Management of the Acute Patient & Trauma Flashcards
(37 cards)
1
Q
Define an acute patient
A
- Patient who is having severe symptoms which appear rapidly
2
Q
State points to be aware of when working with an acute patient
A
- Patient could be in a lot of pain
- May have breathing difficulties
- Unresponsive
- Uncooperative
- Limited in ability to move and comply with instructions
- Condition where normal anatomy is altered
- Could be attached to monitoring equipment
3
Q
When working with an acute patient you must that the patient can…
A
- Identify themselves
- Communicate with you
- Sit upright unassisted
- Take and hold a breath for the duration of the exposure
- Tolerate the image detector behind their back
- Be considered an infection risk
- Be monitored during the examination
4
Q
When working with an acute patient you must check that the equipment can…
A
- Be moved out of the FOV
- Be removed for the duration of the examination
- Be considered a siginifcant artefact
- Physically impede the x-ray equipment
- Be considered as sterile or an infection risk
5
Q
When monitoring a conscious patient what should be considered
A
- Listen to their manner and rate of speech
- Does this explain their mental or emotional state?
- Make eye contact, verbalise your actions
- Remember, attending emergency is usually stressful regardless
6
Q
When monitoring an unconscious patient what should be considered
A
- Monitor their blood pressure, oxygen saturation, heart rate
- What is their Pallor like?
- If they are brought to the department, they should have a medical escort
- Do you know where the adult and paediatric crash carts are
- If in doubt get help or call 2222
7
Q
How can we confidently identify an unresponsive patient?
A
- All admitted patients should have an identifying wristband on always
- All patients who have been brought to the hospital unresponsive with no-one to identify them will be assigned a unique ‘unknown’ ID
8
Q
What is the Glasgow Coma Scale
A
- Used to determine state of consciousness by assigning a score (3-15)
- The lower the number assigned, the more likely a brain injury has been sustained
9
Q
What is the potential problem with the GCS
A
GCS may not be the best idea as patients could come in drunk or on drugs
10
Q
What is the Golden Hour?
A
This is the first 60 minutes after traumatic injury where rapid investigation and treatment can lead to increased patient outcomes
11
Q
Describe the triage system
A
- Immediate / Critical
- Very Urgent
- Urgent
- Standard
12
Q
What is consent
A
- Permission or Agreement
- The principle that an individual gives permission before they receive tests / treatments
13
Q
Why is consent important
A
- Ethical Requirement
- Legal Requirement
14
Q
What is the consequences when their is failure to obtain consent
A
- Negligence
- Sexual Harassment
- Battery
15
Q
Who can obtain consent?
A
- Initially the Referrer
- Health Professional undertaking the examination
- Health Professional assisting in the examination
16
Q
When should you get consent?
A
- Before the procedure
17
Q
What is valid consent?
A
- Must be given voluntarily
- Individual must be appropriately informed
- Individual must have the capacity to consent
18
Q
State the 3 types of consent
A
- Implied Consent
- Expressed Consent
- Documenting Consent
19
Q
Describe implied consent
A
- Agreement signed by behaviour
- Agreement signed by an informed patient
- Compliance is not implied consent
- Always try to seek verbal consent prior to undertaking the procedure
20
Q
Describe Expressed Consent
A
- Required for investigation / treatments which carry significant risks
- Law does not always require written format as long as the patient is legally competent, volunteers their consent and has been well informed prior to the treatment
21
Q
Describe documenting consent
A
Details of express consent being obtained should be recorded this mean explicity writing on the request card within the patients notes, or on the RIS / Track system
22
Q
How do we obtain consent when a patient is unresponsive
A
- If no relatives present a decision is made by the emergency doctor
- Decisions must be made in the best interest of the patient
23
Q
When is rapid imaging used
A
if a person has sustained injuries a patient may be sent for a CT
24
Q
When is mobiles used?
A
- Used when their is no possible way for the patient to come to the department
25
When is it ok to use mobiles
- If the patient is too unwell to come to the department
- Patient is being monitored or unstable and unable to be transported
- Patient is intubated
- Patient is an infection risk
- Patient is peri / post arrest
- Is immunocompromised
- Just come out of theatre
26
When is it not ok to use mobiles
- Too many members of the public
- Patient management is not likely to be changed by the provision of imaging
- Clinical information is not provided or justified
- The technical limitations of the machine will not produce a diagnostic image
27
Advantages of mobiles
- Patient does no have to. move anywhere
- Staff may be on hand to assist
- Monitoring equipment and medication can continue to be used
- Digital mobile machine can provide image immediately
- If patient is quarantined the rest of the hospital is not at risk
28
Disadvantages of using mobiles
- Lots of dynamic factors, people in your controlled area
- Patient may not be able to adopt any valuable position to an image to be taken
- Staff may leave you on your own
- Mobile images are less diagnostic accuracy than departmental
- Exposure of yourself or to others
29
What is the most common mobile examination request?
- Chest x-ray
30
What are clinical indications for a chest radiograph
- Perforation
- Chest Pain
- Traumatic Injury
- Sepsis of unknown origin
- Decreased Oxygen saturation
- Assessment of invasive lines and tubes
- Shortness of breath
31
Who can request an image
Anyone who has IR(ME)R 2017 authorisation within their scope of practice
32
What is a major incident?
These are incidents or serious situations in which a number of people are threatened with death or severe injury such that special procedures are required for their reception and treatment
32
How do we know a major incident is happening?
- "Major Incident Standby!"
- "Major Incident Declared!"
- "Major Incident Cancelled!"
33
What happens once a major incident is declared?
- Ambulance Control Centre will designate 4 appropriate hospitals to receive casualties
- Order depends on the location of the incident to the hospitals
- Ambulance Control Centre will alert the hospitals, and Respons Team from the 4th hospital is sent out to assess and coordinate casualties
34
How will the emergency department respond to a major incident
They will try clear the waiting room and all bays of all non-life threatening injuries, either treating or sending them home
35
How will radiology respond to a Major incident
- Assign a Lead member of staff
- Assign a Receptionist role
- Ensure all stock is ready
36
How can staff decompress from a major incident
Discussions around the event that have happened, try to attend them and gain some closure
