CSB362 - Integrated Paramedic Practice

What is a Nasopharyngeal airway insertion?

A device incerted in the nasal canal to maximise breathing - this is twisted in slowly

What is a Oropharyngeal airway insertion?

A device incerted in the oral cavity to maximise breathing - make sure there is no force back, this is twisted in to sit against the tongue

What is Oral Suctioning?

When there is foreign liquid in the oral cavity of a patient it is suctioned up - be careful not to injure the patient

What is the Triple airway manoeuvre?

Head tilt, jaw thrust, chin lift

What is the Double airway manoeuvre?

Chin lift, jaw thrust

What is Glucometry?

Used to test blood glucose levels (BGL) 4-7

What is GCS?

Glasgow Coma Score

What is the NSA?

Neurological Status Assessment - GCS (glasgow coma score), PEARL (pupils equal and reactive to light) , speech, CNA (cranial nerve assessment)

How to take Non-invasive Blood Pressure (Manual)?

You get the systolic BP - maximum, and diastolic BP - minimum and then is written as systolic/diastolic 120/80

What is the Pain Assessment?

O - onset

P - palpation/provocation

Q - quality

R - radiation

S - severity

T - timing

What is PSA?

Perfusion Status Assessment - BP (blood pressure), GCS (glasgow coma scale), HR (heart rate), skin

What is the Primary Survey?

D - danger

R - response, AVPU (alert, voice, pain, unresponsive)

A - airway

B - breathing

C - circulation

What is an RSA?

Respiratory Status Assessment -

C - consciousness

A - appearance

P - pulse rate

E - effort

R - rhythm

R - rate

S - sound

S - skin

S - speech

What is a Tympanic thermometer?

Takes the internal temperature of a patient 36-38 Celcius

What is a Head-to-Toe Physical Exam?

Checking each body part starting from the head to the toes - including all limps - to assess trauma and any other medical issues

What is adult history taking?

S - signs and symptoms

A - allergies

M - medications

P - past medical hx

L - last ins and outs

E - events leading to

What is obstetrics history taking?

Score taken for newborns at 1 minute and again at 5 minutes

Appearance, pulse, grimace, activity, respiration

What is the mental status assessment?

Appearance - posture, build, cleanliness

Behaviour - eye contact, mannerisms, gait, activity level

Speech - rate, volume, pitch, tone

Mood - (emotion as described) anxious, depressed, cheerful

Affect - (emotion as observed) restrictive, blunted, labile

Thought form - amount, rate, ideas

Thought content - disturbance, suicidal, delusions

Perception - illusions, hallucinations

Insight and judgement - cognition, understanding of illness, cause and effect

What is a physiological cephalic delivery?

A normal delivery with a normal amount of blood loss (500mL)

How to care for a newly born mother?

Skin to skin contact to increase oxytocin to promote the mebranes of the placenta to seperate and pass through,

Reassurance

Vital signs

Monitor blood loss

How to care for a newly born child?

Appearance

Pulse

Grimace

Activity

Respiration

Taken at 1minute and 5minutes then at 5 minute intervals after

What is the physiological management of 3rd stage?

3rd stage - birth of the newborn to the birth of the placenta and membranes

Skin to skin contact to increase oxytocin production

Type: Aspirin

antiplatelet, per oral

Metabolism and excretion: Aspirin

GI mucosa and liver

Kidneys

Indications: Aspirin

Suspected ACS

Acute cardiogenic pulmonary oedema

Contraindications: Aspirin

Allergy, adverse drug reaction to aspirin and NSAID

Bleeding or clotting disorders

GI bleeding or peptic ulcers

Under 18

Precautions: Aspirin

Hx of GI bleeding or peptic ulcers

Pregnancy

Concurrent anticoagulant therapy

Possible aortic aneurysm

Side effects: Aspirin

Epigastric pain

Nausea and vomitting

Gastritis

GI bleeding

NSAID induce bronchospasm

Onset, duration and half-life: Aspirin

10min

1week

2.3hrs

Dosage: Aspirin

300mg chewed and followed by a sip of water

Type: Glucose gel

Hyperglycaemic, per oral

Indications: Glucose gel

Symptomatic hyperglycaemia (self-admin)

