Paramedic Notes Csb332 Scanlon PDF

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Lecture notes with important parts highlighted, bolded or colored in red. Lecture notes contains diagrams, photos and graphs to assist with understanding as well as paraphrased texts from text books and articles. Teacher was Kerri-Ann...

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Lecture 1 - Introduction + Revision Monday, 20 July 2015 8:45 AM

Primary and Secondary Assessment Revision  o

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Primary Survey DRABC  Triple/Double Airway Manoeuvre  NPA  OPA  CPR Secondary survey Focussed secondary assessment (VSS) -> 8 Vital Signs in total Physical Examination (head to toe) -> DCAP-BTLS Patient History -> SAMPLE Medical History

Primary Survey DRABC or DRCAB or Rapid DRABC

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Danger/Scene Assessment 

Danger: Is it Safe? o

Look out for actual or potential dangers and hazards. The environment should continually be assessed for dangers and hazards.  Mechanism of Injury: How the injury was obtained in the first place  Evidence of Cause: How the injury of caused, seek evidence  Number of Patients  General Impressions:  The environment  Location and position of the patient(s)  General appearance and behaviour of patient(s)  Obvious injuries or signs of illness  Patient's activity and awareness levels 

Other resources available / required

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Doctors ICP (Intensive Care Paramedics) ACP (Advanced Care Paramedics) Queensland Police Queensland Fire Services

"M.E.N.G.O."

Response: Is the Patient Responding? Consider AVPU (And

 C-Spine)    

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Alert: Is the patient alert? Verbal: Is the patient verbal? Or responding verbally? (Making verbal sounds, moans, groans) Pain: Is the patient responding to pain? E.g. Central Stimuli -> Sternum Rub Unconscious: Is the patient unconscious or conscious? o Consider GCS here for further assessment

Airways: Is the airway clear?

Is the airway patent? Check the Oropharyngeal airway for any obstruction o If not... Consider Triple Airway Manoeuvre (No Suspected C-spine) and perhaps AAW  Double Manoeuvre (Suspected C Spine Injury Indicated)  OPA (Prevent occlusion from tongue)  NPA (If unable to use OPA; Trismus, trauma to face/mouth) o Breathing: Is the patient breathing? o Look, Listen, Feel  Look for Rise and Fall  Listen for Breathing Sounds  Feel for Movement o Rise and Fall of Chest o Artificial Ventilation  Nasal Cannula/Catheter (Low Concentrations of Oxygen)  Simple Face mask (Moderate Concentrations)  Non Rebreather Mask (Significant Injury/Severe)  Venturi o

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Bag Valve Mask (IPPV; Unconscious Patients predominantly, Significant Injury/Severe)  Nebuliser Circulation: Is there sufficient circulation of blood? (Check Pulse) o Check Radial Pulse o If Unconscious, Check Carotid Pulse first then Radial? Rapid DRABC Remember: Looks Crook IS Crook Danger: Assess Danger o AVPU Airway? -> Y/N Breathing? -> Y/N Circulation -> Pulse? / Palpable Radial Pulse? -> Y/N Life Threatening Trauma/Haemorrhage? -> Y/N

Lecture 2 - Manual Handling Monday, 20 July 2015 8:46 AM

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High incidences of injury in jobs with high manual handling demand.

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Back, Neck, Shoulders -> Most common Aim of Manual Tasking: Promote, Utilise Safe Manual Task Principles, Postures and Techniques Involves: Lifting/Lowering Pushing/Pulling Move/Carry

Hold/Restrain Any task that involves moving something with any part of your

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Cumulative; Gradual Wear and Tear. Pain; not a good indicator of damage occurring

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Acute; Sudden Damage Caused by unexpected movement, intense, strenuous activity While some manual handling injuries are caused by acute injury, mostly result of cumulative damage

Zero Harm; QAS Policy All injuries are preventable and target is ZERO HARM to all their officers Legislation Workplace Health and Safety Act o Prevent anyone from being killed, injured or contracting illness during work Duty of Care o To employees and employers Obligation o If your actions are going to affect another, you have a duty of care o Onus is on employer and employee WHSA applies to all workplaces, workplace activities and specified high risk plant applicable to that organisation

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Workplace Health and Safety Acts: Set out by state and stipulate OH&S; Must be obeyed Regulations: Set out how tasks/process must be undertaken Advisory Standards/Codes of Practice/AS Standards o Guidance of best practice E.g. of the ones that QAS uses are QLD codes of Practice for Risk Management, AS4360 risk management, Manual Handling of people, hazardous substances, first aid, amenities, etc.

