QAS_ACP2_skills
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| Intravenous access Indications | The administration of a drug or fluid
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| Intravenous access Contraindications | Whenever possible avoid sites of burn,
infection or localised cellulitis
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| Intravenous access Complications | Air embolus
Arterial puncture
• Cannula shear or breakage
• Drug/fluid extravasion
• Haematoma or haemorrhage from the site
• Infection or phlebitis
Irritation to the vein wall
• Nerve damage
• Vasovagal syncope
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| Intravenous access Additional info | sites are not to be used:
- Distal to a complex limb injury
- Limb with a fistula present
- An area of phlebitis or cellulitis
- When a limb has potential or existing lymphodema
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| Intravenous access Additional info.2 | IV access should only be implemented after
all basic cares.
• The number of cannulation attempts should reflect
the urgency of the case.
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| Airway suctioning Indications | • To remove secretions, blood or vomitus
from a patient’s airway
• For standby use in preparation for endotracheal
intubation
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| Airway suctioning Contraindications | • Nil in this setting
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| Airway suctioning Complications | Airway trauma
•Stimulate coughing or gagging
•Hypoxia from delays in ventilation with tracheal
tube suctioning
• Vagal stimulation can result in bradycardia
and hypotension
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| Airway suctioning Additional info | When performing tracheal suctioning, ensure the disruption
to ventilation is less than 30 seconds.
•Consider managing patient in lateral position if secretions
are overwhelming
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| Laryngeal mask airway Indications | •Impending or actual loss of airway patency or
protection, where advanced airway management
is necessary, but the clinician is unable to secure
airway through endotracheal intubation
• Rescue airway in the failed intubation algorithm
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| Laryngeal mask airway Contraindications | • Nil in this setting
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| Laryngeal mask airway Precautions | • Failure to provide adequate airway or ventilation
• Can precipitate vomiting and aspiration
in a patient with intact airway reflexes
• Airway trauma
• Patient intolerance
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| Laryngeal mask airway Additional info | An LMA does not protect the airway from aspirption.
• An LMA typically causes less gastric insufflation than
BVM ventilation alone.
•LMA is easier to insert with 50% air in cuff prior to insertion.
Note: ACPs are only authorised to use 3, 4 and
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| Laryngoscopy Indications | Clearing the airway
• Insertion of an endotracheal tube
• Insertion of a gastric tube
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| Laryngoscopy Contraindications | Epiglottitis
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| Laryngoscopy Complications | • Laryngospasm
• Hypoxia due to delays in oxygenation while
performing procedure
• Trauma to mouth or upper airway, particularly
teeth/dentures
• Exacerbation of underlying C-spine injuries
• Failure to visualise glottis
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| Laryngoscopy Additional info | • Laryngoscopy is not advised in patients with intact
airway reflexes.
• It is possible to use a blade which is larger than necessary
However, using a blade which is inappropriately small will make adequate laryngoscopy impossible.
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| Nasopharyngeal airway Indications | Airway adjunct for use in patients with potential
or actual airway obstruction, particularly in
circumstances where an oropharyngeal airway
is inappropriate (e.g. patient has trismus or an
intact gag)
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| Nasopharyngeal airway Contraindications | • Nil in this setting
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| Nasopharyngeal airway Complications | • Airway trauma, particularly epistaxis
•Incorrect size or placement will compromise
effectiveness
• Exacerbate base of skull fracture, with
NPA potentially displacing into cranial vault
[3] stimulate gag reflex precipitating vomiting or aspiration
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| Nasopharyngeal airway Additional info | An NPA does not protect the patient’s airway from aspiration.
• The right nostril is often preferred for NPA insertion given
that it is typically larger and straighter than the left.
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| Oropharyngeal airway Indications | Maintain airway patency
• Bite block in advanced airways
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| Oropharyngeal airway Contraindications | • Nil in this setting
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| Oropharyngeal airway Complications | • Airway trauma from OPA placement
• Intolerance of OPA requiring removal
• Can precipitate vomiting/aspiration in patient with intact gag reflex
• Incorrect size or placement can potentially
exacerbate airway obstruction
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| Oropharyngeal airway Additional info | Do not attempt to place an OPA if the patient has an intact gag reflex, or actively resists OPA placement.
• An OPA does not protect the airway from aspiration
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| APGAR Stands for: | • colour (Appearance)
• heart rate (Pulse)
• reflex irritability (Grimace)
• muscle tone ( Activity)
• breathing (Respiration)
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| APGAR Appearance | Look at
skin colour:
0. Blue/pale.
1. Pink (extremities blue).
2. All pink
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| APGAR Pulse | Count heart rate:
0. Absent.
1. < 100 .
