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Protocols > Protocols > Flashcards

Protocols Flashcards

1
Q

Arrest life threatening haemorrhage - DEAP

A

Direct pressure on bleeding site
Elevation
Apply tourniquet
Pelvic splint

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2
Q

Urgent transport for…..

A

Unrelieved Upper Airway Obstruction Examples include: burns, epiglottitis, foreign bodies

Severe Breathing Problems
Examples include: chest injuries with deterioration, severe pulmonary oedema, asthma or chronic obstructive pulmonary disease (COPD) and unresponsive to treatment

Severe Circulatory Problems
Examples include: uncontrollable haemorrhage, penetrating trauma (excluding isolated injury to hands and feet), severe shock of any type, dysrhythmias with poor perfusion, cardiac arrest, return of spontaneous circulation following cardiac arrest

Depressed LOC - If level of consciousness V, P or U. Examples include: head injuries, overdose unresponsive to naloxone, uncontrolled fitting

Emergency of Other Types
Examples include: maternal emergencies (including trauma), severe poisoning, uncontrolled severe pain, acute coronary syndrome, gastrointestinal haemorrhage, eye injuries, penetrating or chemical, stroke or sudden onset headache or neurological deficit, fever with lethargy, major trauma (Trauma Triage Tool criteria)

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3
Q

Informed consent requires what?

A
  • Competency: the persons status to make a decision about their healthcare or treatment. they are not effected by chronic cognitive compromise i.e. Dementia, intellectual impairment
  • Capacity: do they have the ability today to make an appropriate decision regarding their health. they are not incapacitated by circumstances such as - head injury, alcohol, drugs, hypo, mental illness
  • Consent: do they have competency and capacity to give consent freely and voluntarily. content is specific and informed. can be expressed, written or implied or given by a person responsible.
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4
Q

When is consent not required

A

consent is not required in an emergency, where the patient is unable to give contest and the treatment is required immediately, to save the persons life, to prevent serious injury or under S20 of the mental health act.

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5
Q

Consent in young persons

A

Emergency treatment may be carried out on a person under 16 without any consent if the paramedic feels that the urgent treatment is required in order to save their life or prevent serious harm.
<14 yrs consent must be given by a responsible adult if non emergency care. If a child over the age of 14 yrs can prove competency and capacity they can make their own healthcare decisions.

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6
Q

Consent documentation must contain

A

Receive, do they have the ability to hear and concentrate to receive the information.
Believe, can they understand the information and accept and believe it.
Retain, can they remember long enough o analyse the information.
Explain, can the patient explain the information back to you including risks involved.

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7
Q

5 R’s medication administration

A 
right person
right drug
right time
right dose 
right route
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8
Q

Pain Medication - 3 steps, >65yrs

A 
Step 1 - Non pharmacological options i.e. ice, elevation, splinting
Step 2 (mild/moderate) - oral medications ie paracetamol, ibuprofen, methoxyflurane.
Step 3 (severe) - parenteral medications ie morphine, fentanyl, ketamine

Any patient over the age of 65 yrs MUST receive a half doses of any pain medications AND sedatives.

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9
Q

FBAO

A

Treatment

Patient care (A2) - Assess severity of FBAO
Ineffective cough - Severe FBAO
If the patient is conscious:
Administer up to 5 sharp back blows (position the patient with their head down to utilise gravity - Skill 101.12)
If back blows fail, administer up to 5 chest thrusts (Skill 101.13)
If both fail, administer oxygen if indicated and continue to alternate back blows with chest thrusts during transport
If the patient is unconscious:
Extricate the foreign body with a laryngoscope and Magill forceps
If this fails, commence CPR
Effective cough - Mild FBAO
Encourage coughing to expel foreign body
Administer oxygen if indicated
Urgent transport (A8) for patients with severe FBAO

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10
Q

Asthma treatment

A

Asthma

Treatment

Patient care (A2)
Assess severity and Peak Expiratory Flow Rate (PEFR - Patients ≥ 8 years of age)

Check for pneumothorax/tension pneumothorax

Administer medication/s if indicated

Expiratory assistance if indicated (skill 102.7)

Urgent transport (A8) for all patients with severe/life threatening asthma

Regularly repeat and document ABCD physical examinations and physiological observations in order to identify trends in clinical deterioration
Protocol specific exclusions
Initial moderate or severe/life threatening presentation
Previous intubation/ICU admission for asthma
Initial PEFR < 75% predicted or known physiological value
Concurrent respiratory illness
Bilateral crepitation on auscultation
History of COPD or heart failure
Nil improvement in PEFR and/or symptomatic post treatment
No access to self-administered bronchodilator
Pregnancy

