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NSW Ambulance > MCPD (Move cards into appropriate decks after completion) > Flashcards

MCPD (Move cards into appropriate decks after completion) Flashcards

1
Q

What happens in Phase 1 of the Ventricular Action Potential?

A
  • The voltage-gated sodium channels close, stopping the rapid influx of Na⁺ ions.
  • Voltage-gated potassium channels open, causing K⁺ ions to move out of the cell, leading to a slight repolarisation.-70mV
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2
Q

Non-Invasive Ventilation - CPAP Procedure

A
  • Place pt in seated position
  • Explain procedure to the pt (their understanding and cooperation is essential for successful CPAP)
  • Prepare equipment
  • Select the appropriate size face mask ensuring the inner circumference of the air cushion encompasses the bridge of the nose, side of the mouth and inferior border of the bottom lip (with mouth slightly open)
  • Size 4 - small adult (red)
  • Size 5 - large adult (blue)
  • Attach the vectored flow valve to the mask and the oxygen tubing, ensuring harness connector remains in place
  • Connect the oxygen tubing to a standard 15 L/min oxygen flow metre
  • Adjust oxygen flow rate to L/min to generate 5cm H2O continuous positive airway pressure
  • Monitor patient’s response to treatment (resp rate, SpO2, BP, chest sound & WOB) and increase airway pressure every 3-5 mins to a maxiumum of 15 cm H2O
  • If the pt shows evidence of deterioration, discontinue CPAP immediately and treat in accordance with appropriate CPG
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3
Q

What are the oxygen flow rates for CPAP?

A

8L = 5cm H2O
10L = 8cm H2O
12L = 10cm H2O
15L = 15cm H2O

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4
Q

Do you pause CPR for ventilations when using a BVM?

A

yes

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5
Q

Do you pause for ventilations when using an advanced airway?

A

no

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6
Q

Do you treat as you go in the primary survey?

A

yes

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7
Q

How can amiodarone cause a vasodilatory effect?

A

by non-competitively binding to α1 Adrenergic receptors

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8
Q

How do you invert the screen display colours of the corpuls?

A

hold monitor key for 3 seconds

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9
Q

How do you measure an OPA?

A

From the Patient’s incisors (front teeth) to angle of jaw

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10
Q

How long should it take to complete a primary survey?

A

90 seconds

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11
Q

How long should you suction for?

A

10 seconds

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12
Q

What happens in Phase 0 (depolarisation) of the Ventricular Action Potential?

A

When membrane potential reaches -70mV, sodium channels open allowing rapid Influx of Na⁺ ions, causing depolarization & rise of membrane potential to about +30 to +40mV.

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13
Q

How may amiodarone cause bradycardia and hypotension?

A

by non-competitively binding to β1 Adrenergic receptors

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14
Q

In an upper airway obstruction, what does complete silence indicate?

A

complete obstruction

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15
Q

In an upper airway obstruction, what does noisy breathing (inspiratory stridor, noring or gurgling) indicate?

A

partial obstruction

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16
Q

What affect does amiodarone have on Phase 0 of the action potential?

A

Inhibition of Na⁺ channels resulting in a slower upstroke of depolarisation

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17
Q

What affect does amiodarone have on Phase 2 of the action potential?

A

Inhibits Ca²⁺ channels prolonging the plateau phase

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18
Q

What affect does amiodarone have on Phase 3 of the action potential?

A

Inhibits K+ Channels extending the duration of repolarisation, slowing down the efflux of K⁺

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19
Q

What affect does amiodarone have on the cardiac action potential?

A

prolongs the action potential duration and the effective refractory period, stabilising the cardiac rhythm and controlling arrhythmias by reducing the likelihood of premature electrical impulses

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20
Q

What age group requires the OPA to be inserted without rotation

A

< 8yrs

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21
Q

What are some adverse effects of OPA?

A

 Can cause vomiting if intact gag reflex
 Spasm of vocal chords
 Improper size or technique can obstruct airway

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22
Q

What are some Class 1 Na+ channel blockers?

A

1a (moderate): quinidine, procainamide
1b (weak): lidocaine, phenytoin
1c (strong): flecainide, propafenone

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23
Q

What are some Class 2 Beta blockers?

