Week 2 Flashcards
What does the patient retrieval system include?
- 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
What is the ARV?
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
What is PIPER?
Paediatric Infant Perinatal Emergency Retrieval
- Under RCH
- NETS - Newborn Emergency Transport Service
- PERS - Perinatal Referral Service
- PETS - Paediatric Emergency Transport Service
What types of jobs are used to staff Patient retrieval system in VIC
- Emergency physicians
- Anaesthetists
- Intensivists
- Critical Care Registered Nurse (CCRN)
- MIdwife
- Flight paramedics
What is the range of Fixed wing air ambulance?
2500km
Staffed by pilot and flight paramedic
What is the range of Rotary wing air ambulance
175-250 km
What do you need to consider when calling for HEMS?
- Time
- Weather
- Landing Site
- Clinical need
With Patient retrieval, what do we do in the first 15 minutes?
0-15mins
Ensure patient safety (DRABCDE)
- everything is set-up and they are prepared
5-15 min
optimised patient
Package patient
What is included in ensuring patient safety when preparing a patient for retrieval?
DRABCDE
What is included in optimising patient for retrieval?
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
What is included in packaging patient for retrieval?
IV access Infusion Arterial line Naso-gastric catheter comprehensive monitoring ventilator etc.
What do you do on completion of packaging patient?
Pre-departure check:
- Extra blood/fluid/FFP
- sufficient infusion volume for transport
- soft bag as fail safe ventilation
- accompanying notes
- AAV equipment
- patient belongings
what are some considerations for packagagin patient?
- patient access
- spinal immobilsation
- head postiion
- monitor application
- removal of pt clothing
- removal of wet soiled linen
- vascular access
What is advanced care directive and what are it’s components?
replaced NFR
Has 2 parts:
- Value directive
- Instructional directive
How is ACD different from NFR?
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
What are the types of common blood tests?
- 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
What does a full blood count (FBC) meaure?
Measures:
- RBC
- Haemoglobin
- WCC
- Platelet
What does a FBC help identify?
- Severity of blood lost
- Anaemia
- Autoimmune problems (allergic reactions)
- Infection
Where does the Venous Blood Gases (VBG’s) get taken from?
- taken from peripheral or central veins
- not as accurate as ABG
- Causes less pain to patients
- lower risk for vascular injuries
Where does the arterial Blood Gases (ABG’s) get taken from?
Directly from artery
What does the ABG’s measure?
pH PCO2 PaO2 HCO3 Base excess
What is the normal pH range?
7.35 - 7.45
>7.45 = alkalosis <7.35 = acidosis
Why is iron so important to measure?
Used to make haemoglobin in blood
what happens to PAO2/PCO2/HCO3 during Respiratory acidosis
PAO2 = Decrease PCO2 = Increase HCO3 = Decrease
what happens to PAO2/PCO2/HCO3 during Respiratory alkalosis
PAO2 = Increase PCO2 = Decrease HCO3 = Increase
what happens to PAO2/PCO2/HCO3 during Metabolic acidosis
PAO2 = Increase PCO2 = Decrease HCO3 = Decrease
what happens to PAO2/PCO2/HCO3 during Metabolic alkalosis
PAO2 = Decrease PCO2 = Increase HCO3 = Increase
What is measured when looking at blood chemistry?
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
What can happen with abnormal levels of potassium and magnesium?
Abnormal level of those electrolytes is a common cause of ectopics (PACs, PVCs) and arrhythmias.
What is the liver function test used for?
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.
What dowe look for in the liver function test?
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
what does the cardiac enzyme test detect?
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
What does the coagulation factor test measure?
Measures clotting time and coagulation factors, for unexplained or prolonged bleed.
What do we check for in the coagulation factor test include?
• 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)
What does the C-Reactive protein (CRP) test measure?
Identify the presence of inflammation, determine its severity, and also monitor response of treatment.
What are some caused of CRP?
- Autoimmune Issues
- Infection
- MI
What does the D-Dimer test look for?
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
What do they look for with a thyroid panel test?
Measures level of various thyroid hormones
Screen for thyroid disorders, monitor treatment of thyroid issues, even some autoimmune response.
What do Iron studies uncover?
Measure iron levels in blood
• Specific test for identifying iron-deficiency anaemia
What do lactate tests look for?
Lactic Acid
• By product of anaerobic respiration
What are the 2 types of lactic acidosis?
Type A
Type B
What is Type A lactic acidosis?
- Most common type
- Inadequate supply of O2 @ cellular level
- Reduced O2 uptake @ lung
- Reduced perfusion @ cellular level
What is Type B lactic acidosis?
Excess demand of O2, metabolic issues
