RSA/PSA/CSA Flashcards
medium child
age
5-11 years
small child
age
1-4 years
Large infant
age
3-12 months
Newborn age
age
birth to 24 hours
small infant
age
under 3 months
SGA
size
Size 1
- 2-5 kg and not max side of gastric tube
Size 1.5
- 5-12 kg and the max size of the gastric tube is 10
size 2.0
- 10-25kg and max size gastric tube 12
size 2.5
- 25-35 kg and max size of gastric tube 12
size 3.0
- 30-60 kg and max size of gastric tube 12
size 4.0
- 50-90 kg and max size of gastric tube 12
size 5.0
- 90+ kg and max size of gastric tube 14
SGA
Precautions and side effects
Precautions
- inability to prepare the patient in the sniffing position
- patients who require high airway pressure
- paediatric patient who may have enlarged tonsils
- vomit in the airway
Side effects
- correct placement does not prevent passive regurgitation or gastric distension
SGA
contraindications
- intact gag reflex or resistance to insertion
- strong jaw tone or trismus
- suspected epiglottitis or upper airway obstruction
SGA
Indications
- unconscious patient without gag reflex
- ineffective ventilation with BVM and basic airway management
- > 10 minutes of assisted ventilation required
- unable to intubate
cool, pale, and clammy
20 bpm
60 BP
unconscious
extremely poor perfusion
cool, pale, and clammy
80 bpm
80 BP
alert and orientated to time and place
Borderline
cool, pale, and clammy
140 bpm
50 BP
altered conscious state
extremely poor perfusion
cool, pale, and clammy
40 bpm
40 BP
unconscious
extremely poor perfusion
cool, pale, and clammy
130bpm
60 BP
altered conscious state
Extremely poor perfusion
cool, pale, and clammy
70bpm
70BP
altered conscious state
Inadequate perfusion
warm pink and clammy
90bpm
90 BP
alert and orientated
Borderline perfusion
mildly anxious
full sentences
mild expiratory wheeze and some find crackles
21
slightly prolonged expiratory phase
90
normal skin
alert
moderate distress
Distressed and fighting to breathe
Unable to cough, with expiratory wheeze and inspiratory wheeze
26
prolonged expiratory phase
marked chest movement
120bpm
pale and sweaty
altered conscious state
Severe distress
distressed and anxious
words only
able to cough but has an expiratory wheeze and crackles at the bases
22
prolonged expiratory phases
marked chest movement with excessive use of accessory muscles
120
pale and sweaty
conscious may be altered
severe distress
Distressed
short phrases only
mild expiratory wheeze and some fine crackles
22
prolonged expiratory wheeze
marked chest movement with excessive
120bpm
pale and sweaty
may be altered
Moderate distress
Calm, quiet
Full sentences
mild expiratory wheeze
18
regular even cycles
slight increase in normal chest movement
80bpm
normal skin
alert
Mild distress
child > 4 years old
CS - motor
none
1
child > 4 years old
CS - motor
abnormal extension to pain
2
child > 4 years old
CS - motor
abnormal flexion to pain
3
child > 4 years old
CS - motor
withdraws from pain
4
child > 4 years old
CS - motor
localises to pain
5
child > 4 years old
CS - motor
obeys command
6
child > 4 years old
CS - verbal
None
1
child > 4 years old
CS - verbal
Incomprehensible sounds
2
child > 4 years old
CS - verbal
Inappropriate words
3
child > 4 years old
CS - verbal
confused
4
child > 4 years old
CS - verbal
orientated
5
child > 4 years old
CS - eye-opening
None
1
child > 4 years old
CS - eye-opening
To pain
2
child > 4 years old
CS - eye-opening
To voice
3
child > 4 years old
CS - eye-opening
Spontaneous
4
child ≤ 4 years old
CS - motor
None
1
child ≤ 4 years old
CS - motor
Abnormal extension to pain
2
child ≤ 4 years old
CS - motor
Abnormal flexion to pain
3
child ≤ 4 years old
CS - motor
Withdraws from pain
4
child ≤ 4 years old
CS - motor
Localises to pain
5