Duty of Care

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Employers are required to produce safe places of work, safe systems, safe plant and competent staff

Costs  o  o o o  o o o

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To the Australian Economy 2000-2001; Estimated total cost of injury, illness approximately $34.3 billion, approx 5% of Australian GDP Personal Costs Consider costs of pain, suffering and early death to injured/ill workers 2000-2001, estimated cost at $48.5 billion Work place injury + disease at $82.8 billion Non-Monetary Costs Costs not measured by dollar value Significant costs/impact on life i.e. Permanent injury Stress on family, friends.. Will you be able to do activities prior to injury?

Participatory Ergonomics Do not do these if you are aware that: o Activities may aggravate previous existing condition or experiencing discomfort in any of these body areas o Do not perform activities if currently experiencing discomfort or receiving treatment for any conditions which may be aggravated by activities o Do not perform fast, jerky movement... Use slow controlled movement

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Injury Prevention What can prevent injury at work? o The Risk Management Approach to control of manual handling injury What can I do to prevent workplace injuries? Reducing risk of manual handling includes: o Risk Management o Understand Causes of Workplace Injuries o Understand Physical Demands o Mitigate against slips, trips and falls o Be aware and rectify poor postures o Keep Personally Safe: Eat, Sleep well.. Keep Fit Risk Management Objectives Basic process of risk management approach: o Establish contexts o Identify Risks o Analyse Risks o Evaluate Risks o Treat Risks o Monitor and Review o Communicate and Consult

Week 3: Communications Monday, 20 July 2015 8:46 AM

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Consider the Challenges of this 000 Call For the Caller For the Communications Centre Call Taker For Communications Centre Supervisor For Paramedics Crew For Back Up Crew

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We DO IT ALL THE TIME, Why then are we so rubbish at it? Too busy to take information Too busy to properly pre-plan Too impatient to listen o "Why is no one listening to me" There is only one point of view; mine Content cloaked in obfuscation o Jargon o Ambiguous o Difficult to interpret o Mixed messages  Verbal and Non-Verbal communication

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Know your audience Plan what you are going to say/write Consider how you are about to say will be interpreted Cultural issues Verbal/Non-Verbal Communication

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Main Functions of Communication Centres Provide precise point of contact for the community in need of ambulance services Manage deployment of ambulance resources in response to

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requests 

Provide rapid, appropriate support for ambulance officers in response to operational requirements

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Optimise use of ambulance resources in accordance to relevant policies, procedures and directives

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Facilitate coordination of health services Undertake other communication and administration requirements in provision of ambulance services Tracking, tasking and coordination of RFDS (royal flying doctors service) and rotary wing aircraft according to both State and local agreements

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Codes

AMIST; Clinical Handover Age and Sex Mechanism of Injury (involved in a Road Collision Accident…. Fell from Height) Injury (Sustaining a fracture… etc) Signs and Symptoms Treatment given and time of arrival

SITREP - ASHICE Age Sex History Illness/Injury Condition Estimated Time of Arrival This is QAS unit 007. This call is to let you know we are coming to you with a 56 year old male patient who has been struck by a motor vehicle at moderate speed. He has multiples fractures to both legs, a fractured right humerus and a head injury. He is responding to painful stimuli only and is poorly perfused with clammy skin, pulse of 115 and a BP of 90 systolic. Our ETA is 5 minutes This is QAS unit 007 we are coming to you with a 42 year old male who has suffered 30 minutes of unrelieved retrosternal chest pain radiating into the left arm. His vital signs are all normal except for mild dyspnoea and clammy skin. His ECG shows significant ST segment elevation in leads 2 & 3 and our ETA to you is approximately 10 minutes. This is QAS unit 007. We are proceeding to you with a 52 year old male patient, post VF arrest. He is now well perfused with a pulse of 88 and BP 120/80 but is unconscious with fixed pupils and no respiratory effort. Our ETA to you is approximately 15 minutes.