A

propranolol
metoprolol

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24
Q

What are some class 3 K+ channel blockers?

A

amiodarone
sotalol

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25
Q

What are some class 4 Ca2+ channel blockers?

A

verapamil
diltiazem

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26
Q

What are some complications of an NPA

A
  • Epistaxis
  • Nasal injury
  • If base of skull fracture is suspected use with caution
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27
Q

What are the adverse effects of amiodarone?

A

*Hypotension – Due to the Adrenergic receptor antagonism (α1 & β1)
*Bradycardia – Due to the Adrenergic receptor antagonism (β1) and decreased automaticity and conduction of the SA and AV nodes
*Dysrhythmias- May occur due to the blockade of K+, Na+, Ca²+, and β antagonism

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28
Q

What are the complications of PEEP?

A
  • Aspiration
  • Hypotension
  • Barotrauma
  • Pneumothorax
  • Breath stacking/over-inflation
  • Gastric distension
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29
Q

What are the complications of CPAP?

A
  • Corneal drying
  • Aspiration
  • Barotrauma
  • Hypotension
  • Gastric distension
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30
Q

What are the components of the primary survey?

A

Initial impression
* Reaction to & appropriateness of verbal response to greeting
* perfusion and posture
* distress or discomfort
Airway + spinal management if required
* consciousness
* ability to take a deep breath
* ability to speak a full sentence (word/phrase/sentance’)
Breathing
* Look, listen & feel
* RR (15 seconds x 4)
* work of breathing (effort & efficacy)
* Auscultate breath sounds
Circulation + arrest life threatening haemorrhage
* Examine for life-threatening haemorrhage
* Count pulse rate (15 seconds x 4)
* Assess pulse volume & rhythm
* Assess peripheral & central perfusion
- Skin temperature
- Skin colour
- Central & peripheral cap refill
Disability/Dysfunction (neurological)
* Measure LOC (AVPU or GCS)
* Check pupil size & function
* Assess ability to walk, if appropriate to do so
* Assess ability to move limbs
Exposure/environment
* Expose and inspect torso and limbs
Focused Hx & adjuncts
* Blood Pressure
* BGL
* Pulse oximetry
* Measure tympanic temperature
* ECG
* Calculate Worthing Physiological Score
Ask questions
* What is the main problem you have called the ambulance for today?
* Do you currently have chest pain or breathing difficulty?
* With respect to the problem that you called the ambulance for today:
- When did it start?
- What were you doing when it started?
- How severe is it at the moment?
- Is it getting better or worse?

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31
Q

What are the components of the secondary assessment?

A

Head
- Posteriorly / laterally - check nose and ears for blood, foreign bodies & CSF & check for facial #
- Assess pupils using pupil torch - PEARL
- Ask Pt to bite and to run tongue around inside of teeth
Neck
- Assess spinal cord function - squeeze both hands wiggle toes numbness/tingling
- Assess jugular vein for distension
Chest/breast
- Assess chest movement - Pneumo/Haemo/Tension Pneumothorax, sucking chest wound, subcutaneous emphysema, tracheal deviation, unequal chest movement, trauma, Oedema/erythema/purpura
- Gently spring the ribs
Abdomen
- Palpate the abdomen across all regions - assess for distension, rigidity, guarding & palpate the presence of femoral pulses as indicated
Pelvis/Genitalia
- Protect modesty and privacy
- Localised trauma
- Oedema / erythema / purpura
**Upper and Lower limbs **
- Assess distal perfusion and pulses - If no # or dislocation is suspected confirm this by asking the Pt to move each limb
- Ensure palpation of all bones is performed, e.g. upper limb from clavicle and scapula to fingers
Back and Spine
- Maintain spinal alignment - log roll
- Check in natural hollows for trauma
- Palpate carefully along the spine for tenderness and deformity
Take the History
- Record chief complaint
- Assess pain - OPQRST
- Ascertain treatment given prior to your arrival
- If the Pt unconscious prior to your arrival, was it continuous and how long
- Obtain an AMPLE history

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32
Q

What are the contraindications for amiodarone?

A

Torsades De Pointes

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33
Q

What are the contraindications for CPAP?

