SAMPLE
SAMPLE
History taking:
S - signs and symptoms
A - allergies
M - medications
P - past medical Hx
L - last ins and outs
E - events leading to the incident/issue
OPQRST
OPQRST
Pain assessment - part of secondary survey:
O - origin and onset (Where did it start and what were you doing?)
P - palliation/provocation (What makes it better or worse?)
Q - quality (crushing, stabbing, throbbing etc)
R - radiation (does it move anywhere?)
S - severity (on a scale of 0 - 10)
T - time and treatment (how long and have you taken anything?)
AVPU
AVPU
Level of consciousness
A - alert
V - voice
P - pain
U - unresponsive
IMISTAMBO
IMISTAMBO
Patient handover:
I - identification - pt’s name and age
M - mechanism - what is the mechanism or presenting problem
I - injuries/information - pt assessment and Hx relevant to complaint
S - signs - vital signs and GCS
T - treatment and trends - interventions and response
A - allergies - what the pt is allergic to
M - medications - regular medications and are they present
B - background - medical Hx
O - other issues - scene, social situation, advanced care directives, belongings/valuables, cultural and religious considerations, interpreter
APGAR
APGAR
Newborn assessment conducted at 1 min and 5 mins post delivery. Usually at 6-8 at 1 min and 10 at 5 mins. Each item scored between 0 - 2.
Includes:
Appearance (skin colour)
Pulse
Grimace (muscle tone)
Activity
Respirations
Glascow Coma Scale
Glascow Coma Scale
Eye Opening:
Spontaneous 4
To Voice 3
To Pain 2
None 1
Verbal Response:
Oriented 5
Confused 4
Inappropriate Words 3
Incomprehensible Sounds 2
Silent 1
Motor Response:
Obeys Commands 6
Localised Pain 5
Withdraws 4
Abnormal Flexion 3
Abnormal Extension 2
No Movement 1
Hs and Ts
Hs and Ts
Conditions that may precipitate cardiac arrest or decrease chances of successful resuscitation
Hs and Ts Conditions
Hs and Ts Conditions
- Hypoxaemia
- Hypovolaemia
- Hypo/Hyperkalaemia & metabolic disorders
- Hypo/Hyperthermia
- Tension pneumothorax
- Tamponade
- Toxins/poisons/drugs
- Thrombosis - pulmonary/coronary
Effect of Toxins
Effect of Toxins
Death caused by airway obstruction and respiratory arrest secondary to a decreased conscious level after self-poisoning (benzodiazepines, opioids, tricyclic antidepressants, local anesthetics, beta-blockers, and calcium channel blockers).
Main Cause of Paediatric Cardiac Arrest
Main Cause of Paediatric Cardiac Arrest
Respiratory issue
Obstetric Emergencies - Breech
Obstetric Emergencies - Breech
- Complete Breech = cross legged
- Frank Breech = legs up on chest
- Kneeling Breech = knees first
- Footling Breech = legs first
How to help:
- Use pinkies to untangle legs
- Loveset Manoeuvre - wrap towel around bubs hips and twist gently back and forth
- Catch newborn with index finger and thumb around chin
- Pop onto mum’s belly - skin to skin (helps with post natal depression)
- Clamp umbilical 1 fist from bub, second fist from bub and then half way between these
- Cut umbilical between 1st and 2nd clamp
Newborn CPR
Newborn CPR
- 30 breaths via BVM on room air with OPA (1-2 breaths per second)
- Reassess pulse, breathing
- No pulse - CPR - 3 chest pumps:1 breath, oxygen at 15L for 1 min or until responsive and then reassess
Mum Haemorrhaging
Mum Haemorrhaging
- external pressure on vagina (tears etc)
- external aortic compression (fist on groin on either side - if no femoral pulse it is working)
- internal aortic compression (fist on inside of vagina - as well as fist on top)
Shoulder Dystocia
Shoulder Dystocia
- delivering sideways
- shoulder gets stuck on pubic bone
- turtle necking (crowing and then goes back in)
To help:
- Gaskin manoeuvre (get mum on all 4s)
- McRoberts Manoeuvre (mum on back with knees on chest - can be held by partner etc)
- Ruben 1 (push down on baby’s shoulder behind mum’s pubic bone)
- Ruben 2 (Ruben 1 plus 2 fingers internally on baby’s shoulder)
- Woodscrew and Return Woodscrew (towel around shoulders and twist and turn gently)
Nuchal Cord
Nuchal Cord
Cord wrapped around baby’s neck
To help:
- Get pinky under cord and try to push over bub’s head
- Push cord over shoulders and deliver baby through it
- Backflip - turn baby’s head towards mum’s inner thigh and summersault baby out, keeping head as close to mum as possible
Newborn Heart Rate
Newborn Heart Rate
Normal = 150bpm = score 2
100 - 140bpm = score 1
< 100bpm = score 0
Paediatric Weight Calculation
Paediatric Weight Calculation
(age x 3) + 7 = weight
Paediatric Joules Calculation
Paediatric Joules Calculation
weight x 4 joules
Paediatric Adrenalin Dose Calculation
Paediatric Adrenalin Dose Calculation
weight x 100 = .ml
Paediatric Amiodarone Dose Calculation
Paediatric Amiodarone Dose Calculation
weight / 10 = ml
Paediatric Medication Formula
Paediatric Medication Formula
(dose - mcg,mg,g / meds mcg,mg,g) x meds ml = . mls needed
Paediatric ALS Respiration Rates
Paediatric ALS Respiration Rates
- BVM - 15:2
- LMA - 1 breath every 4 seconds
Tension Pneumothorax Symptoms
Tension Pneumothorax Symptoms
- resistance on bagging
- tracheal deviation
- jugular distension
- diminished chest sounds (gets worse lower in the lungs)
- Subcutaneous emphasaema
Preferred ACS Analgesic
Preferred ACS Analgesic
Fentanyl