Patient Transport Categories; Communications Centre Guide

Talking On The Radio

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Rhythm Phrases spoken in normal conversation have a natural rhythm Speak all words plainly End each word clearly Avoid running consecutive words together Avoid the tendency to accentuate syllables artificially Messages should be given in short phrases, not word by word Avoid long pauses, but maintain natural punctuation Avoid "Ums" and "Ers" Speed

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Speak steadily and at medium speed. Messages spoken too quickly will be received as a jumble of words. Too slow speech wastes time and exasperates recipient Avoid slurring/hurrying of words

Note: If the message has to be written down, pause longer between phrases. On occasions, it may be beneficial to the receiver to repeat the phrase.  o o o o o

Volume Ordinary Conversation: Important words are stressed over, less important words slurred over Radio: Every word spoken at same volume, and not fade away at last word Speak normally avoid tendency to shout Avoid variations in intensity of speech and unusual inflections in voice Speak directly into microphone, keep lips close to mouth piece and maintain distance whilst speaking Pitch

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High pitched voices usually understood more clearly than lower pitch voice Low pitch voices should speak in higher pitch Avoid allowing pitch of voice to drop on last syllable of each phrase

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Transmission of Time Time indicated by 24hr clock, eliminate use of AM and PM Avoid confusion between afternoon/morning Situation Reports (SITREPS)

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Hazards/safety issues at the scene/incident Most appropriate safe approach and entry to scene for further responding resources Requirement for additional QAS resources – specify what is required and response code Requirement for additional allied service’s to the scene i.e. Queensland Fire and Rescue (QFRS), Queensland Police Service(QPS) Number of patients involved and requiring transport Clinical condition of the patients Potential delays on scene

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Handing over at Hospital Back to ABC (Accuracy, Brevity, Clarity) Patient handover is an art form Think about who you are handing over to Think about how busy their department is Think about how much information they need to triage and categorise the patient Deliver the pertinent information as clearly as possible Make sure the person is ready to receive the handover Don’t take anything personally

Week 4: Mental Health Monday, 20 July 2015 11:46 AM

MENTAL HEALTH DISORDERS: WHAT ARE THEY?

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Condition characterised by severe disturbances in thought form, perception and memory Paramedics not qualified to diagnose mental health illness, however, required to consider behaviour and actions of a reasonable person and consider exclusion criteria

THE MENTAL HEALTH ACT (2000)  Provides involuntary assessment, treatment and protection of persons having mental illness while safeguarding their rights  Assists paramedics to understand their obligations under the act to appropriately manage and care for people with mental health disorders THE MENTAL STATUS EXAMINATION/MSA  Process of conducting a systematic evaluation of the patient's mental status, including thought processes, at that particular time. Although paramedics cannot diagnose specific conditions, the MSE allow evaluation of patient's thought processes and alongside other history assessments, is useful in completing an EEO EXCLUSION CRITERIA: Can't be considered a MH issue on their own  Holds/refuses to hold particular religious, cultural, philosophical or political belief and opinion  Member of a particular racial group  Particular economic/social status  Has particular sexual preference/orientation  Engages in sexual promiscuity  Engages in immoral or indecent conduct  Takes drugs or alcohol  Has intellectual disability  Anti-social behaviour or illegal behaviour  Involved in family conflict  Previously treated for mental health or has been subjected/experienced involuntary assessment or treatment QAS MEDICAL DIRECTOR'S CIRCULAR EEO  Persons with MH issue should be treated/transported voluntarily  Provisions made under MH Act 2000 (Division 3, Subsection 33-36), for patients to be transported and assessed involuntary via QAS or QPS o Enables 6 hours of involuntary assessment o EEO Completed when officer reasonably believes:

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Person has mental illness Illness poses imminent risk of physical harm to self, others Proceeding with JEO (Justice Examination Order) would cause dangerous delay Person needs examination at Authorised Mental Health Service

MENTAL HEALTH GLOBALLY  People affected by mental, neurological or behavioural problems account for 12% of global burden of disease 

Impact of mental illness within Australian population has become increasingly apparent. o 2007 National Survey of Mental Health and Wellbeing found an estimated 3.2 million Australians (20% of the population aged between 16 and 85) had a mental disorder in the twelve months prior to the survey”

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Burden of Disease and Injury in Australia study indicated that mental disorders constitute the leading cause of disability burden in Australia, accounting for an estimated 24% of the total years lost due to disability”

MENTAL HEALTH QUEENSLAND  12% people (approx) have Mental Health o 139, 278 people in Brisbane COMMON MH DISORDERS  Anxiety disorders  Psychosis  Schizophrenia  Mood Disorders  Personality Disorders  Organic Disorders ANXIETY DISORDERS  Persistent Anxiety  Long-lasting anxiety that is not focused on any one object or situation.  Those suffering experience non-specific persistent fear and worry, and become overly concerned with everyday matters  Excessive not consistent with usual anxiety of others in situations where one would expect