child ≤ 4 years old
CS - motor
Spontaneous
6
child ≤ 4 years old
CS - verbal
None
1
child ≤ 4 years old
CS - verbal
Moans to pain
2
child ≤ 4 years old
CS - verbal
Persistently irritable
3
child ≤ 4 years old
CS - verbal
Cries but consolable
4
child ≤ 4 years old
CS - verbal
appropriate words/social smile
5
child ≤ 4 years old
CS - Eyes
None
1
child ≤ 4 years old
CS - Eyes
To pain
2
child ≤ 4 years old
CS - Eyes
To voice
3
child ≤ 4 years old
CS - Eyes
spontaneous
4
Paediatric weight
10 - 11 years
Age x 3.3kg
Paediatric weight
1-9 years
Age x 2 + 8kg
Paediatric weight
1 year
10kg
Paediatric weight
6 months
8kg
Paediatric weight
3 months
6kg
Paediatric weight
<24 hours
3.5kg
Newborn heart rate
HR and BP
HR 110-170
BP > 60mmHg systolic
small infant
HR and BP
HR 110-170bpm
BP > 60mmHg systolic
large infant
HR and BP
HR 105 - 165bpm
BP > 65mmHg systolic
small child
HR and BP
HR 85 - 150bpm
BP > 70mmHg systolic
medium child
HR and BP
HR 70 - 135bpm
BP > 80mmHg systolic
newborn RR
25 - 60 breaths/minute
small infant RR
25 - 60 breaths/minute
large infant RR
25 - 55 breaths/minutes
small child RR
20 - 40 breaths/minute
medium child RR
16 - 34 breaths/minute
SpO <85%
what to do/what level is it
Severe or critical illness
Hypoxaemia
non - rebreather mask (10-15L.min)
consider BVM as requied
Severe SpO2
what to do/what level is it
Hypoxaemia
SpO <85% or critical illness
non - rebreather mask (10-15L.min)
consider BVM as requied
SpO2 85 - 91%
what to do/what level is it
Mild - Moderate
Hypoxaemia
Titrate O2 to SpO2 92 - 96%
- nasal cannula (2-6L/min) or
- simple face mask (5-10L/min)
Mild - Moderate SpO2
what to do/what level is it
SpO2 85 - 91%
Hypoxaemia
Titrate O2 to SpO2 92 - 96%
- nasal cannula (2-6L/min) or
- simple face mask (5-10L/min)
≥ 92% what to do/what level is it
Adequate SpO2
no O2 required
Adequate SpO2
≥ 92%
No O2 required
medium child RR
16 - 34 breaths/minute
small child RR
20 - 40 breaths/minute``
large infant RR
25 - 55 breaths/minutes
small infant RR
25 - 60 breaths/minute
newborn RR
25 - 60 breaths/minute
Paediatrics
RR
16 - 34
medium child
Paediatrics
RR
20 - 40 breaths/minute
small child
Paediatrics
RR
25 - 55 breaths/minute
large infant
Paediatrics
RR
25 - 60 breaths/minute
newborn
small infant
Paediatrics
70 - 135bpm (HR)
> 80mmHg (BP)
medium child
Paediatrics
85 - 150bpm (HR)
> 70mmHg systolic (BP)
small child
Paediatrics
105 - 165 (HR)
> 65mmHg systolic (BP)
large infant
Paediatrics
110 - 170bpm (HR)
> 60mmHg systolic (BP)
newborn
Small infant
medium child
HR and BP
HR 70 - 135bpm
BP > 80mmHg systolic
small child
HR and BP
HR 85 - 150bpm
BP > 70mmHg systolic
large infant
HR and BP
HR 105 - 165bpm
BP > 65mmHg systolic
small infant
HR and BP
HR 110-170bpm
BP > 60mmHg systolic
Newborn heart rate
HR and BP
HR 110-170
BP > 60mmHg systolic
E - to pain
V - inappropriate words
M - withdraws to pain
9
E - to voice
V - incomprehensible sounds
M - extension to pain
7
E - to pain
V - confused
M - flexion to pain
9
E - spontaneous
V - inappropriate words
M - localises to pain
12
PSA
unconscious
no perfusion
PSA
altered or unconscious
extremely poor perfusion
PSA
either alert and orientated to time and place or altered
inadequate perfusion
PSA
alert and orientated to time and place
adequate perfusion
borderline perfusion
PSA
cool, pale, clammy
inadequate perfusion
borderline perfusion
extremely poor perfusion
no perfusion
PSA
warm, pink, dry
adequate perfusion
PSA
unrecordable
no perfusion
PSA
< 60 systolic or unrecordable
extremely poor perfusion
PSA
60 - 80 systolic
Inadequate perfusion
PSA
80 - 100 systolic
borderline perfusion
PSA
BP > 100 systolic
adequate perfusion
PSA
no palpable pulse
no perfusion
PSA
<50 or > 110 bpm
extremely poor perfusion
PSA
<50 or >100 bpm