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11
Q

Asthma drug regime

A

Mild
Salbutamol (216) - via neb & O₂ 8L/pm
≥ 5 YO:
5mg (2.5mL), Repeat whilst indicated, No max

< 5 YO:
2.5mg (2.5mL), Repeat whilst indicated, No max
Moderate
Salbutamol as per mild plus
Ipratropium bromide (223) - Mixed with salbutamol
≥ 6 YO:
500mcg (1mL), Repeat once, Max 2 doses

< 6 YO:
250mcg (1mL), Repeat once, Max 2 doses

Hydrocortisone (238) - 100mg vial reconstituted with 2mL normal saline 0.9% (50mg:1mL)
≥ 16 YO:
100mg IM/IV, No repeat, Max 1 dose

6 - < 16 YO:
4mg/kg Max bolus (100mg) IM/IV, No repeat, Max 1 dose
Severe/Life Threatening
Salbutamol, Ipratropium Bromide & Hydrocortisone (≥6 YO) as per moderate plus:
Arenaline (201) - IM into lateral aspect of thigh
≥ 16 YO:
500mcg (0.5mL) 1:1,000 IM, Repeat every 5 min whilst indicated, No max

100mcg (1mL) 1:10,000 IV bolus if unresponsive to IM injections, Repeat every min whilst indicated, No max

< 16 YO:
10mcg/kg (0.01mL/kg) 1:1,000 IM into lateral aspect of thigh, Repeat every 5 min whilst indicated, No max

10mcg/kg (0.1mL/kg) 1:10,000 slow IV bolus if unresponsive to IM injection, Repeat every 5 min whilst indicated, No max

Hydrocortisone (238) - 100mg vial reconstituted with 2mL normal saline 0.9% (50mg:1mL)
< 6 YO:
4mg/kg (Max bolus 100mg) IM/IV, No repeat, Max 1 dose

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12
Q

Management of Acute Severe Behavioural Disturbance

A

< 14 yrs - head injury: Midazolam (ALS, ICP)
- non head injury: Midazolam (P1 and above)

> 14 yrs - is the aetiology a head injury: Ketamine (ICP)
- non head injury: Droperidol

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13
Q

METHANE

A 
M - declare major incident
E - Exact location, specify if different to original location given
T - Type of incient
H - Hazards
A - Access to loacation
N - Number of casualties
E - Emergency services required
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14
Q

Verification of Death Procedure

A
  • No palpable pulse
  • No heart sounds heard for 2 minutes
  • No breath sounds heard for 2 minutes
  • Fixed and dilated pupils
  • No response to central stimulation
  • No motor response/facial grimace to painful stimuli
  • Identify and coronial checklist flags
  • Support family and keep them informed of the situation and processes
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15
Q

Paediatric transport

A

any unwell paed must be transported in the DHS restraint. children who are well and returning home or to a lower acuity facility.

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16
Q

Abdominal pain treatment

A
  1. Patient care
  2. Pain management
  3. Treat associated conditions - Dehydration, Medical hypo perfusion/hypovolaemia, nausea and vomiting, abdominal trauma.
    4 Urgent transport for hypovolaemic shock and unrelieved pain especially in children
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17
Q

FBAO

A

ffective cough: Indicated by patients who are able to speak, cough and breathe. An effective cough indicates a mild airway obstruction. Patients should be encouraged to continue coughing to expel the foreign material. Transport patient to hospital if unable to remove foreign body, administer oxygen (221) if indicated
Ineffective cough: Indicated by patients who are unable to speak, breathe effectively and/or have wheezy/noisy breathing. Attempts at coughing may be silent or have little air movement. An ineffective cough indicates a severe FBAO and requires immediate treatment
Treatment

Patient care (A2) - Assess severity of FBAO
Ineffective cough - Severe FBAO
If the patient is conscious:
Administer up to 5 sharp back blows (position the patient with their head down to utilise gravity - Skill 101.12)
If back blows fail, administer up to 5 chest thrusts (Skill 101.13)
If both fail, administer oxygen if indicated and continue to alternate back blows with chest thrusts during transport
If the patient is unconscious:
Extricate the foreign body with a laryngoscope and Magill forceps
If this fails, commence CPR
Effective cough - Mild FBAO
Encourage coughing to expel foreign body
Administer oxygen if indicated

18
Q

Asthma - treatment and meds

A

Assess severity and peak expiratory flow
check for pneumothorax/tension pneumothorax
administer medications
expiratory assistance
urgent transport

