Guidelines / Others Flashcards
What is testicular torsion
1)Pathophysiology
2)Common symptoms
3) treatment
Twisting of the tesical cord and rotation of the testicle - causes loss of blood flow leading to necrosis of the testical
2) abdo pain, sudden pain to testical, vomiting—– bruising and swelling or cyanosis to the affected testie alongside elevation or horizontal lay
3) hospital - surgery
What is sepsis
1)Pathophysiology ✅
2)Common symptoms
3) treatment
1) a life threatening organ dysfunction
2) infection symptoms alongside reduced urine output, hypotension, confusion, high NEW2 SCORE,
What is cancer
1)Pathophysiology
2)Common symptoms
3) treatment ✅
1) gene mutations - causing abnormal bad cells
2) depend on type
3) radio/ chemo therapy
What is neutropenic sepsis
Sepsis due infection and helped by weakness of body immune system - due to cancer therapy causing faster development of sepsis
What is metastatic spinal cord
1)Pathophysiology
2)Common symptoms
3) treatment ✅
1) complication of cancer - cancer cells causing compression on spinal cord
2) incontinence, lumbar pain, pain on movements.
3) blue light
What is superior Vena cava syndrome
1)Pathophysiology
2)Common symptoms
3) treatment ✅
1) complication of cancer (normally lung) cause compression of Vena cava
2) dilation/ blueness of chest veins, poor perfusion symptoms,.Severe DIB, STIDOR, ABC PROBS
3) blue light
What is type 1 diabetes
1) pathophysiology
2) symptoms
Due to autoimmune condition - body attacks beta cells @ pancrease = less to no insulin production
What is type 2 diabetes
1) pathophysiology
2) symptoms
When the body cells are resistant - insulin is needed for suger to get into the cell.
What is adrenal crisis
Damage to the adrenal glands
Causing a reduction in aldosterone (allowed raas - K+ out with na+ and water in) and
cortisone ( break down of protein and fatts into glucose )
What is sickle cell crisis
Gene mutations affects Hemoglobin - makes them rigid - causes changes in RBC - making them sickle cell shaped “C”.
Poor oxygen delivery
Life span of RBC is lower - anemia
Increases change of Coagulation
Jaundice - billirubinbfrom breakdown of hemoglobin in RBC explosion
- lack of RBC production, illness,
Skin - what is skin abscess
What is cellulitis
What is a DVT
What is AKA (Alcohol ketoacidosis)
1) pathophysiology
2) symptoms
3) treatment plan
- pre nutritional deficit ( poor diet intake = lack of hormone production = body doesn’t store glucose and doesn’t breakdown glucose ( neutral)
- liver damage = cell damage = mitochondria damage
Mitochondria damage = no kreb cycle = less glucose = fat store activated)
Dehydration - poor fluid intake + vomiting and increase urination = lack of fluid in blood = ketone make blood acidic faster )
2) abdo pain + vomiting
Suger low or normal
Keytones high
What is cellulitis
When should resuscitation be stopped ( not role criteria )
30 minutes of persistent and continuous asystole despite ALS with all reversible causes addressed
When should resuscitation be stopped ( not role criteria )
30 minutes of persistent and continuous asystole despite ALS
In which situations can a paramedic not stop resuscitation ( there are 4)
Hypothermic suspected arrest
Pregnancy
Drug/overdose suspected arrest
Anyone under 18yrs
In which situations can a paramedic not stop resuscitation ( there are 4)
Hypothermic suspected arrest
Pregnancy
Drug/overdose suspected arrest
Anyone under 18yrs
What is Raynards disease
Signs and symptoms
Extream vasoconstriction reaction to temperature or stress
2 types ( idiopathic - under 15yrs old)
Atherosclerosis, diabetes, ect
Symptoms
Pale hands that turn cyanosed, then pink up.