A
  • LOC = P or U
  • Epistaxis
  • Facial Trauma
  • Active vomiting
  • SBP <90mmHg
  • Hypoventilation
  • Pneumothorax
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34
Q

What are the contraindications for LUCAS?

A
  • Traumatic cardiac arrest
  • Patient <16 yrs until transporting
  • Patient <9 yrs
  • Too small or large for the LUCAS to fit
  • Significant patient co-morbidities (including Ventricular
    Assist Device in situ)
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35
Q

What are the contraindications for PEEP?

A

Pneumothorax

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36
Q

What are the indications for amiodarone?

A

Cardiac Arrest – Shockable rhythm (VF/VT)
* Administer between adrenaline cycles until maximum dose is administered

ICP only
Dysrhythmias - Tachycardia

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37
Q

What are the indications for capnography (EtCO2)?

A
  • Airway management
  • Pre-sedation
  • ROSC
  • Any concern regarding cardiac output or respiratory capability
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38
Q

What are the indications for CPAP?

A

Cardiogenic Pulmonary Oedema with:
* Stable with basal crackles & no response to oxygen and GTN +/- frusemide
* Increased WOB and/or mid zone to full field crackles – concurrently with pharmacology

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39
Q

What are the indications for CPR?

A

Cardiac Arrest (Unconscious, absent or gasping respirations & absent central pulse)
* Unconscious with pulse rate < 40 (children 1-8) or pulse rate < 60 (infant)

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40
Q

What are the indications for needle thoracostomy (chest decompression)?

A

Traumatic cardiac arrest with actual or suspected chest injuries

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41
Q

What are the indications for needle thoracostomy (chest decompression)?

A

Traumatic cardiac arrest with actual or suspected chest injuries

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42
Q

What are the indications for PEEP?

A

whenever using bag valve mask (BVM)

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43
Q

What are the normal EtCO2 parameters?

A

35-45mmHg

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44
Q

What are the recommended respiratory rates for patients not receiving CPR?

A
  • adult - 10 to15 breaths per minute
  • children - 20 breaths per minute
  • infant - 40 breaths per minute
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45
Q

What button do you press on the corpuls to change CPR types (adult/30:2/15:2/continuous)?

A

metronome soft key

46
Q

What can amiodarone trigger in Pts with Torsades De Pointes?

A

ventricular fibrillation (VF) or asystole as it extends repolarisation (QT interval)

47
Q

What can cause an upper airway obstruction?

A

Foreign bodies may include;
* Fluid-saliva, vomit, blood
* Solids-food, dentures, other foreign bodies
Swelling from;
* Allergic reactions
* Burns
* Infection
* Trauma
* Tumour

48
Q

What causes a negative deflection on an ECG:

A

electrical movement away from a lead

49
Q

What causes a positive deflection on an ECG?

A

electrical movement towards a lead

50
Q

What drugs are administered if Pt has VF or VT rhythm?

A

adrenaline
amiodarone

ICP only
lignocaine

51
Q

What drugs are administered if the Pt is in a non-shockable rhythm?

A

adrenaline

52
Q

What effect does amiodarone have on an ECG?

A

Prolongs the QT interval

53
Q

What happens in Phase 2 (Plateau phase) of the Ventricular Action Potential?

A
  • Voltage-gated calcium channels remain open, allowing Ca²⁺ ions to continue entering the cell.
  • Potassium channels remain open, causing K⁺ ions to begin exiting the cell.
  • This leads to a plateau in the membrane potential.
54
Q

What happens in Phase 3 (Repolarisation) of the Ventricular Action Potential?

A
  • Voltage-gated calcium channels close, stopping the influx of Ca²⁺ ions.
  • Potassium channels remain open, and K⁺ ions continue to exit the cell.
  • The efflux of K⁺ ions leads to repolarisation, bringing the membrane potential back towards the resting potential.
55
Q

What is a complication of oral suctioning?

A
  • Hypoxia
  • Trauma to teeth, tongue, oropharynx, and bleeding
  • Vomiting or laryngospasm.
  • Increased intra-cranial pressure
  • Bradycardia/Hypotension from stimulation of the vagal nerve
56
Q

What is amiodarone’s Calcium Channel Blocking (weak) action?

