Theory/CPG’s Flashcards
Indications for Cricothyrotomy (Vertical)
- Cant intubate, Cant oxygenate. (CICO) situation with decreasing SpO2%.
- Primary airway attempt if ETT, Supraglottic airway or BVM is not feasible. (E.g. massive facial trauma or burns)
Contraindications for Cricothyrotomy (Vertical)
- Children <6years of age
- Open tracheal injury
Explain DOPES acronym
Displacement
Oxygen
Pneumothorax
Equipment
Secretions
6 stages of intubation
1.Pre-oxygenation
2.Preparation
3.Position
4.Placement (confirmation)
5.Proof (structures)
6.Post intubation care
What are the 5 P’s of supraglottic airway
- Preoxygenate
- Preparation
- Placement
- Proof of Placement
- Post Care
IO access indications
Cannulation of the intraosseous space using EZ-IO:
Cardiac arrest:
- First line for paediatrics
- Consideration for first line in traumatic cardiac arrest
- Second line cardiac arrest management for adults following at least one failed intravenous (IV) access attempt, unless unable to locate appropriate site for IV access.
All other circumstances:
- Where immediate medication or fluid administration is required following at least one failed IV access attempt when unable to administer by any other appropriate route.
IO access contraindications
- Fracture to the targeted bone.
- IO within last 48 hours in the targeted bone.
- Inability to locate landmarks or excessive tissue.
- Prosthetic limb or joint (near insertion point).
- Directly over, or distal to burns, cellulitis, infection or injury
Describe all 4 types of axis deviations and where they are located
- Lead 1 positive and AvF positive = normal
- Lead 1 positive and AvF negative = left axis
- Lead 1 negative and AvF positive = right axis
- Lead 1 negative and AvF negative = extreme right axis deviation
What equipment is needed for a Vertical Cricothyrotomy?
- tube, sized 6.0
- tape cut into 2 dog legged parts
- cobs, BVM, Bac filter
- scalpel
- boujie
- syringe
Explain the pelvic binder decision tool
Significant mechanism suggestive of pelvic fracture:
- pulse greater than or equal to 100bpm OR Systolic BP greater than or equal to 90mmHg
- Less than or equal to GCS13
- Distracting injury
- Abnormal clinical assessment of pelvis
Abnormal clinical assessment includes:
- anatomical deformity (e.g. asymmetry)
- significant pain on palpation
- pelvic instability
Pelvic binder indications
- Haemodynamically compromised trauma patients meeting the pelvic binder decision tool criteria
- Should be considered an immediate and urgent intervention in symptomatic cases
Pelvic binder contrainidcations
- patients under 23kg
- fall from standing
- isolated hip fractures
Chart the APGAR score
Demonstrate the flow chart of New Born Life Support.
PPH arises from 4 sources. What are they?
- Tone - 70% - soft boggy uterus assessed by palpating fundus. Good tone feels like a cricket ball.
- Trauma - 20% to perineum, vaginal wall or cervix.
- Tissue (retained) - 10%
- Thrombin anomalies - 1%
Define a post partum haemorrhage and whats the difference between primary and secondary.
- defined as blood loss >500mls
Primary:
- first 24hrs
- most common and potentially life threatening
- affects approx 6% of all deliveries
Secondary:
- after 24hrs and up to 6 weeks post natal
- less common affecting approx 1-3% of deliveries
What are the 4 positions a patient should be put in during continued shoulder dystocia
- McRoberts position w/gentle traction for 30 seconds
- if no relief commence Rubin 1 for 30 seconds whilst applying gentle down pressure to shoulder
- if no change commence rocking rubin for 30 seconds (slow CPR type)
- if no change roll patient into Reverse McRoberts Position
Whats defined as HTN in pregnancy?
Systolic of greater than or equal to 140mmHg and/or diastolic greater than or equal to 90mmHg.
Whats the fluid replacement indication criteria for burns and the formula involved.
Adults: >15% TBSA
Children 18 months or older: >10% TBSA
Children less than 18months: >8% TBSA
2ml X %TBSA X weight
- 50% of total over first 8hrs
- 50% of total over next 16hrs
Whats the criteria for direct burns unit transfer?
- greater than or equal to 10% TBSA for adults or >5% TBSA in paeds
- airway burns
- burns to hand, feet, perineum, genitalia, joints or neck
- adults greater than or equal to 16yo to FSH and <16yo to PCH
Indications for need thoracocentesis
- TCA with torso involvement
Needle thoracocentes contraindications
- Patients not in cardiac arrest unless trained and authorised
- Consider ASMA consult in a patient with suspected tension pneumothorax and respiratory and/or haemodynamic compromise.
