Skills Flashcards
How long should it take to complete a primary survey?
90 seconds
Do you treat as you go in the primary survey?
yes
What are the components of the primary survey?
Initial impression
* Reaction to & appropriateness of verbal response to greeting
* perfusion and posture
* distress or discomfort
Airway + spinal management if required
* consciousness
* ability to take a deep breath
* ability to speak a full sentence (word/phrase/sentance’)
Breathing
* Look, listen & feel
* RR (15 seconds x 4)
* work of breathing (effort & efficacy)
* Auscultate breath sounds
Circulation + arrest life threatening haemorrhage
* Examine for life-threatening haemorrhage
* Count pulse rate (15 seconds x 4)
* Assess pulse volume & rhythm
* Assess peripheral & central perfusion
- Skin temperature
- Skin colour
- Central & peripheral cap refill
Disability/Dysfunction (neurological)
* Measure LOC (AVPU or GCS)
* Check pupil size & function
* Assess ability to walk, if appropriate to do so
* Assess ability to move limbs
Exposure/environment
* Expose and inspect torso and limbs
Focused Hx & adjuncts
* Blood Pressure
* BGL
* Pulse oximetry
* Measure tympanic temperature
* ECG
* Calculate Worthing Physiological Score
Ask questions
* What is the main problem you have called the ambulance for today?
* Do you currently have chest pain or breathing difficulty?
* With respect to the problem that you called the ambulance for today:
- When did it start?
- What were you doing when it started?
- How severe is it at the moment?
- Is it getting better or worse?
What are the components of the secondary assessment?
Head
- Posteriorly / laterally - check nose and ears for blood, foreign bodies & CSF & check for facial #
- Assess pupils using pupil torch - PEARL
- Ask Pt to bite and to run tongue around inside of teeth
Neck
- Assess spinal cord function - squeeze both hands wiggle toes numbness/tingling
- Assess jugular vein for distension
Chest/breast
- Assess chest movement - Pneumo/Haemo/Tension Pneumothorax, sucking chest wound, subcutaneous emphysema, tracheal deviation, unequal chest movement, trauma, Oedema/erythema/purpura
- Gently spring the ribs
Abdomen
- Palpate the abdomen across all regions - assess for distension, rigidity, guarding & palpate the presence of femoral pulses as indicated
Pelvis/Genitalia
- Protect modesty and privacy
- Localised trauma
- Oedema / erythema / purpura
**Upper and Lower limbs **
- Assess distal perfusion and pulses - If no # or dislocation is suspected confirm this by asking the Pt to move each limb
- Ensure palpation of all bones is performed, e.g. upper limb from clavicle and scapula to fingers
Back and Spine
- Maintain spinal alignment - log roll
- Check in natural hollows for trauma
- Palpate carefully along the spine for tenderness and deformity
Take the History
- Record chief complaint
- Assess pain - OPQRST
- Ascertain treatment given prior to your arrival
- If the Pt unconscious prior to your arrival, was it continuous and how long
- Obtain an AMPLE history
Non-Invasive Ventilation - CPAP Procedure
- Place pt in seated position
- Explain procedure to the pt (their understanding and cooperation is essential for successful CPAP)
- Prepare equipment
- Select the appropriate size face mask ensuring the inner circumference of the air cushion encompasses the bridge of the nose, side of the mouth and inferior border of the bottom lip (with mouth slightly open)
- Size 4 - small adult (red)
- Size 5 - large adult (blue)
- Attach the vectored flow valve to the mask and the oxygen tubing, ensuring harness connector remains in place
- Connect the oxygen tubing to a standard 15 L/min oxygen flow metre
- Adjust oxygen flow rate to L/min to generate 5cm H2O continuous positive airway pressure
- Monitor patient’s response to treatment (resp rate, SpO2, BP, chest sound & WOB) and increase airway pressure every 3-5 mins to a maxiumum of 15 cm H2O
- If the pt shows evidence of deterioration, discontinue CPAP immediately and treat in accordance with appropriate CPG
Where can standard or haemostatic gauze be used to stop bleeding?
- Junctional areas (Groin, axilla, neck, buttocks, perineum)
- Deep extremity puncture wounds
What is the procedure for standard or haemostatic gauze dressing?
- Apply direct pressure to slow bleeding
- Expose wound and sweep blood away with fingers to
identify source of bleeding - Pack gauze towards source of bleeding
- Maintain pressure continuously during packing
- Pack aggressively until wound is tightly packed with gauze
- Hold three minutes of forceful direct pressure over
gauze and wound
What are the indications for CPAP?
Cardiogenic Pulmonary Oedema with:
* Stable + basal crackles – If nil response to oxygen and GTN +/- frusemide
* Increased WOB and/or mid zone to full field crackles – concurrently with pharmacology
What are the contraindications for CPAP?
- LOC = P or U
- Epistaxis
- Facial Trauma
- Active vomiting
- SBP <90mmHg
- Hypoventilation
- Pneumothorax
What are the complications of CPAP?
- Corneal drying
- Aspiration
- Barotrauma
- Hypotension
- Gastric distension
What is the CPAP procedure?
- Ensure patient is sitting
- Explain procedure and obtain consent
- Select appropriate sized face mask
− Small Adult Size 4 (red)
− Large Adult Size 5 (blue) - Attach filter to mask
- Attach vectored flow valve to filter and oxygen tubing
- Adjust oxygen flow rate to 8 L/min for 5cm H2O CPAP
- Position mask on patient’s face and secure using harness to achieve a comfortable, air tight seal
- Check the mask and tubing for leaks
- Increase airway pressure (as required) every 3-5 mins to a maximum of 15 cmH2O (15 lpm)
- Continue to monitor patient and response to treatment (RR, SpO2, ETCO2, Breath sounds, WOB, BP)
What are the indications for PEEP?
whenever using bag valve mask (BVM)
What are the contraindications for PEEP?
Pneumothorax
What are the complicatins of PEEP?
- Aspiration
- Gastric distension
- Hypotension
- Barotrauma
- Pneumothorax
- Breath stacking/ over-inflation
What is the procedure for PEEP?
- Set PEEP value by turning adjustment knob counter-clockwise
- Remove expiratory flow diverter from resuscitation bag and replace with disposable PEEP valve
- Attach capnography
- Attach filter directly onto face mask or advanced airway
- Provide high flow O2 via BVM (15L/min)
- If hypoventilating, commence bag valve mask resuscitation
- If SpO2 not improving after 5 mins increase PEEP by 5cm H2O to a maximum of 10cm H2O
- Continually monitor patient and response to treatment
- Discontinue PEEP if patient deteriorates (cardiovascular collapse, ineffective ventilation)