Occurs with temp changes normally
This occurs bilaterally
What is carpal tunnel syndrome
2) signs and symptoms
3) test
Compression of the medial nerve - gives feeling to all fingers except the pinkie and 1/2 ring finger
Compression due to inflammation of tendons thus odema = pressure
2) pain, tingling, pins and needles
Only occurs @ fingers under side normally not on parm as that’s controlled by Parm nerve
Radial nerve control upper side of hand
Ulner nerve controls pinkie
3) test - phalens maneuver, durkan test
What is DKA
What is HHS
What are the 4h’s and 4t’s
Hypoxia
Hypovolemia
Hypothermia
Hyper/hypokalemia
Tension pneumothorax
Cardiac tampade
Pulmonary or cardiac thrombus
Toxins
What are the check needs to be compled post- ROSC ( A2E
A - adjunct still effective
B - RR normal ? BVM required - what is the capnoghraphy - aim 4.6 to 6.0 KPA
SATS -94+
C - HR, perfusion, BP ( Maintain 100mmgh systolic ) 12 lead ECG
D - BM + TEMP - allow passive cooling
E
What is stack shocking - guidelines around it
- indicated
- shock count age as per ALS algorithm
Pads must be on prior to arrest
When arrest occurs - if shockable
Upto 3 consecutive shocks can be given with increasing voltage 120 150 200j
Then normal ALS
STACK SHOCKS - account for 1 shock as per resus algorithm
What is the guidelines for the usage of advanced airway in cardiac arrest (resus council)
Use an ET tube were possible
- upgrade to an IGEL and ventilate 10 breaths each minute and do not pause compression whilst this happens
If igel leaks air then revert to 30:2
When should early conveyance be considered in cardiac arrest
Children
Maternity
Hypothermia induced
Toxins
Persinat vt/ VF
penetrating trauma
What does a paramedic give amiodrone in a cardiac arrest
Bonus point for dosage
After 3rd (300mg) and 5th shock (150mg)
When do you give adrenaline in a cardiac arrest
After first non shockable rhythm or
After 3rd continuous shock - which ever comes first
When can you stop resuscitation during a normal Als session
After 30 minutes of persistence and continuous aystole
With all reversible causes addressed
When shock a child in cardiac arrest what joules must you shock them at
4joules per kg
What is fibromyalgia
In a patient who is post rosc - with a blood pressure of 85mmgh systolic and a HR of 80BPM - what can you do to resolve the hypotension
And if that doesn’t work what can you do
Give a fluid bolus to aim for 100mmgh systolic ( max fluid 500ml)
If during or after we are still hypotension
Give adrenaline 0.5ml of adrenaline 1:10,000 ever 3-5 minutes
In post rosc care - what must be completed and checked in airway and breathing
- airway in clear
- appropriate airway adjunct is in place and is being tolerated
Assess breathing rate - ventilate accordinly
Place sats probe - maintain sats ( 94%+)
Monitor capnoghraphy - 4.6 to 6.0 kpa
What should be checked in circulation assessment during post rosc care
Defibrillator pads are routinely checked as VF is comman
- check HR via carotid and check femoral and radial pulses
Gain HR, BP & 12 LEAD ECG - multiple times
Check capillary refill and skin warmth to check perfusion
What should you check for in disability in pre rosc care
Avpu
GCS + pupils
BM and temperature
Provide pain relief
Any seizures - rule out hypoxia, hypoglycemia, hypothermia and then provide benzo as per guidelines
When can you not start CPR on a child
If there is signs unequivocally associated with death
- if the child has a life limiting illness AND an advanced care plan stating no CPR is present
What are the guidelines for maternal cardiac arrest management
If 20 weeks plus pregnant displace uterus to the left to release compression of Vena cava = better venous return
- try to add 30 degree tilt left but keep chest flat - for good compression
Early extrication to A&E = provide prealert ( vocerlise the pregnancy)
What is the management for asthmatic cardiac arrests
Assess for bilateral tension pneumothorax
Manually decompression chest get rid of air ( as broncosyriction traps it) - maybe achieved with release of BVM from circuit
Optimise drug timing ( adrenaline = beta 2 )
During a cardiac arrest what are the 4 categories of PT for whom there should be early conveyance
Children
Maternal
Toxin/ drug overdoses
Hypothermic induced
During a cardiac arrest what are the 4 categories of PT for whom there should be early conveyance
Children
Maternal
Toxin/ drug overdoses
Hypothermic induced
How do you treat hypovolemia as a reversible cause in cardiac arrest
