clin pac 6 > Skills paediatric > Flashcards
Skills paediatric Flashcards
Paediatric assessment triangle
What are the 3 titles
Work or breathing
Circulation to skin
Appearance
Paediatric assessment triangle
Work of breathing
- abnormal breath sounds
- abnormal positioning
- retractions
- nasal flaring
- grunting
- head bobbing or pursed lip breathing
Paediatric assessment triangle
Circulation to the skin
- pallor
- mottling
- cyanosis
Paediatric assessment triangle
Appearance
- tone
- interactiveness
- consolability
- look/gaze
- speech/cry
Paediatric assessment triangle
Tone: well
active, reaching, moving, strong grip
Paediatric assessment triangle
Tone: unwell
still, floppy, quiet
Paediatric assessment triangle
Interactivity: well
interested in the environment, looking, smiling
Paediatric assessment triangle
Interactivity: unwell
not interested in their surroundings
Paediatric assessment triangle
Consolability: well
easily comforted/consoled
Paediatric assessment triangle
Consolability: unwell
inconsolable
Paediatric assessment triangle
look/gaze: well
look at caregivers or items of interest
Paediatric assessment triangle
look/gaze: unwell
staring, not engaging in eye contact
Paediatric assessment triangle
speech/cry: well
cries
Paediatric assessment triangle
speech/cry: unwell
moaning, grunting or quiet
Principles of safe drug administration
Right patient
Right drug
Right time
Right dose
Right route
Right documentation
Paediatric pain assessment (FLACC)
0 points
Face
- no particular expression or smile
Legs
- normal position or relaxed
Activity
- lying quietly, normal position, moving easily
Cry
- No cry (awake or asleep)
Consolability
- content, relaxed
Paediatric pain assessment (FLACC)
1 points
Face
- occasional grimace or frown, withdrawn disinterested
Legs
- uneasy, restless, tense
Activity
- squirming, shifting back and forth, tense
Cry
- moans or whimpers, occasional complaints
Consolability
- reassured by occasional touching, hugging, or being spoken to, distractible
Paediatric pain assessment (FLACC)
2 points
Face
- frequent to constant frown, clenched jaw, quivering chin
Legs
- kicking or legs drawn up
Activity
- arched, rigid or jerking
Cry
- crying steadily, screams or sobs, frequent complaints
Consolability
- difficult to console or comfort
Head-toe traumatised
HEAD
Overall looking for
Lacerations/Deformity/Facial muscle/Asymmetry
General crepitus, bony tenderness, subcutaneous emphysema (air under the skin)
Irregular pupils (one really dilatated, bleeding – PEARL)
Racoon eyes (base skull fracture)
Bruising behind the ear (battle sign) – base skull fracture
CFS fluid/if bleeding will be a yellow colour
Halo sign – put cloths in ear and there may be blood in the centre and then yellow around the outside
Teeth – broken/smashed/missing (run tongue around the mouth) – bleeding cuts in the mouth or swelling of the tongue
Bleeding/cute/laceration
Boggy mass – skull fracture
La fate fractures/jaw (clench teeth and does it feel different)
Nose fracture/ deformity, bleeding
Headaches/amnesia/lightheaded/dizzie/tinnitus (ringing or buzzing in the ear)/photosensitivity
Singed facial hairs for burns, soot and swelling/oedema (also look in the throat)
NECK
Deformity/laceration/raised JVP (jugular venous pressure – not easy to see)
Bony tenderness, carotid pulse
Tracheal deviation – tension pneumothorax (signs = sharp chest pain, increased respiratory rate, shortness of breath, decreased BP)
Hoarseness voice (struggle to swallow)
C spine deformity/pain – feel the c spine itself (increased bumpiness, bone out of line, tenderness/pain
CHEST
Expansion/laceration/deformity/accessory muscle movement/tenderness
Paradoxical breathing (failed chest, rib fracture 3 ribs in 2 or more places) – due to the negative and positive pressure
C3/C4/C5 nerves – control the diaphragm (also paradoxical breathing)
Apply gentle pressure (spring the ribs)
Check the sternum
Look for fractures or dislocations
Shallow breathing/diminish breathe sounds
Subcut emphysema – air pockets under the skin (tension pneumothorax)
Heart sounds, air entry and breath sounds, or additional sounds
ABDOMEN
laceration/bruising/distension (bloating and swelling)
rigidity/guarding/grimacing
Check-in quadrants – 4 (right and left upper and lower)
The right upper – portion of the liver, gallbladder, right kidney, a small portion of the stomach, portions of the ascending and transverse colon, and parts of the small intestine
Left upper – the left portion of the liver, the larger portion of the stomach, the pancreas, left kidney, spleen, portions of the transverse and descending colon, and parts of the small intestine
Right lower – the cecum, appendix, part of the small intestines, the right female reproductive organs, and the right ureter
Left lower – the majority of the small intestine, some of the large intestine, the left female reproductive organs, and the left ureter
The liver and spleen are not hollow so are more likely to cause an issue
Distension (pushed outwards) – due to fluid retention in the bladder/peritoneal cavity (can hold 5 litres) (contains the organs??)