A

blocks of Ca²+ entering the cell in phase 2, resulting in a slightly prolonged plateau leading into repolarisation.

57
Q

What is amiodarone’s Sodium Channel Blocking (weak) action?

A

blocks Na+ influx in Phase 0 of the action potential, slightly prolonging depolarisation of the cell.

58
Q

What is amiodarone’s primary action?

A

blocking K+ leaving the cells during repolarisation, prolonging the absolute refractory period inhibiting further depolarisation

59
Q

What is the adult (≥ 16) amiodorone dose for cardiac arrest (Shockable rhythm VF/VT)?

A

300mg undiluted
repeated once at 150mg
Total max dose 450mg

Administered whilst indicated between adrenaline cycles until max dose achieved

60
Q

What is the aim of upper airway management?

A

To clear and maintain a patient’s airway

61
Q

What is the cardiac arrest transport destination cascade?

A

1st Option: Hospital with cardiac catheter laboratory <90min
2nd Option: Hospital with cardiac services <90min
3rd Option: Nearest ED with medical coverage
For Paeds: Follow T1 paediatric destination cascade

CODE 3: to receiving hospital

62
Q

What is the CPAP procedure?

A
  • Ensure patient is sitting
  • Explain procedure and obtain consent
  • Select appropriate sized face mask
    − Small Adult Size 4 (red)
    − Large Adult Size 5 (blue)
  • Attach filter to mask
  • Attach vectored flow valve to filter and oxygen tubing
  • Adjust oxygen flow rate to 8 L/min for 5cm H2O CPAP
  • Position mask on patient’s face and secure using harness to achieve a comfortable, air tight seal
  • Check the mask and tubing for leaks
  • Increase airway pressure (as required) every 3-5 mins to a maximum of 15 cmH2O (15 lpm)
  • Continue to monitor patient and response to treatment (RR, SpO2, ETCO2, Breath sounds, WOB, BP)
63
Q

What is the defibrillation electrode pad placement for 6 years and older/Adults?

A

Anterior-Lateral (A-L)
placement:
* Sternum pad – below right clavicle
* Apex pad – level to apex of heart mid auxilla line

64
Q

What is the defibrillation electrode pad placement for <6 years?

A

depending on size of torso:
Larger torso A-L; or
Smaller torso Anterior-Posterior (A-P) placement
* Sternum pad – anterior chest
* Apex pad –posterior left chest

Do not overlap DE pads

65
Q

What is the electrical pathway through the heart?

A
  1. SA Node ->
  2. Atria (causing atrial contraction) ->
  3. AV Node (delays impulse) ->
    Bundle of His ->
  4. Left and Right Bundle Branches ->
  5. Purkinje Fibers (causing ventricular contraction)
66
Q

What is the handplacement in HPCPR for 1-8 yrs?

A

Place one or both hands over lower ½ of sternum

67
Q

What is the hand placement in HPCPR for Adults & Children ≥ 9yrs?

A

Place both hands over lower ½ of sternum

68
Q

What is the handplacement in HPCPR for ≤1 yr ?

A

Both thumbs over centre chest with hands encircling chest

69
Q

What is the joule calculation for paediatric defibrillation?

A

4 joules/kg

70
Q

What is the mechanism of amiodarone in wide complex tachycardia?

A
  • Prolongation of Action Potential (Phases 0-3) and Refractory Period
  • Inhibition of Multiple Ion Channels
  • Suppression of Ectopic Pacemakers
  • Anti-Adrenergic Effects
71
Q

What is the order of attachments for a BVM?

A
  • mask
  • filter
  • bvm
72
Q

What is the order of attachments for an igel?

A

igel
filter
EtCO2
BVM

73
Q

What is the pathophysiology of hypotension in hyperventilation using a BVM?

A

Increased intrathoracic pressure decreases venous return and reduces cardiac output

74
Q

What is the preparation of amiodarone?

A

150mg/3ml

75
Q

What is the procedure for attaching EtCO2 sensors to the BVM/SGA/ETT adapter?

