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SAAS CPGs Flashcards

0
Q

Pain Control: How long after administration do morphine and fentanyl exert their maximum analgesic effects?

A

Morphine 15 minutes and Fentanyl 5 minutes, however sedation can continue to develop for up to one hour.

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1
Q

Pain Control: What are some of the ‘simple measures’ that can be used for pain control? (5)

A

Reassurance, oxygenation, temperature control, posturing and splinting all contribute significantly to pain control.

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2
Q

Pain Control: What are the two biggest adverse effects of narcotic drugs in pain control?

A

Hypotension and respiratory depression.

Best practice is to administer supplemental oxygen with continual oxygen saturation monitoring.

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3
Q

Pain Control: The adverse effects of narcotics for pain control are potentiated by what? (4)

A

Hypoxia
Hypovolaemia
Extremes of age
Presence of other CNS depressants

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4
Q

Pain Control: What it the dose of methoxyflurane given for pain control? Can it be repeated?

A

Methoxyflurane is administered 3mL inhaled. Multiple doses are not indicated due to the anesthetic effects and toxicity to the kidneys

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5
Q

Pain Control: When is morphine indicated and what is the dose?

A

Morphine is indicated for patients with uncontrolled pain from musculoskeletal injuries or burns; IF the patient has a systolic BP greater than 100 mmHg and a stable GCS 15.
The dose is 2.5mg IV (with NSL KVO) every 5 minutes until pain is controlled.

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6
Q

Pain Control: When might Morphine be contra-indicated and what is the alternate option?

A

Morphine may not be appropriate in people with morphine allergies, unable to gain IV access, or paediatrics. Fentanyl is an alternate option.

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7
Q

Pain Control: What is the dose and route of administration of Fentanyl?

A

Fentanyl, also a narcotic agent, is initial dose up to 180mcg IN (0.3mL each nostril with 0.1mL prime). If pain remains uncontrolled administer a further 90mcg every five minutes to a maximum of 360 mcg. Consult for further management.

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8
Q

Pain Control: What cases must paramedics consult with ECP for management advice? (2)

A

Uncontrolled pain from other causes ie non musculoskeletal or burns.
Paediatrics with uncontrolled pain.

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9
Q

APO: What are the three main paramedic treatments for a patient with APO?

A

Posture
Oxygenation
GTN if adequate blood pressure

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10
Q

APO: Assessment of adequate blood pressure takes what factors into account? (6)

A 
Systolic BP 
Diastolic BP 
MAP
Posture 
ECG - preload dependent rhythms 
Heart rate
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11
Q

APO: What is the dose of GTN given and how often in APO? What must be taken into account when giving GTN? (3)

A

GTN is administered 400mcg SL every 5 minutes PRN, IF
Adequate blood pressure
Rate and rhythm are appropriate
No use of erectile dysfunction agents in last 24 hours

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12
Q

APO: What clinical intervention can ICPs offer for severe cases of APO?

A

CPAP - continuous positive airway pressure. Consider early activation of clinical support in severe cases.

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13
Q

Adult Cardiac Arrest: What are the two most important aspects of management of cardiac arrest?

A

Early defibrillation

Continuous quality chest compressions with minimal interruptions

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14
Q

Adult Cardiac Arrest: Compressions should be performed at a rate of …… and at a depth of……

A

100 beats per minute at 1/3 depth of the chest

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15
Q

Adult Cardiac Arrest: What compression/ventilation ratios are used in arrests with basic airway management and advanced airway management?

A

Basic airway management 30:2 with a pause for ventilations.

Advanced airway management 15:1 with no pause for ventilation (approx 6 ventilations per minute)

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16
Q

Adult Cardiac Arrest: What are the four different types of arrest rhythm?

A

Ventricular fibrillation
Ventricular tachycardia
Asystole
Pulseless Electrical Activity

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17
Q

Adult Cardiac Arrest: What are the two shockable arrest rhythms? What dose and how often are shocks delivered?

A

Shockable rhythms are VF and pulseless VT. Shocks are delivered at 200J every two minutes.

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18
Q

Adult Cardiac Arrest: How much adrenaline is administered, how often, and to patients in what arrest rhythms?

A

1mg IV adrenaline is administered every 4 minutes (every 2 cycles) in all 4 cardiac arrest rhythms

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19
Q

Adult Cardiac Arrest: after delivering a 200J defibrillation what should be done next?

