- Salbutamol 10mg Neb AND - Ipratropium Bromide 500mcg single dose - Dexamethasone 8 mg O/IV If good response consider O2 low flow Titrate SpO2 to 88-92%

Treatment Flashcards by Aaron Suckling

ACS treatment

Assess - 12 lead with in 10 minutes if STEMI see STEMI card
Aspirin 300 mg
GTN tablet 300- 600 mcg if SBP >100 mmhg repeat at 5 minute intervals
GTN patch 50 mg apply to top top left chest (remove if SBP <100)
Other pain relief
Fentanyl 50 mcg IV at 5 minute intervals

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STEMI

-Transmit ECG
-Request MICA
-Treat with Aspirin 300mg
-Treat with GTN 300-600 mcg at 5 minutely intervals
-Apply GTN 50mg patch
If symptoms < 12 hours treat as below if > 12 hr treat as per ACS
If time greater then 1 hour to PCI then treat as per Pre Hospital Thombolysis
- IV x2 with Na Saline TKVO
- Complete checklist and read statement to patient
- Tenecteplase IV bolus
- Haparin bolus 4000 iu and then 1000 iu every 1/24
If less then one hour to PCI then treat as urgent transport
Heparin bolus 4000 iu with 1000 iu every hour
Apply pads for transport

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Anaphylaxis

Severe allergic reaction onset under 30 min up to 4 hour post exposure to antigen
2 or more of :
R respiratory distress
A abdominal symptoms
S Skin/mucosal symptoms
H hypotension
OR
isolated Hypotension ( SBP < 90) following exposer to KNOWN ANTIGEN
OR
Isolated respiratory Distress following exposure to KNOWN ANTIGEN

IM adrenaline 500mcg every 5 minutes
request MICA if risk factor ie Px Hospitilisation, Asthma OR unresponsive to initial dose

A airway oedema or stridor
adrenalin 5 mg via Nab consult for additional dose
B bronchospasm
Salbutamol 5 mg neb (or 4-12 PMDI) repeat 20minutely
Ipratropium Bromide 500 mg once off
Dexamethasone 8 mg IV/O
C cardiovascular - Hypotension SBP < 90 despite adrenalin
Na Saline 40 ml/kg titrate to response
If unresponsive to adrenalin OR taking Beta blockers
Glucagon 1mg repeat 1 @ 5 minutes

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Asthma treatment

Mild to moderate
-Salbutamol 4-12 doses with 4 puffs per breath @ 20/60 intervals
Severe
- Salbutamol 10mg Neb then 5 mg @ 5/60
-Ipratropium bromide 500 mcg Neb (combine nebs) one off
Dexamethasone 8 mg O/IV
Inadequate response
Adrenaline IM 500 mcg 1:1000 mcg @ 5-10/60 interval
if no response consult for IV 20 mcg at 2 minutes (thunderstorm)

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Medical Arrest (Not updated)

No ETT/SGA
- 30 compressions : 2 ventilations (pause for ventilations)
ETT/SGA insitu
- 15 compressions : 1 Ventilation (6-8 ventilations a minute)
SITREP MICA
Aim for >5 cm chest compression rate 100-120 allow full recoil 2 minute cycles
Time to first defib is < 2min (200kj)
ONCE IV insitu
Adrenalin 1mg every 4 minutes priority to Defib

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Agitation

Severe SAT +3
Ketamine - < 60 kg 200mg
- 60-90 kg 300 mg
- >90 kg 400 mg
Moderate SAT+2
Droperidol 5-10 mg IM/IV
Repeat once after 15 min
Elderly or frail 5 mg
Midazolam - 5-10 mg IM or if Frail Elderly <60kg 2.5 - 5mg repeat after 10 minutes MAX dose 20 mg
Mild SAT +1
Olanzapine 10mg Oral 5mg for Frail / Elderly repeat aft 20/60 if still agitated

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Factors for suspected COPD

Over 40
Smoker or Px of smoking
Dyspnoea that is progressive persistent or worse with exercise
Chronic cough
Chronic sputum production
Family history of COPD