Roll motion to see whether it is soft or firm
PELVIS
Laceration/bruising/deformity
Checking for alignment - shortening if the leg
Checking for pain - light palpation
Bony tenderness
Lift leg to see if they can do that
LIMBS
Laceration/bruising/deformity
Shortening
Rotating
Pain
Open wounds
Check movement – does it hurt
Checking if not able to move a particular way
Neurovascular status
Check cap refill – checking blood supply to limbs
No cap refill (single) = Compartment syndrome, clots
No cap refill on both = may be an injury higher up, or there is a perfusion injury
Check sensation, push-pull, sensation
Compare limbs to each other
BACK
Laceration/deformity/bruising
Bony tenderness
Evidence of a bony step
Subcutaneous emphysema
Pain
Check spine is in place
5Heads
To determine TBI there could be any of the following
- GCS = 13-15
- Mechanism of injury of blunt head/face trauma
loss of consciousness and/or +/- amnesia
- With the following 1 or more of:
5Heads
- Any loss of consciousness exceeding 5 minutes
- Skull fracture (depressed, open or base of the skull)
- Vomiting more than once
- Neurological deficit/pupil action or decreased GCS or spinal issues
- Seizure
Unconscious patient
AEIOUTIPS
A
- alcohol (Confusion, Dysphasia, Unsteady Gait, Aggressive/Bizarre behaviour)
- acidosis
- arrhythmia
- asthma (Difficulty breathing, Bronchospasm, Cough)
- anaphylaxis (Difficulty breathing, Nausea, Vomiting, Diarrhoea, Rash - Hives, Urticaria, Hypotension)
E
- epilepsy (Seizure activity, Rapid onset, Urinary incontinence)
I
- infection/sepsis (Tachypnoea, Tachycardia, Diaphoresis, Hypotension)
O
- Overdose (Opioids) - Hypotensive, Bradycardia - pin point pupils
- Overdose (Amphetamines) - Anxiety, Tachycardia, Diaphoresis, Seizure - dilated pupils
U
– underdose
- uremia (Uremia is a buildup of toxins in your blood. It occurs when the kidneys stop filtering toxins out through your urine) - Confusion, Fatigue, Cramping in legs
T
- trauma (Perform a Head-Toe Secondary Survey)
I
– insulin hypoglycemia (Abnormal respiratory pattern. Pale, cold and clammy skin, Tachycardia)
– insulin hyperglycemia (Increased respiratory rate, Polyuria, Polydipsia, Polyphagia, Dehydration)
- Infarction (Diaphoretic, Anxious, Pale, Tachycardic, Hypotensive)
P
– pain (FLACC)
– psychiatric/mental health (Bizarre Behaviour, Preform a Mental Status Assessment)
– pregnancy
S
– stroke (Dysphasia, Unsteady Gait, Facial droop, Unequal hand grip strength)
- TIA/syncope (fainting)
Sedation assessment - SAT assessment
+3
Responsiveness
- combative, violent out of control
Speech
- continual loud outburst
Sedation agent
KETAMINE
IM
- <60kg: 200mg
- 60-90kg: 300mg
- >90kg: 400mg
IV
50-100mg
need to put restraints on the patient
(also monitor patient’s airway, and blood pressure, add high flow oxygen, call MICA and watch out for hyper-salivation and watch their temperature)
Sedation assessment - SAT assessment
+2
Responsiveness
- very anxious and agitated
Speech
- loud outburst
Sedation agent
DROPERIDOL - IM/IV
- 5-10mg repeat 5-10mg after 15 minutes if required (once only) OR
- 5mg (<60kg/frail/elderly/sedation from drugs or alcohol) repeat 5mg after 15 minutes if required (once only)
think about whether you need to use restraints and put on after sedated the patient
Sedation assessment - SAT assessment
+1
Responsiveness
- anxious/restless
Speech
- normal/talkative
Sedation agent
OLANZAPINE - ORAL
- 10mg repeat initial dose after 20 minutes if required (once only) OR
