Professional Documents
Culture Documents
2012 Edition
Andrew Osborn
Pulse
BP
GCS
Adequate
Perfusion
Borderline
Perfusion
Inadequate
Perfusion
Extremely Poor
Perfusion
No Perfusion
Mild Distress
Moderate
Distress
Severe
Distress
Normal
Mild Distress
Moderate
Distress
Severe
Distress
Pulse Rate
Skin
Conscious
State
GLASCOW COMA SCORE:
Eyes Opening:
4
3
2
1
Verbal Response:
5
4
3
2
1
Motor Response:
6
5
4
3
2
Emergent:
Potential:
Pregnancy
Medical Triage: These patients are time critical to the nearest appropriate hospital.
VITAL SIGNS
Respiratory Rate
Blood Pressure
Pulse
GCS
Oxygen Saturations
Emergent Time Critical
Pattern of Injury
Penetrating Injuries
Blunt Injuries
Specific Injuries
1
2
3
4
5
6
7
Co-Morbidities
Child
1-8 years
Respiratory
Rate
Blood Pressure
Pulse
GCS
SpO2
Skin
Blunt Injuries
Specific Injuries
1
2
3
4
5
6
7
Child
9-15 years
STROKE ASSESSMENT
Normal
Facial Droop
Speech
Hand Grip
As GCS
Blood Glucose
As BSL
Stroke Mimics
Abnormal
Stroke Mimics
Withhold O2 in
- Once Pt Stable
Conditions with chronic hypoxaemia who develop above critical illnesses as above should
have the same initial aggressive oxygen administration.
Chronic Hypoxaemia
Titrate SpO2 to
CARDIAC ARREST
Ratio
Not Intubated
Ratio:
Rate:
Intubated / LMA
Ratio:
Rate:
Temperature Adjustment
> 32 degrees
30 - 32 degrees
< 30 degrees
Amount
Interval
Defibrillation
Adrenaline
Amiodarone
Sodium Bicarbonate
Normal Saline
Pulseless Electrical Activity (PEA)
Causes:
Action
Amount
Interval
Amount
Interval
Defibrillation
Adrenaline
Atropine
Sodium Bicarbonate
Normal Saline
Asystole
Action
Adrenaline
Action
Atropine
Sodium Bicarbonate
Normal Saline
Amount
Interval
Size
3
4
5
Weight
Inflation
Amount
Frequency
Drug
Amount
Frequency
Drug
Amount
Frequency
Amount
Frequency
Amount
Frequency
Antiplatelet Rx
Pain Relief
PAIN RELIEF
Drug
Amount
Frequency
Methoxyflurane
Morphine IV
Morphine IM
Fentanyl IV
Fentanyl IN
RESPIRATORY
ASTHMA
Mild or Moderate
Drug
Amount
Frequency
Amount
Frequency
If inadequate response:
Drug
COPD
Amount
Frequency
Drug
Amount
Frequency
HYPOGLYCAEMIA
BSL < 4 responds to
commands
Drug
Amount
Frequency
Drug
Amount
Frequency
Age
Amount
Frequency
ANAPHYLAXIS
Status - Evidence of anaphylaxis/anaphylactoid - Exposure to foreign antigen
Assess for systemic Involvement
Drug
Amount
Frequency
SEPSIS / SIRS
VSS 2 or more of
Then
MENINGOCOCCAL SEPTICAEMIA
Confirmed by
IV Access
Drug
Amount
Frequency
Dilution: ............................................................................
No IV Access
Drug
Amount
Dilution: .............................................................................