A

Immediately commence two 2 full minutes of CPR, followed by a pulse check and then determine the rhythm.

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20
Q

Adult Cardiac Arrest: how often should signs of life (eg pulse check) and rhythm be assessed? Then what?

A

Every 2 minutes.
If shockable rhythm > defibrillate and commence 2 mins CPR
Non shockable rhythm > commence 2 mins CPR.
Adrenaline every 4 mins.
Establish advanced airway

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21
Q

Adult Cardiac Arrest: What are the reversible causes of cardiac arrest?

A 
Hypoxia 
Hypovolaemia 
Hyper/hypokalaemia
Hyper/Hypothermia 
Toxins
Thrombosis
Tamponade
Tension Pneumothorax
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22
Q

Adult Cardiac Arrest: What advanced airway options are available to paramedics and ICPs? What is the compression:ventilation ratio once an advanced airway has been established?

A

Paramedics - Laryngeal Mask Airway
ICPs - Endo Tracheal Tube
15:1 with uninterrupted compressions

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23
Q

Adult Cardiac Arrest: After how long in different arrest rhythms should cessation of resuscitation be considered?

A

Pulseless VT, VF and PEA - 30 minutes

Asystole - 10 minutes

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24
Adult Cardiac Arrest: What are the fundamentals of treatment of ROSC? (5)
``` Re-evaluate ABCDE Establish an advanced airway Re-evaluate oxygenation, ventilations, temp control Acquire 12 Lead ECG Rapid transport and notification ```
25
Declaration of life extinct: What are the 4 examinations to be documented for declaration of life extinct?
Absence of heart sounds for 1 minute Absence of pulse for 1 minute Absence of respirations for 1 minute Nil pupil reaction to light
26
Ischaemic Chest Pain: What are the three drugs that are used in the pre-hospital treatment of cardiac chest pain?
Oxygen Aspirin 300mg PO GTN 400mcg SL every 5 mins PRN
27
Ischaemic Chest Pain: What is the dose of GTN and what must be considered before administering it?
GTN 400mcg SL every 5 mins PRN IF Adequate blood pressure Appropriate rate and rhythm No use of erectile dysfunction agents
28
What are the ages of neonatal, infants and paediatrics ?
``` Neonates = 2 hours to 28 days Infants = 28 days to 1 year Paediatrics = 1 to 14 years ```
29
NIP cardiac arrest: what is the main cause of cardiac arrest in kids?
Hypoxia. Ventilation with oxygen is the key intervention.
30
NIP Cardiac Arrest: What is the compression to ventilation ratio for paediatrics?
Compressions are delivered at a ratio of 15:2 at 100 beats per minute, pausing for ventilations in both a basic and advanced airway.
31
NIP Cardiac Arrest: At what joules and how often is defibrillation delivered in a Paediatric arrest?
4 joules per kilogram every 2 minutes
32
NIP Cardiac Arrest: What is the guideline re adrenaline for paediatrics in cardiac arrest?
IV access can be gained but IV adrenaline 10mcg/kg every 4 minutes is under consult to the ECP
33
Newborn Care: What age is considered a newborn?
Delivery up to 2 hours
34
Newborn Care: Preventing ........ ........ is a significant clinical management imperative. How can this be done? (5)
Heat Loss Thoroughly dry the newborn (also stimulates respiration) Support skin to skin contact with the mother Wrap mother and baby in dry warm blankets Apply baby hat Maintain an environment >25C en route
35
Newborn Care: What is the compression ventilation ratio for newborns?
Newborn CPR is 3 compressions to 1 ventilation.
36
Newborn Care: When are chest compressions indicated for newborns?
If heart rate drops below 60 beats per minute commence CPR at a rate of 3:1
37
Newborn Care: When is ventilation and oxygenation required for newborns?
Ventilation is required if the newborn does not commence spontaneous respirations within 60 seconds of delivery & stimulation. Ventilations should be delivered at 40-60 breaths per minute. If no improvement after 5 mins commence oxygenation.
38
When might it not be appropriate to commence CPR? (7)
Advanced Directives Rigor Mortis is present Clear and unmistakeable lividity (blood pooling) Injuries incompatible with life eg decapitation Pulseless, not breathing, unresponsive >30 mins prior to SAAS arrival Environmental hazards Triage
39
Behavioural: Can paramedics administer Midazolam as a sedative for mental health patients?
Yes. But only if the patient has already been commenced on IV Midazolam and the paramedic has written consent from a medical officer or consult with ECP. Midazolam 1mg IV slow push every 5 mins up to a maximum 3mg, IF GCS 15 and systolic BP over 100mmHg
