Theory Flashcards
SAMPLE
SAMPLE
History taking:
S - signs and symptoms
A - allergies
M - medications
P - past medical Hx
L - last ins and outs
E - events leading to the incident/issue
OPQRST
OPQRST
Pain assessment - part of secondary survey:
O - origin and onset (Where did it start and what were you doing?)
P - palliation/provocation (What makes it better or worse?)
Q - quality (crushing, stabbing, throbbing etc)
R - radiation (does it move anywhere?)
S - severity (on a scale of 0 - 10)
T - time and treatment (how long and have you taken anything?)
AVPU
AVPU
Level of consciousness
A - alert
V - voice
P - pain
U - unresponsive
IMISTAMBO
IMISTAMBO
Patient handover:
I - identification - pt’s name and age
M - mechanism - what is the mechanism or presenting problem
I - injuries/information - pt assessment and Hx relevant to complaint
S - signs - vital signs and GCS
T - treatment and trends - interventions and response
A - allergies - what the pt is allergic to
M - medications - regular medications and are they present
B - background - medical Hx
O - other issues - scene, social situation, advanced care directives, belongings/valuables, cultural and religious considerations, interpreter
APGAR
APGAR
Newborn assessment conducted at 1 min and 5 mins post delivery. Usually at 6-8 at 1 min and 10 at 5 mins. Each item scored between 0 - 2.
Includes:
Appearance (skin colour)
Pulse
Grimace (muscle tone)
Activity
Respirations
Glascow Coma Scale
Glascow Coma Scale
Eye Opening:
Spontaneous 4
To Voice 3
To Pain 2
None 1
Verbal Response:
Oriented 5
Confused 4
Inappropriate Words 3
Incomprehensible Sounds 2
Silent 1
Motor Response:
Obeys Commands 6
Localised Pain 5
Withdraws 4
Abnormal Flexion 3
Abnormal Extension 2
No Movement 1
Hs and Ts
Hs and Ts
Conditions that may precipitate cardiac arrest or decrease chances of successful resuscitation
Hs and Ts Conditions
Hs and Ts Conditions
- Hypoxaemia
- Hypovolaemia
- Hypo/Hyperkalaemia & metabolic disorders
- Hypo/Hyperthermia
- Tension pneumothorax
- Tamponade
- Toxins/poisons/drugs
- Thrombosis - pulmonary/coronary
Effect of Toxins
Effect of Toxins
Death caused by airway obstruction and respiratory arrest secondary to a decreased conscious level after self-poisoning (benzodiazepines, opioids, tricyclic antidepressants, local anesthetics, beta-blockers, and calcium channel blockers).
Main Cause of Paediatric Cardiac Arrest
Main Cause of Paediatric Cardiac Arrest
Respiratory issue
Obstetric Emergencies - Breech
Obstetric Emergencies - Breech
- Complete Breech = cross legged
- Frank Breech = legs up on chest
- Kneeling Breech = knees first
- Footling Breech = legs first
How to help:
- Use pinkies to untangle legs
- Loveset Manoeuvre - wrap towel around bubs hips and twist gently back and forth
- Catch newborn with index finger and thumb around chin
- Pop onto mum’s belly - skin to skin (helps with post natal depression)
- Clamp umbilical 1 fist from bub, second fist from bub and then half way between these
- Cut umbilical between 1st and 2nd clamp
Newborn CPR
Newborn CPR
- 30 breaths via BVM on room air with OPA (1-2 breaths per second)
- Reassess pulse, breathing
- No pulse - CPR - 3 chest pumps:1 breath, oxygen at 15L for 1 min or until responsive and then reassess
Mum Haemorrhaging
Mum Haemorrhaging
- external pressure on vagina (tears etc)
- external aortic compression (fist on groin on either side - if no femoral pulse it is working)
- internal aortic compression (fist on inside of vagina - as well as fist on top)
Shoulder Dystocia
Shoulder Dystocia
- delivering sideways
- shoulder gets stuck on pubic bone
- turtle necking (crowing and then goes back in)
To help:
- Gaskin manoeuvre (get mum on all 4s)
- McRoberts Manoeuvre (mum on back with knees on chest - can be held by partner etc)
- Ruben 1 (push down on baby’s shoulder behind mum’s pubic bone)
- Ruben 2 (Ruben 1 plus 2 fingers internally on baby’s shoulder)
- Woodscrew and Return Woodscrew (towel around shoulders and twist and turn gently)
Nuchal Cord
Nuchal Cord
Cord wrapped around baby’s neck
To help:
- Get pinky under cord and try to push over bub’s head
- Push cord over shoulders and deliver baby through it
- Backflip - turn baby’s head towards mum’s inner thigh and summersault baby out, keeping head as close to mum as possible
Newborn Heart Rate
Newborn Heart Rate
Normal = 150bpm = score 2
100 - 140bpm = score 1
< 100bpm = score 0
Paediatric Weight Calculation
Paediatric Weight Calculation
(age x 3) + 7 = weight
Paediatric Joules Calculation
Paediatric Joules Calculation