Contraindications: Glucose gel

Unconsciousness

Difficulty swallowing

Under 2

Precautions: Glucose gel

Nil

Side effects: Glucose gel

Nausea, vomitting

Diarrhoea

Onset, duration, half-life: Glucose gel

10mins

Variable

N/A

Dosage: Glucose gel

15g repeated once at 15mins if BGL

Type: Glyceryl Trinitrate

Vasodilator, sublingual, intravenous infusion

Indication: Glyceryl Trinitrate

ACS w/ pain

Acute cardiogenic pulmonary oedema

Autonomic dysflexia w/ systolic BP>160

Irunkanji sydrome w/ systolic BP>160

Contraindications: Glyceryl Trinitrate

Allergy, adverse drug reaction

Heart rate

Systolic BP

Precautions: Glyceryl Trinitrate

Inferior AMI

Cerebral vascular disease

Risk of hypotension, syncope

Intoxication

Side effects: Glyceryl Trinitrate

Diziness

Hypotension

Syncope

Reflex tachycardia

Vascular headaches

Onset, duration, half-life: Glycerl Trinitrate

2mins

20-30mins

5.5mins

Dosage: Glyceryl Trinitrate

400microg repeated 5min intervals

No max

Type: Methoxyflurane

Analgesic, inhalation

Metabolism and excretion: Methoxyflurane

Liver

Lungs

Metabolism: Glyceryl Trinitate

Liver

Indications: Methoxyflurane

Pain

Contraindications: Methoxyflurane

Allergy, adverse drug reaction

Less than 1

Hx of liver or renal disease

Hx of malignant hyperthermia

Precautions: Methoxyflurane

ALOC

Intoxicated or drug affected patients

Cardiovascular instability

Resp. depression

Side effects: Methoxyflurane

ALOC

Cough

Renal/hepatic failure

Onset, duration, half-life: Methoxyflurane

1-3mins

5-10mins

N/A

Dosage: Methoxyflurane

3mL repeated once after 20mins

Max dose- 6mL

Type: Oxygen

Gas, nasal cannulae, nevuliser mask, simple face mask, non-rebreather mask, bag-valve mask

Indications: Oxygen

Hypoxia or suspected hypoxia

Contraindications: Oxygen

Paraquat poisoning

Hx of blemycin therapy

Precautions: Oxygen

Premature neonate

Cyanotic heart disease

False reassurance

Side effects: Oxygen

Hypoventilation

Drying of airways

Onset, duration half-life: Oxygen

Immediate

N/A

N/A

Dosage: Oxygen

1-2% O2

Type: Paracetamol

Analgesic and antipyretic, per oral

Metabolism and excretion: Paracetamol

Liver

Kidney

Indications: Paracetamol

Mild to moderate pain

Fever - causing distress

Contraindications: Paracetamol

Allergy, adverse drug reaction

Less than 1month

Precautions: Paracetamol

Hepatic dysfunction

Sodium restriction

Phenylketonuria

Side effects: Paracetamol

Nausea

Onset, duration, half-life: Paracetamol

10-60mins

4hrs

2hrs

Dosage: Paracetamol

0.5-1g repeated every 4hrs

Max dose - 4g in 24hrs

Type: Salbutamol

Beta-adrenergic agonsit, metered dose inhaler, nebuliser, intravenous infusion

Metabolism and excretion: Salbutamol

hepatic

renal

Indications: Salbutamol

Bronchospasm

Suspected hyperkalaemia

Contraindications: Salbutamol

Allergy, adverse drug reaction

Less than 1

Precautions: Salbutamol

Acute pulmonary oedema

Ischaemic heart disease

Side effects: Salbutamol

Anxiety

Tachyarrhythmias

Tremors

Hypokalaemia and metabolic acidosis

Onset, duration, half-life: Salbutamol

2-5mins

16-60mins

1.6hrs

Dosage: Salbutamol

Bronchospams

- 1.2mg MDI inhalation, single dose

- 5mg nebuliser mask, single dose

Suspected hyperkalaemia

- 20mg nebuliser mask, single dose

Type: Ipratropium Bromide

Anricholiergic agent, nebuliser

Indications: Ipratropium Bromide

Moderate bronchospasms

Severe bronchospasms

Metabolism and excretion: Ipratropium Bromide

Hepatic

Kidney

Contraindications: Ipratropium Bromide

Allergy, adverse drug reaction

Less than 1

Precautions: Ipratropium Bromide

Glaucoma

Side effects: Ipratropium Bromide

Dilated pupils

Dry mouth

Palpitations

Onset, duration, half-life: Ipratropium Bromide

1.5-3mins

4-6hrs

3hrs

Dosage: Ipratropium Bromide

500microg repeated at 20min intervals

Max dose - 1.5mg

Type: Ondansetron

Anti-emetic, per oral, intramuscular injection, intravenous injection

Metabolism and excretion: Ondansetron

Liver

Kidney

Indications: Ondansetron

Nausea or vomiting

Contrainidications: Ondansetron

Allergy, adverse drug interaction

Congential long QT syndrome

Current apomorphine therpay

Less than 2

1st trimester pregnancy

Precautions: Ondansetron

Hepatic impairment

Elderly

Intestinal obstruction

QT interval prolongation or cardiac arrhythmias

Side effects: Ondansetron

Headache

Constipation

Hypersensitivity reaction

ECG changes

Onset, duration, half-life: Ondansetron

4mins

hrs

3-4hrs

Dosage: Ondansetron

4-8mg 8hr intervals

Max dose - 8mg

Bag valve mask ventilation flow rate

8-15L/min

Nasal prongs flow rate

1-4L/min

Simple mask flow rate

6-8L/min

Nebuliser mask flow rate

6-8L/min

Resevoir mask flow rate

8-10L/min

Reversible causes of cardiac arrest

hypovolemia

hypoxia

hydrogen ion (acidosis)

hypo/hyperkalemia

hypothermia

tension pneumothorax

tamponade, cardiac

toxins

thrombosis, pulmonary

thrombosis, coronary

Post ROSC care

Re-evaluate primary survey

12 Lead ECG

Treat underlying cause

Aim for SpO2 94-98%

Targeted temp management

COACHED acronym for CPR

Continue compressions

Oxygen away

All others aways

Charging

Hands off

Evaluate

Defibrillate or disarm