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COPD treatment

Salbutamol 10mg Neb AND
Ipratropium Bromide 500mcg single dose
Dexamethasone 8 mg O/IV
If good response consider O2 low flow
Titrate SpO2 to 88-92%

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Pulmonary Oedema Sign and Symptoms

SOB
Orthopnoea
Agitation
Pale clammy sweaty
Adventitious breath sounds
BP changes < >
Increase in JVP
Paroxysmal nocturnal dyspnoea
Pink frothy sputum

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Pulmonary Oedema treatment

GTN 600 mcg if SBP > 100
OR
GTN 300 first dose no Px, elderly , frail, < 60 kg
Repeat original dose @ 5/60 titrate to pain and effect
GTN patch 50 mg (remove if BP drops < 90)
IF NOT responding
CPAP

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Tachycardia (narrow complex)

Confirm its a narrow complex
- QRS < 0.12 sec
- Absent or abnormal P waves
- Exclude AF
SVT and SBP > 90
- Modified Valsalva
- Patient semi recumbent - forced expiration - Lay patient flat and raise legs for 15 sec
OR
- Abdominal Valsalva
- Patient supine blowing into a 10ml syringe for 15 seconds repeat 2/60 X3 attempts

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CPAP contraindications NEEDS edit

Facial Trauma
GCS < 13
Needs ETT
Hypopnea
Pneumothorax
Vomiting
VT

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Hypothermic cardiac arrest defib and adrenaline timing

Less then 30degress
Adrenalin 8 minutes
Defib is remains at 2 minutes consult after 3 defib attempts

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List 2 of 3 safety measures Zoll

Water hazards
On metal surfaces
Flammable agents

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Give clinical values for red flags

HR > 120 bpm
RR > 30
SBP < 90 mmhg
SPO2 < 90 (COPD exception to rule/ chronic resp )
GCS < 13 (if 16 or under ANY GCS is a go)

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List clinical conditions that mandate (red flag) transportation

CNS

First time Seizure
Stroke TIA
Sudden onset headache
Unable to walk

Respiratory/ airway

Stridor
Post tonsillectomy bleeding

CVS

Anaphylaxis
ACS

Other

Ectopic pregnancy
Obstetric concern

Clinical Flags defined

Red = Mandated transport 
Yellow = do not mandate transport but have increased risk

Clinical Yellow flags

Must be advised to attend a hospital or GP within 2 hours

ongoing carer or patient concern
infection that’s non responsive to community care
immunocompromised with suspected infection
surgery in past 2/52
unexplained pain with pain score >5/10
syncope
abdominal pain

Patient must be capable to attend to advice and read advice

List 9 reasons Treat and refer

Epistaxis
Suspected Gasto
Heroin OD
Hypoglycemia
Minor burns
Minor wounds
Seizures
Soft tissue injuries
Undiagnosed lower back pain

Epistaxis

Nose bleed
Apply pressure in upright position for 15 minutes
Dont blow or pick for 12 hours you grot
If constant flow continues after 15 minutes GO to ED

Gastro

3 + loose stools in 24 hours
Including cramping vomiting and lethargy
we can treat with 4 mg of ondans

ED if

cant self care
BGL > 17
GIT bleeding
Px of bowel disease
pregnancy
immunocompromised

Heroin OD. NEEDS edit

Give one dose of Narcan
If fully recovered can stay as referral
IF incomplete recovery need 2nd dose must go to ED
If suspected OD from other substance must go to ED
If pregnant, aspirated or seizure must GO to ED
Risk to self or others must go to ED

Hypoglycemia NEEDS edit

BSL < 4 and responds to treatment can stay at home

Must go to ED if
GSC <15
unwitnessed/prolonged event
patient on oral hypo’s
if due to OD of meds accidental or intentional
unable to be monitored for 4 hours
no official diagnosis of Diabetes
suspected infection
injury sustained
pregnancy

