Anaphylaxis and antiemetic PDF

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Summary

Scenario...

Description

Paramedic Equipment

Patient

Context

Background & Specifications

APS301 SCENARIO PREPARATION

Topic:

3

This scenario is for a 62 year old person who is in a pre-cardiac arrest state. The patient is found in a sitting position at a work address (office / industrial / farm). This lowmedium fidelity simulation enables students to apply a treatment regime that will be developed in the tutorial session Setting

Simple workplace setting only (office / industrial / farm)

Chattels

Simple furnishings consistent with the selected workplace setting

Dangers

There are no obvious dangers planned for this scenario

Appearance (incl. Clothing and Cosmetics) There are no clothing specifications beyond being consistent with the dress of a person in the relevant workplace setting. Comsmetics to reflect hives / widerspread urticarial rash and "flushed" appearance Injuries or Features of Illness Hives type rash, or any obvious widespread 'red' to the abdomen, neck and groin would be optimal. Cheeks and forehead with a flushed look would also be helpful Medications (and poisons) Aspirin close by would be optimal

PPE (including specialist PPE) PPE for minimum precautions (gloves, hand rub, eyewear) is required. There are no specialist PPE requirements Kits Standard paramedic equipment to a 3rd year level is required, being Oxy Viva, LP15, Drug Kit, Medication Kit, Trauma Kit. Please ensure ampoule snapper is included in Medication kit for student safety Specialist Equipment Nil required

TOPIC 3 - ANTI-EMETICS & ANTI-HISTAMINES Scenario

This scenario is for a 62 year old male / female who is in a pre-cardiac arrest state. The patient is found in a sitting position at a work address in Wee Waa in the NSW New England area. The patient has had a generalised low grade headache today and, in the absence of other medications being available, he/she took two aspirin tablets. The last known time they took an aspirin tablet was when they were a child (until recent years, the patient has made a point of staying away from medications and doctors). Transport time to the closest appropriate hospital (Tamworth) is 1hr 40mins

M Initial Info E T H A N E

NA Work address, Wee Waa pre-cardiac arrest Low risk workplace area Simple access & egress 1 Nil Available

IMPRES'N LOC A B C D GCS

Sitting, moribund Responds to Pain Tongue swollen Decreas'd Bi-lat., Base to Apex Central & Brachial present unable to assess 2+2+5 = 09

Basic History

S A M P L E

Headache today NKA GORD, Hypertensive meds GORD, Hypertension (mild) 30 mins ago (Lunch) Took aspirin for headache

Adv History

Medical Family Social Lifestyle Meds

GORD, Investigated (Ix) for peptic ulcer and HB Pylori (NAD) 3/12 ago. Intermittent headaches past 3/12. Has been on anti-HT meds for 2 years Father died of stroke, Mother died at child birth Well known citizen maintains strong network of friends Smoker (8-12 cigarettes per day) Tazac, Zoton (trade names), metoprolol (drug name)

GCS Resp R Heart R Pulse BP MAP

9 8 38 38 70/30 43.3

Vitals

Other Notes

/15 /min /min /min mmHg mmHg

O No pain / discomfort P Q R S T

BSL Temp SpO2 L Apex L Mid L Base

8.6 mmol/L 37.0 C (Tymp) unreadable D R Apex D R Mid D R Base

D D D

This page outlines the first stage of the scenario to enable initial assessment. Please see second page

TOPIC 3 - ANTI-EMETICS & ANTI-HISTAMINES Scenario

After initial primary treatment (including drug therapy with relevant repeat doses), the patient's condition improves. There is a 1hr 40minute transport time to hospital and hence treatment needs to be commenced for this journey

M Initial Info E T H A N E

NA Work address, Wee Waa pre-cardiac arrest Low risk workplace area Simple access & egress 1 Nil Available

IMPRES'N LOC A B C D GCS

Alert Nil Wheeze Present (Radial) Nil 15

Basic History

S A M P L E

Headache today NKA GORD, Hypertensive meds GORD 30 mins ago (Lunch) Took aspirin for headache

Adv History

Medical Family Social Lifestyle Meds

GORD, Ix for peptic ulcer and HB Pylori (NAD) 3/12 ago. Intermittent headaches past 3/12. Has been on anti-HT for 2 years Father died of stroke, Mother died at child birth Well known citizen maintains strong network of friends Smoker (8-12 cigarettes per day) Tazac, Zoton (trade names), metoprolol

