Treat and Refer Flashcards
What conditions are there treat and refer guidelines for? (8)
Suspected gastro Heroin OD Hypoglycaemia Minor burns Minor wounds Seizures Soft tissue injury Undiagnosed lower back pain
When do you suspect gastro?
Acute onset diarrhoea, 3+ episodes in 24 hours
When wouldn’t you leave a gastro pt at home?
Significant dehydration requiring IVT Potential GI bleeding Severe and constant abdo pain BGL>17 Pregnancy Comorbidities Possible differential diagnosis (no diarrhoea, history of inflammatory bowel disease)
When wouldn’t you leave a heroin OD at home?
Incomplete recovery (GCS<15, RR<10) Suspected opioid other than heroin Suspected polypharmacy overdose Factors affecting altered consciousness (hypoglycaemia, infection, trauma) Suspected/reported seizure Suspected aspiration or APO Pregnancy Risk to self or others
When wouldn’t you leave a hypoglycaemic pt at home?
Incomplete recovery to normal GCS Unwitnessed onset/prolonged episode Pt on oral antihypoglycaemics Overdose on medication Unable/unwilling to consume further carbs Unable to be monitored by an adult for 4/24 Non-diabetics Cause requires investigation Injury/seizure Pregnancy
Who does the minor burn guideline apply to?
Adults with a minor, superficial burn injury from a thermal source
What are the characteristics of a superficial burn?
Appearance: dry, red, no blisters, skin not broken Sensation: may be painful Circulation: normal or increased Colour: red, warm Blisters: none
What are the characteristics of a partial or full thickness burn?
Appearance: pale pink/white/black
Sensation: increased or no sensation
Circulation: rapid cap refill to no circulation
Colour: pink/white/charred/black
Blisters: yes (partial), no(full thickness)
When wouldn’t you leave a burn pt at home?
Burns to sensitive areas Partial or full thickness burns Potential smoke inhalation Chemical, electrical or radiation burns Suspected non-accidental burn Associated traumatic injury Pain unlikely to be controlled by oral analgesics Comorbidities impairing wound healing
When wouldn’t you leave a pt with minor wounds at home?
Uncontrolled serious bleeding Neurovascular impairment or loss of function Penetrating, degloving or crush injuries Compound fracture Pain unlikely to be controlled by oral analgesics Suspected non-accidental or self harm injury Potential to require plastic surgery Foreign material in wound Bite wounds Wound >6 hrs old Sign of infection Comorbidities affecting wound healing
Who does the seizure guideline apply to?
Adults diagnosed with epilepsy who have had a single, uncomplicated seizure with full recovery to normal GCS
When wouldn’t you leave a seizure pt at home?
Incomplete recovery to normal GCS Suspected non-epileptic cause First presentation seizure Different to usual seizure Concurrent illness Injury, aspiration or submersion sustained AV administered Midaz Unwitnessed seizure History of multiple seizures per episode Feeling of impending seizure Unable to be monitored by an adult Pregnancy
When wouldn’t you leave an epistaxis pt at home?
Unable to control bleeding after 15 mins
Recent history of facial or head trauma
History of bleeding disorder or on anticoagulants
When wouldn’t you leave a soft tissue injury pt at home?
Evidence of significant fracture or dislocation
Neurovascular impairments
Pain unlikely to be controlled by oral analgesia
Suspected non-accidental injury
Positive Ottowa Ankle Rule (isolated ankle/foot injury)
Who does the lower back pain guideline apply to?
Adults with lower back pain suspected to be caused by minor mechanical injury.
Acute pain <4 weeks duration
