Dip IMC Jan 26 > Operational Practice > Flashcards

Operational Practice Flashcards

(158 cards)

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1
Q

What Is The Aim of Prehospital Activation / Deployment?

A

Right Resource to Right Patient in Right Time Frame

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2
Q

Where Do Emergency Calls Go in UK?

What Is Their Role?

A

Operator Assistance Centres (OAC)

Connect Call to Appropriate Emergency Service + Provide Caller / Location Details

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3
Q

How Are Emergency Calls in UK Prioritised?

What is the Process?

A

Systemised Caller Interrogation

NHS Pathways Uses Symptoms to Match Response Time to Severity

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4
Q

What Are the NHS Pathways Dispatch Priorities + Response Targets?

A

Cat 1: Life Threatening - Aim 7min - Eg: Cardiac Arrest
Cat 2: Time Critical Emergency - Aim 18min - Eg: Stroke
Cat 3: Urgent - Aim: 60min - Eg: Abdo Pain
Cat 4: Less Urgent - Aim: 180min - Eg: Back Pain

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5
Q

What Are the Immediate Dispatch Criteria for London Air Ambulance?

A

THREAT

Trapped Under Vehicle
Height > 2 Floors (Fall)
Request from Other Emergency Service
Ejection or Death in Vehicle
Amputation (Above Wrist / Ankle)
Train Related

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6
Q

What Are the Categories for Interrogation for London Air Ambulance?

A

DEATH SEABIRDS

Drowning
Entrapment
Amputation
Two Floor Fall
Hanging

Shooting
Explosion
Amputation
Burns
Impalement
RTC
Death @ Work
Stabbing

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7
Q

Who Is Responsible for Allocating Resources?

A

Dispatcher

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8
Q

Describe How Emergency Calls Are Handled?

A

SPR

Structured Question-Answer Logic Tree
Pre-Arrival First Aid Advice Given
Review by HEMS Paramedic IF Meet Immediate / Interrogation Criteria

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9
Q

Pros + Cons of Land Vehicle Response?

A

Pro
- Similar Response Time Over Short Distance
- Operate @ Night / Bad Weather
- Cheap

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10
Q

Pros + Cons of Helicopter Response?

A

Pro
- Distance: Increased Range
- Speed: Faster Over Large Distances
- View: Birds Eye View of Scene

Cons
- Limits: Can’t Fly @ Night / Bad Weather
- Cost: Expensive

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11
Q

Describe Landing Criteria for Helicopter Response in Daylight?

A

2x Diameter of Rotor Blades
Flat
Free of Debris + Wires

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12
Q

How to Approach Helicopter with Patient?

A

2 + 10 O’Clock Position

If on Slope = Approach / Leave via Downward Slope

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13
Q

Describe the 5 Steps to Risk Assessment?

A

Identify Hazards
Who May Be Harmed + How?
Evaluate Risks
How to Control Risks?
Review / Update Procedures

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14
Q

When Must Head Protection Be Worn?

A

RTC with Extrication
Working @ Height
Civil Unrest
Industrial Sites

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15
Q

What Are the Clothing Regulations for Working On Highway / Low Visibility Setting?

A

EN 471

0.8m2 Fluorescent Background
0.2m2 Retro-Reflective Material [2x 5cm Bands of Reflective Tape]

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16
Q

What Are the Footwear Regulations?

A

ISO 20345:2011

Toe Cap Withstand 200j
Minimum height 4inch (10.2cm)

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17
Q

Who Determines What PPE Is Worn?

A

Health & Safety Executive in PPE @ Work Regulations 1992

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18
Q

List Essential PPE for Prehospital?

A

Helmet
Eye Protection
Ear Protection
Face Mask
Clinical Gloves + Extrication Gloves
High Vis Clothing
Boots

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19
Q

List Essential PPE for HEMS?

A

Flight Helmet
Fire Retardant Flight Suit
Knee Pads

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20
Q

List Essential PPE for Tactical Ops?

A

Ballistic Helmet
Ballistic Body Armour

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21
Q

List Essential PPE for CBRN?

A

Respirator
HAZMAT Suit

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22
Q

List Essential PPE for Water Ops?

A

Personal Flotation Device

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23
Q

What is The Hierachy of Control of Risks?

A

ERICPD

Eliminate
Reduce
Isolate
Control
PPE
Discipline

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24
Q

Describe the HAZCHEM Emergency Action Code?

