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Clinical Decisions

QuestionAnswer
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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