Frequency
NARCOTIC OVERDOSE
Evidence of narcotic overdose
-
Then
Drug
Unless:
Amount
Frequency
Drug
Age
BP
Amount
Frequency
AUTONOMIC DYSREFLEXIA
Confirm
Amount
Frequency
SEVERE HEADACHE
- If after 15/60 of therapy and pain score still > 7 and destination hospital remains > 7
-
Normal Saline
Maximum
Modifying Factors
Amount given
CHEST INJURIES
Open Chest Wound
Rx -
Rx -
Rx -
Sustained Seizures
Rx -
Normal Saline IV
Rx - AIM -
Hypoglycaemia
Rx -
5HEDS-
BURNS
9%
9%
9%
9%
9%
9%
9%
9%
9%
9%
9%
1%
BURN MANAGEMENT
APPEARANCE
Superficial
Partial
Full thickness
Non-Cardiac Arrest
Moderate to Severe
Hypothermia Management
PAEDIATRIC PATIENT
WEIGHT
Newborn
5 months
1 year
1-9 years
10-14 years
DEFINITIONS
Newborn
Infant
Young Child
Older Child
NORMAL BLOOD VOLUME
Newborn
Infant and Child
ADEQUATE PERFUSION
Pulse
Blood Pressure
Newborn
Infant
Small Child
Large Child
Skin Consciousness -
INADEQUATE PERFUSION
Pulse
Blood Pressure
Newborn
Infant
Small Child
Large Child
Skin Consciousness -
NO PERFUSION
- Absence of palpable pulses
- Skin - Cool, Pale
- Unrecordable blood pressure
- Unconscious
NORMAL RESPIRATORY RATES
Newborn
Infant
Small Child
Large Child
SIGNS OF RESPIRATORY DISTRESS
Children
PAEDIATRIC GCS
CHILD < 4
CHILD > 4
Eyes Opening
4
Verbal Response
Motor Response
APGAR SCORE
0
Appearance
Pulse
Grimace
Activity
Respiratory Effort
7-10 Satisfactory
4-6 Moderate depression and may need respiratory support
0-3 Newborn requiring resuscitation
Ratio:
Rate:
Intubated / LMA
Ratio:
Rate:
Ratio:
Rate:
Intubated / LMA
Ratio:
Rate:
Amount
Interval
PEA
- Manage causes and continue resuscitation
Asystole
- Manage causes and continue resuscitation
PAIN RELIEF
Drug
Methoxyflurane
Fentanyl IN
Morphine IM
Amount
Frequency
RESPIRATORY (Paediatric)
UPPER AIRWAY OBSTRUCTION
Partial Obstruction
Complete Obstruction
SUSPECTED EPIGLOTTITIS
CROUP
Severe
and/or
and/or
3
then:
Drug
Amount
Frequency
ASTHMA (Paediatric)
Mild or Moderate
Drug
Amount
Frequency
Amount
Frequency
Amount
Frequency
HYPOGLYCAEMIA (Paediatric)
BSL < 4 responds to
commands
Drug
Weight
Amount
Frequency
Frequency
Max Dose
Amount
ANAPHYLAXIS
Status - Evidence of anaphylaxis/anaphylactoid - Exposure to foreign antigen
Assess for systemic Involvement
Drug
Amount
Frequency
MENINGOCOCCAL SEPTICAEMIA
Confirmed by
No IV Access
Drug
Amount
Frequency
Dilution: .............................................................................
Administered into: ...............................................................
Then
Drug
Unless:
Amount
Frequency
Max Dose
Amount
Frequency
Max Doses
OBSTETRIC EMERGENCIES
Term
Pre Term
Show
Spontaneous Rupture of
Membranes
Merconium Stained Liquor
First Stage Labour
Precipitate Birth
ASSESSMENT
ANTEPARTUM HAEMORRHAGE
Assess:
No clinical signs of altered perfusion
PRE-ECLAMPSIS / ECLAMPSIA
Signs and Symptoms
-
Assess
Significant Hypertension
-
Severe Hypertension
-
Manage with
Birth of head
Birthing placenta
PRE-TERM LABOUR
Birth Imminent > 34 weeks
Birth Commencing
SHOULDER DYSTOCIA
Shoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the
anterior shoulder of the infant cannot pass below the pubic symphysis, or requires
significant manipulation to pass below the pubic symphysis. It is diagnosed when the
shoulders fail to deliver shortly after the fetal head. In shoulder dystocia, it is the chin that
presses against the walls of the perineum. Shoulder dystocia is an obstetrical emergency,
and fetal demise can occur if the infant is not delivered, due to compression of the
umbilical cord within the birth canal.
- Contact PERS 1300 137 650 via clinician
- Time critical 5-7 minutes to deliver baby due to compression of the cord against
the pelvic rim
- Explain the situation to the mother to gain maximum co-operation
- Important to note time of birth of head, timing of manoeuvres and delivery of the
body
- The newborn is likely to be compromised and require resuscitation
- During procedures be prepared for a sudden release of resistance and delivery of
baby
- The process of release may cause a clavicle fracture Rx as per fracture Rx
Prolonged head to body delivery time (>60 sec)
Delivery accomplished
Then:
Drug
Intractable Haemorrhage
-
Dose
Frequency
NEWBORN
Resuscitation
Cord cutting in the vigorous newborn is not urgent. General care and cut cord when
it has stopped pulsating.
Cord cutting in the non-vigorous newborn is required earlier to allow effective
resuscitation. This would usually be after initial basic tactile efforts and commencement
of IPPV.
If resuscitation is required, provide warming for newborn during resuscitation,
covering with bubble wrap and place a woolen hat on the newborns head.
Preterm newborns (<28 weeks) should be placed immediately, without drying into a
polyethylene bag with the head (dried) outside and then placed against the mother and
covered with warm blankets.
