Immediate Emergency Care (5 Day IEC) Flashcards
Which Act of Parliament establishes the principle of ‘Assumed Capacity’?
The Mental Capacity Act 2005. It also states that patients should be given practical help with decisions, that a lack of capacity should not be assumed just because of a bad decision and freedoms should not be restricted
Capacity can be ‘impaired’ by poor brain function. How do we test for this impairment? (4)
Can the individual:
1) Understand information
2) Retain information
3) Weigh up information
4) Communicate
What does DNAR stand for?
Do Not Attempt Resuscitation
In which of the following circumstances are Responders to initiate resuscitation:
A) A close family member states that there is a DNAR
B) A copy of the DNAR is shown to the responder
C) The reason stated on the DNAR does not correspond with circumstances?
All of the above. The original DNAR must be available and the stated reason for the DNAR must correspond with the circumstances
There are 8 listed:
‘Signs Unequivocally Associated with Death’ can you name 5?
1) Decapitation
2) Massive cranial/cerebral destruction
3) Hemicorporectomy (cut in half)
4) Massive Truncal Injury
5) Decomposition/Putrefaction
6) Incineration (95%+)
7) Hypostasis (Coloration caused by blood pooling in the lowest quarter of the body
8) Rigor Mortis
These are the same no matter what the age of the casualty
When someone is lying on their back (face up) are they Prone or Supine?
Supine
When beginning a ‘Primary Survey’ latex gloves must be worn. Which other item of PPE should be considered?
Eye protection
Always change gloves between casualties
What does the first D stand for in the Primary Survey Acronym DR C ABCDE?
Danger.
Posed by People, objects or the environment
What does the first R stand for in the Primary Survey Acronym DR C ABCDE?
Response
When gauging the response of a casualty during a primary survey do we use:
A) The Glasgow Coma Scale or
B) AVPU
B) AVPU
What does AVPU stand for?
Alert
(Responsive to) Voice Commands
(Responsive to) Pain
Unresponsive
A casualty is always deemed as being one of the above
What does the first C stand for in the Primary Survey Acronym DR C ABCDE?
Catastrophic Bleed, consider use of tourniquet or blast dressing
On approach to a casualty you say ‘Hello, Hello’ and get no response (A) you then say ‘Open your Eyes’ and still get no response (V) how do you then attempt to elicit a pain response (P)?
Tap or squeeze the shoulders
What does A stand for in the Primary Survey Acronym DR C ABCDE?
Airway.
Open mouth and look but don’t use fingers to clear (Adult/child may clench teeth, Trismus, and in infants it could trigger vagus nerve with catastrophic results)
In what circumstances might we consider the ‘Jaw Thrust’ (CE or Anaesthetist grip) as a manoeuvre to clear the Airway instead of the ‘Head Tilt Chin Lift’ (simultaneously using 3 fingers under chin to lift and 3 fingers on forehead to tilt the head back)
Suspected cervical spine injuries
What 2 types of adjunct might be used to maintain a clear airway?
Nasopharyngeal Airways (NP’s) for altering levels of consciousness and Oropharyngeal Airways (OP’s) for unconscious casualties only
How do we now size an OP airway correctly?
Angle of the jaw to a point level with the mid incisor (Green currently fits Resusci Annie).
To correctly fit an OP hold the chin to open mouth, point end toward roof of mouth place in gently until resistance then turn, seat resting lip on lips. In children aged 8 and under insert with no turn.
How many sizes of OP airway do we carry?
4
We currently carry 2 full sets of 4 OP’s in each bag. These can be replenished by LAS
How many sizes of NP airway do we carry in each EIC bag?
2 size 7 (mm) adult male and size 6 (mm) adult female. We carry a packet of 2 of each, not replenished by LAS.
To Fit an NP correctly apply lubricant, point curve toward mouth, wiggle slightly on entry to nostril, do not force if wiggle does not work remove. NPs DO NOT need rotating.
When are NP Airways contra indicated (not to be used)? (2)
1) Where a base of skull fracture suspected
2) Where a casualty is less than 12 years old
What does B stand for in the Primary Survey Acronym DR C ABCDE?
Breathing
Each intake of breath contains approximately 79% Nitrogen and 21% Oxygen. Each exhaled breath contains 79% Nitrogen, 16% Oxygen and 5% CO2
How long should be spent checking for a breath?
10 seconds
Assess every 60 seconds
In what circumstances would we consider ‘Rescue Breaths’? (2)
5 for a child not breathing
5 for and adult drowning victim
At what rate of respiration (breaths per minute) would we begin to assist using the ‘Bag and Mask’?
<10 breaths per minute
(less than 10).
Count to six with each
How many litres per minute should the Oxygen cylinder always be set at?
15 Litres per minute
Remove the grey cover and afix hose to fir tree connection, the reservoir on the bag and mask will inflate itself.
OXYGEN IS CLASSED AS A DRUG and so it’s administration should always be recorded
What type of Oxygen cylinder do we carry, ZD or CD?