A

Clip each EtCO2 sensor to the
adaptor with the arrows facing
forward (corresponding markers)
* Attach adaptor to filter & attach to resuscitation mask/SGA/ETT
* Attach resuscitation bag to the top of the adapter & commence ventilations
* Verify EtCO2 is displayed as vital parameter and the waveform is displayed as a curve

Note: The numerical
value and waveform of EtCO2 are
only displayed in Standard Plus or
Critical view

76
Q

What is the procedure for attaching EtCO2 sensors to the nasal/oral adapter?

A
  • Clip each EtCO2 sensor to the nasal/oral adaptor with the arrows facing forward (corresponding to markers)
  • Apply oxygen as required
  • Verify EtCO2 is displayed and the waveform is
    displayed as a curve

Note: The numerical value and waveform of EtCO2 are only displayed in Standard Plus or
Critical view

77
Q

What is the procedure for cardiac arrest (pt unresponsive and no pulse)?

A
  • HPCPR (second officer)
  • confirm code 2 and request backup
  • apply defib pads (first officer)
  • assess rhythm:* SHOCKABLE:
    - defibrillate
    - HPCPR and assess rhythm every 2 minutes
    * administer:
    - adrenaline (repeat every 2nd cycle)
    - amiodarone (2 doses only)
    - lignocaine (ICP only)
      * **NON SHOCKABLE:**
     - HPCPR and assess rhythm every 2 minutes
     - administer adrenaline only (repeat every 2nd cycle)
  • aim for first rhythm assessment within 2 mins and advanced airway ASAP
78
Q

What is the procedure for needle thoracostomy (chest decompression)?

A
  • Swab site
  • Use scalpel to make a small 2mm to 3mm
    incision
  • Place scalpel in sharps container
  • Attach 10ml syringe to Pneumofix™
  • Grip transparent plastic top end of stylet with index finger & thumb
  • Insert needle into second intercostal space at a 90 degree angle to chest wall
  • Apply downward force through transparent
    plastic top end of stylet
  • Push into pleural space; observe for sudden movement of green indicator
  • Then insert a further 1cm
    further into patient’s chest
  • Advance catheter 2-3cm off needle
  • Hold catheter in position by firmly holding it & gently
    withdraw needle
  • Place red needle vice on hard surface & insert needle
  • Secure catheter to patient’s
    chest using hinged tape technique
79
Q

What is the procedure for PEEP?

A
  • Set PEEP value by turning adjustment knob counter-clockwise
  • Remove expiratory flow diverter from resuscitation bag and replace with disposable PEEP valve
  • Attach capnography
  • Attach filter directly onto face mask or advanced airway
  • Provide high flow O2 via BVM (15L/min)
  • If hypoventilating, commence bag valve mask resuscitation
  • If SpO2 not improving after 5 mins increase PEEP by 5cm H2O to a maximum of 10cm H2O
  • Continually monitor patient and response to treatment
  • Discontinue PEEP if patient deteriorates (cardiovascular collapse, ineffective ventilation)
80
Q

What is the procedure for standard or haemostatic gauze dressing?

A
  1. Apply direct pressure to slow bleeding
  2. Expose wound and sweep blood away with fingers to
    identify source of bleeding
  3. Pack gauze towards source of bleeding
  4. Maintain pressure continuously during packing
  5. Pack aggressively until wound is tightly packed with gauze
  6. Hold three minutes of forceful direct pressure over
    gauze and wound
81
Q

What is the procedure to fit and position a LUCAS?

A
  • Position back plate under patient head
  • Remove LUCAS from case & push the ON/OFF button for one second to activate
  • Slide back plate under patient below armpits during the pause for ventilations
  • Position neck strap
  • Pull the release pins to open the
    attachment claws & attach back plate, by attaching closest support leg first
  • At next ventilation pause, attach
    opposite leg with assistance from
    compressor
  • Listen for the “click” and pull up on device to confirm attachment
  • Confirm placement of plunger and mark position
  • Push ACTIVE (continuous) or ACTIVE (30:2)
    to start compression
  • Attach LUCAS neck strap to prevent movement
82
Q

What happens in Phase 4 (resting potential) of the Ventricular Action Potential?