inadequate perfusion
PSA
50 - 100 bpm
borderline perfusion
PSA
60 - 100 bpm
adequate perfusion
RSA
> 120 bpm
severe distress
RSA
100 - 120 bpm
moderate distress
RSA
60 - 100 bpm
normal
mild distress
RSA
> 20
< 8 (bradypnoea)
severe distress
RSA
>20 RR
moderate distress
RSA
16 - 20 RR
mild distress
RSA
12 - 16 RR
normal
RSA
distressed, anxious, fighting to breathe, exhausted, catatonic
severe distress
RSA
calm or mildly anxious
mild distress
RSA
calm, quiet
normal
RSA
altered or unconscious
severe distress
RSA
may be altered
moderate distress
RSA
alert
normal
mild distress
RSA
pale and sweaty, +/- cyanosis
severe distress
RSA
pale and sweaty
moderate distress
RSA
normal skin
normal
mild distress
RSA
marked chest movement +/- use of accessory muscle
moderate distress
RSA
slight increase in normal chest movement
mild distress
RSA
normal chest movement
normal
RSA
words only or unable to speak
severe distress
RSA
short phrases only
moderate distress
RSa
full sentences
mild distress
RSA
clear and steady sentences
normal
RSA
Asthma - prolonged expiratory phase
moderate distress
severe distress
RSA
Asthma - may have a slightly prolonged expiratory phase
mild distress
RSA
regular even cycles
normal
RSA
unable to cough
severe distress
RSA
Upper airway obstruction - inspiratory stridor
severe distress
RSA
Asthma- expiratory wheeze +/- inspiratory wheeze, maybe no breath sounds (late)
severe distress
RSA
LVF - crackles at bases - to mid-zone
moderate distress
RSA
Asthma - expiratory wheeze, +/- inspiratory wheeze
moderate distress
RSA
LVF - there may be some fine crackles at the bases
mild distress
RSA
asthma - mild expiratory wheeze
mild distress
RSA
able to cough
normal
mild distress
moderate distress
RSA
no crackles or scattered fine basal crackles
normal
RSA
usually quiet no wheeze
normal
PSA
unconscious
no perfusion
PSA
altered or unconscious
extremely poor perfusion
PSA
either alert and orientated to time and place or altered
inadequate perfusion
PSA
alert and orientated to time and place
adequate perfusion
borderline perfusion
PSA
cool, pale, clammy
borderline perfusion
inadequate perfusion
extremely poor perfusion
no perfusion
PSA
warm, pink, dry
adequate perfusion
RSA
HR - 140
severe distress
RSA
HR - 105
moderate distress
RSA
HR - 75
normal
mild distress
RSA
HR - 90
normal
mild distress
RSA
HR - 62
normal
RSA
HR - 110
moderate distress
RSA
HR - 125
severe distress
RSA
HR - 80
normal
Mild
RSA
RR - 21
moderate distress
severe distress
RSA
RR - 8
severe distress
RSA
RR - 17
mild distress
RSA
RR - 26
severe distress
RSA
RR - 12
normal
RSA
RR - 6
severe distress
RSA
RR - 22
moderate distress
severe distress
RSA
RR - 18
mild distress
RSA
RR - 14
normal
PSA
Pulse - 50
borderline perfusion
PSA
Pulse - 90
adequate perfusion
borderline perfusion
PSA
Pulse - 30
inadequate perfusion
extremely poor perfusion
PSA
Pulse - 62
adequate perfusion
PSA
Pulse - 70
adequate perfusion
borderline perfusion
PSA
Pulse - 105
inadequate perfusion
PSA
Pulse - 120
extremely poor perfusion
PSA
Pulse - 40
inadequate perfusion
extremely poor perfusion
PSA
Pulse - 55
borderline perfusion
PSA
Pulse - 80
adequate perfusion
borderline perfusion
PSA
BP - 95
borderline perfusion
PSA
BP - 105
adequate perfusion
PSA
BP - 50
extremely poor perfusion
PSA
BP - 61
Inadequate perfusion
PSA
BP - 110
adequate perfusion
PSA
BP - 90
borderline perfusion
PSA
BP - 75
inadequate perfusion
PSA
BP - 40
extremely poor perfusion
PSA
BP - 90
borderline perfusion
PSA
BP - 120
Adequate perfusion
Red flag
HR - >120
RR - >30
BP - <90
SpO2 < 90% (unless chronic hyperaemia)
GCS < 13 - <15 if age is ≤15 yrs
other illnesses affecting SpO2 levels
Cardiac arrest or resuscitation
Major trauma
Shock
Severe sepsis
Anaphylaxis
Status epilepticus
