CSB362 Skills Assessment

Triple Airway Manoeuvre

1. Head tilt

2. Jaw thrust

3. Open mouth

Double Airway Manoeuvre

SUSPECTED C-SPINE

1. Jaw thrust

2. Open mouth

GCS - Eyes

4 - spontaneous

3 - reacts to speech

2 - reacts to pain

1 - no response

GCS - Verbal

5 - orientated

4 - confused

3 - inappropriate words

2 - incomprehensible

1 - no response

GCS - Motor

6 - obeys commands

5 - localised to pain

4 - withdraws from pain

3 - flexion response

2 - extension response

1 - no response

GCS Interpretation

• 3-8 = severe

• 9-12 = moderate

• 13-15 = mild

Neurological Status Assessment

1. Level of consciousness - AVPU, GCS

2. Pupils - pinpoint (<2mm), normal (2-6mm), dilated (>6mm), PEARL

3. Motor function - coordination, strength, facial weakness, abnormal movements (seizing, tremors, decorticate/decerebrate)

4. Sensory function - hearing/comprehension, superficial sensation

5. Vital signs - respiration (RRE), blood pressure, pulse, temperature

Pain Assessment

1. Onset

2. Provocation

3. Quality

4. Radiation

5. Severity

6. Timing

7. Treatment

5 Step ECG Interpretation

1. Regularity - look at R and R interval

2. Rate - 1500 method (count little squares, 1500/x)

3. P-waves - present, upright, rounded

4. PR Interval - 0.12 -0.2 seconds

5. QRS Complex - >0.12 seconds

12 Lead ECG Application

• V1 - 4th intercostal space, right of sternum

• V2 - 4th intercostal space, left of the sternum

• V4 - 5th intercostal space, on the left midclavicular line

• V6 - on the left mid axillary line, level with V4

• V3 - midway between V2 and V4

• V5 - midway between V4 and V6

Reversible Causes of Cardiac Arrest

• Hypovolemia

• Hypoxia

• Hydrogen ions

• Hypo/hyperkalemia

• Hypo/hyperthermia

• Hypoglycaemia

• Tension pneumothorax

• Tamponade

• Toxins

• Thrombosis

Post-ROSC Care

1. Airway and breathing

2. Circulation

3. Control temperature

4. BGL

5. Combative patient

6. Pain relief

7. Seizure control

Methoxyflurane MOA

Modulation of excitation and inhibitory ion channel in the CNS

Methoxyflurane Indications

Pain (with ability to self-administer)

Methoxyflurane Contraindications

• Allergy/adverse drug reaction

• <1 year of age

• Liver or renal disease

• Malignant hyperthermia

Methoxyflurane Side Effects

• ALOC

• Dizziness

• Cough

Methoxyflurane Dosage

• Inhalation

• 3ml, repeat after 20 minutes

• Max: 6ml

Aspirin MOA

Inhibits platelet aggregation by inhibiting cyclooxygenase, reducing the synthesis of thromboxane A2

Aspirin Indications

• Suspected ACS

• Acute cardiogenic pulmonary oedema

Aspirin Contraindications

• Allergy/adverse drug reaction

• Bleeding or clotting disorders

• Current GI bleeding/peptic ulcers

• <18 years of age

Aspirin Side Effects

• Epigastric pain

• Nausea

• Gastritis

• GI bleeding

• NSAID induced bronchospasm

Aspirin Dosage

• Tablet (chewable)

• 300mg

Glucose Gel MOA

Absorbed into the intestinal tract after ingestion to increase blood sugar

Glucose Gel Indications

• symptomatic hypoglycemia

Glucose Gel Contraindications

• Unconsciousness

• Patients with difficulty swallowing

Glucose Gel Side Effects

• Nausea

• Diarrhoea

Glucose Gel Dosage

• Gel (oral)

• 15g, repeat at 15 minutes if BGL<4

• Max: 30g

Glyceryl Trinitrate (GTN) MOA

Potent vasodilator that decreases preload by increasing venous capacity, pooling venous blood in peripheral veins, reducing ventricular filling pressure and decreasing arterial blood pressure

GTN Indications

• Suspected ACS

• Acute cardiogenic pulmonary oedema

• Autonomic dysreflexia

• Irukandji syndrome

GTN Contraindications

• Allergy/adverse drug reaction

• Heart rate <50 or >150bpm

• Systolic BP <100mmHg

• Active CVA

• Head trauma

• Phosphodiesterase 5 inhibitor medication administration

• Currently taking riociguat

GTN Side Effects

• Dizziness

• Hypotension

• Fainting

• Reflex tachycardia

• Vascular headaches

GTN Dosage

• Sublingual

• 400mg, repeat at 5 minutes

• No max

Oxygen Indications

• Systematic/localised hypoxia

Oxygen Contraindications

• Paraquat poisoning with SpO2 > 88%

• Bleomycin therapy with SpO2 > 88%

Oxygen Side Effects

• Drying of the airway mucous membranes

Paracetamol MOA

Exhibits analgesic and antipyretic activity

Paracetamol Indications

• Mild to moderate pain

• Fever

Paracetamol Contraindications

• Allergy/adverse drug reaction

• <1 month of age

Paracetamol Side Effects

• Nausea

Paracetamol Dosage

• Tablet (oral)

• 0.5-1g, repeat every 4 hours

• Max: 4g

Salbutamol MOA

Sympathomimetic agent which affects beta 2-adrenoreceptors primarily acting as a bronchodilator, and also directs stimulation of the sodium/potassium ATPase pump, drawing potassium into cells

Salbutamol Indications

• Bronchospasm

• Suspected hyperkalemia

Salbutamol Contraindications

• Allergy/adverse drug reaction

• <1 year of age

Salbutamol Side Effects

• Anxiety

• Tachyarrhythmias

• Tremors

• Hypokalemia and metabolic acidosis

Salbutamol Dosage

• Nebuliser

• 5mg, repeat when needed

• No max

Ipratropium Bromide MOA

Antimuscarinic agent which promotes bronchodilation by inhibiting cholinergic bronchomotor tone

Ipratropium Bromide Indications

• Moderate bronchospasm (unresponsive to QAS salbutamol)

• Severe bronchospasm

Ipratropium Bromide Contraindications

• Allergy/adverse drug reaction

• >1 year of age

Ipratropium Bromide Side Effects

• Dilated pupils

• Dry mouth

• Palpitations

Ipratropium Bromide Dosage

• Nebuliser

• 500microgram, repeat every 20 minutes

• Max: 1.5mg

Ondansetron MOA

Serotonin 5-HT3 receptor antagonist, works by blocking the action of serotonin

Ondansetron Indications

• Significant nausea/vomiting

Ondansetron Contraindications

• Allergy/adverse drug reaction

• Congenital long QT syndrome

• Current apomorphine therapy

• <2 years of age

• First trimester pregnancy (only given for extreme/uncontrolled hyperemesis)

Ondansetron Side Effects

• Headache

• Constipation

• Hypersensitivity reactions

• ECG changes

Ondansetron Dosage

• Disintegrating tablet (oral)

• 4-8mg

• Max: 8mg (must not be given within 8 hours of previous dose)