PARAMEDICINE

What is the first thing you do on scene ?

Check for DANGER to self, pt, or dangerous environment.

What does AVPU stand for

Checking for response. ALERT, respond to VOICE, respond to PAIN, UNRESPONSIVE

What are we looking for when assessing AIRWAY

BAFITT,

Burns, allergy, foreign body, infection trauma, tumour

How to assess breathing?

LOOK at posture, cyanosis?

LISTEN to breathing, wheezing?

FEEL for rise & fall

What are we looking for when assessing CIRCULATION in primary survey?

Colour, level of consciousness, cool peripheries, uncontrolled haemorrhage

What are some DISABILITY assessments?

PEARL, BE FAST

What to do for exposure &egress

Look for other issues

What is the point of primary survey?

Find & fix life threatening injuries or illness

What is involved in INTRODUCTION? (WIIPPP)

Wash hands, introduce self, identity of patient, permission and consent, purpose explanation, positioning

What does SOCRATES stand for? (Hx of complaint)

Site, Onset, Character, Radiation, Associations, Time course or pattern, Exacerbations or relieving factors, Severity

What does SAMPLER stand for? (PMHx)

Signs and symptoms, Allergies, Medications, Pertinant medical hx, Last oral intake, Events leading to injury/illness, Risk factors

What to look for in NEUROLOGICAL review?

Numbness, weakness, visual changes

What to look for in PSYCHOLOGICAL review?

Depressions, anxiety, daily management

What to look for in CARDIOVASCULAR review?

Chest pain, palpitations, dyspnoea, peripheral oedema

What to look for in RESPIRATORY review?

Cough, SOB, lung sounds

What to look for in GASTROINTESTINAL review?

Abdo pain, bowel change, heart burn, vomiting

What to look for in GENITOURINARY / RENAL review?

Discharge, dysuria

What to look for in INTEGUMENTARY review?

Rashes, discolouration, lumps, bump

What does IMISTAMBO stand for?

Identification, mechanism of injury/illness, injury/illness, signs and symptoms, treatment, allergies, medications, background, other

When calling for a REFERAL (ICP, helicopter, bariatric), what information do you need to provide control centre with?

Locations, reason for referral, condition of patient, specialised equipment required

When should you pre notify the hospital?

Urgent and specialised care, time critical (stroke, heart attack, severe trauma)

What information is required for a hospital pre notification? ASHICE

Age, sex, history, illness, condition, ETA

For a MAJOR INCIDENT, what does METHANE stand for?

Major incidents confirmation, exact location, type of incident, hazards, access / egress, number of casualties and severity, emergency services present and required

GCS eyes scores?

4. Spontaneous eye opening

3. Open eyes to voice

2. Open eyes to pain

1. No eye opening

GCS verbal score?

5. Pt can state date, time, place, person

4. Confused about one aspect

3. Inappropriate words or out of context

2. Moaning / groan / mumble

1. No audible response

GCS motor score?

6. Obey commands: squeeze hand, touch nose

5. Localise pain: move hand to remove pain

4. Withdraws from pain: move hand away from pain (normal flexion)

3. Decorticate posturing (abnormal flexion)

2. Decerebrate posturing (abnormal extension)

1. No motor response

What is decorticate posturing?

Abnormal flexion.

Adduction and internal rotation of arms and extension of legs

What does decorticate posturing indicate?

Damage ABOVE level of midbrain. Effects eye movement, auditory and visual reflexes, coordination

What can cause decorticate posturing?

TBI, CVA, brain tumour, infection, brain swelling, hypoxia, hypoglycaemia

What is decerebrate posturing?

Abnormal extensions of elbow, wrist and legs

What does decerebrate posturing indicate?

Damage in brain stem. Effects vital functions like breathing, HR, consciousness

What can cause decerebrate posturing?

TBI, CVA, brain stem tumour, intracranial hemorrhage, toxic metabolic conditions (severe liver failure)

Normal BGL level?

4-8 mmol/L

Hypoglycaemia BGL level and causes?

<4 mmol/L

Fasting, drugs (insulin, alcohol), extreme exercise

Hyperglycaemia BGL levels and causes?

>8mmol/L

Insulin deficiency, infection, diabetes, food / drink intake

Normal body temp

35.9 - 37.6 °c

What does PERRLA stand for?

Pupils equal, round, reactive to light, accomodation

What can cause pinpoint pupils? (Miosis)

Hypoxia, brain stem CVA, opiate overdose, miotic eye drops, horners syndrome

What can cause dilates pupils? (Mydriasis)

Fear, anxiety, anti-cholinergic drug overdose (atropine), pain, mydriatic eye drops

What can cause unequal pupils?

Acute stroke, aneurysm, 3rd nerve palsy, brain tumour, increased intracranial pressure

What can cause unresponsive pupils?

Brain herniation, glaucoma, stroke, cardiac arrest

What can cause photophobia? (Increased sensitivity to light)

Acute iritis, migraine, meningitis

What does STRIDOR sound like

Continuous high pitch crow or whistle on inspiration

What causes STRIDOR lung sounds?

Partial obstruction of larynx or trachea

Croup

Where is STRIDOR the loudest?

Anterior neck as air moves turbulently over the partially obstructed upper airway

What does WHEEZE sound like?

Continuous high pitched whistle

What causes sibilant wheezing?

Air passing through and obstructed, narrow airway

Asthma, allergies, infection

What does ronchi (sonorous wheeze) sound like?

Deep low pitch rumbling or course sound on expirations

What causes ronchi (sonorous wheeze)

Air moving through tracheal / bronchial passages in presence of mucus or respiratory secretions

Asthma, emphysema, bronchitis

What does crackles sound like (alveolar rales)

Short, fine, high pitched and intermittent

what is and where do u hear crackles?

Air passing through fluid, pus< mucus.

Heard in bases of lung lobes during inspiration

What causes fine crackles (like hair rubbing near ear)?

CCF and pulmonary fibrosis

What can cause course crackles (low pitch and moist)

Pulmonary oedema and bronchitis

What is pleura rub and what does it sound like?

Movement of inflamed pleural surfaces against one another during chest wall movement.

Sounds like harsh grating or creaking.

Can be caused by tuberculosis and pneumonia

What does a pulse oximeter do?

Measles SpO2 to assess how well oxygen is being delivered to peripheral extremities

What is SpO2 normal range?

95-100%

What can effect SpO2 readings?

Nail polish, cold extremities, poor circulation, movement, severe anaemia, dark skin, CO poisoning

Nasal cannula flow rate

2-4 L/min

Hudson mask flow rate?

6-8 L/min

Nebuliser flow rate?

8 L/min

Non-rebreather flow rate?

10-15 L/min

BVM flow rate?

15L

What is pharmacokinetics?

What the drug does to the body.

How a drug moves through the body over time

What is pharmacodynamics?

What the drug does to the body

What are the 6 rights of drug administration?

Right patient, right drug, right dose, right time, right route, right documentation