Minor Burns

provide cooling for 20 minutes
clean with Gauze
can give panadol

ED
If burn involves sensitive area Face hands feet major joints genitalia
Partial or thickness burns
Smoke inhalation
Chemical electrical or radiation (not sunburn)
suspected non - accidental
Associated traumatic injuries
Pain unable to be controlled by paracetamol
other co morbilities associated with wound healing ie diabetes

Minor wound

Can give panadol irrigate wound ED uncontrolled or serious bleeding wound required surgery wound to special areas face hands feet genitals penetrating wound wound healing co morbilities suspected tendon damage

Seizure yellow flag

self resolve and full recovery back to normal conscious state ED Incomplete recovery suspected non epileptic cause no diagnosis of seizure different presentation to their normal concurrent illness injury unwitnessed Midazolam required from AV pregnancy

Soft tissue injury

RICE and HARM R rest I ice 15-20 minutes every 1-2 hours C compress E elevation and also avoid HARM ``` H heat (increases blood flow \> swelling) A alcohol (increases blood flow and swelling) R reinjury M massage ( increases blood flow \> swelling ) ``` Can give panadol

ED for soft tissue when

Evidence of significant fracture or dislocation Neurovascular impairment Pain needing moderate Pain meds suspected non accidental isolated ankle or foot injury (ottawa ankle rule)

Lower back pain to ED

Can give panadol ED - Pain not isolated to lower back - Suspected Cauda equine syndrome - Incontinent - Saddle anaesthesia - Lower limb weakness Suspected vertebral fracture Suspected DAA Moderate to severe pain Spinal infection

Metrics for HP CPR NEEDS EDIT

- Compression rate 100-120 - Minimum depth 5 cm - 50:50 compression release - Allow full recoil - Minimise interruptions - Change operator every 2 minutes IF pregnant push to the left and use mechanical CPR

H O T management

Sort out the Haemorrhage oxygen Tension pneumothorax

Traumatic Head injury REVIEW And EDIT

* Airway management - if patent **DO NOT** insert NPA/OPA - If not patent, consider position, suction NPA - If ETT not possible and gag reflex is absent then SGA * Ensure Oxygenation/ventilation - Vt 6-7 ml/kg - Keep SpO2 \> 95% and EtCO2 30-35 - Mx causes of hypoxia and avoid hypo/hypercapnia * Perfusion * Na saline IV 40ml/kg titrate to patients response (unless penetrating truncal trauma or uncontrolled overt bleeding) * Aim for SBP \>120 * If SBP \< 100 post 40ml/kg consult and if unavailable another 20mkl/kg

Traumatic Head injury CPG notes

* Use opioid analgesia to Mx combativeness * If combativeness prevents preoxygenation a small bolus of 20-40mg may be given * If severely agitated manage as per agitated patient CPG * A patient is considered a blunt force trauma if they are GCS 13-15 with ANY of the following * Any LOC for \>5 min * Skull fracture * Vomit more then once * Neurological defect * Seizure * Elderly pt who has a standing height fall and are on anti coagulants,anti platelets or have bleeding disorder req transport * intoxicated patients are at high risk of occult clinical significant head injury

Anaphylaxis

Sudden onset of 2 or more of the following (30 - 240 min) R - respiratory A - Abdominal S - Skin H - Hypotension or Known exposure to an allergen with one of the following Hypotension or Respiratory distress (even if respond to 1 dose clinical red flag) Adrenalin 10mcg/kg max 500mcg repeat every 5/60 request Mica if risk factors or requires multiple doses apply high flow O2 Airway (oedema) Adrenalin 5 mg neb Bronchospasm Salbutamol Neb at 20/60 6 - 11y 2.5 - 5mg or 4-12puffs 2y - 5y 2.5 mg or 2 - 6 puffs Ipratropium Bromide Neb 6 -11y 250 mcg or 8 puffs 2 - 5y 250mcg or 4 puffs Dexamethasone 600 mcg/kg oral (IV MICA only)