Managing an unconscious casualty Flashcards
Causes of unconsciousness
FISHHSHAPED
FISHHSHAPED Fainting Infections (not all) Shock Head injury Heart attack Stroke Hypoxia Abnormal temperatures (hyper/hypothermia) Poisoning Epilepsy Diabetes (hyper/hypoglycaemia)
Definition of Epilepsy
Epilepsy is a disorder that effects the brain.
The cells in the brain, known as neurons, conduct electrical signals and communicate with each other in the brain using chemical messengers.
Epilepsy is a diagnosed condition where a sufferer has 2 or more unprovoked seizures
causes of seizures
A seizure is abnormal bursts of neurons firing off electrical impulses, which can cause the brain and body to behave strangely. Causes can include; Epilepsy Hypoglycaemia Hypoxia Brain damage Tumours Alcohol withdrawal Drugs Fever (particularly in children)
Signs and symptoms of a seizure
Suddenly loss of responsiveness
Rigidity and arching of back
Breathing may be noisy and become difficult
Lips may become cyanosed
Convulsive movements occur
The jaw may clench
Casualty may become incontinent
Saliva may be blood-stained if tongue or lips have been bitten
Tiredness – casualty may feel tired and fall into a deep sleep
Just before a seizure a casualty may have a brief warning (aura)
Strange feeling
Special smell or taste
management of seizures
Dangers- Clear space, do not restrain. Loosen tight clothing
Response- AVPU - Continuously reassess
Airway- Do not forcibly open the airway
Breathing- High flow oxygen required in seizure
Adults till 94=98%
Paediatrics irrespective of SPO2
Circulation- Radial pulse, colour, temperature of patient
Disability- Pupils, Sleep after the seizure is normal (Post Ictle)
Expose and Examine- Any injuries? Secondary Survey
Recovery position post fit
Call an ambulance if:-
Seizures > 5 mins
It’s their first seizure
Patients not sure of reason for seizure
Unresponsive for >10minutes
Has sustained and injury from seizure
Define Status Epilepticus
Convulsion continue for more than 30 minutes or longer with no rest period
Potential life threatening. Can result in neurological damage, respiratory failure and cardiac arrest.
4 ways poisoning can occur
Ingestion
Inhalation
Absorption
Injection
Treatment for poisoning from an unknown substance
ABC (primary survey)
Oxygen (<94% Sats) high flow oxygen in carbon monoxide poisoning
Vital signs
Try to establish the event, drug or substance involved and the quantity
Never induce vomiting
Take any substances found to the hospital for inspection.
Call for paramedic for further treatment and urgent evacuation
Treatment for snakes and scorpion bites
Lie patient down Get a description of what has bitten the patient Identify and record symptoms Correct ABC Oxygen if required (<94% Sats) Gain IV access (qualified personnel) If hypotensive consider fluids (qualified personnel) Analgesia as needed Rapid transfer Measure circumference of affect limb and mark area of Oedema Check tetanus status Document any bleeding and paralysis Immobilise with pressure bandage Rapid evacuation
DO NOT: Elevate limb Allow patient to walk around Wash the limb Feed patient Vital signs
Definition of diabetes
It usually occurs when there is a deficiency or absence of insulin, or insulin resistance at a cellular level, causing abnormally high levels of glucose in the blood
Definition of Type 1 diabetes
Mainly occurs in children, young and adolescent adults
The cause is not fully understood but thought to be an autoimmune problem
Insulin producing cells called β-islet cells in the pancreas are destroyed and either don’t produce any or enough insulin
This causes glucose to build up in the blood stream as there is no ‘key’ to allow it into the cells.
Treatment is usually with insulin injections.
Definition of type 2 diabetes
Most common of the 2 types, and makes approximately 90% of cases
Causes can be due to lifestyle or predisposing factors such as obesity, sedentary lifestyle, increasing age, genetic factors
With type II diabetes there may be less than, more than or normal amounts of insulin being produced, but there is still a problem with glucose entering a cell as the ‘key’ doesn’t fit the lock, causing blood glucose levels to rise
Treatment can be dietary changes, medication and sometimes insulin injections.
Causes and S/S of Hypoglycaemia
May be due to medication mistakes, missed or delayed meals, infection
A low blood glucose level is defined as <4.0mmol/L. Normal range 4.0 – 5.6mmol/L.
