packaging a casualty / prolonged field care Flashcards
Assessing pain PQRST
Provoking factors – What makes it worse/better?
Quality – What does the pain feel like? Sharp? Stabbing? Ripping? Aching?
Region/Radiating – Where is the pain? Does it radiate anywhere else?
Severity – How bad is the pain on a scale of 0 – 3
Time of onset – When did it come on and under what circumstances
Reasons for giving pain relief
4
Duty of Care
Prevent the physiological responses to pain
Geneva Convention
Human rights.
Types of pain relief
4
Reassurance (and it’s free!!!)
Pharmacology/Drugs
Splinting
Distraction (Very effective in Children).
common analgesia
Entonox
Paracetamol
Ibuprofen
Fentanyl lozenge.
When to use entonox / colour of canister
When to use it
Analgesia for mild to moderate pain (1-2 Scale)
Entonox can be used prior to applying traction or splints
It will take at least 2 mins before being fully effective.
blue and white canister
Contraindications of Entonox
Severe Head Injuries with impaired consciousness due to possible presence of intracranial air\
Decompression sickness (the bends) consider anyone who has been diving within past 24 hours to be high risk
Violently disturbed psychiatric patient
Suspected pneumothorax or air in any bodily cavities (e.g. following trauma).
Paracetamol/ Ibuprofen oral dosages
Paracetamol
2 tabs 4-6 Hourly (Max 4g / day)
Ibuprofen
400mg 4-6 Hourly (Max 1.6g/ day).
Fentanyl administration timings
A Fentanyl lozenge 800 mcg to be administered if;
Pain score = 2 or 3
AND….
AVPU = A or V
Total dose is given over 15 minutes
A second lozenge may be used if required 30 minutes after completing use of first lozenge
A third lozenge may be administered under professional medical direction only.
25% rapidly absorbed through the lining of the mouth
75% absorbed through stomach after being swallowed.
fentanyl administration
Place in mouth, rubbed against cheek and twirled regularly
Moisten mouth with small sip of water if dry
Mark cheek with ‘F’ and time (24 hour clock)
Monitor for side effects
Consider 2nd dose at 45 mins (15 mins administration, 30 mins to maximal effect)
3rd dose only with MO’s guidance
Contraindications of fentanyl
Do nots when issuing
Pain score under 2
P or U of AVPU
Suck or chew lozenge Tape to a casualty’s thumb or finger Use more than one at a time Use concurrently with Morphine Auto Injector Use for children
Side effects of fentanyl
Very common:
Headache, drowsiness, dizziness
Constipation, nausea, vomiting and abdominal pain
Common:
Confusion, vertigo, hallucinations, incoordination
Respiratory depression (dyspnoea)
Uncommon:
Euphoria, coma, slurred speech,
Vasodilatation
3 parts of prolonged field care
Preparation. Creation of a safe environment for the delivery of care. This is dictated by the operational situation and facilities available.
Delivery and Maintenance. Initially hourly, this cyclical phase is then adjusted to meet the needs of the patient.
Prep for evacuation.
HITMAN
H Head to toe search, hydration, hygiene I Infection control T Tubes M Medications A Analgesia N Nutrition, nursing, notes
Stages of prepping for extraction
Ensure that the patient is being transported to the most appropriate medical facility.
Send regular patient status reports to the receiving medical facility.
Prolonged field care MUST continue until the patient is handed over to definitive medical care
factors to consider during in transit care
You may be required to care for a casualty in transit.
The environment may be cramped, noisy and dark. You should consider the following prior to departure:
Are you trained to meet the casualty’s needs?
Do you have:
O2, fluids, meds, suction, dressings, blankets
Bed pans, bottles, wipes
Space for personal kit (yours and casualty’s)
Water and rations
PPE
