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59 Cards in this Set
- Front
- Back
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Oxygen Therapy
When to give oxygen with sats above 94 |
Haemodynamically unstable patients
Cardiac Arrest Major Trauma Head Injury Carbon monoxide poisoning shock severe sepsis anaphylaxis |
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Pulse Oximerty
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May be unreliable in pt with severe illness
reading below 80% increases chance of being inaccurate |
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Adequate Perfusion
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Skin: Warm, Pink, Dry
HR: 60-100 BP: Over 100 sys Alert and Oriented |
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Borderline Perfusion
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Skin: Cool, Pale, Clammy
HR: 50-100 BP: 80-100 sys Alert and Oriented |
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Inadequate Perfusion
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Skin: Cool, Pale, Clammy
HR under 50, over 100 BP 60-80 sys Alert or Altered |
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Extremely Poor Perfusion
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Skin: Cool, Pale, Clammy
HR under 50, over 110 BP Under 60sys or unrecordable Altered or unconsious |
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No Perfusion
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Skin: Cool, Pale, Clammy
HR Non palp BP Unrecordable Unconsious |
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NORMAL RSA
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Calm, Quiet
Clear and steady sentences Quiet on Ausc RR 12-16 Rhythm: REG EVEN CYCLES Effort: Normal HR 60-100 Skin: Normal Alert |
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MILD DISTRESS
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Calm or Mildly anxious
Full Sentences able to cough ASTHMA: MILD EXP WHEEZE LVF: FINE BASAL CRACKLES RR 16-20 Prolonged exp phase Slight increase in chest effort HR 60-100 Skin: Normal Alert |
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MODERATE DISTRESS
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Distressed or anxious
Short phrases only able to cough Asthma: EXP WHEEZE +/- INS WHEEZE LVF BASAL-MIDZONE CRACKLES RR: Over 20 Prolonged exp phase Marked chest movement (+/- Accessory muscles) HR 100-120 Pale, Sweaty May be Altered |
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SEVERE DISTRESS (LIFE THREAT)
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Distressed, Anxoius, Fight to breathe, exhausted
Words only Unable to cough ASTHMA: EXP + INP WHEEZE (no breath sounds, late) LVF: Full Field, possible wheeze Stridor (Upper Airway obstruction) prolonged expiratory phase Marked Chest Movement, Intercostal retraction, tracheal tugging HR 120 or Brady Pale+Sweaty, Cyanosis Altered or Unconsious |
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LMA
INDICATIONS |
Unconscious pt without gag reflex
Ineffective ventilation with BVM/oxysaver/OP/NPA Over 10/60 of assisted ventilation required Unable to intubate/ difficult intubation |
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LMA
CONTRAINDICATIONS |
Intact gag reflex
Strong Jaw tone/Trismus Suspected epiglottitis or upper airway obstruction Need to use sedation |
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LMA
PRECAUTIONS |
No sniffing position
Pt requires high airway pressures (obesity, pregnancy, pulmonary fibrosis, increased airway pressures) Under 14 Significant vomit in airway |
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INTUBATION INDICATIONS
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RESPIRATORY ARREST
CARDIAC ARREST GCS UNDER 10 DUE TO RESP FAILURE NEUROLOGICAL INJURY OD STATUS EPILEPTICUS DKA |
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ACS TREATMENT = ASPIRIN
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ASPIRIN 300mg
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ACS TREATMENT= GTN
BP over 110 |
BP OVER 110/ NO PREV ADMIN= GTN 300mcg SL
BP OVER 110/ HAD GTN= 600mcg SL If Symptoms continue repeat at 5 mins |
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ACS TREATMENT= GTN
BP over 90 |
GTN 50mg Patch
REMOVE IF BP FALLS UNDER 90 |
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ACS TREATMENT= PAIN
UNDER 60, OVER 60 KG |
FENTANYL IN
200mcg IN REPEAT 50mcg at 5 mins to a max of 400mcg |
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ACS TREATMENT= PAIN
OVER 60, UNDER 60 KG |
FENTANYL IN
100mgc IN REPEAT 50mcg at 5 mins to a max of 200mcg |
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ACS TREATMENT
METHOXYFLURANE |
3ml to a max of 6ml
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ACS TREATMENT= MORPHINE IV
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UP TO 5mg IV
REPEAT UP TO 5mg AT 5mins MAX 20mg |
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ACS TREATMENT = MORPHINE IM
OVER 60 KG |
OVER 60kg
10mg IM Repeat 5mg at 15 mins. Once only |
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ACS TREATMENT= MORPHINE IM
UNDER 60 KG |
0.1mg/kg IM
ONCE ONLY, CONSULT FOR FURTHER DOSE |
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ACS TREATMENT= FENTANYL IV
IF ALLERGIC/SENSITIVE TO MORPHINE |
25-50mcg IV
REPEAT AT 5 MINS MAX 200mcg |
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ASPIRIN CONTRAINDICATIONS
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HYPERSENSITIVITY
ACTIVELY BLEEDING PEPTIC ULCER BLEEDING DISORDERS SUSPECTED AAA CHEST PAIN FROM PSYCHOSTIMULANT OD IF BP OVER160 |
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FENTANYL CONTRAINDICATIONS
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KNOWN HYPERSENSITIVITY
IV AMIODARONE |
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GTN CONTRAINDICATIONS
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KNOWN HYPERSENSITIVITY
BP UNDER 110 FOR TAB BP UNDER 90 FOR PATCH VIAGRA/LEVITRA IN PREV 24. CIALIS IN PREV 4 DAYS HR OVER 150 HR UNDER 50 (EXCEPT AUTONOMIC DYSREFLEXIA) VT INFERIOR STEMI with BP UNDER 160 RIGHT VENTRICULAR MI |
