Section 8 CPGs Flashcards
Burns
Burn or scald
-Cease contact with heat source
-Was there any inhalation of a facial burn
-If yes, manage the airway, is there respiratory distress, if yes, go to abnormal work of breathing CPG, if no consider humidified oxygen therapy and continue to commence local cooling of burn area (Brush off powder and irrigate chemical burns, follow local expert direction)
-If no, commence local cooling of burn area (Brush off powder and irrigate chemical burns, follow local expert direction)
-Remove burned clothing and jewellery (unless stuck)
-dressing/covering of burn area
-determine the pain level
-If the pain is above a 2/10, go to pain management CPG
-If the pain is below a 2/10, determine if there is an isolated superficial injury excluding FHFFP (Face, Hands, Feet, Flexion points, Perineum)
-If there is an isolated superficial injury excluding FHFFP (Face, Hands, Feet, Flexion points, Perineum), Transport
-If there is not an isolated superficial injury excluding FHFFP (Face, Hands, Feet, Flexion points, perineum), determine TBSA of burn (Total Body Surface Area of burn)
-If the TBSA of burn is more than 10% request ALS, monitor ECG and SpO2 levels, and monitor body temperature, transport
-If TBSA of burn is less than 10%, monitor body temperature, transport
-SHOULD COOL FOR ANOTHER 10 MINUTES DURING PACKAGING AND TRANSFER CAUTION WITH HYPOTHERMIA
-CAUTION WITH THE ELDERLY, CIRCUMFERENTIAL AND ELECTRICAL BURNS
External haemorrhage -Adult
Open wound
-Is there active bleeding
-If there is not active bleeding, continue to apply sterile dressing
-If there is active bleeding, determine if it is catastrophic haemorrhage
-If it is not catastrophic haemorrhage, is the wound still bleeding, if it is still bleeding, ALS must treat, if it is not still bleeding, posture, elevation, examination, pressure, continue to apply sterile dressing
-If it is catastrophic haemorrhage, request ALS, Posture, elevation, examination, pressure, If limb injury, apply and mark tourniquet, place 2-3 inches (5-7cm) above wound, not on joint, consider applying a dressing impregnated with haemostatic agent, continue to apply sterile dressing.
-Consider oxygen therapy
-determine if the haemorrhage is controlled
-If it is controlled, determine if there was significant blood loss, if there was ALS must treat, if not, Transport
-If it isn’t controlled, apply additional dressings and determine if this has controlled the haemorrhage
-If it isnt controlled, depress proximal pressure point and determine fi this has controlled the haemorrhage
-If it isn’t controlled, apply tourniquet and determine if this has controlled the haemorrhage
-If it isn’t controlled, ALS must treat
Harness induced suspension trauma
Fall arrested by harness/rope
-Is the patient still suspended
-If the patient is still suspended, advise the patient to move legs to encourage venous return, elevate the lower limbs if possible during rescue and repeat is patent still suspended
-If patient is not still suspended request ALS
-place patient in a horizontal position as soon as practically possible
-Monitor Bp, SpO2 and ECG
-Administer oxygen therapy to maintain SpO2 levels above 94%
-go to appropriate CPG
-Transport
-THIS CPG DOES NOT AUTHORISE RESCUE BY UNTRAINED PERSONNEL
-PERSONAL SAFTEY OF THE PRACTITIONER IS PARAMOUNT
-IF CIRCULATION IS COMPROMISED, REMOVE THE HARNESS WHEN THE PATIENT IS SAFELY LOWERED TO THE GROUND
-CONSIDER REMOVING A HARNESS SUSPENDED PERSON FROM SUSPENSION IN DIRECTION OF GRAVITY IE DOWNWARDS SO AS TO AVOID FURTHER NEGATIVE HYDROSTATIC FORCE, HOWEVER THIS MEASURE SHOULD NOT OTHERWISE DELAY RESCUE
-PATIENTS MUST BE TRANSPORTED TO ED FOLLOWING SUSPENSION TRAUMA REGARDLESS OF INJURY STATUS
Head injury - Adult
Head trauma
-Maintain airway
-Oxygen therapy
-Control external haemorrhage
-Maintain in-line immobilisation
-Carry out AVPU assessment
-If patient is A on AVPU scale, consider ALS, (Paramedic)
-If patient is V, P or U on AVPU scale, request ALS
-consider mechanism of injury, is spinal immobilisation indicated