Mild-
salbutamol

Moderate-
salbutamol
Ipratropium Bromide
Hydrocortisone

Severe-
all meds as per moderate regime plus
adrenaline

19
Q

Nausea and Vomiting

A 
Patient care
Medications (fors sever nausea/vomiting)-
Ondansetron first line.
metoclopramide if ondansetron is contraindicated or ineffective after 10 minutes.
Treat associated conditions-
dehydration
gastroenteritis
medical hypoperfusion/hypovolaemia
20
Q

Croup

A 
Patient care
assess severity
mild- transport
moderate - oxygen
severe- nebulised adrenaline
urgent transport
21
Q

Dehydration

A 
Patient care
assess severity
mild - oral fluids
moderate/severe - oral fluids and compound sodium lactate 10mls/kg, no repeats
treat associated conditions if any
determine referal options
22
Q

Seizures

A 
patient care
protect patient from injury
administer medications - Midazolam >5min
treat associated conditions-
hypoglycaemia
hyperthermia
traumatic injuries
urgent transport if recurrent or continuous
23
Q

Meningococcal

A

patient care - identify any rash and good history
compound sodium lactate if signs of hypovolaemia
if a rash - Benzyl Penicillin
urgent transport

24
Q

Autonomic Dysreflexia

A

patient care -
posture pt with legs dependant
loosen any tight clothing
monitor blood pressure every 2-3 minutes
look for and rectify any reversible causes
administer meds - GTN
urgent transport for pets with altered loc, stroke symptoms or persistent symptoms despite treatment

25
Q

Anaphylaxis

A 
confirm probability of anaphylaxis
assess systemic involvement
if they have NO ABCD sympotms - Fexofenadine
if ABCD symptoms -
adrenaline
compound sodium lactate
salbutamol
for pts >16 if unresponsive to 4 doses of adrenaline administer adrenaline infusion
26
Q

COPD

A 
patient care
administer medications-
Salubtamol
ipratropium bromide
urgent transport
27
Q

Gastro

A

Same protocol as N&V however

wear PPE
treat associated conditions - 
medical hypoperfusion/hypovolaemia
dehydration
hypoglycaemia
hyperglycaemia
28
Q

Hypoglyceamia

A

patient care
check BGL
administer medications -
glucose gel if pt conscious
Glucose 10% if BGL below 4 and decreased LOC
Glucagon if BGL under 4, LOC and unable to cannulate
Triage need to be notified if 10% given to known alcoholic

29
Q

Hyperglyceamia

A

patient care
check BGL
administer meds -
compound sodium lactate if BGl >17 with signs of moderate dehydration. 10ml/kg

30
Q

ACS

A 
patient care
monitor with ECG including 12 lead
if suspected STEMI refer to cardiac repercussion protocol
administer meds - 
Aspirin
GTN
pain management 
oxygen in pots with SpO2 <94%
transport without delay monitoring at all times
31
Q

Cardiac Arrest - reversible causes

A 
hypoxia
hypovolaemia
hyperkalaemia
hyper/hypothermia
tension pneumothorax
toxins/poisons/drugs
anaphylaxis
32
Q

cardiac arrest

A 
assess rhythm 
if shockable rhythm defibrillate
2 minutes CPR
adrenaline
assess rhythm
33
Q

Pulmonary Oedema

A 
patient care
treat dysrhythmia
administed medications - 
GTN
urgent transport
34
Q

cardiogenic shock

A 
patient care
treat associated conditions i.e. ACS
treat dysrhythmias
administer meds -
compound sodium lactate 10ml/kg
adrenaline infusion
pain management
urgent transport
35
Q

Bradycardia

A 
patient care
administer meds -
atropine
adrenaline 
repeat jobs
36
Q

bradycardia ranges

A

> 13 yrs 40
6-<13 yrs 60
1-<6yrs 70
<1 yrs 80

37
Q

tachycardia

A

patient care - consider history and reversible causes

conscious -
Narrow QRS: perform valsalva
Wide QRS: urgent transport, amiodarone

unconscious-
synchronised cardio version

urgent transport

38
Q

Hyperkalaemia

A

indications -
renal failure,crush injury, prolonged confinement/immobility
ECG changes - peaked T wave, disappearing p wave, widening QRS, systole/VF/VT

Pt care
meds - 10ml/kg
urgent transport

39
Q

stroke

A

patient care
FAST assessment
Check BGL
transport to ED code 3

40
Q

trauma

A 
assess scene
primary survey
provide mist report
spinal/pelvic immobilisation
minimise scene time
code 3
41
Q

head injuries

A 
patient care
treat associated conditions -
hypoxia
hypovolaemia
spinal injury
consider other causes of loc
urgent transport if decreased loc

Protocols (2 decks)

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