Treat and refer guidelines Flashcards
1
Q
What are the indications NOT to T&R for Hypoglycaemia
A
- Incomplete recovery
- Unwitnessed onset
- Prolonged episode
- Pt on oral hypoglycaemic medication
- OD on medication
- unable to consume further carbohydrates
- Unable to be monitored for 4 hours
- No PHx of diabetes
- Cause requires further investigation
- Injury/seizure
- Pregnancy
2
Q
What are the indications NOT to T&R for Epistaxis
A
- Unable to control bleeding after 15min
- Recent Hx of facial/head trauma
- Hx of bleeding disorder of anticoagulant therapy
3
Q
What are the indications NOT to T&R for Suspected Gastroenteritis
A
- Significant dehydration requiring fluid IV
- Potential GIT bleeding
- Severe/constant abdominal pain
- BGL >17
- Absence of diarrhoea
- PHx of inflammatory bowel disease
- Pregnancy
- Co-morbidities
4
Q
What are the indications NOT to T&R for Heroin OD
A
- Incomplete recovery (GCS<15, RR<10)
- > 1 dose of naloxone
- Opioids other than heroin involved
- Polypharmacy OD
- Other causes of altered CS
- Seizure
- Suspected aspiration / APO
- Pregnancy
- Pt is a risk to others
5
Q
What are the indications NOT to T&R for Minor burns
A
- Burn involves face/hands/feet/major joints/genitalia
- Circumferential burns of limbs/chest
- Partial/full-thickness burns
- Smoke inhalation or inhalation injury
- Chemical, electrical or radiation burns
- Suspected non-accidental burns
- Associated traumatic injuries
- Pain unable to be controlled with oral analgesia
- Co-morbidities that may impair wound healing
6
Q
What are the indications NOT to T&R for Minor wounds
A
- Uncontrolled serious bleeding
- Neurovascular impairment or loss of function
- Penetrating injury/degloving/crush injuries
- Other injuries requiring hospital Mx
- Pain unable to be controlled with oral analgesia
- Suspected muscle / tendon damage
- Foreign material unable to be cleaned out of wound
- Bite wounds
- Wound > 6 hours old
- Signs of infection
- Co-morbidities
7
Q
What are the indications NOT to T&R for seizure
A
- Incomplete recovery (to normal GCS)
- Suspected non-epileptic cause
- No PHx of epilepsy/first presentation seizure
- Different to usual 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
- Unable to be monitored by a responsible adult
- Pregnancy
- Pt requests transport
8
Q
What are the indications NOT to T&R for Soft tissue injury
A
- Evidence of significant # or dislocation
- Neurovascular impairment
- Pain unable to be controlled by oral analgesics
- Suspected non-accidental injury
- Ankle/foot injuries - positive ottawa ankle rules
9
Q
What are the indications NOT to T&R for Lower back pain
A
- Pain not isolated to Lower back
- Loss of bladder/bowel control
- Saddle anaesthesia
- Lower limb weakness/numbness
- Hx of fall or significant trauma
- PHx osteoporosis or chronic steroid use
- Suspected dissecting AAA
- Pain unable to be controlled by oral analgesics
- PHx of cancer or recent unexplained weight loss
- Fever pr recent PHx of infection
- PHx of IV drug use
- Immunocompromised