A

2 or 3 Digits (3YE / 4X)

Number (1 - 4) = What to Use
1 = Coarse Spray
2 = Fine Spray
3 = Foam
4 = Dry Agent
* = Alcohol Resistant Foam

Letter (P - Z) = What Kit To Wear + Volatile / Not Volatile + Dilute / Contain
P = Volatile + Liquid Tight Suit + Dilute
R = Non Volatile + Liquid Tight Suit + Dilute
S = Volatile + Fire Kit + Dilute
T = Non Volatile + Fire Kit + Dilute
W = Volatile + Liquid Tight Suit + Contain
X = Non Volatile + Liquid Tight Suit + Contain
Y = Volatile + Fire Kit + Contain
Z = Non Volatile + Fire Kit + Contatin

Letter E = Public Safety Hazard

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25
Describe the HAZCHEM Action for This?
Petrol 3 = Foam Y = Volatile + Fire Kit + Contain E = Public Safety Hazard
26
Describe the HAZCHEM Action for This?
Acrylonitrile 3 = Foam W = Volatile + Liquid Tight Suit + Contain E = Public Safety Hazard
27
Describe the HAZCHEM Action for This?
Ammonia 2 = Fine Spray X = Non Volatile + Liquid Tight Suit + Contain
28
Who Is In Charge of Extrication?
Fire Rescue Service
29
Favoured Method of Extrication?
Self Extraction
30
Describe The Anatomy of The Car?
Support Structures That Attach to Roof Front to Back A to D
31
Describe Fend Off Position If First on Scene?
50m From Incident Wheels Turned In Safe Direction (Away From Incident) Keys In Ignition Engine Running Lights On (IF First) Maximal View of Reflective Markings (Side On)
32
Describe Team Process for Extraction?
2 Teams Casualty Care + Extrication
33
Describe Casualty Care Tasks @ Extraction?
Rapid Access + Assessment Treatment + Monitoring
34
Describe The Anatomy of The Car?
Support Structures That Attach to Roof Front to Back A to D
35
Describe Extrication Tasks @ Extraction?
Vehicle Stability Glass Management + Space Making
36
Describe Extrication Action Plan for Extraction?
Plan A = Roof + Dash Off to Enable KES Insertion Plan B = Side Entry to Enable KES Insertion
37
Describe Casualty Action Plan for Extraction?
Plan A = Controlled Release + Gentle Handling Plan B = Immediate Release + Accept More Handling
38
Describe Post Extrication Care?
Move to Casualty Reception Area (Min 10m From Incident) COMA Reassess MARCH
39
Describe Immediate Actions on Casualty?
C7OMA4 Clock On + Cut Out + Control Maj Haem + Confirm Airway + Check Back + Cover Up + Communicate Oxygen Monitoring Access + Analgesia + Anti Thrombotic + Anti Biotic + Anti Emetic
40
Describe Primary Survery?
MARCH Maj Haem Airway Respiration Circulation Head + Heat + Handling
41
Describe Maj Haem Assessment?
Cut Out + Find Bleed Treatment = Pressure + TQ + Celox / Bandage
42
Describe Airway Assessment?
Check - Clear - Maintain Talk to Patient + Look with Torch Treatment = Head Tilt / Chin Lift (Or Jaw Thrust) + NPA + OPA + SGA + FONA
43
Describe Respiration Assessment?
R FLAPS WET Rate + Feel + Look (Expansion) + Auscultate + Percuss + Sides/Back + Wounds (Neck) + Emphysema (Neck) + Trachea (Neck Treatment = Russel Chest Seal (Occlude 2nd) + Needle Decompression 5th ICS MAL + Finger Thoracostomy (4th ICS MAL + 4cm)
44
Describe Circulation Assessment?
Recheck Maj Heam Chest + Abdo + Pelvis + Long Bones Pulse Check (Radial - Femoral - Carotid) Treatment = TQ + Celox/Bandage + IV Access + Splint #
45
Describe Head / Heat Assessment?
Head = AVPU + Pupils + Injuries (Ears - Nose - Head) + BM Heat = Temp Treatment Head = 30 Head Up / Hypertonic Saline 5% 6mls/kg (MAX 350ml) + 100ml Glucose 10% IV (=10g Sugar) + Consider Heat = Package
46
Initial Analgesia Options (Pre Access)?
Penthrox - 3ml INH - Check HR Fentanyl - 800mcg PO - Check RR
47
Causes of Airway Obstruction?
