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PAR3032 - Special Populations > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What does the patient retrieval system include?

A
  • Includes triage and advice services
  • Critical care coordinators to advise on the care of critically ill patients
  • outgoing transport with appropriate staff
  • arrange suitable care bed at receiving hospital
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2
Q

What is the ARV?

A

Adult Retrieval Victoria

A - Adult critical care advice and bed access
R - Retrieval of critical adult patients
V - Victorian adult major trauma advice and referral

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3
Q

What is PIPER?

A

Paediatric Infant Perinatal Emergency Retrieval

  • Under RCH
  • NETS - Newborn Emergency Transport Service
  • PERS - Perinatal Referral Service
  • PETS - Paediatric Emergency Transport Service
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4
Q

What types of jobs are used to staff Patient retrieval system in VIC

A
  • Emergency physicians
  • Anaesthetists
  • Intensivists
  • Critical Care Registered Nurse (CCRN)
  • MIdwife
  • Flight paramedics
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5
Q

What is the range of Fixed wing air ambulance?

A

2500km

Staffed by pilot and flight paramedic

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6
Q

What is the range of Rotary wing air ambulance

A

175-250 km

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7
Q

What do you need to consider when calling for HEMS?

A
  • Time
  • Weather
  • Landing Site
  • Clinical need
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8
Q

With Patient retrieval, what do we do in the first 15 minutes?

A

0-15mins
Ensure patient safety (DRABCDE)
- everything is set-up and they are prepared

5-15 min
optimised patient
Package patient

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9
Q

What is included in ensuring patient safety when preparing a patient for retrieval?

A

DRABCDE

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10
Q

What is included in optimising patient for retrieval?

A 
optimise physiological state:
PSA
- invasive monitoring
- 12 lead
- urine output and fluid balance
- pathology lab results
- temp
- haemodynamic trneds
- chest x ray

RSA
- chest xray
ABG’s/VBG’s
- revisit ventilator masks

Neurological assessment

  • pains of sign
  • GCS
  • Bilateral movement
  • BSL
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11
Q

What is included in packaging patient for retrieval?

A 
IV access
Infusion
Arterial line
Naso-gastric
catheter
comprehensive monitoring
ventilator
etc.
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12
Q

What do you do on completion of packaging patient?

A

Pre-departure check:

  • Extra blood/fluid/FFP
  • sufficient infusion volume for transport
  • soft bag as fail safe ventilation
  • accompanying notes
  • AAV equipment
  • patient belongings
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13
Q

what are some considerations for packagagin patient?

A
  • patient access
  • spinal immobilsation
  • head postiion
  • monitor application
  • removal of pt clothing
  • removal of wet soiled linen
  • vascular access
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14
Q

What is advanced care directive and what are it’s components?

A

replaced NFR

Has 2 parts:

  • Value directive
  • Instructional directive
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15
Q

How is ACD different from NFR?

A

NFR has to have a valid reason. Has to be very specific to the situation and scenario.
eg. someone has kidney cancer but has a stroke - still need to resuss.

  • Doesn’t have to be as specific and precise.
  • > dont need a lawyer
  • > do need 2 witnesses
  • –> none can be appointed as decision maker
  • –> one needs to be registered medical practitioner
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16
Q

What are the types of common blood tests?

A
  • Full blood counts
  • VBG/ABG
  • Blood chemistry (Urea and electrolytes)
  • Liver function tests
  • Cardiac enzzymes
  • Coagulation factors + INR
  • C-Reactive protein
  • D-Dimer
  • Thyroid panel
  • Iron studies
  • Lactate
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17
Q

What does a full blood count (FBC) meaure?

A

Measures:

  • RBC
  • Haemoglobin
  • WCC
  • Platelet
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18
Q

What does a FBC help identify?

A
  • Severity of blood lost
  • Anaemia
  • Autoimmune problems (allergic reactions)
  • Infection
19
Q

Where does the Venous Blood Gases (VBG’s) get taken from?

A
  • taken from peripheral or central veins
  • not as accurate as ABG
  • Causes less pain to patients
  • lower risk for vascular injuries
20
Q

Where does the arterial Blood Gases (ABG’s) get taken from?