40
Behavioural: When can paramedics take a patient into their care and control?
If the patient has a mental illness and has caused or is at significant risk of causing harm to themselves, others or property, or otherwise requires medical examination.
41
Anaphylaxis: What are the three major components of a severe anaphylactic reaction?
Hypotension, bronchospasm, and oedema.
42
Anaphylaxis: What are the three drugs and their doses that can be administered for a MILD anaphylactic/allergic reaction?
Salbutamol 10mg & Atrovent 500mcg Nebulised for bronchospasm component. Fexofenadine 180mg PO for skin rash/itchiness
43
Anaphylaxis: What are the three treatment rationales (and doses) for a SEVERE anaphylactic reaction?
IPPV with slow ventilation rates and 15L oxygen PRN Adrenaline 300mg IM repeated at 5 minute intervals PRN If hypotensive consider NSL IV PRN
44
Anaphylaxis: What is the dose and route of administration of adrenaline for a paediatric patient with severe anaphylaxis?
Adrenaline 10 mcg/kg IM repeated every 5 minutes PRN. No consult required.
45
How is the weight of a paediatric patient calculated?
For children under 8: Weight = (age x 2) + 8 For children 8-14: Weight = age x 3
46
Bronchospasm: What is the pharmacological treatment of a mild to moderate bronchospasm?
Pre-Oxygenation, followed by Salbutamol 10mg and Ipratropium 500mcg Nebulised
47
Bronchospasm: Why are nebulisers not used in severe bronchospasm?
They do not deliver high concentrations of oxygen and nebulised medications are unlikely to reach the site of action in severe bronchospasm
48
What is the treatment of an adult patient with severe bronchospasm leading to respiratory arrest?
IPPV with slow ventilation rates | Adrenaline 300mcg IM every 5 minutes PRN
49
Bronchospasm: What is the dose of adrenaline given to a paediatric patient with severe bronchospasm?
10mcg/kg IM every 5 mins PRN to a maximum single dose of 300mcg No consult required
50
Which patients should have a BGL taken? (5)
All patients, particularly children, who have an altered conscious state, altered cerebral function, trauma, and seizures.
51
Hypoglycaemia: What are the different treatment options available to manage hypoglycaemia?
If concious state allows - oral carbohydrates and glucose paste 15 mL If conc state not suitable - 1IU Glucagon IM If glucagon ineffective - IV Glucose
52
Hypoglycaemia: How is IV Glucose administered and what is the dose?
100mL NSL IV before and after glucose administration | Glucose is 25g in 250ml therefore a 10% solution, titrated to the patients neurological function and BGL
53
Hypoglycemia: What are some important criteria to address when leaving a patient who has had a hypoglycaemic episode at home? (5)
Patient has consumed carbohydrates BGL is within a stable physiological range Patient is a previously stable diabetic An identifiable cause for the episode Patient will be monitored by a third party
54
Hypothermia: What are three main physiological consequences in the profoundly hypothermic patient?
Decreased vascular volume CNS depression Unstable cardiac rhythm
55
Hypothermia: why is IV fluid loading not warranted in the hypothermic patient?
This may further lower the patients core temperature as cold blood is moved from the peripheries back into central circulation
56
Hypothermia: at what point should resuscitation be ceased on the hypothermic patient? What other considerations are there in a hypothermic resuscitation?
CPR should be continued until the core temperature is over 35C If the patient remains in a shockable rhythm after three shocks cease further defibrillation and continue CPR
57
Hypothermia: What is a special consideration, particularly in extrication, with the hypothermic patient?
Active rewarming should not be attempted pre-hospital. Treatment focuses on preventing further heat loss. Minimize movement and simulation of the patient as they can spontaneously VF arrest
58
Hypoglycaemia: What is the dose of glucagon given to a paediatric patient?
Paeds up to 7 years = 1/2 IU Paeds 8 years and over = 1 IU IV glucose can be given under consult with ECP
59
Medical Hypovolaemia: What is the principle of permissive hypotension?
Giving only enough fluid to gain a palpable peripheral pulse and a stable GCS (to a maximum of 1L - consult ECP for further management)
60
Which hypovolaemic patients (trauma) can paramedics treat with permissive hypotension? (3)