A
  • The cell membrane returns to its resting potential of -90mV
  • The sodium-potassium pumps (Na⁺/K⁺-ATPase) actively transport 3 Na⁺ ions out of the cell and 2 K⁺ ions into the cell, maintaining the ion concentration gradients
  • Potassium ions continue to move out of the cell through leak channels, contributing to the negative resting membrane potential.
  • Sodium ions slowly leak into the cell, but this is much less significant compared to the movement of K⁺.
83
Q

What is the treatment for Torsades De Pointes in Pts with a pulse?

A

P1 - Urgent transport. Minimise time on scene

ICP:
LOC P or U - Synchronised Cardioversion
LOC A or V - Lignocaine 2%

84
Q

What is the treatment for Torsades De Pointes in Pts with a pulse?

A

Defibrillate
HPCPR - Assess rhythm every 2 minutes
Administer medications
Adrenaline - repeat every 2nd cycle (approx. 4 mins)
Lignocaine (ICP only) - administer between adrenaline cycles until total maximum dose administered

85
Q

What is Torsades De Pointes?

A

type of polymorphic ventricular tachycardia, occuring from a prolonged QT interval (congenital or drug induced). When depolarisation occurs (R wave) during repolarisation (T wave) it may precipitate Torsades

86
Q

What part of the NPA faces the septum?

A

bevel (angled side)

87
Q

What should you always be able to see when suctioning?

A

tip of the sution catheter

88
Q

What size Pt do you use a paediatric BVM & filter?

A

10-30kg

89
Q

What size Pt do you use an adult BVM & filter?

A

> 30kg

90
Q

What size Pt do you use an infant BVM & filter?

A

<10kgs

91
Q

What skills are included in upper airway management?

A

foreign body removal - magills, back blows, chest thrusts, suction, ideo laryngoscopy
triple airway manoeuvre
artificial airway - opa, npa, igel, ett

92
Q

What vitals do you need to get post ROSC?

A
  • 12 lead
  • BP (target of >100mmHg)
  • BGL (normal ranges 4-17mmol/L)
  • pupils
  • temperature (maintain normothermia)
  • reassess for reversible causes
93
Q

Where can standard or haemostatic gauze be used to stop bleeding?

A
  • Junctional areas (Groin, axilla, neck, buttocks, perineum)
  • Deep extremity puncture wounds
94
Q

Why is padding under infants shoulders required when undertaking upper airway management?

A

their large occipult causes excessive head tilt, occluding the trachea

95
Q

What is th indication for a slishman traction splint?

A

fractured femur where knee and neck of femur injuries have been excluded

96
Q

What are the contraindications of a slishmans traction splint?

A
  • Suspected pelvic injuries where pelvic binding is not in place
  • Fractured hip/ neck of femur
  • Significant injury to the knee
  • Lower limb injury where no calf muscle mass is left.
97
Q

What are the steps in applying a slishmans traction splint?

A
  • apply the ankle strap firmly
  • Place extension pole next to lateral thigh with groin strap near upper thigh
  • Apply groin strap - Pass male end of buckle under the thigh and place the female end of buckle over the lateral thigh with padding tab against the patient and connect and tighten
  • Loosen black clamp thumb screw on extension pole and lengthen splint
  • Connect distal end in the receiver socket of ankle strap
  • Extend pole to achieve desired length
  • Apply moderate tension (not traction) until splint is aligned in correct position
  • Tighten black clamp thumb screw while holding the pole in position
  • Apply fine traction
    o While holding the traction cord
    located at the top of the splint, loosen red clamp thumb screw
    o Apply fine traction by pulling on
    traction cord until effective traction is obtained
    o While still holding traction cord,
    tighten red clamp thumb screw. Cord can be released once screw is tightened
98
Q

What do you do before applying slishman in open (compound) fractures?

A

Irrigate and remove all debris from compound fractures and cover with saline moistened sterile dressing

99
Q

What is the procedure for preparing a burette (adrenaline & oxytocin infusions - big drugs)?