Modified valsalva contraindications
- Recent or current acute myocardial infarction
- Severe coronary artery disease
- Haemodynamic instability (i.e. systolic BP below 90mmHg)
- Known glaucoma or retinal myopathy
What is a LEMON
Look
Evaluate
Mallipattie
Obstruction
Neck
Indications for Magills forceps and direct laryngoscopy
- To identify and remove a suspected foreign body from the hypopharynx that is preventing ventilation.
- In order to create a patent airway and an ability to achieve adequate ventilation
Contraindications to magills forceps and laryngoscopy
- Conscious patient or Gag reflex intact
- Do not use Magill forceps if obstruction below the vocal cords.
- SpO2 reading of 90% and ventilation is achievable
- Suspected epiglottitis.
When should spinal precautions be applied?
Cervical spine pain
Altered mental state
Neurological deficit
Distracting injury
Iintoxications
Indications for IV cannulation
- Administration of intravenous fluids where oral intake is unavailable or unsuitable
- Administration of intravenous medications where other routes are inappropriate or unsuitable
- Unstable or deteriorating patients
Contraindications to IV cannulation
Directly over or distal to:
- Burns
- Cellulitis
- Infection
- Injury
- Frail or immunocompromised patients unless clinically warranted
- More than 2 attempts by appropriately trained and skilled clinician
- More than 1 attempt of vascular access (IV/IO) in traumatic cardiac arrest
When do you discontinue the use of an I-Gel
- Effective ventilations (i.e.: adequate chest rise and fall) cannot be achieved (some air leakage can be expected)
- GCS of the patient increases with a return of gag reflex or patient attempts to remove
- i-Gel is faulty.
- Regurgitation occurs and is anticipated to be compromising
Stroke inclusion criteria
- symptom onset <9hrs
- possesses full ADL’s
- BGL between 4-22mmol/L
What are the metro acute stroke centres? (RACE of equal to or <4)
- Sir Charles Gairdner Hospital
- Fiona Stanley Hospital
- Royal Perth Hospital
- St. John of God - Midland
- Joondalup Health Campus
What are the 6 rights of medication administration
Right patient
Right medication
Right dose
Right time
Right route
Right documentation
Pick a random age between 1-12yo and calculate weight and all the surrounding cardiac arrest drug calcs/treatments.
Paediatric anatomical differences for respiratory/airway
- larger/rounder head
- floppy eppiglotis
- short neck
- hogher larynx
- predominately nose breathers
- fewer alveoli
- diaphragmatic breathers
What is the calculation to find hypotensive SBP in a paediatric? And what is the hypotensive level in ROSC?
70+ (2 x Age) = hypotensive BP
What are the IMPACT principles?
- standardised equipment placement
- high quality focused compressions with minimal interruptions
- use feedback and CPR quality devices
- swap compressor every loop
- controlled ventilation
- calm, quite and coordinated scene
- closed loop communication/ functional language
- create an overview position if possible
- create or move to a good working space
Describe the acronym SLUDGEBBB
Salivaton
Lacrimaton
Urination
Defacation
GI upset
Emesis
Bronchorrhea
Bronchospasm
Bradycardia
What are the components of the “diamond of death?”
- Acidosis
- Coagulopathy
- Hypothermia
- Hypocalcaemia
What are the components of “Cushings triad?” In a TBI?
- widening pulse pressure
-Irregular/erratic breathing (
-Bradycardia
Indications for blood sample collection
- Patients to be transported to an Emergency Department with successful Peripheral IV Access or External Jugular Access whose clinical presentation warrants pre-hospital blood sample collection.
- Patients 16 years and older
Contraindications for blood sample collection
- Any patient whose clinical condition does not warrant IV cannulation.
- Where prehospital blood collection will delay life saving treatment
- Patients <16 years old.
Indications for External Jugular Access
- Administration of intravenous medications or fluids where peripherally inserted intravenous catheters (PIVC) or intraosseous catheters (IO) are inappropriate, unsuitable or unavailable
Contraindications for External Jugular Access
- Access is available by other means (PIVC/IO)
- Patients in spinal precautions
>1 attempt by appropriately trained and skilled clinician - Directly over or distal to:
-Burns
-Cellulitis
-Infection
-Injury