Hypotension in the presence of; Haemorrhagic Hypovolaemia (medical or trauma) Obstructive shock eg PE, tension pneumo Neurogenic shock secondary to SCI
61
Medical Hypovolaemia: What is the treatment rationale for a dehydrated patient?
Clinical support Consult ECP for fluid Treat hyperthermia - remove excess clothing, ice packs to groin and axilla
62
Medial Hypovolaemia: Can paramedics administer fluid to a hypotensive patient secondary to sepsis?
No, not without consult. Request clinical support
63
Meningococcal: When should paramedics consider Benzylpenicillin? (4)
Febrile Altered conscious state Evidence of sepsis - shock or circulatory collapse Acute onset of purpuric rash
64
Meningococcal: what dosage vials does Benzylpenicillin come in? How much water is added to these vials?
600 mg vial add 1.6 mLs of water 1.2 g vials add 3.2 mLs of water Both make preparations of 300mg per mL
65
Meningococcal: What dose of Benzylpenicillin is given to adults and paediatrics?
10 years and over = 1.2g IM or IV 1-9 years = 600mg IM Less than 1 year = 300mg IM
66
Meningococcal: When should paramedics consult for the administration of Benzylpenicillin?
If the patient is febrile, altered conscious state, and there is a clinical suspicion of meningococcal disease (no evidence of sepsis or purpuric rash)
67
Narcotic OD: What are the three treatment priorities for a patient who has overdosed on narcotics?
Re-establish airway control Effective ventilation Naloxone
68
Narcotic OD: What are the three doses of naloxone that can be given to an adult patient via the different routes?
IM 400mcg IN 120mcg IV 100mcg
69
Narcotic OD: What dose and route of admin of naloxone are given to paediatric patients?
Over 6: 400mcg IM PRN to a maximum of 1600mcg Under 6: 200mcg IM PRN to a maximum of 1600mcg Aiming for complete narcotic reversal in paediatrics
70
Narcotic OD: What dose of naloxone is given to a newborn with respiratory depression post long term maternal narcotic use?
None. Newborns should not routinely be given naloxone in the pre-hospital setting. Basic care and consult ECP for management advice
71
Nausea and Vomiting: When should ondansteron be used with caution? (2)
Patients with a previous history of dystonic reaction to any drug or hypersensitivity to serotonin receptor antagonists
72
Nausea and Vomiting: What is the dose and how should Ondansteron be administered in adults with N&V?
4-8mg IV or IM. | IV doses given over at least 5 minutes.
73
Nausea and Vomiting: What is the dose and route of admin of Ondansetron for paediatrics?
Paeds over two years: ondansetron 100mcg/kg IM up to a maximum of 4mg
74
Stroke: What is the stroke assessment tool used in South Australia?
The ROSIER - recognition of stroke in an emergency room.
75
Stroke: Which patients are eligible for thrombolysis? (4)
Pre-morbid level of independent living Positive ROSIER score Arrival at CSU within 4 hours of the onset of stroke symptoms Less than 60 min travel time to CSU
76
Stroke: Where are the comprehensive stroke units in the Adelaide metro area? (4)
RAH FMC QEH LMHS (0800-1600 Mon-Fri)
77
Stroke: Can paramedics call a Code Stroke?
Yes. If the ROSIER is positive, within 4 hours of symptoms, independent living etc paramedics can call a code stroke on 1300 365 211
78
Stroke: Providing they don't delay transport time, what other treatment/assessment options should paramedics consider?
12 Lead ECG | 1x 18 G cannula IVA in each arm
79
Stroke: What factors will give a patient a score of -1 on the ROSIER score? (2)
Loss of conciousness/syncope | Seizure activity
80
Stroke: What factors will give a patient a +1 on the ROSIER scale? (5)
``` Asymmetric facial weakness Asymmetric arm weakness Asymmetric leg weakness Speech disturbance Visual field defect ```
81
Stroke: What is the pneumonic ISBAR and when is it used?
``` ISBAR is used for handover. Introduction Situation Background Assessment Recommendation ```
82
Paediatric Croup: What is the primary aim in the treatment of Croup? What is the prime requirement?
To restore adequate airway lumen for ventilation and oxygenation. High concentrations of oxygen are the prime requirement.
83
Croup: What is the treatment for severe croup ie severe respiratory distress and or hypoxic?
Nebulised adrenaline 5mg/5mL repeated PRN
84
Seizures: When is Midazolam indicated?
When there is risk of physical injury, hypoxia, or aspiration associated with a prolonged seizure or repeated seizures.
85
Seizures: The adverse effects of Midazolam are potentiated by ....... (4)