Fluid - upto 2L - rapid bolus
When attending a patient who is cardiac arrest - they have been rescued from a canal. What should you consider
If you are resuscitating - will there be any chances to the ALS algorithm
Resusiation can only beging within the first 90 minutes = after 25 minutes outcomes are poor but ok really cold water hypoxia and metabolic acidosis can be slowed
Provide 5 Rescue breaths before normal ALS algorithm
What are the two exception whereby you do not resuscitate a child in cardiac arrest
Where sign unequivocally associated with death are apparent ( BE CAREFUL WITH - hypnosis ( mottling in children may mimic ) and rigor Mortis ( This maybe apparent quicker /slower on different people))
2) those with life limiting irreversible condition AND have a advanced care plan which is specially against CPR
When arriving at a cardiac arrest - what must you check before starting resuscitation ( adult)
Any valid RESPECT/ DNACPR, ADRT or LPA
- you may begin BLS : but check if the patient has a irreversible condition whereby this is the end of their life even in the absence of any paper saying not to do CPR
Why is it in some adults CPR isn’t recommend despite no DNACPR/ RESPECT FORM / ADRT or LPA or ROLE criteria found within 5 minutes
** What can you do whilst obtaining or making this decision**
This is because they have :
An irreversible progressive condition
- CPR would be ineffective and distressing for staff and family and pt
- the outcome of ROSC, will not improve quality or life or worsen it
BLS : should be started till more info is gained
What is hypostasis ( role criteria )
The coagulation of blood which pool through gravity to the lower parts of the body
This makes small circles of bruise looking pattern that get bigger with time
Above this area the patient looks pale
1)What is rigor Mortis
2)What must it not get confused with
Breakdown of enzymes in muscle causing stiffness one group of muscle at a time - over a period of time
2) cadaveric spasm( sudden full body stiffening ) and trismus ( stiffening isolated to the jaw)
What is evidence that a irreversible condition is present if the patient is found in cardiac arrest
Palliative care notes
Anticipatory packs
Conditions such as ( cancer, MS, Parkinson’s, dementia
DOCUMENT THESE as clear EVIDENCE
( consult senior clinician if unsure )
When can you stop or not start resuscitation ( they are 5 reasons)
1) RESPECT form, DNACPR, ADRT,LPA
2) irreversible condition whereby CPR wouldn’t be successful
3) ROLE CRITERIA
4) drowning for 90 minutes plus
5) 15 minute rule
What is the 15 minute rule for not starting CPR
ALL OF THESE MUST BE MET
1) 15 minutes + since onset of cardiac arrest and your arrival
2) no bystander CPR when you arrive
3) asystole on first rthym check ( for 30 seconds +)
4) exclusion criteria mustnt be present ( maternity, drugs or hypothermic arrests, children )
What must you include when completing a ROLE
1) confirm no pulse ( carotid )
2) listen to breath and heart sounds
3) 30 seconds of systole must be present on 3 lead ECG - TAKE A PAPER COPY
4) Systematic searching for ROLE criteria
What is an ADRT
1) advanced directive to refuse treatment ( it’s a Legal Document) only in action once capacity is lost
What criteria must be present to make an ADRT valid
1)Must be in writing
2)Signed by patient
3)Be spefic in which treatment they are refusing
4)Must acknowledge risk to life by reducing treatment
5)Must be signed by a witness
In which situation does a valid ADRT become redundant
1) patient withdraws the ADRT
2) PT appoints an LPA after the ADRT
3) if you believe they would have changed their decision if they knew about the current situation
4) any suicide or attempted suicide
**Must document why you went against the ADRT - what doubts did you have/ what made you question the validity of the document
What is an LPA
1) what makes it valid
2) what does this power mean in terms of life saving treatment
Legal power of attorney - they make the decision when someone has lost capacity - it’s as the PT had made the decision
The document must have the official stamp from public guardian / you can check online ( gov website )
The document must clearly state if they can consent / retract consent for life saving treatment
What is a DNACPR/ RESPECT FORM
- is it a legally binding document
- what does this mean in terms of resus
- does a photograph count
- can you go against the respect form/ dnacpr