2. > 100
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| APGAR Grimace | Monitor response
0. No response.
1. Grimace.
2. Vigorous cough
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| APGAR Activity | Look at muscle tone:
0. Limp.
1. Some flexion/extension.
2. Active motion.
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| APGAR Respiration | Count and assess:
0. Absent.
1. Slow/irregular.
2. Good cry
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| APGAR Indications | An APGAR score is required for all newborns
at one minute and five minutes following
delivery.
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| APGAR Contraindications & Complications | • Nil in this setting
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| Glucometry Indications | Seizures
• Sick paediatric patients
• Impaired consciousness
• Post collapse
• Abnormal behaviour
• Any patient who is suspected of being
hypoglycaemic
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| Glucometry Contraindications | • Although no actual contraindication exists to glucometry and the recording of BGL, it must be remembered that this procedure is invasive and so judgement must be used as to the
appropriateness of performing the procedure
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| Glucometry Precautions |
Alwaysconsider other clinical signs
and available history.
Numerous variables may distort test results such as:
• blood volume on the sensor
• oxygen level of the blood
• glucose contaminants on the skin.
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| Glucometry Additional info | Note: A patient with impaired consciousness must
have BGL checked whenever practical, even if the
ALOC is suspected to be of other causes.
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| Glucometry Additional info.2 | Blood may be drawn from a cannula while gaining IV access.
Alcohol can affect the BGL result
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| Mental status assessment, Points to consider | Appearance
Behaviour
Speech
Mood
Affect
Thought form
Thought content
Perception
Insight & judgement
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| 12-Lead ECG acquisition Indications | To aid in the identification of:
- myocardial ischaemia or infarct
- rhythm and conduction disturbance
- electrolyte imbalance
- hypertrophy of the heart
- drug toxicity
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| 12-Lead ECG acquisition Contraindications & Precautions | Nil in this setting
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| 12-Lead ECG acquisition Additional information | •Should be acquired as part of an early
secondary assessment of the patient, especially in the setting of suspected cardiac ischaemia or infarct.
• Electrodes should remain in their original placement for comparison of serial 12-Lead ECGs
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| 12-Lead ECG acquisition Additional information.2 | ECG frequency is set at 0.05–40 Hz, and
• paper speed is set at 25 mm/sec
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| Cardiac monitoring Indications | All unconscious or collapsed patients or recently unconscious
Patients CO chest pain or dyspnoea
Poisoned pts
Pts poorly perfused/shocked
or hypoxic, or with abnormal vital signs
When M.O requests.
Pts in arrest
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| Cardiac monitoring Contraindications | Nil in this setting
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| Cardiac monitoring Precautions | Detached electrodes due to diaphoresis,
oily skin, or chest hair
• Patient movement, breathing, muscle tremor
or lead movement
• AC electricity/50 hertz interference
• Broken cable tip, wire or machine malfunction
• Dry electrode conductive
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| Cardiac monitoring Additional info | Note: If the patient goes into cardiac arrest, any electrodes impeding the proper application of the defibrillator pads must be removed.
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| Valsalva manoeuvre Indications | Haemodynamically stable SVT
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| Valsalva manoeuvre Contraindications | Haemodynamic compromise
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| Valsalva manoeuvre Complications | Syncope
Prolonged hypotensive state
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| Valsalva manoeuvre Additional information | This reflex bradycardia is induced in an effort to break the pattern
of a re-entrant circuit causing the SVT.
A maximum of three attempts at the Valsalva manoeuvre is recommended.
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| Valsalva manoeuvre Additional information.2 | - minimum pressure of 40 mmHg
- optimal duration of 15 seconds
- supine position as an ideal posture
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| Bimanual compression Indications | •Significant bleeding from the vagina
• Enlarged soft uterus upon abdominal palpation
• Tachycardia
• Restlessness
• Profound hypotension
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| Bimanual compression Contraindications | • Nil in this setting
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| Bimanual compression Complications | • Trauma
• Pain
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| Bimanual compression procedure: | 1)External aortic compression
2) Bimanual compression
scrub hands, sterile gloves, Insert a gloved lubricated, form a fist, Apply pressure against anterior wall of uterus, other hand deeply into abdomen, pressure applied against posterior wall of uterus
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| Breech birth Types: | Frank breech, Complete breech, Footling breech, Kneeling breech
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| Breech birth Breech birth Indications | To assist a labouring woman in the delivery
of her child when the child presents in a
breech position
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| Breech birth Contraindications | • Nil in this setting
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| Breech birth Complications | Failure to deliver
• Pain
• Prolapsed cord
• Shoulder dystocia (refer CPP)
• Head entrapment
• Meconium aspiration
• Post-partum haemorrhage (refer CPG)
• Inversion of the uterus
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| Breech birth Additional information | Complications of breech delivery can lead
to fetal distress and hypoxia potentiating
a compromised neonate.
