Procedures/Checks Flashcards
1
Q
Indications for Helmet removal
A
Removal of a motorcycle helmet in the setting of trauma
2
Q
Contraindications of Helmet removal
A
Nil in this setting
3
Q
Complications of Helmet removal
A
C- Spine injury Exacerbation
4
Q
Standard helmet removal procedure
A
- 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.
5
Q
What is the procedure for Helmet removal if the pt is in prone
A
Maintain MILS and loge roll into the lateral or supine position before removal.
6
Q
What is the procedure for Helmet removal with paramedic and bystander?
A
Paramedic should take the primary role and provide MILS
7
Q
Glascow Coma Scale indications
A
The assessment of a pt conscious state
8
Q
GCS contraindications
A
Not applied to newborn as the APGAR score is used.
9
Q
GCS Complications
A
- 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.
10
Q
What are the components of GCS
A
- Eye opening
- Verbal response
- Motor response
11
Q
What are the Eye components and score for GCS
A
4 Spontaneous
3 Reacts to speech
2 Reacts to pain
1 No response
12
Q
What are the Adult Verbal components and score for GCS
A
5 Orientated 4 Confused 3 Inappropriate words 2 Incomprehensible 1 No response
13
Q
What are the Adult motor components and score for GCS
A
6 Obeys commands 5 Localised to pain 4 Withdraws from pain 3 Flexion in response 2 Extension response 1 No response
14
Q
What are the Paed Verbal response and Score for GCS
A
5 Babbles, follows objects 4 Irritable, cries 3 Cries to pain 2 Moans and grunts 1 No response
15
Q
What are the Paed Motor response and score for GCS
A
6 Spontaneous 5 Localised to pain 4 Withdraws from pain 3 Flexion response 2 Extension response 1 No response
16
Q
Indications for NSA
A
To assess pt neurological status
17
Q
Contraindications for NSA
A
Nil in this setting
18
Q
Complications for NSA
A
- Pre existing pt status must be taken into account during ax
- Painful stimuli may result in violent response.
19
Q
What are the 5 critical areas to NSA
A
- 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)
20
Q
Indications of Primary and Secondary Survey
A
All pts in QAS care to be provided with this Ax
21
Q
Contraindications of Primary and secondary survey
A
Nil in this setting
22
Q
Complication of Primary and Secondary Survey
A
Application of painful stimuli may result in violent response.
23
Q
What are the components in the primary survey for cardiac arrest
A
- Danger
- Response
- Circulation
- Airway
- Breathing
24
Q
What are the components in the primary survey for other presentations
A
- Danger
- Response
- Airway
- Breathing
- Circulation
25
What do you consider re Danger
To yourself, partner, bystanders and pt.
26
What do you consider re response
Determine level of consciousness, AVPU (alert, verbal, pain, unconscious)
27
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.
28
What do you consider re Airway
Patent airway? danger of future obstruction i.e stridor
Consider: C spine, simple airway manoeuvres, suction, adjuncts.
29
What do you consider re Breathing
Breathing? adequate ventilations?
| Consider Oxygen, IPPV
30
What are the components of a Secondary Survey?
1. History
2. Vital Signs Survey
3. Physical Exam
31
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
```
32
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
33
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
34
Indications for Perfusion Status Ax
All pt who raise suspicion of haemodynamic compromise.
35
Contraindications of Perfusion Status Ax
Nil in this setting
36
Complications of Perfusion Status Assessment
Nil in this setting
37
What are the components of a Perfusion Status Ax
Conscious state
Skin
BP
Pulse rate
38
What is adequate Perfusion status of an Adult
Skin: Warm, pink dry
Pulse: 60 - 100
BP: >100 sys
Consciousness: alert orientated
39
What is adequate Paediatric Perfusion Status Ax
Skin: Warm, pink, dry
Pulse: 80 - 160
BP: >100 Sys
Consciousness: Alert and interacting for age
40
What is borderline Perfusion in Adult
Skin: Cool, pale, clammy
Pulse: 50-100
BP: 80 - 100 sys
Consciousness: Alert Orientated in time an place
41
What is borderline perfusion in a Paed
Skin: Cool, pale, clammy
Pulse: 50 - 80
BP: 50 -70 sys
Consciousness: Alert and interacting for age
42
Indications for a Respiratory Status Ax
All chest and REspiratory symptoms and complaints (SOB, Chest pain)
43
Contraindications for RSA
Nil in this setting
44
Complications of an RSA
Nil in this setting
45
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?)
```
46
What are the primary aims after initial resuscitation care
1. support circulation, airway and breathing
2. Maintain cerebral perfusion.
3. Manage Cardiac dysrhythmias
47
What are reversible causes aimed to be treated/managed after ROSC
1. Hypoxia
2. Hypo/hyperthermia
3. Hypovolaemia
4. Hypo/Hyperkalaemia
5. Hydrogen ion (acidosis)
6. Tension pneumothorax
7. Tamponade
8. Toxins
48
How would you optimise ventilation and oxygenation following ROSC
1. Maintain SpO2 ≥ 94%
2. Consider advanced airway
3. Maintain EtCO2 30-40mmHg
4. if no EtCO2 ventilate 8-12 per minute, do not hyperventilate
49
How would you optimise circulation following ROSC
Aim for SBP ≥ 100mmHg for adults and ≥ 80mmHg for Paeds
Consider adrenaline, posturing
50
Do ROSC pt require 12- Lead ECG
All ROSC pt need 12 Lead ECG.
51
What criteria must be met for ROLE
1. No palpable carotid pulse
2. No heart sounds heard for 30 secs
3. No breath sounds for 30 secs
4. Fixed dilated pupils
5. No response from centralised stimuli.
52
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
53
What are reportable deaths as defined in S8 of the Coroners Act 2003
1. identity of person is unknown
2. death was violent or unnatural
3. death happened in suspicious circumstances
4. health care related death
5. Unlikely a death certificate will be issued
6. Death in care
7. Death in custody
8. Death in course of or result of police operations.
54
What happens if a death occurs during transportation
Notify Comms, and they will advise where to go.
55
Indications of a Handover
1. Pt transported by QAS to a health facility
| 2. when handing over the care of a pt to an alternate QAS crew
56
Contraindication of a Handover
A clinical handover must accurately.
57
Complications of a Handover
1. Handover must be accurate and succinct convey pertinent case details and treatment or management
2. in emergency situtation treatment decisions may be guided by information provided in handover
58
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)
59
Non Specific Symptoms of a snake bite
1. Nausea/Vom/Diarrhoea
2. Headache
3. Adbo pain
4. Diaphoresis
60
Other signs/symptoms that may present
1. Altered Mental status, visual disturbances and seizures
2. Respiratory dysfunction
3. Hypotension, haemorrhage or haematoma at site
4. fang marks or scratch marks, swollen tender glands of limb
61
Systemic effects of a snake bite, depending on venom
1. Neurotoxicity (drooping eyelids/drooling, paralysis NB: monitor Airway, ventilation rate, rhythm and effort)
2. Coagulopathy (bleeding from nose and gums, major haemorrhage)
3. Myotoxicity (damage to skeletal muscles (muscular pain, tenderness and weakness)
4. Renal impairment/failure
