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Clinical Decisions
| Question | Answer |
|---|---|
| What are the benefits of protocols? | Standardised approach |
| What are the limitations of protocol? | - Don't always fit every complaint. It is quite a grey area. – Don’t address multiple etiologies – Promote linear thinking |
| Why do we follow a protocol for life threatening conditions such as cardiac arrest? | There is a lot of evidence surrounding the protocol and that is why there is only the one approach |
| Why do patients with minor to life threatening conditions pose a critical thinking position? | Because you have to workout the condition where you have to work out the best possible treatment. The A-E approach |
| What are the items on our mental checklist? | Plan, scan the situation, decide and act, maintain clear and concise control, regularly and continually re-evaluate the patient |
| Definition of unconscious | Unconsciousness is a state of unrousable, unresponsiveness, where the victim is unaware of their surroundings and no purposeful response can be obtained. |
| How do we recognise whether a patient is unconscious? | Illicit a response- voice, touch and pain |
| What are the causes of unconsciousness? | A- Alcohol E-Epilepsy/ environment I-Insulin O-Oxygen/ overdose U- Uraemia/underdose T- Trauma/toxins I-Infection P-Psychiatric S-stroke |
| How do we assess the level of unconsciousness? | A-Alert V-Responds to VOICE P-Responds to PAIN U-Unresponsive to all stimuli |
| Why does assessing unconsciousness take precedence over any other injury? | There is no point in fixing other injuries if they can't breathe and stay alive |
| What are the 4 main airway/adjuncts? | – Oropharyngeal airway (ILS 1st year) – Nasopharyngeal airway (ILS 1st year) – Laryngeal mask (ALS 2nd year) – Endotracheal intubation (ALS 3rd year) |
| Why is every unconscious patient in danger of asphyxia? | Main cause is from the tongue rolling back and obstructing the entrance to the trachea |
| When should airways never be used? | In a conscious patient |
| What will the OPA do? | The Oropharyngeal adjunct will control the lips, teeth and tongue |
| How to you insert the OPA? | Hold the flange end and rotate the airway so as the curved end is facing the roof of the mouth • When you have inserted it approx one third, rotate the airway 180 degrees and advance it until the flange rests on the lips. |
| When is an NPA useful? | – Semi-conscious/ unconscious – Injuries to mouth – Seizure patients – Likely vomiting |
| What is the contraindications of NPA? | – Brain matter is exposed (eg: base of skull fracture) – Drainage of CSF/blood from nose, mouth or ear |
| What are some complications of NPA? | – Nasal trauma – Epistaxis – May trigger gag reflex if NPA is too long |
| How do we insert the NPA? | • Lubricate with water soluable lubricant • Place head into a neutral position; extend nostril • Insert tip (bevelled end towards septum) of the NPA through the R nostril (or largest) and push down (not back towards brain) |
| If you are unable to manually manage airway, which position should the patient be in? | Lateral- Recovery position |
| If the patient the patient has a suspected spinal injury, which position should you put them in? | Supine- flat |
| Tidal volume | Amount of air moved in one breath |
| Dead space air | Air moved in ventilation not reaching alveoli |
| Alveola ventilation | Air actually reaching alveoli |
| Ventilation | Both inhaling and exhaling |
| Diffusion | Movement of gases from high concentration to low concentration |
| External respiration | Diffusion of oxygen and carbon dioxide (exchange of gases) between alveoli and circulating blood |
| Internal Respiration | Exchange of gases between blood and cells |
| What is a BVM? | Bag-mask ventilation- Positive pressure ventilation |
| How many L of oxygen an a BVM provide? | 15L/Min |
| What are the side effects of a BVM? | – Decreasing cardiac output/dropping blood pressure – Gastric distension – Hyperventilation |
| What are the key concerns of BVM? | – Do not ventilate patient who is vomiting or has vomitus in airway—PPV will force vomitus into patient’s lungs – Watch chest rise and fall with each ventilation – Ensure rate of ventilation is sufficient |
Created by:
maddunn23
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