possible scenarios Flashcards
CPO
Pt will present SOB. Must always ask what they were doing when SOB came on. CPO is a gradual onset, often worsened by lying down/ sleeping. To confirm CPO ask if they have heart failure, check pedal oedema, poor perfusion. Ask if they have had asthma, CORD, recent chest infection.
Get offsider to prioritze B vitals, HR, RR, SPO2, oscillate. and BP and Temp.
Will present as SOB, cyanosed, wheeze if lower lungs (asthma is wheeze in all lobes), hypertensive, clammy and peripherally vasoconstricted.
-call R51 backup cancel if improve with treatment
Prioritize getting 12 lead (as need one to give gtn?)
Give GTN- if cautions, make sure they are sitting down (as cant lie down) if necessary raise legs.
-Apply PEEP is SPO2 less than 92% after treatment, or severe respiratory distress
start at 10 increase to 15 if necesary.
-take to hospital Status 2
Asthma
Pt presents SOB- ask if they have COPD or asthma. Ask what they were doing when came on, Ask worse then usual. Have they taken there own inhaler. Been to hospital with asthma before. ICU?
ABC’s
poke out tounge no swelling (differentiate anaphalaxis)
RR, WOB- determines severity of asthma and treatment
check pulse
B issue so Offsider prioritize auscilitate HR,RR, Spo2, and then BP, Temp and 3-lead.
Asthma sudden onset, symptom free between attacks have history of asthma, wheeze in all lung fields.
Administer 5mg salbutamol, 0.5mg Ipratropium.
Moderate or severe- call R50 back up can cancel if improvement with treatment.
Severe asthma-( speaking few words)
0.5mg adrenaline IM- repeat after 10 minutes if not improving.
administer 40mg prendisone.
Take to hospital.
do systems check and retake vitals R40 if necessary
Hypoglycaemia
Enter ABC if unconcious or states fell rapid trauma sweep
Prioritize BGL and temp for altered LOC
History from bystanders/ medic alert or pt
If pt is able to obey commands than glucose gel.
Unconscious 1mg Glucagon-note time
check BGL every 10 minsuntil at be at 3.5 mmol.
Gain history had insulin overdose? Has diabetes? been sick recently? When they collapsed any seizures?
Back up R51 - stand down if glucogon makes improvement
Make patient eat a meal- carbohydrates- as glucagon uses up all the stores
Take to hospital
In amb to secondary survey if fell and review all systems take another set of vitals
If pt unstabe R40
CPO
Pt will often present in middle of night been in a lying down position, used less pillows than usual and had a gradual onset of SOB. Also diaphoretic and hypertensive.
Offsider prioritize auscultate (wheeze crackles lower fields), RR, SPO2, BP
ABC
A-Poke out tounge- make sure not anaphylaxis
B-make sure not COPD or asthma- oxygen GTN
C-feel pulse
Get history, medications?
Sit Pt up
Get 12 lead
Give 0.8 mg GTN note time
IF no cautions re-administer 3-5 minutes if cautions wait 10
Apply o2 if low sats
If pt has respiratory distress or spo2 less than 92% despite treatment apply PEEP (If CORD pt may be lower threshold for sats)
Take pt to hospital
Reassess vitals, systems review- check for pedal oedema.
R40 if necesary
COPD
Enter ABC
A- clear- poke out tounge to make sure not anaplaxasis
B- sob ask how sob they usually are ask about accessory muscles
C- feel pulse
Ask if they have CORD/ Asthma
Symptom free between attacks
When did this come on, what where you doing?
Do they have a cough is there a wheeze in all lung fields?
If not and been lying down could b cpo and wheeze mostly in lower lungs and hypertensive.
Administer 0.5 mg ipratropium, 5mg salbutamol nebulised a fr of 8.
Ask if CO2 retainer, and if they are on home oxygen.
If so do 5 mins on and 5 mins of neb or use medical air.
If not still aim for SpO2 not above 92%
Continuous salbutamol
If moderate and not improving ICP backup
Give Prednisone 40mg ( if it has had 40mg or more dose don’t give, otherwise still give).
Take pt to hosp as bronchodilators given. In ambulance do systems review, place 12 lead if old, do secondary if any fall.
If severe CORD load and go as quick as possible, treat en route.
Chest pain-cardiac
Enter does pt look pale diaphoretic?
A- clear r they speaking
B- sob? O2 low apply oxygen
C- feel pulse strong weak regular?
Chest pain prioritize HR 3lead 13lead BP
Ask what happened sudden onset? History of chest pain, medications.
Is it cardiac, what does pain feel like, hurt on inspiration, hurt on palpation, sharp, where is it radiating, any heavy lifting recently, any chest infection recently?
If Mi or STEMI
Give aspirin 300mg
Give GTN 0.4mg if any cautions present wait 10 mins till repeat. Note time of administration.
Transport- if STEMI transport immediately treat en route
If pain give methoxyflurane
Do full systems review, check pedal oedema, JVD. Secondary if any fall.
R40 if STEMI or pain unrelieved by GTN.
Back up if STEMI ICP strait away if MI and close transport time jst transport
Minor TBI
Enter
A- clear
B- may b sob as distressed
C-feel pulse
Rapid trauma sweep, clear c- spine consider MOI
Asess pt GCS
Minor TBI can Oney commands may be confused and fail co-ordination test
Ask if any loc
Any seizure
Take anticoagulant?
Had brain injury/ surgery before
Ask a few questions about memory
Ask about nausea, headache
Lightheadedness, groggyness, tiredness
Finger to nose test
Romburgs test
If negative to any of these mild concussion is likely
If can’t Oney command severe TBI
Give methoxy for pain
Give ondans if necessary
No back up if only signs of minor TBI
No r40 if no other symptoms
Sci
A- clear
B-normal sob?
C- feel pulse
Consider MOI look for alertness
Clearing c-spine
Are they alert, have they got c spine tenderness, have they got altered sensation or movement to limbs, any distracting injuries.
Examine pt
Ask if neck pain
Ask if any numbness tingling or pain anywhere
Touch all limbs , normal sensation, temp, pain?
All movement of limbs normal?
If not cleared c-spine collar should b placed
If severe posterior tenderness place collar
If pt is co-operative a lanyard and head blocks and instructing pt to keep head still can occur. However if long bumpy transport recommend collar.
If pt un-cooperative avoid placing collar, place lanyard and manual stabilisation.
If suspected TBI or compromised airway do not place collar as can increase intracranial pressure, lanyard and manual stabilisation instead.
