Paramedic

How long is the timer for drowning in water above 6 degrees

30 Minutes

5 principles of the Mental Capacity Act

A person must be assumed to have capacity unless it is established that he lacks capacity.

A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

What section covers a person to perform A vital act is any act which the person doing it reasonably believes to be necessary to prevent a serious deterioration. MCA

Mental Capacity Act section 4b

A person lacks capacity if….

Because of an impairment or disturbance of the mind or brain they cannot make a specific decision when needed

What is section 3 of the MCA

Functional test of capacity - Understand - Retain - Weigh up - Communicate

Section 4 - When someone lacks capacity you should consider..

past wishes, beliefs, values, advanced statement, LPA, Regaining capacity? can the decision wait?

What is section 5 of the MCA

The protection in law for those acting in the best interest of the patient

What does section 6 of the MCA relate to

Restraint, Necessary and proportionate,

Contraindications of kendrick traction device

Ankle or lower leg fracture

Contraindications for IO access

infection, amputation, previous IO in last 48 hours, unable to find landmarks prosthetic limb

What syndrome may lead to weakening of the Aortic walls, valves becoming floppy, a tall thin build with long limbs effecting the bodies connective tissues

Marfans syndrome

Which syndrome effects the sympathetic nervous system between the face and the brain

Horners Syndrome

During a cardiovascular assessment what could cause a radio-radial delay

• 
  Subclavian artery stenosis (e.g. compression by a cervical rib)

• Aortic dissection

• Aortic coarctation

Causes of a collapsing pulse during cardiovascular assessment

• 
  Normal physiological states (e.g. fever, pregnancy)

• Cardiac lesions (e.g. aortic regurgitation, patent ductus arteriosus)

• High output states (e.g. anaemia, arteriovenous fistula, thyrotoxicosis)

Causes of raised JVP

• 
  Right-sided heart failure: commonly caused by left-sided heart failure. Pulmonary hypertension is another cause of right-sided heart failure, often occurring due to chronic obstructive pulmonary disease or interstitial lung disease.

• Tricuspid regurgitation: causes include infective endocarditis and rheumatic heart disease.

• Constrictive pericarditis: often idiopathic, but rheumatoid arthritis and tuberculosis are also possible underlying causes.

Causes for positive hepatojugular reflux test

A positive hepatojugular reflux result suggests the right ventricle is unable to accommodate an increased venous return, but it is not diagnostic of any specific condition. The following conditions frequently produce a positive hepatojugular reflux test:

• Constrictive pericarditis

• Right ventricular failure

• Left ventricular failure

• Restrictive cardiomyopathy

When assessing the front of a patients chest during cardiovascular assessment what 4 things would you be looking for?

• 
  Scars suggestive of previous thoracic surgery: see the thoracic scars section below.

• Pectus excavatum: a caved-in or sunken appearance of the chest.

• Pectus carinatum: protrusion of the sternum and ribs.

• Visible pulsations: a forceful apex beat may be visible secondary to underlying ventricular hypertrophy.

When assessing the apex beat it should be 5th intercostal space midclavicular, why may it be displaced?

• Displacement of the apex beat from its usual location can occur due to ventricular hypertrophy.

When assessing for heaves over the left sternal border what may a positive result indicate?

• Parasternal heaves are typically associated with right ventricular hypertrophy.

When assessing for thrills over the valve locations what would you be feeling for and what may it mean?

Turbulent blood flow through the valve

when assessing Auscultate the carotid arteries using the diaphragm of the stethoscope whilst the patient holds their breath. what are you listening for?

listen for radiation of an ejection systolic murmur caused by aortic stenosis.

When Sitting the patient forwards and auscultate over the lower left sternal border (3rd/4th intercostal space) with the diaphragm of the stethoscope during expiration what are you listening for?

listen for an early diastolic murmur caused by aortic regurgitation.

Roll the patient onto their left side and listen over the mitral area with the diaphragm of the stethoscope during expiration to listen for………

With the patient still on their left side, listen again over the mitral area using the bell of the stethoscope during expiration

pansystolic murmur caused by mitral regurgitation. Continue to auscultate into the axilla to identify radiation of this murmur.

for a mid-diastolic murmur caused by mitral stenosis