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CPG Key points and treatment > Treatment > Flashcards

Treatment Flashcards

1
Q

ACS treatment

A

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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2
Q

STEMI

A

-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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3
Q

Anaphylaxis

A

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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4
Q

Asthma

A

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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5
Q

Medical Arrest

A

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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6
Q

Agitation

A

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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7
Q

Factors for suspected COPD

A
  • 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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8
Q

COPD treatment

A
  • 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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9
Q

Pulmonary Oedema Sign and Symptoms

A
  • SOB
  • Orthopnoea
  • Agitation
  • Pale clammy sweaty
  • Adventitious breath sounds
  • BP changes < >
  • Increase in JVP
  • Paroxysmal nocturnal dyspnoea
  • Pink frothy sputum
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10
Q

Pulmonary Oedema treatment

A

GTN 600 mcg if SBP > 110
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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11
Q

Tachycardia (narrow complex)

A

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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12
Q

CPAP contraindications

A

7

  1. Facial Trauma
  2. GCS < 13
  3. Needs ETT
  4. Hypopnea
  5. Pneumothorax
  6. Vomiting
  7. VT
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13
Q

Hypothermic cardiac arrest defib and adrenaline timing

A

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

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14
Q

List 2 of 3 safety measures Zoll

A
  • Water hazards
  • On metal surfaces
  • Flammable agents
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15
Q

Give clinical values for red flags

A

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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16
Q

List clinical conditions that mandate (red flag) transportation

A

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
17
Q

Clinical Flags defined

A 
Red = Mandated transport 
Yellow = do not mandate transport but have increased risk
18
Q

Clinical Yellow flags

A

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

19
Q

List 9 reasons Treat and refer

A
  • Epistaxis
  • Suspected Gasto
  • Heroin OD
  • Hypoglycemia
  • Minor burns
  • Minor wounds
  • Seizures
  • Soft tissue injuries
  • Undiagnosed lower back pain
20
Q

Epistaxis

A
  • 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
21
Q

Gastro

A
  • 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
22
Q

Heroin OD

A
  • 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
23
Q

Hypoglycemia

A
  • 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

24
Q

Minor Burns

A

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

25
Q

Minor wound

A

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

26
Q

Seizure yellow flag

A

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

27
Q

Soft tissue injury

A

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

28
Q

ED for soft tissue when

A

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

29
Q

Lower back pain to ED

A

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

30
Q

Metrics for HP CPR

A
  • 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

31
Q

H O T management

A

Sort out the
Haemorrhage
oxygen
Tension pneumothorax

32
Q

Traumatic Head injury

A
  • 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
33
Q

Traumatic Head injury CPG notes

A
  • 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
34
Q

Anaphylaxis

A

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)

CPG Key points and treatment (6 decks)

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