Preparation for neonate resuscitation with
breech presentation.
Consider early ICP/obstetric team backup.
Ensure aseptic technique
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| Breech birth Procedure:buttocks and legs | When buttocks have entered the vagina, woman can push, let lower back and shoulder blades deliver, If not spontaneous deliver 1 leg at a time, Hold the baby by the hips 2 avoid internal damage
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| Breech birth Procedure:Delivery of the arms | Allow arms to disengage spontaneously assist if necessary. After first arm, lift buttocks to mums abdomen to enable the second arm to deliver. If an arm does not spontaneously deliver, place 1 or 2
fingers in elbow, bend arm, hand down over baby’s face.
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| Breech birth Procedure:Arms stretched above the head | Loveset’s manoeuvre: Hold baby by hips, turn half circle,keep back uppermost, applying downward traction at the same time. Sweep hand over the face. 2nd arm:turn back 1/2 circle, keeping the back uppermost, repeat.
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| Breech birth Procedure: Baby's body cannot be turned | To deliver posterior shoulder, Hold and lift baby up by ankles, move the baby’s chest towards woman’s inner leg.
The posterior shoulder should deliver, free the arm and hand. Lay the baby back down by the ankles. The anterior shoulder should now deliver
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| Breech birth Procedure: Delivery of the head, Mauriceau-Smellie-Veit: | bby face down,body over ur arm. 1st n 3rd fngrs on bb’s cheek bones, 2nd fngr in bb’s mouth, pull jaw down n flex head. Other hand hooks bb’s shoulders w index n ring fngrs. middle fngr gently flexs bb's head 2 chest,pull on jaw.Pull gently 2 deliver head
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| Breech birth Procedure:Post-delivery care | •Suction the baby’s mouth and nose, if meconium
is present.
•Clamp and cut the cord.
•See the CPG normal cephalic delivery for care
of the newborn
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| Cephalic delivery Indications | To assist a labouring woman in the delivery
of her child
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| Cephalic delivery Contraindications | • Breech delivery
• Mother not in labour or delivery not imminent
• Normal transport to hospital a viable option
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| Cephalic delivery Complications | •Pain
• Malpresentation
• Cephalopelvic disproportion (CPD)
• Shoulder dystocia
• Infection
• Postpartum haemorrhage
• Prolapsed cord
• Inversion of the uterus
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| Cephalic delivery definition: | process by which fetus, placenta and membranes are expelled via the birth canal. In normal labour:
• The fetus presents by the vertex
• The occiput rotates anteriorly
• The result is the birth of a living, mature fetus (28–42 weeks)with no complication
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| Cephalic delivery Procedure.1 | cervix fully dilated,push.
pant as head delivers.
to control birth,fingers
against head to keep it flexed.
support the perineum
Once head delivers,no pushing
if meconium present,suction mouth then nose.
If cord around neck loosely, slip it
over th
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| Cephalic delivery Procedure.2 | cord tight around neck, two
clamps, cut between them, before
unwinding cord from around neck.
Allow the fetus’s head to turn spontaneously
place hand on each side of fetus’s head. mother to push gently with next contraction.
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| Cephalic delivery Procedure.3 | Move fetus’s head posteriorly then anteriorly to deliver top then bottom shoulder.Support fetus’s body as it slides out.
fundus massaged until uterus is contracted. Repeat uterine
massage every 15 minutes for the first two hours.
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| Cephalic delivery Care of the newborn | Place baby mother’s abdomen,skin
to skin. dry baby, wipe eyes
assess breathing.
If baby is breathing
(rr:30) leave baby with mother.
not breathing < 30 seconds,
resuscitate .
Complete an Apgar score on the baby at 1 and 5 minutes after birth
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| Cephalic delivery Care of the newborn.2 | Clamp cord 10, 15,20 cm from baby
cut between 15 and 20cm
Deliver placenta and membranes
if reqd.
Ensure baby is kept warm en route to the receiving facility. Maintain skin to skin with the mother and cover the baby’s head and back with a warm blanket
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| Shoulder dystocia Indications | The anterior shoulder does not deliver
spontaneously with good contractions.
The head does not restitute and externally rotate.
The chin burrows into the perineum as the anterior shoulder is caught on the symphysis pubis.
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| Shoulder dystocia Contraindications | • Nil
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| Shoulder dystocia Complications | Damage to the upper brachial plexus nerves
• Fetal hypoxia
• Fetal death
• Cerebral palsy
• Maternal postpartum haemorrhage
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| Shoulder dystocia Procedure: | McRoberts
Rubin I (suprapubic pressure):
All-fours (Gaskin)
Rubin II(1 hand, push shoulder towards fetal chest.