A
  • Open air vent
  • Open filling regulator and fill burette with required amount of Compound Sodium Lactate
  • Close burette filling regulator
  • Swab burette injection point with alcohol wipe
  • Add medication, Adrenaline or Oxytocin to burette via burette injection port and label burette
  • Squeeze lower half of drip chamber until half full (Alaris Smartsite Gravity Burette Set > 2/3 full)
  • Open infusion regulator and prime line until all air is expelled in the IV line
  • Connect and secure infusion set to reflux valve attached to cannula.
  • Control flow rate with infusion regulator
100
Q

What is the procedure for preparing a burette (big drug) for Paediatric hartmanns & adult 10% glucose?

A
  • Close burette roller valve
  • Check filtered vent is open
  • Ensure blue clip at bottom of burette chamber is closed
  • Insert spike at top into fluid bag
  • Open the burette roller valve to fill chamber 100 mL volume to prime the giving set
  • Close burette roller valve
  • Close roller valve on pump set infusion line
  • Prepare Pump Set
  • Remove plug from bottom of chamber, insert Pump Set spike then loosen blue clip
  • Prime infusion line as per Pump Set
  • Open burette roller valve and top up chamber to dose required
  • Close burette roller valve
  • Connect infusion line to cannula and secure
  • Open roller valve on Pump Set infusion line to
    commence fluid administration
  • Continually observe patient and line during infusion
  • Continually monitor site for signs of extravasation.
101
Q

What is the procedure for preparing a pump set?

A
  • Re-position infusion regulator near the drip/pump chamber and close it
  • Remove protective caps from fluid container and spike
  • Ensure all clips and regulators are closed and then insert spike into fluid bag
  • Squeeze lower half of drip chamber until half full
  • Invert the pump chamber and injection port
  • Open regulator and prime the line until all air is expelled
  • Close regulator
  • Connect infusion set to cannula reflux valve
102
Q

What is the procedure for administering medications?

A

 Confirm provisional diagnosis and establish the need to administer medications or fluids
with your partner
 Ask the patient if they have any allergies
 Check the “5 Rights” with your partner
 Read the label carefully (to yourself) and check the expiry date, integrity of packaging, physical appearance of the medication or fluid for sediment or cloudiness
 Hand the medication or fluid to the second officer and without telling them what is on the label ask them to read out the:
 Name of the medication or fluid
 Presentation
 Expiry date
 Draw up required dose into administration device
 Administer medication according to pharmacology
 Discard unused medications

103
Q

What are the 5 rights?

A

Right:
 Patient (medication indicated, not contraindicated)
 Medication
 Dose (Confirms dose with current Medication
Calculation and Reference Guide)
 Time
 Route

104
Q

What are the indications for Magills forceps?

A

Removal of foreign body from upper airway where back blows
and chest thrusts have failed

105
Q

What is the procedure for using magills forceps?

A
  1. Position patient supine and apply head tilt and jaw lift
  2. Open lips and teeth with right hand
  3. Hold the laryngoscope in left hand
    * Insert blade into the right side of the mouth.
    * Sweep tongue to midline, attempting to visualise the object
    * Lift laryngoscope at an approximate 40 degree angle in an upwards and forwards motion to visualise obstruction.
    DO NOT LEVER ON TEETH
    * Insert Magill’s forceps with the tips closed into right side of the
    mouth.
    * Grasp the foreign body and remove.
    * Repeat the procedure if required
    * Attempt to ventilate patient
    * If unsuccessful begin CPR and ventilate with 100% oxygen via
    Bag Valve Mask
    * DO NOT DELAY TRANSPORT
106
Q

What are the complications for magills forceps?

A
  1. Vomiting
  2. Laryngospasm
  3. Trauma to Lips, teeth & tongue, Pharynx, Larynx & Epiglottis
107
Q

What are the contraindications for magills forceps?

A

Conscious patient

108
Q

What is the preparation of adrenaline to be used in adult and paediatric cardiac arrests?

A

1mg/10ml (1:10,000)

109
Q

What is the paediatric <16yrs dose of adrenaline in cardiac arrest?

A

10mcgs/kg
every 2nd cycle (approx 4 mins)
no max dose

110
Q

What are the contraindications of adrenaline?

A

nil

111
Q

What is the ≥16 adrenaline IM dose for cardiac arrest?

A

1mg
every 2nd cycle (approx 4 mins)
no max dose

NSW Ambulance (19 decks)

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