The vigorous newborn does not require suctioning unless born through merconium
stained amniotic fluid and is showing signs of respiratory difficulty.
Newborns who are not vigorous at birth only require suctioning if born through
merconium stained amniotic fluid
The mouth should be suctioned followed by the nose.
A 10 or 12 FG catheter is the usual ssize for suctioning the newborn.
By 30 seconds
NOT BREATHING NOT MOVING OR CRYING (Non-Vigorous newborn)
Assess
HR < 60
ASPIRIN
Presentation
Pharmacology
Metabolism
Indications
Contraindications
1
2
3
4
5
Precautions
1
2
3
Route
Side Effects
1
2
3
Special Notes
Onset Times
Onset
Peak
Duration
ADRENALINE
Presentation
Pharmacology
Metabolism
Indications
1
2
3
4
5
6
7
Contraindications
Precautions
1
2
3
4
Route
Side Effects
2
3
4
5
6
7
Special Notes
Onset Times
IM
Onset
Peak
Duration
Onset
Peak
Duration
IV
CEFTRIAXONE
Presentation
Pharmacology
Metabolism
Indications
1
2
Contraindications
Precautions
Route
Side Effects
1
2
Special Notes
DEXTROSE
Presentation
Pharmacology
Metabolism
Indications
Contraindications
Precautions
Route
Side Effects
Onset Times
Onset
Peak
Duration
FENTANYL
Presentation
Pharmacology
CNS CVS
Metabolism
Indications
Contraindications
1
2
3
4
Precautions
1
2
3
4
5
6
7
8
Route
Side Effects
1
2
3
Presentation
/
4
Onset Times
IN
Onset
Peak
Duration
Onset
Peak
Duration
IV
GLUCAGON
Presentation
Pharmacology
Metabolism
Indications
Contraindications
Precautions
Route
Side Effects
Onset Times
Onset
Peak
Duration
GLYCERYL TRINITRATE
Presentation
Pharmacology
The effects of above are to:
-
Metabolism
Indications
1
2
3
4
Contraindications
1
2
3
4
5
6
7
8
9
Precautions
1
2
3
Route
Side Effects
1
2
3
4
5
Onset Times
Buccal
Onset
Peak
Duration
Peak
Duration
Transdermal
Onset
ATROVENT
Presentation
Pharmacology
Metabolism
Indications
Contraindications
Precautions
1
2
Route
Side Effects
1
2
3
4
5
6
7
Special Notes
Onset Times
Onset
Peak
Duration
LIGNOCAINE
Presentation
Pharmacology
Metabolism
Indications
Contraindications
Precautions
Route
Side Effects
Onset Times
Onset
Peak
Duration
METHOXYFLURANE
Presentation
Pharmacology
Metabolism
Indications
Contraindications
1
2
3
Precautions
1
2
Route
Side Effects
1
2
3
Onset Times
Onset
Peak
Duration
METOCLOPRAMIDE
Presentation
Pharmacology
Metabolism
Indications
1
-
Contraindications
1
2
3
Precautions
Route
Side Effects
1
2
3
4
5
Onset Times
IM
Onset
Peak
Duration
Onset
Peak
Duration
IV
MIDAZOLAM
Presentation
Pharmacology
Metabolism
Indications
1
2
3
4
Contraindications
Precautions
1
2
3
4
Route
Side Effects
1
2
3
4
Onset Times
IM
Onset
Peak
Duration
MORPHINE
Presentation
Pharmacology
CNS CVS
Metabolism
Indications
Contraindications
1
2
Precautions
1
2
3
4
5
6
7
8
Route
Side Effects
1
2
3
4
5
6
7
8
Special Notes
Onset Times
IM
Onset
Peak
Duration
Onset
Peak
Duration
IV
NALOXONE
Presentation
Pharmacology
Metabolism
Indications
Contraindications
Precautions
1
2
Route
Side Effects
1
2
3
4
5
Special Notes
Onset Times
IM
Onset
Peak
Duration
NORMAL SALINE
Presentation
Pharmacology
Metabolism
Indications
1
2
3
4
5
Contraindications
Precautions
Route
Side Effects
Special Notes
PROCHLORPERAZINE
Presentation
Pharmacology
Metabolism
Indications
1
-
Contraindications
1
2
3
4
Precautions
1
2
3
Route
Side Effects
1
2
3
4
5
6
Onset Times
Onset
Peak
Duration
SALBUTAMOL
Presentation
Pharmacology
Metabolism
Indications
1
-
Contraindications
Precautions
1
2
Route
Side Effects
1
2
Special Notes
Onset Times
Onset
Peak
Duration
Metabolism
Indications
Contraindications
Precautions
Route
Side Effects