Treat and Refer Guidelines Flashcards
Epistaxis - treat and refer criteria
If bleeding stops after 15 mins:
- Provide pt with advice and info sheet
- Confirm pt understands advice
OR
Refer pt to primary care provider for review within 24 hrs if:
- very minor or intermittent bleeding remains
- Pt has experienced recurrent episodes of epistaxis
- Pt is on anti-platelet therapy
- BP remains high after epistaxis has resolved
Epistaxis - general care
Some nose bleeds (approx 5%) are unable to be controlled with manual pressure and will require surgical intervention or other management such as packing, vasoconstricors etc
Mx:
- position pt upright with neck slightly flexed forward
- Pinch soft part of their nose for 15 mins without releasing
- Cold compress may be applied to the forehead
- Encourage pt to breathe through their mouth and to spit out any blood
- Pts should avoid blowing or picking their nose for at least 12 hrs
Suspected Gastroenteritis treat and refer criteria
Treat and refer: Advice and health sheet: - Oral rehydration - Anti-diarrhoeal rx on consultation with GP - Maintain good hygiene
Refer pt for review if:
- Symptoms >48hrs
- Recently returned from overseas
- Temp >40
Consider ondansetron 4mg orally and confirm pt understanding
Suspected gastro symptoms
Acute onset of diarrhoea (3 or more loose bowel motions over 24hrs) associated symptoms: - nausea - vomiting - cramping - lethargy - fever
Gastro general care
- Maintain hydration - Gastrolyte or Hydralyte are appropriate but not sports drinks
- Anti diarrhoea medication can be bought after discussion with pharmacist
- Encourage good hygiene practices, no food handling and avoid school/work for 48hrs
- Advise pts to seek medical attention if symptoms haven’t improved after 48hrs of onset
- Advise pt to call 000 if reaction to ondansetron
Heroin Overdose treat and refer criteria
Assess:
- Clear chest
- SpO2 > 94%
- Fully recovered, low risk, and able to be monitored for 4 hours
- Offer tx if any of the above not met
Treat and refer:
Advice and HIS:
- Risk or relapse if opioid taken within 6 hours
- Avoid all sedating agents whilst still drug affected
- Local social/drug support resources
- Confirm understanding
Hypoglycaemia treat and refer guideline and general care
Treat and refer:
- Advice and HIS
- Refer to GP within 24 hrs
- Confirm pt/carer understanding
General Care:
- manage as per cpg
- Give pt long acting carbohydrate
- Remind pt of appropriate glucose sources for future episodes (6-7 jellybeans, a spoonful of honey, 200ml fruit juice, 150-200ml soft drink, 20g glucose tablets)
- Advise pt to inform their diabetes provider of episode within 24hrs, particularly if becoming frequent
Minor burns treat and refer
Treat and refer:
- Cool burn under running water for 20 mins
- Clean wound with normal saline
- Consider plain moisturiser if no broken skin
- Advice and HIS
- Refer to GP within 24hrs
- Consider paracetamol
- Confirm pt understanding
Superficial burn definition
Only involves the epidermal layer of the skin
Appearance - Dry and red, no blisters, skin not broken
Sensation - May be painful
Circulation - normal or increased
Colour - red, warm
Blisters - None, or may appear days later
Partial/full thickness burns definition (not appropriate for treat and refer)
Appearance - pale pink/white/black
Sensation - increased sensation to no sensation
Circulation - rapid cap refill to no circulation
Colour- pink/white/charred/black
Blisters- yes (partial), no (full thickness)
Minor wounds - stop criteria
Do not proceed if:
- uncontrolled serious bleeding
- Neurovascular impairment or loss of function
- Penetrating injury/degloving/crush injuries
- Other injuries requiring hospital management
- Pain unable to be controlled with oral analgesia
- Self harm/intentional injury
- Wounds to face/hands/feet/joints/genitals/pre-tibial area*
- Suspected muscle/tendon damage*
- Foreign material unable to be cleaned out of the wound*
- Bite wounds*
- Wound > 6 hours old*
- Signs of infection*
- Co-morbidities*
- If appropriate, alternative measures to ED may be considered
Minor wounds - treat and refer
- Irrigate/dress wounds
- Advice and HIS
- Refer to primary care provider within 6 hrs for wound management - confirm they can provide this
- Consider paracetamol
- Confirm pt understanding
Seizures - stop criteria
Do not proceed if:
- Incomplete recovery to normal GCS
- Suspected non-epileptic cause of seizure
- No Phx of epilepsy/first presentation seizure
- Different to usual seizure presentation
- Concurrent illness
- Injury/aspiration/submersion
- Patient administered IM/IV Midaz
- Unwitnessed seizure
- Hx of multiple seizures per episode
- Pt has feeling of impending seizure
- Pt unable to be monitored by responsible adult
- Pregnancy
- Pt requests tx
Seizure - treat and refer/general care
- Advice and HIS
- Refer to primary care provider within 24hrs
- Consult pts management plan if available
- Confirm pt/carer understanding
Advise pts family to call ambulance if:
- Seizure recurs before pt is reviewed by doctor
- Future seizures do not stop after 5 minutes or are different to usual
- Seizure continues despite management plan
- Pt sustains injury, vomits, or is immersed in water during seizure
- Pt has not regained consciousness or takes longer to wake up
- Carer/family have other concerns and need advice
Soft tissue injury - stop criteria
Do not proceed if:
- Evidence of significant # or dislocation
- Neurovascular impairment
- Pain unable to be controlled with oral analgesia
- Suspected non-accidental injury
- Ankle/foot injuries - positive Ottawa ankle rule