Exams, interviews, public speaking (usual examples) Unable to focus on present, concerned with past or what might happen in the future Worry and discomfort present can be expressed physically/psychologically o

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Psychological Symptoms: Dread, worry, endless thinking about past events, obsessive; difficult to stop, OCD behaviours, panic and fear despite no obvious danger

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Physical Symptoms: Chest pain, tachypnoea, lethargy, muscle tension, trembling, sweating, chronic headaches, nausea/vomiting, teeth grinding, restlessness, difficulty sleeping

AETIOLOGY OF ANXIETY DISORDERS  Caused by a number of factors which can include: o Physical health problems o Excessive drug or alcohol use o Experiences during critical stages of childhood o Financial problems o Experiencing death of somebody o Break up of relationship o Being in an unpredictable new situation (overseas, work change) TYPES OF ANXIETY DISORDERS  Generalised Anxiety Disorders o Persistent and excessive worries over everyday life aspects  Obsessive Compulsive Disorders o Ritualistic behaviours in cleaning, hoarding or counting  Phobias o Intense, persistent and irrational fears over objects or situations  Panic Attacks o Frequent, sudden/acute panic attacks of intense fear  Social Anxiety Disorders o Anxiety in social situations  Post-Traumatic Stress Disorder o From a traumatic event PSYCHOSIS  Broad classification of disorders, listed are most severe

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Loss of contact with reality Bizarre/irrational behaviours Hallucinations and Delusions Speech affected, stilted, rambling Thought processes incoherent and disjointed Extreme changes in mood Acting out fantasies Frozen postures Stares into space o Aetiology: Schizophrenia, organic: drug intoxication and metabolic causes

SCHIZOPHRENIA  Common; affects 1:100 o Onset for Males: Adolescence and early twenties o Onset for Females: Early twenties to thirties  Chronic: Well managed with combination of drug therapy, ECT, CBT  Psychosis symptoms o Disruptions to emotions and thought process Aetiology of Schizophrenia  Genetic susceptibility  Environmental factors  Chemical and hormonal changes  Brain damage  Drugs and Alcohol  Childhood deprivation and abuse  Stress factors  Dopamine Deficiencies Characteristics of Schizophrenia  Hallucinations  Delusions  Paranoia  Thought disturbances  Difficulty expressing emotions  Low Motivation Treatment Options

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Patients presents differently, combination with medications may be an option Patient will be prescribed medication by psychiatrist, who reviews regime frequently Many drugs have undesirable side effects, patients may choose not to take medications for this reason o Antipsychotics; o Anti-depressants; For Depression o Benzodiazepines; Sedative for aroused patients o Lithium; For Mood o ECT; Depression in schizophrenia and acute catatonic stress

AFFECTIVE DISORDERS (Disorders affecting mood, feelings, attitudes)  Depression and Bi-polar disorders  Also called mood disorders  Affects 2:100 of population (Manic Disorder) BI-POLAR DISORDER  Treatable illness; excessive mood swings and periods of normal moods in between  “Characterised by two or more episodes in which the patient’s mood and activity levels are significantly disturbed  Disturbance consisting on some occasions of o Elevation of mood, increased energy and activity (hypomania or mania) OR.. o Lowering of mood, decreased energy and activity (depression).  Repeated episodes of hypomania or mania only are classified as bipolar”  Cyclic illness, periods of mania, major depression and intervening periods of normal function Symptoms:  Depression: o Difficulty concentrating o Loss of interest, individual normally enjoys o Sleep problems (too little/too much) o Guilt o Delusions and Hallucinations o Suicidal  Manic:

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Talking fast Little sleep Grandiose thoughts Reckless Behaviour Sexually active Delusions/Hallucinations Super Powers, Deifies themselves

Aetiology of Bi-Polar:  Strong genetic disposition o Linked to brain chemicals/neurotransmitters that regulate mood  Serotonin, norepinephrine o Balancing issues of chemicals Balance of serotonin and norepinephrine that regulate mood out of balance Drug Therapy Options:  Medications can take some time for psychiatrists and individuals to trial (for Bi-Polar)  Medications treat/prevent mania by stabilising mood: o Lithium, Valproate, Carbamazepine or Lamotrogine 

Medications treating depression; Different classes: o (Selective Serotonin Receptor Inhibit...