Week 10: Introduction to Rural Emergencies 1

Question 1

Briefly define triage

Answer 1

The system of organising the order in which patients are seen, based on urgency when not all patients can be seen straight away

Question 2

Fill the blanks 1-5

Answer 2

1. critical 2. urgent 3. serious but less urgent 4. less serious 5. admin

Question 3

Fill the blanks A-E

Answer 3

A. Immediately B. < 10 minutes C.< 30 minutes D. < 1 hour E. < 2 hours

Question 4

Is the Australasian Triage Scale used rurally?

Answer 4

Generally, this may be overkill in rural settings. Instead a 3 tier system may be used: 1. Critical - dying 2. Urgent - may die 3. Everyone else

Question 5

Give 3 general presentations which may be a category 1

Answer 5

-unconscious - major trauma - severe asthma - fitting on arrival - shock

Question 6

Give 3 general presentations which may be a category 2

Answer 6

-Chest pain - pregnant with abdominal pain - severe pain - children with fractures

Question 7

Physiologically, what defines category 1?

Answer 7

Evident current major physiological disturbance

Question 8

Physiologically, what defines category 2?

Answer 8

Urgent but no current major physiological disturbance

Question 9

How is a disaster defined in emergency medicine?

Answer 9

Any event where emergency patient requirements exceed staff capacitites

Question 10

Fill in the blanks to complete to triage sieve

Answer 10

1. Can walk 2. Priority 3/green 3. Breathing 4. Breathing resumes when airway is cleared 5. Dead/white/black 6. Breathing rate 7. >29bpm OR <10bpm 8. Priority 1/red/immeddiate 9. Circulation 10. 120bpm 11. Priority 2/orange/urgent

Question 11

Describe the primary survey

Answer 11

A: airway - check if unobstructed and functioning. If not neck tilt and chin lift unless spinal injury suspected, then jaw thrust B: breathing - if yes check pulse oximeter, observe threatening injuries to chest (flail chest, pneumothorax, etc) C: Circulation: most common problem is hypovolaemia -> IV fluids and blood products, oxygen gas D: Disability: neurological dysfunction, assess level of consciousness, measure blood glucose E: Exposure: quickly check for other injuries, keep patient warm

Question 12

What are the 3 main questions when surveying circulation? Describe each including any grading systems

Answer 12

1. Are they bleeding?: External bleeding, tachycardia, cool/clammy skin, weak pulse, low BP (signs of hypovolaemia 2. Where are they bleeding?: External - obvious. If not: palpate, auscultate, use ultrasound to find the source. May need explorative surgery 3. How much are they bleeding?: - Grad 1: vitals normal - Grade 2: tachycardia, BP >100 - Grade 3: tachycardia BP<80 - Grade 4: CVS collapse, very low BP

Question 13

What are some of the common areas of internal hidden bleeding?

Answer 13

-Chest cavity - abdomen - retroperitoneal space - pelvic cavity - long bones

Question 14

What are the grades of haemorrhage? include volumes and what general treament

Answer 14

Grade 1: <750ml - little treatment required (blood donation metaphor) Grade 2: 750ml -1.5L - IV fluids Grade 3: 1.5L - 2L - IV fluids and O- blood Grade 4: >2L - IV fluids, blood, and usually need surgery

Question 15

What is the secondary survey?

Answer 15

This is a careful head to toe examination carefully looking for injuries and documenting them. Eg: joint injuries, dislocations

Question 16

How are these requirements dealt with in a rural setting?

Answer 16

Difficult, most of the time not available in rural facilities -> require referral

Question 17

What is the RSQ?

Answer 17

Retrieval Services Queensland

Question 18

How do RSQ help decide on the logistics of transer?

Answer 18

• Will consider: weather, distance, access to helipad/airstrip, local geography, saftey aspects, etc. - Can arrange teleconference with relevant specialists to decide course of action. - Most emergency rooms have videoconferencing facilities to allow clinical coordinators to assess the case

Question 19

What are some of pros of ambulance for transfer?

Answer 19

• Best choice in <100km - Can stop and provide interventions and have reasonable equipement - minimal weather/night limitations -

Question 20

What are some of pros of helicopters for transfer?

Answer 20

• Fastest in 100-350km distance - point to point transfer: dropoff directly at hospital - can overcome geographical limitations such as absence of roads

Question 21

What are some of pros of airplanes for transfer?

Answer 21

• Best for distances over 350km - very well equipped and trained staff - Able to fly in most weather conditions - pressurised cabin