Pharynx = Max Facs Trauma + Soft Tissue Swelling (Anaphylaxis / Epiglottitis + Liquid (Secretions / Blood / Vomit) + Tongue Larynx = FB + Oedema + Laryngospasm + Laryngeal Trauma Sub-glottis = GB + Swelling (Tracheitis) + Haematoma
48
Difficult Airway Assessment?
HAVNOT History Anatomical Abnormalities Visual Clues (Obesity / Facial Hair / > 55) Neck Immobility Opening of Mouth (< 3 Fingers) Trauma
49
Predicting Difficult Mask Ventillation?
MOANS Mask Seal Difficulty (Beard / Trauma) Obesity / Obstetrics / Obstructed Age > 55 No Teeth Snorer / Stiff Lungs
50
Predicting Difficult iGel (SGA) Insertion + Ventilation?
RODS Restricted Mouth Opening (< 3 Fingers) Obstruction Distorted Airway (Trauma / Infection) Stiff Neck / Stiff Lungs
51
Predicting Difficult Cricothyroidotomy?
SHORT Surgery / Short Neck Haematoma Obesity / Oedema Radiotherapy Trauma / Tumour
52
How to Size NPA?
Soft to Soft Nose to Ear Lobe
53
How to Size OPA?
Hard to Hard Teeth to Angle of Mandible
54
Location of FONA?
Cricothyroid Membrane Thyroid Cartilage (Superiorly) Cricoid Cartilage (Inferiorly)
55
Steps to FONA?
Identify Anatomy (Cricothyroid Membrane) Horizontal Incision Bougie Tube Inflate Cuff Secure
56
Airway Circuit?
Catheter Mount - HME Filter - ETCO2 - BVM
57
Indication for FONA?
Definitive Airway Upper Airway Burn MaxFacs Injury
58
Euipment for FONA?
Scalpel Size 10 Bougie Size 6 Cuffed ET Tube
59
Airway Plan?
A = Direct / Video Laryngoscopic Intubation with Bougie B = Supraglottic Airway (iGel) C = 2 Person BVM D = FONA
60
OPA Sizing?
000 to 4 000 = Neonate 00 = Infant 0 = Small Child 1 = Child 2 = Small Adult 3 = Medium Adult 4 = Large Adult
61
Procedural Sedation / Prehospital Emergency Anaesthesia Check List?
Preparation - Oxygen? - Airway / Resp Kit Dump? - Airway Plan A + Plan B? Monitoring - ETCO2? Drugs - Ketamine @ 0.5mg/kg
62
Confirmation of Successful Intubation?
Waveform ETCo2 Bilateral Chest Movement Bilateral Chest Sounds Misting in ET Tube
63
Minimum Monitoring Standards of Intubated Patient?
O2 Sats ETCo2 3 Lead ECG Non Invasive BP
64
Minimum Standards for Clinical Assessment of Intubated Patient?
R: RR + Resp Effort C: HR + CRT H: Pupil Size + Sweating + Limb Movement
65
Describe 30s Intubation Drill?
For Failed Intubation Adjust Operator Adjust Patient Change Operator Suction Longer Blade McCoy Blade BURP (Backward Upward Rightward Pressure Release Cricoid Pressure
66
FONA for Paeds (< 12)?
Needle Cricoidthyroidotomy 45 Degree to Feet Aspirate on Insertion Attach 3 Way Tap 15L O2
67
Types of Laryngoscope Blade?
Macintosh = Curved Miller = Straight McCoy = Curved + Levered Tip
68
Airway Assessment?
Speak to Patient > Talking = Airway Patent LOOK: FB + MaxFacs Trauma FEEL: Breath + Mist on Mask LISTEN: Breath Sounds + Stridor + Gurgling ACT: Postural Drainage > Simple Manoeuvres > NPA > OPA > SGA > FONA
69
Indication for PHEA?
Airway Compromise Respiratory Failure Head Injury (Unmanageable) Anticipated Clinical Course Humanitarian
70
Describe Sellicks Manoeuvre?
Cricoid Pressure for Intubation
71
Describe Initial Scene Assessment?
SCREAMER Safety - Self / Survivors Communicate - METHANE Read Wreckage - Mechanism of Injury Everyone Found? Assess Casualties - Number / Acuity Methods of Extrication - Plan A / Plan B Evacuation Route Right Hospital
72
T1RF Causes?
[4P] PE Pulmonary Oedema Pneumothorax Pneumonia Adequate Ventilation BUT Poor Oxygenation V/Q Mismatch
73
T2RF Causes?
[HCA] Head Injury COPD Asthma Inadequate Ventilation [Also T1RF + Tiredness]
74
Signs of Hypercarbia?
[HVT] Headache Vasodilation Tremor
75
Traumatic Causes for Respiratory Problems?