- 5mg (<60kg/frail/elderly/sedation from drugs of alcohol) repeat initial dose after 20 minutes if required (once only)
Sedation assessment - SAT assessment
0
Responsiveness
- awake and calm/cooperative
Speech
- speaks normally
Sedation
- none
Sedation assessment - SAT assessment
-1
Responsiveness
- Asleep but rouses if name is called
Speech
- slurring or prominent slowing
Sedation
- none
Sedation assessment - SAT assessment
-2
Responsiveness
- responds to physical stimulation
Speech
- few recognisable words
Sedation
- none
Sedation assessment - SAT assessment
-3
Responsiveness
- no response to stimulation
Speech
- none
Sedation
- none
Oral medication how to give
Check your 6 rights
- Right patient
- Right medication (check with your partner date and the actual medication presentation/contraindications)
- Right route (contraindications to be able to have it - unable to tolerate oral medication/vomiting, difficulty swallowing, supine positioning, unable to comprehend instruction)
- Right dose (calculate the weight if needed as well as the right mL)
- right time (when to give a repeat dose if needed)
- right education (explain why you are giving it to them and what it will help with if needed, also explain how to
take the medication whether to swallow or let it sit under the tongue or on the cheek)
- Right to refuse (obtain content)
- Right documentation
IM Injection (specifically Ceftriaxone)
check 6 rights
- Right Patient
Indicated for: Suspected Meningococcal Septicaemia
- Right Medication (incl. Right Date)
Read out loud, verify the name, and expiry date on the packaging.
Ceftriaxone 1gm (1000mg)
Lidocaine 1%
No contraindications (Ceftriaxone):
Allergy to Cephalosporin.
Consider precautions:
Allergy to Penicillin
No contraindications (Lidocaine):
Hypersensitivity to lidocaine or related local anaesthetics (bupivacaine, levobupivacaine, prilocaine, ropivacaine).
Consider precautions:
Inadvertent intravascular administration may result in systemic toxicity
- Right Route Intramuscular
- Right Dose
Calculate and/or state the correct weight and dose.
- Right Time
Check the correct time for administration as indicated/prescribed.
Check frequency required.
No repeat dose; Single dose only
- Right Education Discuss and explain the procedure with patient and/or their guardian.
- Right to Refuse
Obtain informed consent.
ACTION
- prepare equipment and hand hygiene with gloves
Select syringe for use.
- 5ml syringe, select and attach appropriate non-bevelled/blunt drawing-up needle to the syringe
Verify Lidocaine 1% plastic ampoule:
- Twist cap to expose the opening on the lidocaine plastic ampoule.
- Invert plastic ampoule.
- Push/place the uncapped needle say “Sharps Out” in the opening.
- Keep tip in the fluid level
- Withdraw syringe plunger to aspirate 3.5mls of lidocaine
Verify Ceftriaxone vial:
- Remove cap
- Clean stopper with antiseptic/alcohol swab and allows >30 seconds to dry.
- Insert needle and syringe with lidocaine into the stopper of ceftriaxone vial.
- Inject lidocaine into ceftriaxone vial, keep the needle in place, and gently shake/rotate/stir (solute required to dissolve a solid substance first)
When solution is ready:
- Invert vial,
- Withdraw needle slightly to keep tip in/below the fluid level,
- Withdraw syringe plunger to aspirate required ceftriaxone-lidocaine solution
Preparing to give meds:
- Attach medication label to syringe. Accompany with ampoule/vial for verification.