-Immobilise spine appropriately
-SpO2 and ECG monitoring
-Check blood glucose levels, see glycemic emergency CPG
-Is the patient seizing, see seizures/convulsions CPG
-Consider vacuum mattress
-Transport
Limb injury - Adult
Limb injury
-Consider hypovolaemic shock and go to appropriate CPG
-Establish need for pain relief, consider ALS, go to pain CPG
-Expose and examine limb
-Dress open wounds
-Provide manual stabilisation for injured limb
-Check CSMs distal (farther) to injury site
-Is there a fracture
-If there is a fracture, is it a femur fracture, if it is a femur fracture, request ALS, if it is not a femur fracture apply appropriate splinting device, recheck CSMs and transport
-If there is not a fracture, is there a dislocation or a soft tissue injury
-If it is a dislocation, is it a isolated lateral dislocation of the patella, if yes ALS must treat, if it is not an isolated lateral dislocation of patella splint/support in position found, recheck CSMs
-If it is a soft tissue injury, apply RICE (Rest, Ice/Cooling, Compression, Elevation)
-Recheck CSMs
-Transport
Spinal injury Management
Trauma and concern by practitioner of spinal injury
-Active spinal motion restriction until clinical assessment is complete
-Return head to neutral position unless on movement there is an increase in; Pain, Resistance, or Neurological symptoms
-Rapid extrication with appropriate device if life threat present
-Remove helmet if worn
-Assess risk factors
-Either high risk or low risk factors
-Active spinal motion restriction
-secure to appropriate transportation device
-Transport
-CONSIDER USE OF UNBROKEN CHILD’S SEAT FOR APPROPRIATE AGE GROUP
-SPINAL INJURY RULE IN CONSIDERATIONS
ANY SIGNIFICANT DISTRACTING INJURIES
IMPAIRED AWARENESS (ALCOHOL/DRUG INTOXICATION/CONFUSED/UNCOOPERATIVE/ALOC)
IMMEDIATE ONSET OF SPINAL/MIDLINE BACK PAIN
HAND OR FOOT WEAKNESS (MOTOR ISSUE)
ALTERED OR ABSENT SENSATION IN THE HANDS OR FEET (SENSORY ISSUE)
PRIAPISM
HISTORY OF PAST SPINAL PROBLEMS, INCLUDING PREVIOUS SPINAL SURGERY OR CONDITIONS THAT PREDISPOSE TO INSTABILITY OF SPINE
UNABLE TO ACTIVELY ROTATE THEIR NECK 45 DEGREES TO THE LEFT AND RIGHT
-PHECC SPINAL INJURY MANAGEMENT STANDARD
ACTIVE SPINAL MOTION RESTRICTION (USING INLINE TECHNIQUES WITH OR WITHOUT SPINAL INJURY MANAGEMENT DEVICES TO REDUCE SPINAL COLUMN MOTION
-LOW RISK FACTORS
INVOLVED IN A MINOR REAR-END MOTOR VEHICLE COLLISION
COMFORTABLE IN A SITTING POSITION
AMBULATORY AT ANY TIME SINCE THE INJURY
NO MIDLINE CERVICAL SPINE TENDERNESS
NO SPINAL COLUMN/MIDLINE PAIN
ARE ABLE TO ACTIVELY ROTATE THEIR NECK 45 DEGREES TO THE LEFT AND RIGHT
-HIGH RISK FACTORS
DANGEROUS MECHANISM OF INJURY
FALL FROM A HEIGHT GREATER THAN 1 METRE OR 5 STEPS
AXIAL LOAD TO THE HEAD OR BASE OF THE SPINE
FOR EXAMPLE, DIVING, HIGH SPEED MOTOR VEHICLE COLLISION, ROLLOVER MOTOR ACCIDENT, EJECTION FROM A MOTOR VEHICLE, ACCIDENT INVOLVING MOTORISED RECREATIONAL VEHICLE, BICYCLE COLLISION, HORSE RIDING ACCIDENT, PEDESTRIAN V VEHICLE
IMPAIRED AWARENESS (ALCOHOL/DRUG INTOXICATION/CONFUSION/UNCOOPERATIVE/ALOC)
AGE 65 YEARS OR OLDER
AGE 2 YEARS OR YOUNGER INCAPABLE OF VERBAL COMMUNICATION
Submersion/immersion incident
submersion/immersion in liquid
-request ALS
-remove patient from liquid (provided it is safe to do so)
-remove horizontally if possible (consider C spine injury)
-Is the patient responsive
-If yes, Auscultate lungs
-If no, is there spontaneous breathing, if yes auscultate lungs, if no open airway and give 5 rescue breaths
-is there spontaneous breathing, if yes auscultate lungs, if no, continue ventilations, give oxygen therapy, complete primary survey (Commence CPR if appropriate), ALS must treat further, go to BLS CPG
-Upon auscultating lungs, is there crepitation sounds
-If there is no crepitations, transport to ED for investigation of secondary drowning insult
-If there are crepitation sounds, give oxygen therapy, monitor ECG and SpO2 levels, is there any indications of respiratory distress
-If there are signs of respiratory distress, if bronchospasm give 5mg via NEB if 5 years old or older and 2.5mg if younger than 5 years old), continue to monitor pulse, respirations and Bp
