How do you manage airway in an unconscious patient
Look - foreign body ( teeth, toy, food)
Fluid ( blood vomit, phlegm)
Swelling ( airway or tongue)
Position - htcl, jaw thrust
Listen- audible wheeze/stidor, snoring, gurgling
Feel - air movement
Secure - OPA/ NPA
How do you assess breathing in an unconscious patient
Rate
Inspect RATE, Rhythm, volume Cyanosis or mottling, accessory muscle
Tracheal deviation, chest rise and fall
Palpate- ribs for : flail segments, crepitus or pain and chest compliance,
Percuss hypo hyper or normal
Auscultate - breath sounds ( vestibular, crackles, stridor wheeze ect)
Satsprobe placed after inspection + 02 if required
How do you assess circulation in an unconscious patient
Check carotid pulse ( rate rhythm volume)
Check central capillary refill and skin temperature and colour
Bilateral radial pulses, (RRV), skin warmth colour and peripheral CBR
Look at femoral towards ( if mottled ? Ruptured aneurysm)
HR, BP, 12 LEAD
How do you assess disability in an unconscious patient ( primary survey)
Avpu
Head - trauma ( battle axe + raccoon)
Pupils (location, size, equal and reactive)
GCS
Rashes
Can they move limbs ( have you seen them move) + track marks
BM + TEMP
What is CPR induced consciousness
- how do you differentiate this from a ROSC
When CPR is so good that there is signs of conscious despite no ROSC
- eyes opening
- speech or sounds
- combative movement
But one of the following will be present
-There will be no pulses
-ECG rhythm with be incompatible with life
-Once CPR stop they reduce in gcs
How to address hypoxia as a cause in cardiac arrest
100% oxygen @ 15L via BVM
How to address hypo/hyper glycaemic as a cause in cardiac arrest
+ = check keytones, then ( fluids)
- = 10g of glucose in 100ml IV/io with a max of 30g in 300ml
1) how do you confirm cardiac arrest in hypothermic
2)How to address hypothermia as a cause in cardiac arrest
3) can you give drugs - if so whats the timings
4) what is the rule regarding shocks
Obtain ECG, palpate carotid pulse + breathing efforts and signs of life for one minute
Reduce heat loss
If under 35degrees but above 30 double drug timings
If under 30 degrees max 3 shocks and no drugs
How to address hyperthermia as a cause in cardiac arrest
Remove clothing or change environments
Normal ALS/BLS
? Fluids ( potential swearing = fluid loss + fluid = cold = ? Decrease temp
How to address toxins as a cause in cardiac arrest
You will convey to hospital
- if known report it to hospital on prealert
If opioid ( then narcan = 400mcg then 800cmg every minute to max of 10000mcg = 13 dosages in total )
During a cardiac arrest you see PEA - there are two types ( wide qrs and narrow ) what does it mean
Narrow - mechanical problem
( Pe, tension/ tamponade / mi cardiac rupture)
Wide qrs pea - metabolic problem
( hyperkalemia / sodium problem / acidosis, mi pump failure )
What are the adaptation to B/ALS in patient who are pregnant
- provide utrine displacement to the left @ 20 weeks plus
- add tilt to left at 15-30 degrees if possible but must allow good compression ( aid venous return)
Cpr a little higher
Early transfer to hospital - ALS on route
How do you manage and confirm cardiac arrest in patient with drowning drowning
Confirm cardiac arrest with lack of pulse + ECG or capnoghraphy - until 1 minute
- provide 5 rescue breath then ALS
How do you manage an Anaphylaxis
1) confirm anaphylaxis ( ABC problems + skin probls + spontaneous onset/worsening )
2) OXYGEN(15L)
3)Adrenaline 1:1000 (0.5ml for IM) (Every 5 minutes)
- Cannulate + OBS on
- fluids +nebs (if needed)
- choraphemine + hydrocortisone
- pre alert - if refractory
Re assess Re assess. Re assess
Always convey due to high chance of reoccurring —- consider pre-alert 🚨🚨🚨🚨
What are the symptoms of anaphylaxis
1) spontaneous worsening symptoms+ ABC concerns + skin problems
1) airway = swelling lips tongue throat, stridor
2) Breathing= tachy + poor stats + wheezing+ cyanosis/mottling
3) circulation = tachy, poor caprefill, hypotension reduced GCS, clammy
4) skin = hives, redness, itchyness, swelling
What is Allen Test
What does it test
How do you conduct it
Test collateral blood flow to hand
- compress both radial and ulner artery
Tell pt to close and open hand - release one artery = should go white to pink, then test other ones
If stays white = poor circulation
What is head up CPR
- benefits
- evidence
- risks
Tilt head up @ 30degrees decreases ICP by improving cerebral vascular drainage in PT with head injury
- limited evidence of affect ability
- causes issues with C-SPINE
What is the blood pressure you should aim for post rosc in traumatic cardiac arrest patients
90mmgh or radial pulse
In patient with a penetrating injury, that is in cardiac arrest = what is the management plan
HOTT principles
- penetrating to chest or above umbilical area = consider merrit or early extrication for cardiac tamponade
5 minutes on scene time
What is percussion pacing
Pacing through rapid rhythmic thumping over left sternal edge = when p wave flattening in sever bradycardia seen
Not a core paramedic skill
CCP only don’t attempt = stack shock and or CPR
What are the clinical manoeuvre you can proform for PT in SVT
Vasalgar manover
Carotid sinus massage
How do you conduct a vasalgar manover
Pads on
- confirm SVT ( via 12 lead ECG)
- get patient to blow into a 10ml syringe + when supine
- print on 12 whilst doing
- What is condition do you conduct carotid massage
- How do you conduct a carotid sinus massage
- what must you check before conducting the procedure + on what mustyou put on
pads on
12 lead ECG - completed to test 4 svt
- locate carotid artery whilst supine
- confirm no brues or arthrosis or aneurisms
- massage carotid ( firm but don’t occlud ) for upto 5 seconds
- have a 12 lead whilst doing
-
How do you know a patient with severe asthma is likely to be time critical
If they are unresponsive to
- 1- sabutamol
- 1- ibriprtopium bromide
Risk factors = brittle asthma/ previous ICU admission