- Keep syringe tip covered within Ceftriaxone vial. Place syringe and vial on clean surface or suitable dish, ready for use. Do not recap needle (to maintain asepsis and avoid needlestick injuries)
When preparing actual medication
- prepare equipment and hand hygiene with gloves
- Select injection site appropriate to the patient and the medication involved.
- Expose site by removing clothing as necessary.
- Position patient to expose and relax the muscle.
- Ensure sharps waste container is conveniently within reach
- Select and attach appropriate bevelled needle to syringe (non-bevelled/Drawing up needle can be left in the vial and discarded)
- Verify, prepare and draw medication into syringe
- Discard excess medication to amount to be administered
When injecting:
- Anatomically locate the injection site.
- Prepare site by antiseptic swabbing in concentric circles.
- Uncap needle, state “Sharps out”
- Use Z-track method to hold skin taut over site with non-dominant hand.
- Hold syringe in dominant hand. Push needle firmly and quickly into injection site, using either dart or push method, in one continuous motion at 90 degrees until needle hub is reached or 2/3 the way in
- With needle injected, pull plunger back and inspect it for blood return (If blood does return, withdraw needle, discard, prepare new syringe and repeat)
- If no blood returns into syringe, push plunger in to inject medication at rate of 1 mL per 5–10 seconds.
- Once medication has been injected, hold needle in place for several seconds.
- Withdraw needle quickly and discard immediately into sharps waste container stating, “Sharps away”
- Release Z-track tension
- Press over site for 10 seconds
- Monitor patient for medication effectiveness and adverse effects
- Accurately document/hand over findings, including therapeutic benefit or adverse reaction
Assembling and connecting an intravenous giving set
check 6 rights
- Right Patient
Indicated for:
Suspected expansion of intravascular volume in the non-cardiac, non-hypovolaemic hypotensive patient e.g. … sepsis
- Right Medication (incl. Right Date)
Read out loud, verify the name, and expiry date on the packaging.
- Normal Saline 500ml / 1000ml
No contraindications: Nil of significance in the above indication.
Consider precautions: Ensure aseptic techniques is practised at all times/do not re-spike fluid bags
- Right Route:
Intravascular via a giving set
- Right Dose:
- Right Time
Preparing equipment
- Open the outer pouch of Normal Saline and Check clarity of solution.
- Keep in the pouch, or place on a clean surface and obtain an IV administration/giving set.
- Open packaging and place on inside of packaging, or on a clean surface
Hand Hygiene/protecting the packaging:
Wash/sanitise hands and don gloves.
Pick up the administration/giving set from its packaging, ensuring that you hold on to both ends.
- Do not remove protective caps.
- Move the roller clamp/drip regulator towards and just below (about 5 cm) the drip chamber.
- Tighten the clamp/drip regulator.
Spike the fluid bag:
- Pick up the fluid bag of Normal Saline and remove the seal exposing the port.
- Remove the protective cover from the spike on the IV administration/giving set
- Rest the fluid bag on a flat, clean surface
- Hold the side of the port with the fingers of your non-dominant hand.
- With your dominant hand, firmly push the spike into the port, with a slight twist, to the length of the spike.
- Take care not to touch the outer edges of the port.
Prime the bag
- Pick up and/or hang the fluid bag
- Gently squeeze and release the drip chamber until the drip chamber is half-full
- Ensuring the roller clamp/drip regulator is closed.
- Gently turn on/open the roller clamp/drip regulator and allow fluid to fill the giving set/line.
- Hold the distal end of the giving set/line higher than the drip chamber, to expel the air and not spill fluid
- Or hold the line over a kidney dish.
- When the giving set/line is full and there are no air bubbles, close the roller clamp
- If there are air bubbles: Keep the line straight between the bubble/s and the drip chamber - Gently tap/flick the line at the air bubble/s and bubbles will dislodge from the line and ascend into the drip chamber.
- Do not remove the protective cap at the end of the giving set/line until required for administration.
Nebuliser Mask administration with nebulising solution
check 6 rights
- Right Patient Indicated for:
* Severe respiratory Distress with suspected bronchospasm (Asthma). Consider breathing difficulty and suitability for pMDI vs nebulised delivery.