[BLATOMFC] Blast Lung Airway Obstruction Tension Pneumothroax Open Pneumothorax Massive Haemothorax Flail Chest Cardiac Tamponade
76
Medical Causes for Respiratory Problems?
[PAPC] Pulmonary Odema Asthma PE COPD
77
Normal RR for Adults?
12-20
78
Normal RR for Children?
15-30
79
Normal RR for Infants?
30-40
80
Normal RR for Newborn?
40-60
81
Normal ETCo2?
35 - 45 mmHg 4 - 5.7 kPa
82
Describe Normal Capnography Wave?
A - B = Respiratory Baseline (Inhalation) B - C = Expiratory Upslope C - D = Expiratory Plateau D = End Tidal CO2
83
Ambulance Command Tabard Green/White Check Shoulders + WHITE Lower Half?
Ambulance Incident Commander
84
Ambulance Command Tabard Green/White Check Shoulders + BLUE Lower Half?
Ambulance Safety Officer
85
Ambulance Command Tabard Green/White Check Shoulders + GREEN/WHITE CHECK Lower Half?
Command Support / Airwave Tactical Advisor
86
Ambulance Command Tabard Green/White Check Shoulders + YELLOW Lower Half?
Ambulance Bronze (Operational) Commander
87
Ambulance Command Tabard Green/White Check Shoulders + PURPLE Lower Half?
Decontamination Officer
88
Ambulance Command Tabard Green/White Check Shoulders + RED Lower Half?
Medical Advisor (Doctor)
89
Ambulance Command Tabard Green/White Check Shoulders + GREEN Lower Half?
NILO
90
Ambulance Command Tabard Green/Yellow Check Shoulders + GREEN/YELLOW CHECK Lower Half?
Ambulance Entry Control Officer
91
Ambulance Command Tabard Green/White Check Shoulders + ORANGE Lower Half?
Logistics
92
Blue Light Driving Maximum Speed?
10mph > Speed Limit
93
Blue Light Driving Rule for Red Lights?
Treat as Give Way Sign
94
Blue Light Driving Rule for Level Crossing?
Do Not Cross If Flashing
95
Blue Light Driving Overarching Rule?
Do Not Put Others in Danger
96
Blue Light Driving Overtake On Solid White Line?
No Puts Others in Danger
97
Blue Light Driving Drive on Hard Shoulder of Motorway (Even Agaisnt Traffic)?
Yes If Instructed by Police to Do So
98
Blue Light Driving Ignore No Entry Sign?
No
99
Blue Light Driving Drive Wrong Way Down 1 Way Street?
No
100
Blue Light Driving Drive Wrong Way Down 1 Way Street?
No
101
Ventilator Settings Tidal Volume?
6-8 ml / kg
102
Ventilator Settings Peak Airway Pressure?
30 cmH2O
103
Ventilator Settings Positive End Expiratory Pressure?
5 cmH2O
104
Ventilator Settings Mode?
Controlled Mandatory Ventillation RR + TV Set
105
Management of Tension Pneumothorax?
Needle Decompression 5th ICS MAL (2nd ICS MCL 2ndry)
106
Management of Open Pneumothroax?
Russel Chest Seal (Occlusive Dressing If > 1 Wound)
107
Management of Haemothroax?
Chest Drain Thoracostomy (4cm / 4th ICS / Spencer Wells) Finger Guide Tube Anterior / Apical Suture Close
108
Massive Haemothorax Definition?
1500ml Blood
109
Management of Flail Chest?
O2 Analgesia Positive Pressure Ventilation
110
Describe Lethal Triad of Trauma?
Acidosis + Hypothermia + Coagulopathy Lose Blood > Anaereobic Respiration > Lactic Acidosis > Can’t Clot
111
Describe Types of Shock?
CHOD Cardiogenic = Pump Failure Hypovolaemic = Loss of Volume Obstructive = Pump Block/Compressed Distributive = Volume in Wrong Place
112
Causes of Cardiogenic Shock?
[Pump Failure] MI Arrhythmia
113
Causes of Hypovolaemic Shock?
[Loss of Volume] Dehydration Haemorrhage
114
Causes of Obstructive Shock?
[Pump Block / Compression] PE Tamponade Tension Pneumothorax
115
Causes of Distributive Shock?
[Volume in Wrong Place] Sepsis Anaphylaxis Neurogenic [SC Damage Above T4]
116
Define Shock?
Inadequate Tissue Perfusion to Meet Metabolic Requirments
117
Signs of Hypovolaemic Shock?
SHOCKS Sinus Tachycardia Hypotension Oliguria Cool Klammy Slow Cap Refil