GCS Resp R Heart R Pulse BP MAP

15 22 58 58 80/50 60

Vitals

Other Notes

/15 /min /min /min mmHg mmHg

O No pain / discomfort P Q R S T

BSL Temp SpO2 L Apex L Mid L Base

8.6 37.0 89.0 W W W

mmol/L C (Tymp) % R Apex R Mid R Base

W W W

In addition to the signs above, the pateint has profound urticaria and pruritis to the abdomen, groin and neck. The patient feels lethargic and vomits frequently during this phase until treated.

TOPIC 3 - ANTI-EMETICS & ANTI-HISTAMINES General Instructions On Campus students: Separate into groups of four. Each member of the group should perform one of the tasks below. Distance/Online students: Review each of the questions below and bring your answers to the online consultation session. Pathophysiology

Review the pathophysiology of allergic reaction. At what threshold is the condition considered serious? How might one differentiate between minor and severe presentations? What pathophysiology are responsible for life threatening aspects of the condition, as opposed to non-life threatening aspects of the condition?

Mechanism of Action Task: Outline the mechanism of action for the following paramedic medications. Start with a simple explanation, progressing to a deeper scientific understanding. Hydrocortisone Fexofenidine Adrenaline Ondansetron Protocols & Pharmacological Guidelines

Review the clinical guidelines and protocols relating to the condition (anaphylaxis). Pay particular attention to short and long term treatment regimes for allergy in a prehospital setting. Develop a treatment plan for this patient based on the clinical and pharmacology guidelines which you have reviewed.

Home Medication Review

Task: Review the following home medications. Understand what these medications may be used for (as there will be multiple uses), and briefly describe how these medications work Tazac (trade name) Zoton (trade name) Metoprolol Aspirin

Final Notes

Develop answers for the above questions and be prepared to discuss these (in a supportive way) with your lecturer. Use the answers to each question (above) to inform the development of a comprehensive treatment regime for this simulated patinet. You will implement your treatment regime in class (on-campus students) or at the residential school (online students).

Oral Viva Notes Overview

Dignosis and Pathophysiology (questions are suggestions only)

Topic:

3

The plan of action for this week is to (a) Chiefly, develop student confidence in emergency use of sympathomimetics and anti-cholinergics, (b) develop theoretical and practical understanding of antiemetic use, and (b) introduce common GI home medications Key Question: Tell me about the diagnosis and relevant pathophysiology as it relates to this patient's condition(s) Supplimentary / Support Questions (if needed to prompt): What is the primary diagnosis & what is the likely allergen? Why is the patient only now displaying allergic symptoms? Pls differentiate between minor/moderate/severe presentations.

Protocols & Pharmacological Guidelines (suggestions only)

Key Question: Describe the treatment plan that your group has decided upon. Why did you choose that treatment plan? Supplimentary / Support Questions (if needed to prompt): What non pharmacological treatments did you use, and why? Name 3 interventions that would help this patient the most? Did your treatment provide enough attention to the basics? ABCD's?

Pharmacology (suggestions only)

Key Question: Couly you please name, and justify the use of, all the sympathomimetic and anticholinergic drugs used in this scenario? Supplimentary / Support Questions (if needed to prompt): Describe the MOA of "Zoton" and "Tazac" What anti-emetic did you decide to use? Why this one? How is metoptolol of relevance to this patient's presentation?

Final Notes

We would like participants to understand the importance and dominance of sympathomimetics (and sometimes anti-cholinergics) in the treatment of life threatening asthma and anaphylaxis - as a way of reinforcing the learning that has occurred over the past fortnight. At the same time, the importance of basic measures (ABC's, posture, oxygen) should also be reinforced. This week we also commence a discussion on the common gastrointestinal drugs used in the home setting, and expect students to understand the basic pharmacodynamics of each key drug group in this area. Thereafter, candidates need to start developing a comprehensive understanding of the mechanisms that produce nausea and vomiting, with a view of tailoring their treatment regimes (pharmacological and non pharmacological) to address the underlying causes of nausa and vomiting, rather than just treating vomiting per se....