Signs and symptom: Sweating Palpitations Shaking Hunger Irritable, confused, drowsiness, uncoordinated, aggressive and anti-social behaviour Rapid onset Fitting Headache Nausea Dizziness Seizures Unconsciousness
Management of Hypoglycaemia
ABC
Oxygen if required (<94% Sats)
Measure BM
Administer oral glucose gel (40%) if conscious and able to swallow.
Reassess blood glucose level after 10 minutes
Glucagon (IM) if unable to give glucose
Recovery position
Transfer patient to hospital
Continue patient management until more definitive care
Signs and symptoms of hyperglycaemia
A high blood glucose reading often >20mmols/l
Gradual onset (hours to days) Dry skin Deep sighing rapid respiration Rapid weak pulse Restless, drowsy, or lethargic Sweet fruity breath Excessive urination Excessive thirst Abdominal pain High blood sugar reading Hypotension
Management of hyperglycaemia
ABCDE
Oxygen if required (<94% Sats)
Measure Blood sugars
Recovery position if unconscious
Transfer or arrange emergency transfer to hospital
Continue patient management until more definitive care
Glucagon
Glucagon is a hormone that induces the conversion of glycogen to glucose in the liver, thereby raising blood glucose levels.
Administered intramuscular (IM)
Adults - 1mg
Children 7 years old and under - 500mcg
Babies less than 1 month - 100 mcg
Definition of hypothermia
Hypothermia is defined as a core body temperature below 35 degree C. It is a potentially life-threatening condition.
3 levels of hypothermia
Temperature ratings for each
Mild 32 – 35 degree C
Moderate 28 – 32 degree C
Severe <28 degree C
Management of hypothermia
ABCDE
Oxygen if required (<94%)
Identify signs and symptoms of hypothermia
Record patients temperature and vital signs
Warm food and drink if patient is conscious
Shelter and rewarm (slowly). Replace wet clothing with dry
Not dead until warm and dead. Hypothermia may mimic death
DO NOT give alcohol, apply direct peripheral heat or rub the skin
heat exhaustion s/s
Headache, dizziness, nausea, vomiting, tachycardia
Hypotension, sweating, muscle pain, weakness and cramps
Temperature - >37 - <40 degrees C
May rapidly progress to heat stroke
Heat stroke s/s
Core temperature >40 degrees
Hot, dry skin (sweating is present in about 50% of cases of heat stroke)
Extreme fatigue, headache, fainting, facial flushing, vomiting and diarrhoea
Seizures
Management of heat injuries
ABC
Remove patient from hot environment
Remove all clothing
Commence cooling with fanning, cool sponge, water misting
Record temperature
Oxygen if required (<94%)
Fluid therapy (Class 1) Class 2 can help assist
Cool oral fluids
Check BM and vital signs
Recovery position and transfer to definitive care
Stoke FAST test
F - Facial weakness – The casualty is unable to smile evenly and mouth or eye my droop
A - Arm weakness – The casualty is only able to raise one of their arms
S - Speech problems – The casualty is unable to speak clearly or talk non-sense
T - Time – Time to call 999/112 or evac.
Advanced Airways- Adrenaline
Dosages
Indications
Actions
1mg to 10ML 1:10,000
Indications
Cardiac Arrest
Shockable rhythms - administer after 3rd shock then every alternate shock 5th, 7th etc.
Non-shockable rhythms – administer adrenaline immediately as soon as IV access is achieved, then alternate loops.
Actions
Increases heart rate (If present)
Vasoconstriction and increases perfusion
Adrenaline enhances myocardial and cerebral blood flow during CPR
CPR becomes more effective due to increased peripheral resistance, this maintains a central blood reserve
Advanced Airways- Amidarone
Dosages
Indications
Effects
300mg in 10ML
Indications
Cardiac arrest shockable rhythms.
Administered by clinician after 3rd shock via IV/IO
After 5th shock administer half dose of 150mg by clinician via IV/IO
Actions
Antiarrhythmic (suppresses bad heart rhythms)
Stabilises and reduces electrical irritability of cardiac muscle.
2 Drugs used is advanced cardiac arrest
Adrenaline
Amidarone