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INFERIOR STEMI
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ST elevation in leads II, III and aVF
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RIGHT VENTRICULAR MI
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Preload sensitive (due to poor RV contractility) and can develop severe hypotension in response to nitrates
ST elevation in lead III > lead II |
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MORPHINE CONTRAINDICATIONS
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KNOWN HYPERSENSITIVITY
LATE SECOND STAGE LABOR |
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METHOXYFLURANE CONTRAS
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PRE EXISTING RENAL DISEASE
TETRACYCLINE ANTIBIOTICS MORE THAN 6ml IN 24HRS |
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PULMONARY OEDEMA
SOB + BASAL OR MIDZONE CRACKLES |
BP OVER 110
GTN 300mcg (NO PREVIOUS ADMIN) GNT 600mcg (PREVIOUS ADMIN) BP OVER 90 GTN PATCH 50mg |
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PULMONARY OEDEMA
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GTN AS PER BASAL/MIDZONE
ASSISTED VENTILATION WITH 100% O2 |
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ASTHMA MILD/MODERATE
SALBUTAMOL |
SALBUTAMOL VIA PDMI 4 DOSES AT 4 MINS
NEB 10mg (5ml) 2 VIALS REPEAT 5mg (2.5ml) 1 VIAL AT 5 MINS NO MAX |
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ASTHMA MILD/MODERATE
ATROVENT (IPRATROPIUM BROMIDE) |
500mcg (2ml) 2 VIAL
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ASTHMA UNCONSCIOUS
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VENTILATE AT 10ml/KG 5-8 VENTS A MIN
ALLOW FOR PROLONGED EXPIRATORY PHASE LATERAL CHEST PRESSURE |
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ASTHMA UNCONSCIOUS
ADRENALINE |
300mcg IM
REPEAT AT 20 MINS MAX 900mcgIM |
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ASTHMA LOSS OF C/O
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1 MIN APNOEA
-EXCLUDE TPT -LATERAL CHEST PRESSURE -PREPARE FOR RESUS |
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SALBUTAMOL CONTRAINDICATIONS
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NONE
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ATROVENT CONTRAINDICATIONS
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KNOWN HYPERSENSITIVITY TO ATROPINE OR ITS DERIVATIVES
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ADRENALINE CONTRAINDICATIONS
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HYPOVOLEMIC SHOCK WITHOUT ADEQUATE FLUID REPLACEMENT
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ANAPHYLAXIS ASSESMENT
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-ANGIO-OEDEMA
-URTICARIA -GIT DISTURBANCE PLUS ONE OF THE FOLLOWING -RESPIRATORY DISTRESS/BRONCHOSPASM -LESS THAN ADEQUATE PERFUSION -ALTERED CONSCIOUS STATE |
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ANAPHYLAXIS TREATMENT
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MONITOR FOR CARDIAC RHYTHMS
-ADRENALINE 300mcg IM -REPEAT 300mcg AT 5 MINS TREAT BRONCHOSPASM AS ASTHMA |
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PEDIATRIC WEIGHTS
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NEWBORN = 3.k kg
2 MONTHS = 5kg 5 MONTHS = 7kg 1 YEAR =10kg 1-9 YEARS = AGE x's 2 + 8 10-14 YEARS = AGE x 3.3 |
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PAED PAIN RELIEF
FENTANYL IN |
2mcg/kg
Repeat up to 1mcg/kg at 5mins MAX 4/mcg/kg |
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PAED PAIN RELIEF
METHOXY |
3 and 3
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PAED PAIN RELIEF
MORPH IM |
0.1 mg/kg IM
SINGLE DOES CONSULT FOR FURTHER |
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PAED ASTHMA
MILD/MODERATE SALBUTAMOL |
PDMI 4 puffs at 4 mins
SALBUTAMOL 10mg (5ml) REPEAT 5mg (2.5ml) at 5 mins SAME AS ADULT DOES |
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PAED ASTHMA
IPRATROPIUM BROMIDE ATROVENT |
250mcg (1ml) 1 Vial ONCE
HALF ADULT DOES |
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PAED UNCONSIOUS ASTHMA
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VENT INFANT @ 15-20
VENT SMALL CHILD @ 10-15 VENT LARGE CHILD @ 8-12 ADRENALINE 10mcg KG REPEAT AT 20mins to 30mck/kg |
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PAED ASTHMA LOSES C/O
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APNOEA 30 SEC
-EXCLUDE TPT -LATERAL CHEST PRESSURE -PREPARE FOR RESUS |
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PAED ANAPHLYXIS
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ADRENALINE
10mcg/kg @ 5mins BRONCHOSPASM AS PER ASTHMA |
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Anaphylaxis definition
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an acute alergic reaction to an antigen to which the body has become hypersensitive, leading to cardiovascular collapse
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Anaphylaxis pathophysiology
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Inflammatory mediators are released. These increase the contraction of the bronchial smooth muscle, trigger vasodilation and cause heart muscle depression
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Why is adrenaline effective in anaphylaxis
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alpha causes peripheral vasoconstriction
B1: Constricts blood vessles and increases BP, corrects relative fluid shift B2: Relaxes smooth bronchial muscles, opening airways |
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Aspirin mechanism
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Aspirin inhibits platelet aggregation and thrombus formation- halts progression of ACS
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GTN mechanism
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Reduces myocardial O2 demand
reduces preload and afterload on heart |
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Atrovent mechanism
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Allows bronchodilation bu indhibiting cholinergic
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