ZD
300 bar 600 litres giving 40 minutes use at 15 litres per minute. They should be replaced by LAS crews, they carry 6 plus 2 larger ones. But make sure they are not marked CD as they also carry these.
In what circumstance is the use of Oxygen still contra indicated?
Highly Flammable Atmospheres.
COPD and Hyper Ventilation are still treated but with close monitoring. It is LAS that have set this protocol for LFB (paraquat has not been available for more than 10 years so is no longer a likely consideration)
Which lung has 3 lobes and which has 2 lobes?
The right has 3 the left 2 to make room for the heart
What are the 4 signs of Hypoxia? (Insufficient Oxygen)
1) Pale cold and clammy skin
2) Rapid breathing
3) CONFUSION
4) Cyanosis (very late stages)
Prior to using the Paediatric Bag and Mask what must be in the Open position?
The pressure relief valve (if it farts it’s open)
What is the last sense to be lost and the first to return during altering levels of consciousness?
Hearing
If Oxygen is administered to someone who has suffered smoke inhalation, what must follow?
Referral to LAS as carbonaceous deposits in the lungs can provoke the body to produce liquid/mucus that then has a similar effect to pneumonia. The casualty should also be encouraged to clear their nose and throat prior to administration.
What is the Hudson Freeflow mask now known as?
High Concentration Oxygen Mask
Delivering 95-98% Oxygen
The High Concentration Oxygen Mask is used when casualties are breathing at a rate of 10 breaths a minute or more. What must you remember to do prior to administration?
Fill the reservoir bag by placing a gloved finger over the valve in the mask
An adult is considered to be Hyper Ventilating when they are breathing at rate of how many breaths per minute and above?
30 breaths per minute
Hyperventilating is always caused by an underlying condition. The average rate in an adult is 12-20, a child 20-30 and an infant 30+
An infant is 0-1 years of age, how is a child classified?
1 to Puberty
What does the second C stand for in the Primary Survey Acronym
DR C ABCDE?
Circulation
Adult 60-80 bpm
Child 100-140
Infant 140+
The Chest Compression rate is 100-120 a minute (‘Staying Alive’) for all age groups
What are the 3 principles of IEC?
1) Preserve life
2) Prevent Deterioration
3) Promote Recovery
What stage of Assessment follows Scene Assessment?
Primary Survey
PPE - gloves (new for each casualty) and eye protection
History Taking follows the Primary Survey. What acronym can be used to remember the questions that need to be asked?
S signs and symptoms A allergies M medication P past medical history L last ate drank E events leading up to injury/illness
How long should a Secondary Survey (4th stage of Assessment) typically take?
60-90 seconds. If it’s taking longer check pulse and breathing then carry on
Where an individual is breathing at a rate of <10 or >30 we would consider assisting but at what rate?
10-12 respiration’s per minute
What is ‘stridor’ and what might it indicate?
A higher pitched noise on inspiration which is indicative of an obstruction in the upper airway
If present what does a radial pulse imply?
Profusion of blood is likely to be adequate to vital organs
How do we check capillary refill?
Press your thumb to the casualties nail bed, or for a child forehead, for 5 seconds and see if colour returns within 2 seconds
What is the Tympanic membrane also known as?
Eardrum
What is Hypovolemic shock?
Shock caused by a lack of blood in the system
What is Cyanosis?
A bluish discolouration under the skin usually visible around the lips caused by low O2 levels in red blood cells. This is a late sign and indicates the need for immediate treatment
The average pulse rate for an adult is 60-80 beats per minute and for a child 100-140. What is the average pulse rate in an infant?
140+ beats per minute
Do all Arteries carry blood away from the the heart and all Veins carry blood to the heart (Venus return)?
No, 99% do but the Pulmonary Artery and Pulmonary Vein do the opposite
What piece of equipment do we now use to give us a casualties pulse rate?
The Pulse Oxymeter
It measures Oxygen saturation levels IN THE BLOOD
A warning beep will sound when a casualties pulse is <50 beats per minute (Bradycardic - slow), >120 (Tachycardic - fast) or their Oxygen saturation falls below 90%. The black button simply changes the display
In what 5 circumstances might the Pulse Oxymeter fail to work?
1) In direct sunlight
2) Carbon monoxide poisoning
3) Poor tissue perfusion eg Cold casualty
4) Shivering/movement
5) Nail Varnish (try turning it around)
Only use it on a finger and functions between 30 and 240 beats per minute
When the Pulse Oxymeter is used why should we also take a manual pulse?
To determine whether the pulse is weak, rapid, pounding or missing beats
Name 4 of the 9 pulse sites listed in the manual
Carotid - neck running in hollow next to wind pipe
Brachial - inside upper arm
Femoral - inside thigh level with genitalia
Popliteal - inside leg at knee
Posterior tibial - inside heal
Dorsalis Pedis - top of foot above arch
Superficial temporal - head temple
External maxill - jaw
Radial - grove in the wrist, follow line of the thumb
Do not use your thumb to take pulse as there is a pulse in the thumb