Emergency Handover
- Verbal Structure
SBARD
S - Calling about Mr/Mrs ___ on ___ ward who is septic/___
B - They are ___YO with b/g of ___.
- Febrile and ___ admitted ___ to ____
A - A: Clear
- B: RR __, Sats __ on __l O2, ABG
- C: HR 1__ BP __/__, CRT __, T ___
- D: Drowsy
- E: SNT
R - Prepping __ medication
- Need help with ___
D - We have agreed you will___
Airway Manoeuvres
Airway manoeuvres
- Head-tilt Chin-lift
1. Palm on forehead
2. Other fingers under chin - Jaw thrust
1. C Grip
2. E Grip
Simple Airway adjuncts
- Two Paths
Simple Airway adjuncts
1 Oropharyngeal
2 Nasopharyngeal
Advanced Airway Adjuncts
Advanced Airway Adjuncts
- Supraglottic
- ET
Airway Protection
- Fluids and Secretions
Airway fluids
- Suction visible areas
- 5-10 seconds
- Pouch of cheek - arch of tongue - pouch of cheek
- Yankauer catheter - Recovery position
Anaphylaxis
- Definition
- Treatment dose adrenaline
Anaphylaxis
- Sudden onset and rapid progression
- Life-threatening A/B/C problems
- Skin/mucosal changes
Adrenaline
- 0.5ml (1mg/mill)
- Children 0.3ml
Choking
- Maneuvers
Choking maneuvers
- Cough
- Back-slaps
- Abdominal thrust
AVPU - GCS Correlation
AVPU- GCS
A - 15
V - 12
P - 7/8
U - 3
Pupillary Light Reflex
- Normal vs Abnormal
Pupillary Light Reflex
- Bright light
- 2-4mm
- Dark
- 4-8mm
Miosis vs Mydriasis
Miosis
- Constricted
- Opioids
Mydriasis
- Dilated
- ICP
- Brain insult
- Cocaine/marijuana/amphetamines
Hypoglycaemia
- Mx
Hypoglycaemia mx
- Quick acting carbohydrates
- 60mls gluco juice
- 150 mls fruit juice
- 5-7 dextrose tablets - Long-acting carbohydrates
- 2 biscuits
- 1 slice bread/toast
- 200-300ml milk
- Normal meal - Hourly obs
- IV insulin infusion if necessary
Assessing AKI
- Stages 1-3
- Serum Creatinine vs Urine
Assessing AKI
Stage 1
- 1.5-1.9 x baseline (>26micromol/litre)
- <0.5ml/kg/hr urine x 6hr
Stage 2
- 2-2.9 x baseline
- <0.5ml/kg/hr x 12 hr
Stage 3
- 3 x baseline (>354 micromol/litre)
- <0.3ml/kg/hr 24hr or anuric 12 hr
Acute Asthma
- Mx
Acute Asthma
O - xygen
S - albutamol (5mg)
H - ydrocortisone
I - pratropium bromide (500mcg)
T - hipholine/aminophylline 5mg/kg
M - agnesium
E - scalate care
Advanced Life Support
- Algorithm
- CPR 30:2
- Assess Rhythm
A: ROSC
- Return of spontaneous circulation
B: Shockable (VF/pulseless VT)
- Shock x 1
- CPR x 2 min
- Adrenaline 3-5min
- Shock x 3 - Amiodarone
C: Non Shockable (PEA/Asystole)
- CPR x 2 min
Reversible Cardiac Arrest
H
1,2,3,4
T
1,2,3,4,
Reversible causes of cardiac arrest
Hs
1. Hypoxia
2. Hypovolaemia
3. Hyp(o/er)thermia
4. Hyp(o/er)kalaemia
Ts
1. Thrombosis
2. Tension pneumothorax
3. Tamponade
4. Toxins
Chest compressions
- Position
- Rate
Chest compressions
- Lower half of sternum
- 100-120 per minute
Defibrillator
- Pad requirements
Defibrillator pad requirements
- Dry
- Not hairy
- Piercings on chest
- Known implanted device
AE Defibrillator ‘Shock Advised’
- Checks
- Joules
AED Shocks
- Checks
1. Oxygen
2. Metals on chest
3. Indirect/direct contact
4. Fluids in zone - Joules (auto escalation)
1. 200J
2. 300J
3. 360J
AED Lifepak 20e
- Converting to Manual
Converting to manual AED
- Turn on and wait for full start
- will beep - Press manual button
- Open door
Lifepack 20e
- Converting back to AED
Converting back to AED
- Press analyze
- Prompts will resume
Manual defibrillation
- Analysis
Manual defibrillation
- Stop compressions
- Check monitor
- Check for pulse if required
- Prepare for safe shock
Cardiac arrest
- Shockable rhythms
- Non-shockable rhythms
Cardiac arrest
- Shockable
1. Pulseless VT
2. VF - Non-shockable
3. PEA
4. Asystole
ALS
- Asystole Mx
Asystole Mx
- CPR
- 2 minute 2 checks - IV/IO access
- 1mg Adrenaline IV (1:10,000) immediately
- Repeat adrenaline IV
ALS
- PEA Mx
PEA Mx
- CPR
- Check every 2 minutes - IV/IO access
- Adrenaline IV 1mg (1:10,000)