Woods screw (2 hands, fingers both shoulders n screw)
Reverse Woods screw
Delivery of the posterior arm (sweep posterior arm across che
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| Defibrillation Indications | • Ventricular fibrillation
• Pulseless ventricular tachycardia
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| Defibrillation Contraindications | • Ventricular fibrillation
• Pulseless ventricular tachycardia
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| Defibrillation Complications | Injury incl burns:
- Arcing between electrodes
- Foreign bodies (inc leads)
between pads n patient
- Pads with insufficient lubrication
Explosion:
-shock could cause explosion if combustibles
in vicinity.
Transmitted shock to operator or bystande
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| Defibrillation Joules: | Shock 1 200
Shock 2 300
Shock 3 360
Children eight years and below:
- All shocks given at 4 J/kg
Chrildren 9yrs+ Adult shocks
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| Defibrillation Additional information (ICD) | Do not place defibrillation pads over the top of
pacemakers or ICDs
If ICD is discharging:
- Allow ICD to discharge and continue CPR
- Do not externally defibrillate.
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| Donway traction splinting Indications | Mid shaft femoral fractures
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| Donway traction splinting Contraindications | • Pelvic injury
• Fracture/dislocation of the knee
• Ankle injury
• Bilateral femoral fractures
• Multiple fractures on the same leg
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| Donway traction splinting Precautions |
Gently re-align to decrease the chance of a closed fracture becoming a compound fracture
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| NEANN immobilisation & extrication jacket Indications | To facilitate safe extrication from a confined space
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| NEANN immobilisation & extrication jacket Contraindications | • When the patient is actual time critical and
the application of the NIEJ will delay transport to a trauma centre, or appropriate hospital.
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| NEANN immobilisation & extrication jacket Precautions | •Chest straps 2 tight interfere with resp.
•Groin straps secured 2 minimise jacket and neck movement
•Incorrect head padding lead to C-spine
hyperextension or hyperflexion.
•Immobilising head without properly securing
torso may cause C-spine move
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| SAM Pelvic Sling™ Indications | Suspected pelvic fracture with evidence of
haemodynamic comprimise
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| SAM Pelvic Sling™ Contraindications | • Suspected isolated neck of femur fracture
• Suspected traumatic hip dislocation
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| SAM Pelvic Sling™ Precautions | Once applied, a binder should not be removed
due to the risk of haemodynamic instability.
• Other methods (e.g. a vacuum splint)
may be used in small children.
•Apply carefully in gross compound fractures
to minimise pain and further complications
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| Procedure: notification | “My name is X I’m an ACP with
QAS. I’m phoning with a notification.
I have a X year old male / female patient with X.
Treatment to this point has involved X and current vital signs are X.
I have administered / performed X
Our ETA is X minutes.”
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| Clinical consultation | My name is X,I’m an ACP with QAS. I’m phoning with a clinical consult.
I have a Xyo m/f pt with X.
Treatment has been X VSS are X.
I would like to administer / perform / seek advice regarding X.
this is appropriate? anything u suggest?
Confirm X
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| Tension pneumothorax decompression Indications | Suspected tension pneumo with
resp and/or haemodynamic compromise
- Resp: Chest pain, dyspnoea,
tachypnoea, surgical emphysema,
diminished breath sounds on affected
side,tracheal deviation, cyanosis.
- Cardio: Tachycardia, decreased LOC, hypotension
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| Tension pneumothorax decompression Contraindictions | • Nil in the setting of acute trauma
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| Tension pneumothorax decompression Complications | •Improper diagnosis and insertion of pleural
catheter may creat simple or tension pneumo
• Incorrect placement may injure heart, great vessels, or damage lung
*Bilateral pleural decompression in
spontaneously breathing pt may cause resp compromise.
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| Tension pneumothorax decompression Procedure | Locate 2nd intercostal space
midclavicularline
Swab
Insert 14Gcannula, perpendicular to chest on superior border of 3rd rib until sudden loss of resistance
Remove stylet, advance cannula until hub is flush
Re-evaluate breath sounds n haemodynamic
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| Waveform capnography Indications | •CPR or IPPV (BVM/LMA/ETT)
•Sedation and procedural sedation
• Endotracheal intubation (placement confirmation)
• Ongoing monitoring of ventilation
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| Waveform capnography Contraindications | • Nil in this setting
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| Waveform capnography Precautions | When performing effective CPR during cardiac
arrest, EtCO2 values are not to be used to vary
IPPV from the recommended rate
When capnography is not in use,close EtCO2 connnection port door or it will break
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