SAAS Guidelines Flashcards
What is the dose and route of administration of aspirin in suspected ischaemic chest pain?
300mg oral - chewable tablet
What is the dose and route of administration of GTN in suspected ischaemic chest pain?
300micrograms, sublingual dissolvable tablet
what is the dose and route of administration of GTN in ACPO?
300micrograms sublingual, every 5 mins prn
What general considerations need to be made before GTN is administered?
- adequate blood pressure (SBP =/> 100mmHg)
- adequate conscious state
- caution in suspected right ventricular injury
- no use of PDE-5 inhibitors within 24 hours (sildenafil, vardenafil, avanafil) or 48 hours (tadalafil)
What interventions can be done to prevent further heat loss in cases of hypothermia or trauma?
- remove patient from wet or cold surfaces
- remove patient from windy environments
- remove wet clothing
- dry the wet patient
- insulate patient with cloth and space blankets
- apply trauma cap
- turn on heater in the ambulance
why should you avoid administering fluids hypothermia?
thermal after-drop
- fluid can cause cool blood that has been relatively static in the peripheries (as a result of shunting to major organs) to return to normal circulation and cause a reduction in core temperature
What changes are made in cardiac arrest management for patients who have a temperature below 30 degrees?
max of 3 shocks administered and cardiac drugs withheld
What changes are made in cardiac arrest management for patients who have a temperature between 30 and 35 degrees?
shocks should be administered as normal, drug interval should be doubled (i.e. 8 minutes between adrenaline)
What is the dose and route of administration of adrenaline in the treatment of anaphylaxis?
IM - 10 microg/kg to single max dose of 500 microg, repeat every 5 mins prn
what intervention should be prioritised in the treatment of suspected anaphylaxis?
IM adrenaline
what are the paediatric and adult doses of nebuliser adrenaline administered in anaphylaxis with upper airway angioedema?
=/> 6 months: 5mg/5mL (including adults)
< 6 months: 2.5mg/2.5mL (made up to 5mL with saline)
what is a primary post partum haemorrhage?
blood loss of 500mL or more form the vagina in the first 24 hours after birth
What are the 4 T’s and what do they refer to?
- tone
- trauma
- tissue
- thrombin
refer to the aetiology of primary PPH
what is a secondary postpartum haemorrhage?
an acute and excessive bleed between 24 hours and 12 weeks post birth
What is Tranexamic Acid (TXA) and what are the indications and parameters for administration in PPH?
TXA is an antifibrinolytic haemostatic agent - it works by displacing plasminogen from fibrin resulting in inhibition of clot breakdown
- first dose must be administered within 3 hours of birth
- 1g slow push over 2 to 3 minutes
- must be clearly handed over to hospital
- typically given after all other interventions have been completed
what are the targets of permissive hypertension in PPH?
administration of fluid to maintain a level of alertness where the patient responds appropriately to verbal commands. If alertness is affected by other factors the presence of a radial pulse is a suitable target
Give an overview of the guideline for PPH management
> universal care
clinical support (ICP, MedSTAR)
early EOC to liase with SAAS MO/ Perinatal Advise Line
temperature management
early transport
assess fundus
assess external labia and perineum
void bladder
facilitate skin to skin and breastfeeding where possible
2x large bore IV access
early notification
1g IV TXA for pts >16 years / consult for TXA in secondary PPH
IV saline 250mL aliquots up to 20mL/kg
Give an overview of the guideline for anaphylaxis
> IM adrenaline 10microg/kg - single dose 500microg, repeat every 5 min prn
request clinical support (adults = consider, paeds = must)
in case of bronchospasm follow asthma guideline
upper airway angioedema - nebuliser adrenaline 5mg/5mL >/=6 months, 2.5mg/2.5mL <6months
hypotension - IV saline 10mL/kg to max 250mL aliquots, up to 20mL/kg
- aiming for SBP =/>100 or in lower end of normal range for age
persistent wheeze - oral prednisolone 50mg (pads 1mg/kg)
persistent itch after systemic signs resolved - oral fexofenadine 180mg (over 12)
What key things should be done in the ambulance when a code stroke has been initiated?
- bi-lateral access (minimum 18 gauge)
- 12-lead ECG
- notify receiving hospital
In the ‘general approach to fluid resuscitation’ guideline, what are the amounts of fluid given to adults and pads?
Adults -
what is the IV dose of naloxone given to an adult showing signs of narcotic overdose and respiratory compromise?
50 - 100 microg every 2-3 mins prn
how do naloxone vials come and how do you draw it up for IV administration?
comes in a 400microg/1mL vial, draw it up with 3 mL of saline to make 100microg/1mL
what is the IM dose of naloxone given to an adult showing signs of narcotic overdose and respiratory compromise?
400 microg every 2-3 min prn (consider that IM dose may take time to disperse into circulation)
what is the IN dose of naloxone given to an adult showing signs of narcotic overdose and respiratory compromise?
120 microg
