30
Q

Overdose - TCA (amitriptyline)

A

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

31
Q

Overdose - Psychostimulants

A 
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

32
Q

ABD - Acute Behavioural Disturbance

A

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

33
Q

Organophosphate Poisoning

A

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

34
Q

Autonomic Dysreflexia

A

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

35
Q

Trauma - Hypovolaemia

A

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.

36
Q

Trauma - Chest Injuries

A

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

37
Q

Trauma - Severe Head Injuries

A

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

38
Q

Trauma - Spinal Injury

A

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

39
Q

Trauma - Burns

A

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

40
Q

Trauma - Fractures

A

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.

41
Q

Trauma - Crush Syndrome

A

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

42
Q

Diving Emergency

A

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.

43
Q

Hypothermia

A

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

44
Q

Heat Stress

A

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.

45
Q

Obstetrics - Normal Birth

A

Positioning

APGAR 1, 5 and 10 mins if needed.
Appearance
Pulse
Grimace
Activity
Resps
46
Q

Obstetrics - PPH

A

> 600mls

Primary: First 24 hours
Secondary: 1 day to 6 weeks

Treat with inadequate perfusion with hypovolaemia

ICP ONLY
Medical consult for ergometrine

47
Q

Obstetrics - Eclampsia

A 
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

48
Q

Paed - Pain Management

A

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

49
Q

Paed - Upper airway Obstruction (Croup)

A

Mild/Moderate:
BLS

Severe:
Adrenaline 5mg in 5ml NEB
If no improvement:
RPT adrenaline 5mg/5ml NEB

ICP ONLY
Dexamethasone

50
Q

Paed - Nausea

A

ICP ONLY
Ondansatron 0.1mg/kg IV/IM (max 4mg)

Ondansetron and Stemetil contraindicated <2yrs
Maxalon <8yrs contraindicated

51
Q

Glycaemic Emergency - Hyperglycaemia

A

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.

52
Q

Anaphylaxis - Management

A

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

53
Q

Sepsis Management

A

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

54
Q

Trauma - Inadequate Perfusion - Fluid Modifying Factors

A

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.

55
Q

Paed - Asthma

A 
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

56
Q

Paed - Glycaemic Emergency - Hypoglycaemia

A

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

57
Q

Paed - Seizures

A

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

58
Q

Paed - Anaphylaxis

A

As per adult except:

Adrenaline 10mcg/kg IM
RPT: @ 5 mins
Consider nebulised adrenaline for upper airway swelling

ICP:
Consider IO access
Adrenaline infusion

59
Q

Paed - Meningococcal Septicaemia

A

As per adult except:

Ceftriaxone Dose:
50mg/kg IV/IM (max 2g)

Manage as per Sepsis
Normal Saline 10mg/kg
RPT once after 15mins

60
Q

Paed - Overdose - Narcotics

A

As per adult except:
No partial or complete

Naloxone Dose:
10mcg/kg IM (max 400mcg)
RPT: @ 10 mins
total max 2mg

Ambulance Tasmania Guidelines (9 decks)

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