118
Management of Hypovolaemic Shock?
MARCH Assessment Control Bleeding [TQ / Celox / Binder] 1g TXA STAT Blood Transfusion as Per Protocol
119
What is Celox Made From?
Chitosan
120
Location of Pelvic Binder?
Greater Trochanter
121
Key Steps to Pelvic Binder?
Align Legs Skin 2 Skin Locate Greater Trochanters Fasten (Traction + Counter Traction) Bind Feet
122
Key Steps to Kendrick Traction Device?
Analgesia Pedal Pulse Ankle Hitch Thigh Anchor Counter Traction Pedal Pulse Secure Straps
123
Indications for Pre Hospital Anaesthesia?
CAVPU Compromised Airway Anticipated Clinical Course Ventilator Failure Patient Unmanageable Unconscious
124
Prehospital Anaesthesia Monitoring Requirements?
A - ETCO2 R - Sats C - HR + BP + ECG Every 3 Min
125
Pre Hospital Anaesthesia Common Drugs?
Fentanyl [Analgesia] Ketamine [Hypnotic] Rocuronium [Neuro Block]
126
Drugs Ketamine Mechanism of Action?
NMDA Receptor Antagonist
127
Drugs Rocuronium Mechanism of Action?
Non Depolarising Muscle Relaxant
128
Drugs Midazolam Mechanism of Action?
GABA Receptor Agonist
129
Drugs Ketamine Dose?
0.1 - 0.5 mg/kg = Analgesia 0.5 - 1 mg/kg = Sedation 1 - 2 mg/kg = Anaesthesia
130
Drugs Rocuronium Dose?
0.6 mg/kg
131
Drugs Midazolam Dose?
0.5 - 2 mg
132
How Does Pulse Oximetry Work?
Absorption of Red + Infrared Light
133
How Does ETCO2 Work?
Spectrophotometric Analysis of CO2
134
Describe Bronchospasm on ETCO2?
Shark Fin [Asthma / COPD]
135
Describe Sudden Loss of ETCO2 Waveform?
ET Tube Dislodged / Circuit Failure Cardiac Arresst
136
Describe Sudden Increase in ETCO2?
ROSC
137
Describe ETCO2 Normal Range?
35 - 45 mmHg [4 - 5.7 kPa]
138
Describe Arterial Line Set Up?
Arterial Line Non Compressible Tubing [Saline Filled] Pressure Transducer Zero @ Level of Heart Pressure Bag + Monitor
139
Fluid Used for Arterial Line?
Normal Saline [NEVER GLUCOSE]
140
Main Issue with In Flight Monitoring?
Hypoxia [ETCO2 Not Affected]
141
What Freq Used for Ultrasound?
2.5 - 12 MHz
142
Describe uses for Prehospital Ultrasound?
A - Observe Intubation + Locate Cricothyroid Membrane for FONA R - RULE IN Pneumothroax / Pleural Effusion / Pulmonary Oedema C - Echo / FAST / Vascular Access H - Optic Nerve [Raised ICP]
143
Describe Findings on POCUS for Pneumothroax?
Absence of 3: - Lung Sliding - “Walking Ants” - B Lines - Comet Tails
144
Describe Findings on POCUS for Pleural Effusion?
Anechoic Lung
145
Describe Findings on POCUS for Pulmonary Oedmea?
B Lines
146
Describe Locations for FAST?
1) Subcostal = Pericardium 2) RIGHT 5th ICS MAL Down= Liver (Morrisons Pouch) 3) RIGHT 5th ICS MAL Up = Lung 4) LEFT 5th ICS MAL Down = Kidney / Spleen 5) LEFT 5th ICS MAL Up = Lung 6) Suprapubic = Bladder / Pelvis
147
Probe for FAST?
Curvilinear @ 3 - 5 MHz
148
Limitations of Transfer?
SLANT Space Lighting Aggressive Vibrations Noise Temperature
149
Impact of Flight Physiology?
Daltons Law % Oxygen = Same Partial Pressures = Decrease Boyles Law Gas Expands as Pressure Decreases
150
Calculation for Anticipated Oxygen Consumption?
Minute Volume (RR x TV) x Transfer Time
151
Volume of CD Cylinder?
460L
152
Volume of ZX Cylinder?
3040 L
153
Volume of E Cylinder?
680 L
154
Volume of ZD Cylinder?
600 L
155
Methods for Prehospital Analgesia?
Psychological [Reassure] Physical [Splint / Traction] Pharmacological [Analgesia]
156
Define Pain?
Unpleaseant Sensory + Emotional Experiance Associated with Actual OR Potential Tissue Damage
157
Drugs Contraindication for Entonox?
Pneumothorax
158
Drugs Entonox in Cold Conditions?
Separates @ -6
Dip IMC Jan 26
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