A

Directly from artery

21
Q

What does the ABG’s measure?

A 
pH
PCO2
PaO2
HCO3
Base excess
22
Q

What is the normal pH range?

A

7.35 - 7.45

>7.45 = alkalosis
<7.35 = acidosis
23
Q

Why is iron so important to measure?

A

Used to make haemoglobin in blood

24
Q

what happens to PAO2/PCO2/HCO3 during Respiratory acidosis

A 
PAO2 = Decrease
PCO2 = Increase
HCO3 = Decrease
25
Q

what happens to PAO2/PCO2/HCO3 during Respiratory alkalosis

A 
PAO2 = Increase
PCO2 = Decrease
HCO3 = Increase
26
Q

what happens to PAO2/PCO2/HCO3 during Metabolic acidosis

A 
PAO2 = Increase
PCO2 = Decrease
HCO3 = Decrease
27
Q

what happens to PAO2/PCO2/HCO3 during Metabolic alkalosis

A 
PAO2 = Decrease
PCO2 = Increase
HCO3 = Increase
28
Q

What is measured when looking at blood chemistry?

A

Urea and electrolytes

Detects abnormalities of blood chemistry, such as electrolytes imbalances, dehydration and kidney issues.

Urea and Creatinine level are good indicators for renal function

29
Q

What can happen with abnormal levels of potassium and magnesium?

A

Abnormal level of those electrolytes is a common cause of ectopics (PACs, PVCs) and arrhythmias.

30
Q

What is the liver function test used for?

A

Use to screen, detect, evaluate and monitor acute and chronic liver functions

• Helps Dx of liver inflammation (hepatitis), infection or damages, and also bile ducts
problems.

31
Q

What dowe look for in the liver function test?

A

Albumin

Produced by liver, level would affect fluid shift in the body.

Not enough albumin means fluid can’t be held in blood, it moves into interstitual space

32
Q

what does the cardiac enzyme test detect?

A

Cardiac enzymes would be released from damaged cardiac cells, into blood stream

  • Traces of cardiac enzymes > Cardiac Cells damage
  • Not always due to MI
  • Renal Patients and Heart Failure Pt > might have baseline troponin trace
33
Q

What does the coagulation factor test measure?

A

Measures clotting time and coagulation factors, for unexplained or prolonged bleed.

34
Q

What do we check for in the coagulation factor test include?

A

• Prothrombin Time (PT)
• activated Partial Thromboplastin Time (aPTT)
-» Heparin
• Thrombin Time (TT)
• International Normalised Ratio (INR)
-» Warfarin (normal is around 1… bigger the number the more thin the blood)

35
Q

What does the C-Reactive protein (CRP) test measure?

A

Identify the presence of inflammation, determine its severity, and also monitor response of treatment.

36
Q

What are some caused of CRP?

A
  • Autoimmune Issues
  • Infection
  • MI
37
Q

What does the D-Dimer test look for?

A

Fibrin Degradation Product

Fibrin degradation products (FDP) would be formed, as body break down thrombus.
• Elevated trace of FDP > Clot in the vascular system

Part of investigation of PE, DVT, DIC or any forms of clotting disorder

Monitor treatment of various thrombotic conditions

38
Q

What do they look for with a thyroid panel test?

A

Measures level of various thyroid hormones

Screen for thyroid disorders, monitor treatment of thyroid issues, even some autoimmune response.

39
Q

What do Iron studies uncover?

A

Measure iron levels in blood

• Specific test for identifying iron-deficiency anaemia

40
Q

What do lactate tests look for?

A

Lactic Acid

• By product of anaerobic respiration

41
Q

What are the 2 types of lactic acidosis?

A

Type A

Type B

42
Q

What is Type A lactic acidosis?

A
  • Most common type
  • Inadequate supply of O2 @ cellular level
  • Reduced O2 uptake @ lung
  • Reduced perfusion @ cellular level
43
Q

What is Type B lactic acidosis?

A

Excess demand of O2, metabolic issues

PAR3032 - Special Populations (13 decks)

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