CPGs

Question 1

What is the first step in assessing a patient’s capacity?

Answer 1

Explain their clinical condition using language they can understand

This includes recommendations for treatment and/or transport, benefits of accepting recommendations, and risks of declining them.

Question 2

What should you ask the patient after explaining their condition and recommendations?

Answer 2

If they have any questions

After 2-3 minutes, ask them to explain back their clinical condition and decision.

Question 3

A patient has capacity if they can demonstrate they can: (list the criteria)

Answer 3

• Understand information and the decision they are making
• Understand and consider the consequences of their decision
• Remember information to the extent needed to make a decision
• Communicate their decision in any way

If they do not meet all these criteria, they do not have capacity.

Question 4

What indicates a patient has diminished capacity?

Answer 4

They understand some but not all information or consequences

For example, a patient who can make simple decisions about medicines but struggles with life-threatening treatment options.

Question 5

When should a patient be presumed to have diminished capacity?

Answer 5

If they have severely impaired vital signs

For example, severe acute hypotension.

Question 6

What is fluctuating capacity?

Answer 6

Ability to understand or remember information changes over time

For example, a patient who improves with oxygen administration may regain capacity.

Question 7

If a patient has capacity, when can treatment and/or transport be provided without their informed consent?

Answer 7

• They have attempted suicide
• Treatment is indicated for a life-threatening condition
• They have been sectioned under the Mental Health Act

In all other circumstances, the patient may decline recommendations.

Question 8

If a patient does not have capacity, who can make decisions on their behalf?

Answer 8

A person legally able to provide informed consent

If no such person is contactable, treatment may occur if it is in the best interest of the patient.

Question 9

When providing treatment/transport without informed consent, what should be encouraged?

Answer 9

Encourage the patient to accept recommendations

Involve the patient’s family/whānau, caregivers, and/or healthcare providers when appropriate.

Question 10

What should be considered when a patient has diminished or fluctuating capacity?

Answer 10

• Allow informed consent within their capacity
• Balance risks and benefits of treatment versus not doing so
• Consider previously expressed views and advance directives

Involve family/whānau and caregivers when appropriate.

Question 11

How should children aged 16 years or older be treated regarding capacity?

Answer 11

As adults

They can provide informed consent.

Question 12

Children under 16 years do not have the legal ability to provide informed consent. Who should provide it?

Answer 12

A parent or guardian

Their views should be considered based on their maturity.

Question 13

What should be documented regarding a patient’s capacity?

Answer 13

• Ability to understand information
• Ability to consider consequences
• Ability to remember information
• Ability to communicate decisions

For example, document the patient’s understanding of their condition and risks.

Question 14

What is Status One in emergency medical conditions?

Answer 14

• Obstructed airway needing intervention
• Severe stridor
• Severe respiratory distress
• Severe shock
• Multi-system trauma
• Cardiac arrest or post cardiac arrest
• Cardiogenic shock
• ST elevation myocardial infarction
• Dysrhythmia causing severe cardiovascular compromise
• GCS of less than or equal to 9

Status One indicates critical conditions requiring immediate medical attention.

Question 15

List the conditions that define Status Two.

Answer 15

• Moderate stridor
• Moderate respiratory distress
• Moderate shock
• Two or more fractures involving the shaft of the femur, tibia, or humerus
• Fractures or dislocations with signs of limb ischaemia
• Isolated spinal cord injury
• Dysrhythmia causing moderate cardiovascular compromise
• Myocardial ischaemia with significant symptoms or signs on ECG
• GCS of 10-13

Status Two indicates serious but not immediately life-threatening conditions.

Question 16

What are the characteristics of Status Three?

Answer 16

• Mild stridor
• Mild respiratory distress
• Dysrhythmia causing mild cardiovascular compromise
• Myocardial ischaemia with resolved symptoms after nitrates
• Isolated fracture of one long bone
• Dislocations without signs of limb ischaemia
• Spinal pain without signs of spinal cord injury
• Loss of consciousness with normal recovery (GCS 14 or 15)
• Transient ischaemic attack

Status Three indicates less severe conditions that still require medical evaluation.

Question 17

What conditions are classified under Status Four?

Answer 17

• Isolated minor fractures
• Strains and sprains
• Lacerations with controlled bleeding
• Fever without systemic signs of sepsis
• Headache with normal neurological findings

Status Four indicates minor injuries or conditions that are not life-threatening.

Question 18

What is the PCI STEMI pathway

Answer 18

Transmit the 12 lead ECG to the destination hospital.

Administer 300 mg of aspirin PO.

Cautions to PCI:
Time of symptom onset was greater than 12 hours ago.
Requires assistance with their activities of daily living.
Severe comorbidities that significantly limit their life expectancy.
Gain IV access, preferably in the left arm.
Administer 180 mg of ticagrelor PO if asked to do so by the receiving clinician.
Administer an opiate IV as required for moderate to severe pain.
Administer 0.4 mg of GTN SL with caution and withhold GTN SL if signs of poor perfusion are present.

Question 19

What Hospitals are capable of PCI

Answer 19

North shore - in hours of 0730&1530. NR03

Auckland 24hrs. NR01

All STEMIs should have an R40

Question 20

How do you handle concious VT

Answer 20

Confirm with 12 lead
Call status 1

Call clinical for out of scope dissociation 0.5-1mg per kg (if they obey commands)

Select max joules and syn cardiovert

Prep for resus

Question 22

What are the clinical features indicating antibiotics

Answer 22

New onset of ALOC or known neutropenia

New need for 02 to maintain sp02 of 92% or 88% for COPD

BP = or lower than 90 or less than 40 for their normal bp

HR more than 130bpm

Motteled or pale apperance

Question 23

What is the oneumonic for assesing mental health

Answer 23

Behaviour
Affect, appearance and mood
Thought and talk
Orientation
Memory
Intellect and insight

Question 24

How do you asses thoughts of suicide

Answer 24

Most time clear recommendation to ED should be recommended

There is also the sucidal risk screening tool