Ketamine sedation
normal temperature
36.5-37.5
normal blood glucose levels
4-8
Time critical - Vital signs
HR - <60 or >120
RR - <10 or >30
Systolic BP - <90
SpO2 - <90%
≥16 GCS - <13
≤15 GCS - <15
CSA (motor response)
none
1
CSA (motor response)
extension to pain
2
CSA (motor response)
flexion to pain
3
CSA (motor response)
withdraws to pain
4
CSA (motor response)
localises to pain
5
CSA (motor response)
obeys command
6
CSA (verbal response)
none
1
CSA (verbal response)
incomprehensible sounds
2
CSA (verbal response)
inappropriate words
3
CSA (verbal response)
confused
4
CSA (verbal response)
orientated
5
CSA (eye-opening)
none
1
CSA (eye-opening)
to pain
2
CSA (eye-opening)
to voice
3
CSA (eye-opening)
spontaneous
4
5-11 years
medium child
1-4 years
small child
3-12 months
large infant
birth to 24 hours
Newborn age
under 3 months
small infant
child > 4 years old
CS - motor
1
none
child > 4 years old
CS - motor
2
abnormal extension to pain
child > 4 years old
CS - motor
3
abnormal flexion to pain
child > 4 years old
CS - motor
4
withdraws from pain
child > 4 years old
CS - motor
5
localises to pain
child > 4 years old
CS - motor
6
obeys command
child > 4 years old
CS - verbal
1
none
child > 4 years old
CS - verbal
2
Incomprehensible sounds
child > 4 years old
CS - verbal
3
Inappropriate words
child > 4 years old
CS - verbal
4
confused
child > 4 years old
CS - verbal
5
orientated
child > 4 years old
CS - eye-opening
1
none
child > 4 years old
CS - eye-opening
2
To pain
child > 4 years old
CS - eye-opening
3
To voice
child > 4 years old
CS - eye-opening
4
Spontaneous
child ≤ 4 years old
CS - motor
1
none
child ≤ 4 years old
CS - motor
2
Abnormal extension to pain
child ≤ 4 years old
CS - motor
3
Abnormal flexion to pain
child ≤ 4 years old
CS - motor
4
Withdraws from pain
child ≤ 4 years old
CS - motor
5
Localises to pain
child ≤ 4 years old
CS - motor
6
Spontaneous
child ≤ 4 years old
CS - verbal
1
None
child ≤ 4 years old
CS - verbal
2
Moans to pain
child ≤ 4 years old
CS - verbal
3
Persistently irritable
child ≤ 4 years old
CS - verbal
4
Cries but consolable
child ≤ 4 years old
CS - verbal
5
appropriate words/social smile
child ≤ 4 years old
CS - Eyes
1
none
child ≤ 4 years old
CS - Eyes
2
to pain
child ≤ 4 years old
CS - Eyes
3
to voice
child ≤ 4 years old
CS - Eyes
4
spontaneous
Paediatric weight
Age x 3.3kg
10 - 11 years
Paediatric weight
Age x 2 + 8kg
1-9 years
Paediatric weight
10kg
1 year
Paediatric weight
8kg
6 months
Paediatric weight
6kg
3 months
Paediatric weight
3.5
<24 hours
EtCO2
range
35- 45mmHg
Nebuliser face mask for drug administration
how many litres
8-10L/min
CPAP
contraindications
- Inability to manage own airway (alter conscious state, active vomiting or excessive secretions)
- upper airway obstruction
- Hypoventilation (patient must have adequate spontaneous respirations)
- untreated tension pneumothorax (must be treated before considering CPAP)
- Haemodynamic instability (severe hypotension, ventricular arrhythmias - should all be treated before considering)
- Injuries that preclude mask application
CPAP
precautions
- hypovolemia
- post chest decompression (closely monitor)
- COPD (monitor for deterioration)
- Hypotension
CPAP
Indications for it to be removed
- Cardiac/respiratory arrest
- Pt agitation/intolerance
- No improvements after 1hr
- HR <50
- SBP <90
- GCS <13
- Decreasing SpO2
- Loss of airway control
- Copious secretion
- Active vomiting
- Paramedic judgement of Pt deterioration
Adolescents
Age
12-15 years
Adolescents
HR and BP
60-120
>90
Adolescents
RR
14-26
Adolescents
weight
based on pt size
Paediatrics
60 - 120bpm (HR)
> 90mmHg systolic (BP)
Adolescents
Paediatrics
RR
14 - 26
Adolescents
Paediatrics
age
12-15
Adolescents