- Prepare equipment:
Obtain nebuliser mask, Salbutamol nebules and Ipratropium bromide nebules
- Right Medication (incl. Right Date)
Read out loud, verify the name, and expiry date on the packaging.
* Salbutamol (5mg/2.5mls)
* Ipratropium Bromide (250mcg/1ml
No contraindications (Salbutamol):
* Nil of significance in the above indications.
Consider precautions:
* Large doses can cause intracellular metabolic acidosis.
No contraindications (Ipratropium Bromide):
* Known hypersensitivity to Atropine or its derivatives.
Consider precautions:
* Glaucoma.
* Avoid contact with the eyes.
- Right Route
Nebulised.
- Right Dose
State the correct dose (Salbutamol).
* Adult/Critical: 10mcg (5ml)
* 12 – 15yrs: 5mg (2.5ml)
* 5 – 11yrs: 2.5 – 5mg (1.25-2.5mls)
* 2 – 4yrs: 2.5mg (1.25mls)
State the correct dose (Ipratropium Bromide).
* Adult: 500mcg (2ml)
* 12 – 15yrs: 500mcg (2ml)
* 5 – 11yrs: 250mcg (1ml)
* 2 – 4yrs: 250mcg (1ml)
- Right Time
Check correct time for administration as indicated/prescribed.
Check frequency required (Salbutamol).
* Repeat dose after 20 mins until resolution of symptoms.
* If Adult/Critical:
o Repeat/top up 5mcg (2.5ml) every 5 mins until resolution of symptoms.
Check frequency required (Ipratropium Bromide).
* Single dose. No repeat.
- Right Education
Discuss and explain the procedure with patient and/or their guardian.
Prepare paramedic/equipment
- Hand Hygiene
- Unpack Nebuliser Mask and straighten tubing, oosen head elastic strap to its fullest length. Unscrew the cap from the nebuliser cup bottom. Twist top of nebule/s and remove, squeeze the contents of the nebule into the nebuliser cup.
- If a smaller dose is prescribed, like 2.5mg/1.25mls, use a 3ml syringe with a blunt/drawing up needle. Aspirate from the nebule the required volume, then gently push into the nebuliser cup.
- Replace the cap on the nebuliser cup.
- Take care not to lose/spill the liquid.
- Attach nebuliser to the mask
- Attach oxygen tubing to nebuliser.
- Attach oxygen tubing to flow meter. Set flow rate.
- Acknowledge minimum flow rate for device (8lpm).
- Ensure that medication is misting.
- Ensure malleable mask nose clip is wide enough to easily fit over nose.
Apply mask:
- Place mask over the nose and lower it to cover chin. - - Ensure mask sits neatly over nose and symmetrically over face.
- Gently pinch malleable nose clip to mould mask to face.
- Adjust elastic to hold mask in place. Confirm comfortable fit.
- Reassure that medication is appropriately misting.
- Document/hand over administration dose/time.
Oropharyngeal Airway Insertion
Paediatric
Prepare paramedic
- PPE
check 6 rights
- Right patient (Unconscious patient who requires support for airway patency) and check for
Contraindications:
* Trismus
* Gag Reflex
* Traumatic Brain Injury (TBI) / non TBI with adequate ventilation/oxygenation.
Position patient:
Place patient’s head in required anatomical position.
Neutral: external auditory meatus is in line with the middle of the clavicle.
Sniffing: external auditory meatus is raised so it can be seen on the same plane as the sternal angle.
Adult
o Neutral: 2-5cm padding behind the occiput.
o Sniffing: 7-9cm padding behind the occiput.
Large Child
o Neutral: No padding required.
o Sniffing: Padding behind the occiput.
Small Child
o Neutral: Padding behind the shoulders.
o Sniffing: Padding is placed beneath the neck.
Infant
o Neutral: Padding behind the shoulders.
o Sniffing: Padding is placed beneath the neck.
Or allowing effective paramedic access to head and face (if unable to move patient)
Patient airway:
Ensure adequate FBAO clearance has been performed before insertion. (If there is copious vomitus, consider definitive airway management.) Provide simultaneous jaw thrust if support personnel are available.
Measure OPA size:
Measure appropriate size OPA using chosen method. Place:
* One end against the angle of the jaw and the other reaching the central incisor on that side.