Hypoxia Hypovolaemia Extremes of age Other CNS depressants
86
Seizures: What are some of the reversible causes of a seizure? (4)
Hypoglycaemia, trauma, hypoxia, hyperthermia etc these should be attended to as soon as practicable
87
Seizures: What is the dose and route of administration of Midazolam? Can this be repeated?
Midazolam 100mcg/kg to a maximum of 10mg, no more than 5mL in volume in one injection site. Can be repeated after 5 minutes
88
Amputations: What are the three treatment priorities in an amputation?
Direct pressure for haemorrhage control Pain management Hypovolaemia management
89
Amputations: When should tourniquets be used?
Only in extreme circumstances where torrential haemorrhage is unable to be controlled despite direct pressure
90
Amputations: What should be done with the separated body part?
If possible it should be sealed in a water tight bag and the bag placed in ice cool water
91
Burns: What are essentially the three main treatment priorities in a patient with burns?
Removal of the heat source Effective cooling by irrigation to minimize tissue damage and pain Pain control
92
Burns: When should hydrogel dressings be used? How long should they be applied for?
Where cooling cannot be achieved by other means ie lack of running water. Neonates - maximum of ten minutes Children and Elderly - maximum of 20 minutes Burns >15%BSA - maximum 20 minute
93
Burns: How long should a burn be cooled/irrigated for? What do we need to consider throughout this process?
Cool heat burns and chemical burns with cold running water for up to 20 minutes. Ensure patients do not become hypothermic during cooling
94
Burns: How should the burn be dressed/treated post cooling?
Cover burns with cling wrap in a non circumferential fashion. Cooling can be continued over the burn cover
95
Burns: What is the fluid guideline for burns? What is the formula used to determine how much fluid to give?
CPG - "volume proportional to the severity and size of the burn" Parklands formula: %BSA burned x weight of patient x 4 = total mLs of fluid 1/2 over the first 8 hours 1/2 over the following 16 hours
96
Envenomation: What is the treatment for a native Australian snake bite?
Do not apply tourniquets or wash bite sight. Minimal patient exertion Compression bandage over site and limb then splint limb
97
Envenomation: What is the treatment for a red back spider bite?
If available apply ice therapy Pain control Minimal patient exertion
98
Envenomation: What is the treatment for a bee/wasp/ant sting?
Allergy/anaphylaxis guideline Remove any remaining sting Apply ice therapy
99
Envenomation: What is the treatment of a blue ringed octopus sting?
Focus in ventilation due to the paralyzing effects of the neurotoxin Compression bandage over bite then limb then splint limb
100
Traumatic Hypovolaemia: Paramedics can give fluid to trauma patients who are hypotensive from what causes? (3) How much fluid?
Permissive hypotension up to 1000mL; Obstructive shock Neurogenic shock secondary to SCI Haemorrhagic Hypovolaemia
101
Traumatic Hypovolaemia: What is the fluid guideline for severely crushed patients?
IV fluid therapy should be proportional to the extent of the crush and anticipated relative Hypovolaemia and potential hypotension. Prolonged entrapment - consult ECP for advice in fluid volumes
102
Traumatic hypovolaemia: what is the fluid guideline for trauma patients who are in their last trimester of pregnancy?
Fluid challenge. Up to 1000mL normal saline IV even if a radial pulse is present. If the patient shows an increase in blood pressure or a decrease in heart rate (with normotension) reduce to KVO
103
Head Injury: What is the fluid guideline in the head injured patient and what is the rationale?
To maintains cerebral perfusion in patients who have ceased autoregulation -> maintenance of MAP 90mmHg (Paeds - consult)
104
Spinal Immobilisation: When should a C-collar be applied?
When there is a concern regarding mechanism of injury or suspicion of a musculo-skeletal spinal injury or a spinal cord injury
105
Spinal Immobilisation: When would it be appropriate not to apply spinal Immobilisation? (5)
Stable GCS 15 (no drugs alcohol head injury) No pain in head neck and shoulders No pain or deformity on palpation of neck No symptoms of neuro dysfunction No distracting injuries
106
Traumatic Hypovolaemia: Where should obstetric trauma patients be taken?
FMC if no problems are identified in primary survey and notify en route

Guidelines (1 decks)

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