Procedures/Checks Flashcards
Indications for Helmet removal
Removal of a motorcycle helmet in the setting of trauma
Contraindications of Helmet removal
Nil in this setting
Complications of Helmet removal
C- Spine injury Exacerbation
Standard helmet removal procedure
- Primary officer provides MILS from in front of pt (mandible and occipital region.
- Cut chin strap
- Second officer, flexes helmet apart laterally and lifts rearward direction.
- As helmet is removed second officer readjust support on pt occiput.
- Once Helmet is removed, responsibility for MILS is transferred to the officer at the head of the pt.
What is the procedure for Helmet removal if the pt is in prone
Maintain MILS and loge roll into the lateral or supine position before removal.
What is the procedure for Helmet removal with paramedic and bystander?
Paramedic should take the primary role and provide MILS
Glascow Coma Scale indications
The assessment of a pt conscious state
GCS contraindications
Not applied to newborn as the APGAR score is used.
GCS Complications
- GCS developed for TBI, may be limited in other pt groups.
- Modified GCS is required for Paeds
- Painful stimulus in an intoxicated pt can result in a violent response from pt
- repeat painful stimuli is rarely required.
What are the components of GCS
- Eye opening
- Verbal response
- Motor response
What are the Eye components and score for GCS
4 Spontaneous
3 Reacts to speech
2 Reacts to pain
1 No response
What are the Adult Verbal components and score for GCS
5 Orientated 4 Confused 3 Inappropriate words 2 Incomprehensible 1 No response
What are the Adult motor components and score for GCS
6 Obeys commands 5 Localised to pain 4 Withdraws from pain 3 Flexion in response 2 Extension response 1 No response
What are the Paed Verbal response and Score for GCS
5 Babbles, follows objects 4 Irritable, cries 3 Cries to pain 2 Moans and grunts 1 No response
What are the Paed Motor response and score for GCS
6 Spontaneous 5 Localised to pain 4 Withdraws from pain 3 Flexion response 2 Extension response 1 No response
Indications for NSA
To assess pt neurological status
Contraindications for NSA
Nil in this setting
Complications for NSA
- Pre existing pt status must be taken into account during ax
- Painful stimuli may result in violent response.
What are the 5 critical areas to NSA
- Level of Consciousness (AVPU)
- Pupils (normal 2-6mm)
- Motor function (muscle coordination, strength tone, facial weakness, response to pain).
- Sensory function (Hearing ability and understanding comms, light touch or pain)
- Vital signs ( Resp rate rhythm and effort, BP, HR, temp)
Indications of Primary and Secondary Survey
All pts in QAS care to be provided with this Ax
Contraindications of Primary and secondary survey
Nil in this setting
Complication of Primary and Secondary Survey
Application of painful stimuli may result in violent response.
What are the components in the primary survey for cardiac arrest
- Danger
- Response
- Circulation
- Airway
- Breathing
What are the components in the primary survey for other presentations
- Danger
- Response
- Airway
- Breathing
- Circulation
What do you consider re Danger
To yourself, partner, bystanders and pt.
What do you consider re response
Determine level of consciousness, AVPU (alert, verbal, pain, unconscious)
What do you consider re Circulation
Pulse, adequate circulation? Cap refill.
Consider: Defib, Haemorrhage control, Leg elevation, except for spinal, IV access and fluid therapy.
What do you consider re Airway
Patent airway? danger of future obstruction i.e stridor
Consider: C spine, simple airway manoeuvres, suction, adjuncts.
What do you consider re Breathing
Breathing? adequate ventilations?
Consider Oxygen, IPPV
What are the components of a Secondary Survey?
- History
- Vital Signs Survey
- Physical Exam
What are the components in History in 2nd survey
S signs/symptoms A Allergies M Medications P Past MedHx L Last Meal and out E Events prior
O Onset P provocation Q Quality R Radiate S Severity T Timing
What are the components in VSS in 2nd survey
Pulse Resp rate BP Temp SpO2 BGL GCS Auscultate 12-Lead ECG Capnography
Melbourne Ambulance Stroke Score
COAST score
Sedation Assessment Tool
What are the components of a Head to Toe
Head: General (Lacerations, deformity), Eyes, Ears, Nose, Mouth, Voice)
Neck: Inspect (JVP), Palpate
Chest: Inspect, Palpate Auscaltate
Abdomen: Inspect Palpate, Auscultate
Pelvis: Inspect, Palpate
Upper and lower limbs:
Inspect, Palpate.