* One end against the tragus and the other reaching the corner of the mouth on that side
Insert OPA
- Hold the OPA by the flanged end.
- Lubricate the selected OPA (with water, patient saliva) if necessary.
- Adult: Insert distal end into patient’s mouth, inverting curve in opposition to oral cavity.
- Child: Insert directly without inversion.
- Slide the OPA forwards approximately halfway into the mouth between the hard palate and tongue.
- Adults Only: Rotate the device 180°. Continue insertion until flange sits against lips without being pinched against teeth. Apply jaw thrust to ensure OPA seats in oropharynx.
Reassess and report:
Ensure no airway reflex is triggered by placement and that respiratory status is effective. Remove if airway reflexes are present.
Ventilation: IPPV / APPV
Prepare paramedic:
- hand hygiene
Position patient
- Place patient’s head in required anatomical position.
Neutral: external auditory meatus is in line with the middle of the clavicle.
Sniffing: external auditory meatus is raised so it can be seen on the same plane as the sternal angle.
Adult
o Neutral: 2-5cm padding behind the occiput.
o Sniffing: 7-9cm padding behind the occiput.
Large Child
o Neutral: No padding required.
o Sniffing: Padding behind the occiput.
Small Child
o Neutral: Padding behind the shoulders.
o Sniffing: Padding is placed beneath the neck.
Infant
o Neutral: Padding behind the shoulders.
o Sniffing: Padding is placed beneath the neck.
Patient airway and prepare equipment:
- Remove mechanical/foreign body obstructions as required
- attack oxygen
Ventilate patient:
Provide ventilation rate and tidal volume as
Adult
o Rate: 12 - 16 vent/min (Asthma 5-8)
o TV: 6-7ml/kg
Large Child
o Rate:16 - 34 vent/min (Asthma 10-14)
o TV: 5-10ml/kg
Small Child
o Rate: 20 - 40 vent/min (Asthma 12-15)
o TV: 5-10ml/kg
Infant
o Rate:25 - 60
o TV: 5-10ml/kg
* Newborn
o Rate:40-60 vent/min
o TV: 5-10ml/kg
Report
Lateral Chest Pressure
paediatric
Prepare paramedic:
- Hand Hygiene
Right Patient Indicated for:
* poor or no ventilation but still has a cardiac output
Precautions
* Paediatric patient’s chest wall will be more compliant, therefore care must be taken to ensure gentle pressure is applied
Prepare patient
- Can be performed with patient in any position.
Apply:
- Compress the chest medially:
* Coordinate with patient’s expiratory effort.
o If IPPV is being performed, compression commences on the cessation of each positive pressure ventilation.
* DO NOT compress during patient’s inspiration.
Compression must be SLOW, GENTLE, rhythmic, and sustained to assist in forcing air out.
Reassess and report findings
Chest compression
Paramedic
- hand hygiene
Prepare patient:
- Position patient supine with adequate space surrounding them. Expose patient’s chest.
Position hands:
- Adults: Place heel of one hand in the middle of the lower half of the sternum and the other hand on top of the first, with fingers interlacing.
- Children: Place heel of one hand in the middle of the lower half of the sternum (use only one hand).
- Infants: Use two fingers or two thumbs over lower half of sternum.
Apply compressions:
Compress the chest one-third anterior/posterior depth:
- Adults and children – 5 cm
- Infants – 4 cm.
- Compression recoil: Release each compression and allow full recoil before recompressing. Maintain hand contact with the chest without applying any pressure.
- Compression rate: Continue compression and recoil at a rate of 100–120 per minute.
- Alternate rescuers: Change rescuers every 2 minutes if possible.
- Minimise interruptions: Minimise interruptions to compressions (< 10 seconds when necessary).
Report
Defibrillation
Prepare equipment:
- Position defibrillator to maximise operator view yet not interfere with resuscitation efforts.
Ensure pad type is correct for the patient’s age.
* Paediatric Pads <25kg (0-8 years)
* Adult Pads > 25kg (9+ years)
Assess quality of gel and that wires/connections are undamaged
Prepare patient
If required:
* remove or cut away sufficient clothing to expose chest.
* remove medication patches, jewellery, or ECG electrodes.
* clip chest hair (if considered thick enough to interfere with electrode attachment)
* dry the chest (with towel if available).