1) is a clinical support guide detailing the patients wishes
-The clinical decision to resuscitate remains with the clinician
- Yes a photograph act as the real thing
- if you go against the DNACPR/.RESPCECT - you must document your clinical reasoning as your going against the PTS wishings
When can you stop resuscitation
Is a patient had been in persistent and continuous asystole with all reversible causes addressed + they are not in the exclusion criteria who must be conveyed
What is agonal rhythm
2) what is it value in resuscitation
1) HR below 10 BPM - from the ventricles - normally a pre- curser for asystole
2) if it has been present for 30 minutes continuously you treat it as asystole - stop resus
What is the procedure in an expected death
If the PT had been seen by a healthcare professional or doctor within 28 days of death - then GP will a cause of death certificate
What are the 2 signs unequivocally associated with death - that if only one is present you should NOT withhold resus in a child. — state why
Hypostasis - mottling can mimic this
Rigor mortis - this can come on quick or slow in children
You need another sign if only one is present or seek senior clinician support
When should you convey a child who has been confirmed as death to A&E
If there is no care plan in place ( expected or ROLE Criteria met)
Or if the police state you to take them to hospital
Take to A&E not the mortory due to - Kennedy procedure
When attending a child in cardiac arrest with signs unequivocally associated with death - which 2 of these signs cannot be used by themselves to confirm death
hypnosis ( mottling in children may mimic )
and rigor Mortis ( This maybe apparent quicker /slower on different people))
What should you document when attending a child who has passed away and resuscitation isn’t indicated
everything
Include - first glances and scene setout
- where was the child ( cott bed, floor
- what were they wearing / the bedding
- how was the child positioned
- what was the proximity to the child and caregivers
History of last 24 hours ( the leading up events)
In what instances can you leave the child who has passed away at home
When there is A care plan in place and you have spoken to child specialist who give permission
Police have confirmed a crime scene
When can you ask bystanders to stop CPR
- if PT has died due to an irreversible long-term condition ( cor would be ineffective in prolonging sustained life)
- role criteria met
What are two signs during cardiac arrest which are commonly misinterpreted as rigor mortis
cardiavric spasm - sudden fully body stiffening ( rigor is gradual and affects one muscle at a time)
Trismus - stiffness isolated to the jaw ( check face as rigor starts there + rigor isn’t isolated)
In which patient can you withhold CPR respite no ROLE criteria and no DNACPR/LPA/ADRT
- what should you document
Those with advanced irreversible condition whereby this arrest is there normal life end point
- CPR would be unlikely to prolong life
- CPR would be destressing to staff and family
- CPR would significantly reduces quality of life if rosc was achieved
Search for evidence that it’s irreversible ( anticipatory meds, palliative care notes ) Document this
In which situation should you consider CPR in those with a DNACPR
Whereby death is unnatural with a easily reversible cause ( anaphylaxis choking
(Death isn’t caused by natural procession of the disease)
In which patient should you suspect sepsis
Patient who who have an abnormal temp (high/low)
- those who have a news2 score or 5 or more
- those with a history of infection
In which types of patient should you suspect sepsis in
PT with signs of infection +
- feverish/ looks unwell
- NEWS2 of 5 or more
What is the only way sepsis can be ruled out
Blood test and urine output measurement
Interms of observation in PT with sepsis - can they be trusted
- sats
- HR
- RR
- BP
- temp
oxygen = no as in profound shock, sats probe isn’t accurate
RR = YES, one of the most sensitive and early indicators ( best indicator in kids)
Hr - shows compromise but in children, old people, medicated ( beta blockers = no)
Bp- will only change during shock
- temperature doesn’t exclude sepsis - ask about fevers, rigors
What are the red flags for sepsis in children
Abnormal skin colour
- weak cry
- lack of interaction to social cues
- TCRASHING
- sats below 90%
- no urine
- reduced skin turgor
- very Brady or tachy
- poor CBR
- rashes
- seizures