weight x 4 joules
Paediatric Adrenalin Dose Calculation
Paediatric Adrenalin Dose Calculation
weight x 100 = .ml
Paediatric Amiodarone Dose Calculation
Paediatric Amiodarone Dose Calculation
weight / 10 = ml
Paediatric Medication Formula
Paediatric Medication Formula
(dose - mcg,mg,g / meds mcg,mg,g) x meds ml = . mls needed
Paediatric ALS Respiration Rates
Paediatric ALS Respiration Rates
- BVM - 15:2
- LMA - 1 breath every 4 seconds
Tension Pneumothorax Symptoms
Tension Pneumothorax Symptoms
- resistance on bagging
- tracheal deviation
- jugular distension
- diminished chest sounds (gets worse lower in the lungs)
- Subcutaneous emphasaema
Preferred ACS Analgesic
Preferred ACS Analgesic
Fentanyl
Pinpoint Pupils Drug
Pinpoint Pupils Drug
Naloxone (Narcan)
Tension Pneumothorax Needle
Tension Pneumothorax Needle
14 gauge
Amiodarone Administration Round
Amiodarone Administration Round
3rd round if shockable rhythm
Vital Signs Survey
Vital Signs Survey
- BGL
- Temp
- Pupils
- Pulse
- Respiratory rate
- Sats
- Blood pressure
- Capillary refill
- Glasgow Coma Scale
- Chest auscultation
- ECG
5 Moments of Hand Hygiene
5 Moments of Hand Hygiene
- Before touching a pt
- Before a procedure
- After a procedure or body substance exposure risk
- After touching a pt
- After touching a pt’s surroundings
Note: hand hygiene must be performed after the removal of gloves.
Pulse/Heart Rate
Pulse/Heart Rate
Number of beats per minute, normal is 60-100bpm, often seen in the lower half of the range.
Respirations
Respirations
Number of breaths per minute, normal is 12-20rpm (1 breath every 4-5 seconds).
Blood Pressure
Blood Pressure
Combination of cardiac output and peripheral resistance.
Normal range for an adult is: Systolic 100 - 150 Diastolic 60 - 90
Temperature
Temperature
Normal is between 36.5 and 37.5 degrees
Blood Glucose Level (BGL)
Blood Glucose Level (BGL)
The level of millimoles of glucose in each litre of blood.
- Hyperglycaemic = >8mmol/L
- Normal = 4-8mmol/L
- Hypoglycaemic = <4mmol/L
Pulse Oximetry
Pulse Oximetry
% of oxygen carrying haemobglobin that is saturated with oxygen. Normal range is 96% - 100% but don’t treat unless under 93%
Perfusion Status Assessment
Perfusion Status Assessment
Assesses blood flow to tissues and organs Includes assessment of:
- level of consciousness
- capillary refill time
- BP
- skin colour
Access
Access
= Getting in
- safety first
- access challenges, eg locked doors
- terrain for equipment
- once inside, identify exits early
- how many people are on scene
- pt presentation
- selecting correct extrication equipment
Rule of Nines
Rule of Nines
- front and back of head and neck = 9%
- front and back of each arm and hand = 9%
- chest = 9% * Stomach = 9%
- Upper back = 9%
- lower back = 9%
- front and back of each foot and leg = 18%
- genital area = 1%
PERRLA
PERRLA
Pupils Equal - both should be the same size
Round - should be perfectly round Reactive - to light and accommodation
Light - pupils should shrink when exposed to light
Accommodation - should be able to focus close up and far away
TILE
TILE
T - task - type of manual handling activity, eg pushing, pulling, lifting, carrying etc
I - individual - the capabilities of the person carrying out the manual handling activity
L - load - size, shape, surface type and weight of the object being moved
E - environment - the area in which the object is being moved
METHANE
METHANE
Major incident management
M - major incident confirmation
E - exact location
T - type of incident
H - hazards identified
A - access via
N - number of pts, adult/paed, nature and priority
E - emergency services/resources required
IPPA
IPPA
Abdomen assessment
I - inspect - look and observe - distended/swollen/bruising
P - palpate - touch/feel with open hand - rolling palm to fingers
P - percuss - tapping of fingers
A - auscultate - listening with a stethoscope
Prone
Prone
Lying face down
Supine
Supine
Lying face up
Diaphoretic + grey =
Diaphoretic
+ grey = Acute Coronary Syndrome
OPA Measurement
OPA Measurement
Side of mouth to base of ear
NPA Measurement
NPA Measurement
Septum (centre of nose) to base of ear Long edge to outside when inserting Right nostril is a little straighter and bigger
Double Airway Manoeuver
Double Airway Manoeuver
Jaw thrust Mouth opening
Triple Airway Manoeuver
Triple Airway Manoeuver
Jaw thrust Mouth opening Head tilt
Suction Time
Suction Time
5-10 seconds
6 Rights of Medication
5 Rights of Medication
- Right pt
- Right drug
- Right dose
- Right route
- Right time
- Right documentation
