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CSB331 OSCE > Procedures/Checks > Flashcards

Procedures/Checks Flashcards

1
Q

Indications for Helmet removal

A

Removal of a motorcycle helmet in the setting of trauma

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2
Q

Contraindications of Helmet removal

A

Nil in this setting

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3
Q

Complications of Helmet removal

A

C- Spine injury Exacerbation

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4
Q

Standard helmet removal procedure

A
  1. Primary officer provides MILS from in front of pt (mandible and occipital region.
  2. Cut chin strap
  3. Second officer, flexes helmet apart laterally and lifts rearward direction.
  4. As helmet is removed second officer readjust support on pt occiput.
  5. Once Helmet is removed, responsibility for MILS is transferred to the officer at the head of the pt.
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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.

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6
Q

What is the procedure for Helmet removal with paramedic and bystander?

A

Paramedic should take the primary role and provide MILS

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7
Q

Glascow Coma Scale indications

A

The assessment of a pt conscious state

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8
Q

GCS contraindications

A

Not applied to newborn as the APGAR score is used.

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9
Q

GCS Complications

A
  1. GCS developed for TBI, may be limited in other pt groups.
  2. Modified GCS is required for Paeds
  3. Painful stimulus in an intoxicated pt can result in a violent response from pt
  4. repeat painful stimuli is rarely required.
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10
Q

What are the components of GCS

A
  1. Eye opening
  2. Verbal response
  3. Motor response
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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

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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
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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
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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
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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
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16
Q

Indications for NSA

A

To assess pt neurological status

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17
Q

Contraindications for NSA

A

Nil in this setting

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18
Q

Complications for NSA

A
  1. Pre existing pt status must be taken into account during ax
  2. Painful stimuli may result in violent response.
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19
Q

What are the 5 critical areas to NSA

A
  1. Level of Consciousness (AVPU)
  2. Pupils (normal 2-6mm)
  3. Motor function (muscle coordination, strength tone, facial weakness, response to pain).
  4. Sensory function (Hearing ability and understanding comms, light touch or pain)
  5. Vital signs ( Resp rate rhythm and effort, BP, HR, temp)
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20
Q

Indications of Primary and Secondary Survey

A

All pts in QAS care to be provided with this Ax

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21
Q

Contraindications of Primary and secondary survey

A

Nil in this setting

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22
Q

Complication of Primary and Secondary Survey

A

Application of painful stimuli may result in violent response.

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23
Q

What are the components in the primary survey for cardiac arrest

A
  1. Danger
  2. Response
  3. Circulation
  4. Airway
  5. Breathing
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24
Q

What are the components in the primary survey for other presentations

A
  1. Danger
  2. Response
  3. Airway
  4. Breathing
  5. Circulation
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25
Q

What do you consider re Danger

A

To yourself, partner, bystanders and pt.

26
Q

What do you consider re response

A

Determine level of consciousness, AVPU (alert, verbal, pain, unconscious)

27
Q

What do you consider re Circulation

A

Pulse, adequate circulation? Cap refill.

Consider: Defib, Haemorrhage control, Leg elevation, except for spinal, IV access and fluid therapy.

28
Q

What do you consider re Airway

A

Patent airway? danger of future obstruction i.e stridor

Consider: C spine, simple airway manoeuvres, suction, adjuncts.

29
Q

What do you consider re Breathing

A

Breathing? adequate ventilations?

Consider Oxygen, IPPV

30
Q

What are the components of a Secondary Survey?

A
  1. History
  2. Vital Signs Survey
  3. Physical Exam
31
Q

What are the components in History in 2nd survey

A 
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
Q

What are the components in VSS in 2nd survey

A 
Pulse
Resp rate
BP
Temp
SpO2
BGL
GCS
Auscultate
12-Lead ECG
Capnography

Melbourne Ambulance Stroke Score
COAST score
Sedation Assessment Tool

33
Q

What are the components of a Head to Toe

A

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
Q

Indications for Perfusion Status Ax

A

All pt who raise suspicion of haemodynamic compromise.

35
Q

Contraindications of Perfusion Status Ax

A

Nil in this setting

36
Q

Complications of Perfusion Status Assessment

A

Nil in this setting

37
Q

What are the components of a Perfusion Status Ax

A

Conscious state
Skin
BP
Pulse rate

38
Q

What is adequate Perfusion status of an Adult

A

Skin: Warm, pink dry
Pulse: 60 - 100
BP: >100 sys
Consciousness: alert orientated

39
Q

What is adequate Paediatric Perfusion Status Ax

A

Skin: Warm, pink, dry
Pulse: 80 - 160
BP: >100 Sys
Consciousness: Alert and interacting for age

40
Q

What is borderline Perfusion in Adult

A

Skin: Cool, pale, clammy
Pulse: 50-100
BP: 80 - 100 sys
Consciousness: Alert Orientated in time an place

41
Q

What is borderline perfusion in a Paed

A

Skin: Cool, pale, clammy
Pulse: 50 - 80
BP: 50 -70 sys
Consciousness: Alert and interacting for age

42
Q

Indications for a Respiratory Status Ax

A

All chest and REspiratory symptoms and complaints (SOB, Chest pain)

43
Q

Contraindications for RSA

A

Nil in this setting

44
Q

Complications of an RSA

A

Nil in this setting

45
Q

Procedure for RSA

A 
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
Q

What are the primary aims after initial resuscitation care

A
  1. support circulation, airway and breathing
  2. Maintain cerebral perfusion.
  3. Manage Cardiac dysrhythmias
47
Q

What are reversible causes aimed to be treated/managed after ROSC

A
  1. Hypoxia
  2. Hypo/hyperthermia
  3. Hypovolaemia
  4. Hypo/Hyperkalaemia
  5. Hydrogen ion (acidosis)
  6. Tension pneumothorax
  7. Tamponade
  8. Toxins
48
Q

How would you optimise ventilation and oxygenation following ROSC

A
  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
Q

How would you optimise circulation following ROSC

A

Aim for SBP ≥ 100mmHg for adults and ≥ 80mmHg for Paeds

Consider adrenaline, posturing

50
Q

Do ROSC pt require 12- Lead ECG

A

All ROSC pt need 12 Lead ECG.

51
Q

What criteria must be met for ROLE

A
  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
Q

What is an example of a non reportable death?

A

Death as an expected outcome from a diagnosed condition and pt medical practitioner has indicated they will provide a death certiicate

53
Q

What are reportable deaths as defined in S8 of the Coroners Act 2003

A
  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
Q

What happens if a death occurs during transportation

A

Notify Comms, and they will advise where to go.

55
Q

Indications of a Handover

A
  1. Pt transported by QAS to a health facility

2. when handing over the care of a pt to an alternate QAS crew

56
Q

Contraindication of a Handover

A

A clinical handover must accurately.

57
Q

Complications of a Handover

A
  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
Q

Procedure of Handover

A 
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
Q

Non Specific Symptoms of a snake bite

A
  1. Nausea/Vom/Diarrhoea
  2. Headache
  3. Adbo pain
  4. Diaphoresis
60
Q

Other signs/symptoms that may present

A
  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
Q

Systemic effects of a snake bite, depending on venom

A
  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

CSB331 OSCE (3 decks)

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