-If there are no signs of respiratory distress, continue to monitor, use, respirations and Bp
-Is the patient hypotensive
-If the patient is hypotensive ALS must treat
-If the patient is not hypotensive, is the patient hypothermic
-If there patient is hypothermic go to hypothermia CPG
-If the patient is not hypothermic, check blood glucose levels and transport
-Do not delay transport, continue algorithm en route
VENTILATIONS MAY BE COMMENCED WHILE THE PATIENT IS STILL IN WATER BY TRAINED RESCUERS
-SPINAL INJURY INDICATIONS;
HISTORY OF DIVING IN SHALLOW WATER
AN INJURY FOLLOWING;
-WATER SLIDE
-WATER SKIING
-KITE-SURFING
-BOAT INCIDENT
ALCOHOL/DRUG INTOXICATION
HIGHER PRESSURE MAY BE REQUIRED FOR VENTILATION BECAUSE OF POOR COMPLIANCE RESULTING FROM PULMONARY ODEMA
Triage trauma tool - Adult
- Abnormal physiology if any of these are true;
-SpO2 is less than 90% on air
-respiratory rate is less than 10 or more than 29
-heart rate is greater than 120 BPM after adequate analgesia
-Systolic blood pressure is less than 90 mmHg at any stage
-glasgow coma scale is less than 13 or deteriorating
If there is abnormal physiology the patient is major trauma positive - Presence of concerning injuries if any of these are true;
-Airway injury or potential airway injury
-hoarseness or stridor
-evidence of respiratory compromise
-cyanosis, crepitus, subcutaneous emphysema
-suspicion of multiple rib fractures
-severe pain
-seatbelt abrasion, contusion, evidence of blunt impact
-significant chest wall trauma
-severe haemorrhage or suspected severe haemorrhage
-arterial bleeding requiring tourniquet control
-suspected open/depressed skull fracture
-signs of base of skull fracture
-more than 2 episodes of vomiting
-seizure following head injury
-head injury if patient on anticoagulants
-head injury with focal neurological deficit
-spinal trauma suggested by new, abnormal neurology
-visible deformity
-priapism
-severe pain
-fracture to 2 or more of femur, tibia, humerus
-major compound fracture or open dislocation
-crushed, degloved, mangled, pulseless limbs
-amputation above wrist or ankle
-all penetrating injuries except isolated superficial limb injuries
-severe pain in abdomen, rigidity, distension or swelling
-seatbelt abrasion, contusion, evidence of blunt impact
-suspected major pelvic fractures
-more than 20% burn surface area
-suspected respiratory tract burn
if the presence of any of these are true, a major trauma positive - presence of concerning mechanism of injury
-A fall heater than 3m or twice the patients height
-fall of ladder greater than 1m
-collision with, fall off or trampled on by a large animal
-A death occurred in the same vehicle in a RTC
-Ejection
-Significant intrusion
-intrusion with compression
-damage to a post of vehicle
-prolonged extrication time (>30 m)
-motorcycle faster than 30KPH
-Any pedestrian v vehicle
-Bullseye windscreen
-High speed RTC greater than 60 KPH
-High voltage electrocution
-isolated burns may be considered for triage direct to burns unit
-Any rapid declaration incident
-Available information consistent with high risk of injury
-Focal blunt trauma to head or torso
if a presence of any of these, crew discretion of major trauma positive
if major trauma positive Provide ASHICE message, if no major trauma positive in any of the 3 situations, Consider ASHICE message and transport to nearest trauma-receiving ED (or MTC if in catchment)
-after ASHICE message provided, advise HSE trauma desk of major trauma patient and destination
-if transport time is less than 45 minutes to MTC
-Transport to MTC
-IF TRANSPORT TIME IS MORE THAN 45 MINUTES TO MTC CONSIDER RENDEZVOUS WITH CRITICAL CARE TEAM
-IN CASES WHERE TRANSPORT TIME IS BORDERLINE CONTACT HSE TRAUMA DESK FOR DECISION SUPPORT
-MOI CRITERIA IS NOT EXCLUSIVE OR ABSOLUTE, ANY SIGNIFICANT BODY INJURIES INVOLVING MORE THAN ONE BODY REGION OR REQUIRING SPECIALIST CARE TO PRESERVE LIFE, LIMB OR QUALITY OF LUFE SHOULD BE CONSIDERED FOR TRIAGE TO MTC
-MTC = major trauma centre