Check Pads:
Open packaging and assess quality of gel and that connections are undamaged.
Position pads
The ‘Apex’ pad is rolled on the left, at the mid-axillary line. 6th intercostal space.
* For smaller paediatrics place laterally around to the back.
* Alt. Anterior-Posterior
Roll pads on to avoid air pockets. Ensure correct contact/adhesion.
- The ‘Sternal’ pad rolled on laterally from the right sternal margin on the patient’s right chest, under the right clavicle and above the right nipple. Avoid breast tissue, pacemakers and ICDs, placement over sternum and contact with patient’s neck.
- For paediatrics, extend the onto the shoulder, avoiding the neck.
Pause compressions to apply feedback puck:
- The feedback puck can be separated to facilitate accurate placement.
- Roll pads on to avoid air pockets. Ensure correct contact/adhesion.
Charge defibrillator to recommended level.
* Adult: 200 J
* Paediatric: 4 J/kg (max. 200 J)
Hands off
Evaluate rhythm
Defibrillate or disarm
Continue resuscitation
Report
Verbal De-escalation
Prepare paramedic:
- Don PPE, including eyewear, respiratory mask, and gloves.
Self-Awareness:
- Conscious of own beliefs, values, and identity.
- Understand and be aware of emotional reactions, thoughts, and communication skills.
Nominate who will lead the interaction
- Allow time.
- Do not rush
Non-Verbal
- Maintain an open and relaxed posture (by not crossing your arms, placing hands on hips or in pockets, finger wagging/prodding, or clenching fists)
- Use culturally appropriate eye contact to show interest in the patient (Attempt to be at the patient’s eye level)
- Explore the environment with your eyes to recognise patient’s interests, including cultural boundaries.
- Respect the patient’s personal space (give at least two arms length, do not stand over the patient, minimise sudden movements)
Prepare patient:
- Introduce yourself and your role, explaining that you are hear to help (also introduce your partner and/or other services)
- Ask for and use their preferred name (Consider enquiring about other cultural characteristics, such as: Aboriginal and/or Torres Strait Islander identity, Pro-nouns., Gender Identity)
Prepare the environment
- Remove bystanders and unnecessary staff
- Consider the impact of sensory needs (lighting, noise, sensory items)
- Keep exits clear and accessible
- Remove potentially dangerous items
- Make available food, drink, toilet, and bedding
- Allow appropriate access to phone calls.
- Consider nicotine therapy, or a replacement.
Listening
- Actively listen to observe, hear, and understand the patient, by using: (Verbal remarks, Facial expressions, Verbal encouragers (e.g. ‘uh-huh’, ‘go on’).
- Use of silences to allow the patient to consider their responses.
Clarification
- Clarify to determine that the message being sent is what you are hearing or understanding.
- Paraphrase to reflect/clarify what was said.
Feedback
- Interaction should:
* Be respectful.
* Thoughtful
* Honest
* In a friendly tone of voice.
* Verbalise observed behaviour and information (e.g. you seem upset).
* Concerned and interested tone of voice
* Summarise overall points discussed.
* Be centred on their needs.
o Avoid personal information, views, or feelings.
o Avoid threats, orders or advice.
o Avoid arguing points.
Questioning
Questions should be:
* Clear
* Concise
o Address only one topic.
* Easily understood.
o Use simple words
* Open-ended.
* Used to explore information.
Find solutions
Find solutions by:
* Working together to compromise and problem solve.
* Being flexible
* Offering realistic choices and options
* Explain and give reasons for rules and decisions.
* Ask “Is there anything I can do to help us work through this together?”
* Apologise if the solution did not work as expected.
Report
Document and hand over procedure and responses.-
mental illness assessment
Look for, listen to and ask about all the categories below
The patient may be suffering from some of the following examples
- remember verbal de-escalation strategies, active listening and calm/open language
OBSERVE
Initial approach When moving towards the patient, note when they open their eyes:
- spontaneously on approach,
- on verbal exchange,
- in response to pain, or
- no response.
Safety
- paramedic, patient and bystander safety is the first priority. Assess the scene for dangers (I.e. location, weapon). Obtain police support, early if required. Maintain vigilant reassessment of scene safety.