Back: Inspect Palpate
Indications for Perfusion Status Ax
All pt who raise suspicion of haemodynamic compromise.
Contraindications of Perfusion Status Ax
Nil in this setting
Complications of Perfusion Status Assessment
Nil in this setting
What are the components of a Perfusion Status Ax
Conscious state
Skin
BP
Pulse rate
What is adequate Perfusion status of an Adult
Skin: Warm, pink dry
Pulse: 60 - 100
BP: >100 sys
Consciousness: alert orientated
What is adequate Paediatric Perfusion Status Ax
Skin: Warm, pink, dry
Pulse: 80 - 160
BP: >100 Sys
Consciousness: Alert and interacting for age
What is borderline Perfusion in Adult
Skin: Cool, pale, clammy
Pulse: 50-100
BP: 80 - 100 sys
Consciousness: Alert Orientated in time an place
What is borderline perfusion in a Paed
Skin: Cool, pale, clammy
Pulse: 50 - 80
BP: 50 -70 sys
Consciousness: Alert and interacting for age
Indications for a Respiratory Status Ax
All chest and REspiratory symptoms and complaints (SOB, Chest pain)
Contraindications for RSA
Nil in this setting
Complications of an RSA
Nil in this setting
Procedure for RSA
C conscious state A appearance (calm?) P pulse rate E effort (chest movt) R rate (12 - 18) R rhythm (regular?) S speech S skin S sounds(wheeze?)
What are the primary aims after initial resuscitation care
- support circulation, airway and breathing
- Maintain cerebral perfusion.
- Manage Cardiac dysrhythmias
What are reversible causes aimed to be treated/managed after ROSC
- Hypoxia
- Hypo/hyperthermia
- Hypovolaemia
- Hypo/Hyperkalaemia
- Hydrogen ion (acidosis)
- Tension pneumothorax
- Tamponade
- Toxins
How would you optimise ventilation and oxygenation following ROSC
- Maintain SpO2 ≥ 94%
- Consider advanced airway
- Maintain EtCO2 30-40mmHg
- if no EtCO2 ventilate 8-12 per minute, do not hyperventilate
How would you optimise circulation following ROSC
Aim for SBP ≥ 100mmHg for adults and ≥ 80mmHg for Paeds
Consider adrenaline, posturing
Do ROSC pt require 12- Lead ECG
All ROSC pt need 12 Lead ECG.
What criteria must be met for ROLE
- No palpable carotid pulse
- No heart sounds heard for 30 secs
- No breath sounds for 30 secs
- Fixed dilated pupils
- No response from centralised stimuli.
What is an example of a non reportable death?
Death as an expected outcome from a diagnosed condition and pt medical practitioner has indicated they will provide a death certiicate
What are reportable deaths as defined in S8 of the Coroners Act 2003
- identity of person is unknown
- death was violent or unnatural
- death happened in suspicious circumstances
- health care related death
- Unlikely a death certificate will be issued
- Death in care
- Death in custody
- Death in course of or result of police operations.
What happens if a death occurs during transportation
Notify Comms, and they will advise where to go.
Indications of a Handover
- Pt transported by QAS to a health facility
2. when handing over the care of a pt to an alternate QAS crew
Contraindication of a Handover
A clinical handover must accurately.
Complications of a Handover
- Handover must be accurate and succinct convey pertinent case details and treatment or management
- in emergency situtation treatment decisions may be guided by information provided in handover
Procedure of Handover
I Identification M Mechanism/medical complaint I Injuries/ info re complaint S VSS T Treatment and trends
A Allergies
M Medications
B background
O other issues (social, cultural)
Non Specific Symptoms of a snake bite
- Nausea/Vom/Diarrhoea
- Headache
- Adbo pain
- Diaphoresis
Other signs/symptoms that may present
- Altered Mental status, visual disturbances and seizures
- Respiratory dysfunction
- Hypotension, haemorrhage or haematoma at site
- fang marks or scratch marks, swollen tender glands of limb
Systemic effects of a snake bite, depending on venom
- Neurotoxicity (drooping eyelids/drooling, paralysis NB: monitor Airway, ventilation rate, rhythm and effort)
- Coagulopathy (bleeding from nose and gums, major haemorrhage)
- Myotoxicity (damage to skeletal muscles (muscular pain, tenderness and weakness)
- Renal impairment/failure