Appearance (Determine whether the patient is alert, lethargic, obtunded, stuporous or comatose)
- look for signs indicative or mental health issues or poor self-caring; uncleanliness, dishevelled, malnourished, sings of addiction (injection marks/nicotine stains) posture, pupil size and odour.
Behaviour
- patient may display; odd mannerisms, impaired gait, avoidance or overuse of eye contact, threatening or violent behaviour, unusual motor activity or activity level (i.e. wired or buzzing): buzzard/inappropriate responses to stimuli, pacing.
Affect
- observed to be; flat, depressed, agitated, excited, hostile, arguments, violent, irritable, morose, reactive, unbalanced, bizarre, withdrawn ect.
LISTEN
Orientation (person/ place/time)
- Ask the patient what their name is, where they are, and what day, month and year this is.
Speech
- Take not of; rate, volume, quantity, tone, content, overly talkative, difficult to engage, tangential, flat, inflections ect.
Thought process
- may be altered, can be perceived by patient jumping irrationally between thoughts, sounding vague unsteady thought flow when communicating verbally
Cognition
- may be exhibiting signs if impairment such as; poor ability to organise thoughts, short attention span, poor memory, disorientation, impaired judgement, lack of insight
DISCUSS
Thought content
- may be dominated by; delusion, obsessions, preoccupations, phobias, suicidal/depressed or homicidal thoughts, compulsions, superstitions
Memory 1
- Ask the patient to remember three unrelated objects and repeat them back to you, e.g. apple, table, coin. Record how many trials it took for them to remember.
Memory 2
- Ask the patient if they can remember the three objects that you asked them to remember earlier.
Self-harm
- as patient directly if they have attempted self-harm, sucked or are thinking/planning for those. Ask about previous attempts
Perceptions
- patient may be suffering from; hallucinations (ask specifically about auditory, visual and command hallucinations) disassociation i.e. ‘I feel detached from my body’, ‘my surroundings aren’t real’, ‘I am not in control of my actions’.
Environment
- risk factors include; lack of familial and social support, addiction or substance abuse, low socioeconomic status, life experience, recent stressors, sleeping problems or comorbidities (either physical or mental health conditions)
Report
- Accurately document/hand over findings. Accurate record-keeping and continuation of care.
Intravenous Access
how to do
- Dons appropriate PPE
- Discusses procedure. Obtains informed consent and allergies if any
- Exposes limb and arranges it in a supported dependent position.
- Applies tourniquet over bicep or above limb where IV is to be inserted, ensuring pulse is palpable.
- Determines cannulation site, using visualisation, palpation or both, and cannula size for intended use.
- Places sharps waste container in convenient location.
- Lays out equipment on a clean surface, ensuring asepsis.
- Prepares site by swabbing in concentric circles, a 5cm by 5cm area for 10 seconds. Allows 30 seconds to dry. Do not re-touch.
- Holds cannula flashback chamber with dominant hand. Announces that sharp is in use. Removes protective cap and discards.
- Stabilises vein with distal traction using non-dominant hand (stretch skin local and distal)
- Places tip either directly on top of vein or immediately beside it, at appropriate angle for vein.
- Pushes tip through skin at appropriate angle (10-15°), with sufficient force to just enter the vein (if Pt conscious warn Pt)
- Observes for flashback. When flashback is observed, stops advancing trocar and flattens angle to skin.
- Advances trocar a few more millimetres until cannula is also in the vein.
- Either feeds off cannula with forefinger of dominant hand or continues to feed entire trocar further into the vein.
- Releases traction, then releases tourniquet.
- Compresses skin over cannula end with three fingers of non-dominant hand. Maintains pressure until cannula is capped.
- After warning others (SHARPS OUT), withdraws trocar from cannula and immediately drops into sharps waste container.
- Taking care to not dislodge cannula, gently flushes with 5–10 ml saline (pull back and then in). Looks for free flow and no tissue swelling.
- Attaches desired capping option to cannula end and twists in place.
- Covers hub with clear adhesive aseptic dressing.
- Secures capping device with tape and/or bandage.
- flush with 5mL of normal saline
- Clean up area around you, anything contaminated and be careful of sharps
- remove gloves and sanitise hands and put on fresh gloves
