Pocket Paramedic 2013

7/22/2019 Pocket Paramedic 2013

1/1001

[email protected]

Pocket Paramedic

2013By Jason Houghton

A collaboraon of useful guidelines

In a quick reference pocket book;

tailored for pre-hospital care.


2/100

2

Pocket Paramedic

2013

An elegant soluon to a simple problem

A collaboraon of useful guidelines in a quick

reference pocket book tailored for pre-hospital

care.

This handy pocket book resulted from my quest to

consolidate the most relevant and useful

guidance into a single source; something that can

be carried in your pocket at all mes-whenever

you may need it.

Pocket Paramedic is 100% non-prot. Sold at cost.

Hopefully, this will mean more people can benet

from it.

Download the FREE electronic edion from:

PocketParamedic.org

I hope you nd it useful.

Jason Houghton- Paramedic

[email protected]


3/1003

Contents

AdultsAlgorithms and Charts

4

Paediatrics

Algorithms and Charts19

Obstetrics

Useful Informaon and Charts32

EquipmentInstrucons and Guidance

37

Assessment & History Taking

Aid memoirs, Acronyms and Diagnosis45

Trauma & Medical Emergencies

Useful Informaon and Charts53

Anatomy

Diagrams and Terminology62

ECG & ETCO2 Interpretaon

Examples and Explanaons68

Major Incidents

Acronyms and Plan of Acon77

Infecon Prevenon & Control

Useful Informaon91

Key Contacts

Phone Numbers96

Notes

Extra Space97

References

Credits and Informaon Sources99


4/100

4

AdultsAlgorithms and Charts

Adult Basic Life Support 5

Adult Advanced Life Support 6

Adult Cardiac Arrest 7

Adult Bradycardia 8

Adult Tachycardia (With Pulse)

9

Adult Chocking Treatment 10

In Hospital Resuscitaon 11

AED Algorithm 12

Adult Glasgow Coma Scale 13

Adult Normal Ranges & Drug Dosages

14

Normal Peak Flow Readings 15

Normal Peak Flow Readings Chart -Men 16

Normal Peak Flow Readings Chart -Women 17

Adult Analgesic Ladder 18


5/1005

Adult Basic Life Support10

Adu

lts


6/100

6

Adult Advanced Life Support10

Adu

lts


7/1007

Adult Cardiac Arrest10

Adu

lts


8/1008

Adult Bradycardia10

Adu

lts


9/1009

Adu

lts

AdultTachycardia(WithPulse)

10


10/10010

Adult Choking Treatment10

Adu

lts


11/10011

In Hospital Resuscitaon10

Adu

lts


12/100

12

AED Algorithm10

Adu

lts


13/10013

Adult Glasgow Coma Scale

Eyes

Verbal

Motor

4

Opens Eyes Spontaneously

3 Opens Eyes in Response to Voice

2 Opens Eyes in Response to Painful Smuli

1 Does Not Open Eyes

5 Oriented, Converses Normally

4 Confused, Disoriented

3 Uers Inappropriate Words

2 Incomprehensible Sounds

1 Makes No Sounds

6 Obeys Commands

5 Localizes Painful Smuli

4 Flexion / Withdrawal to Painful Smuli

3 Abnormal Flexion to Painful Smuli (Decorcate)

2

Extension to Painful Smuli (Decerebrate)

1 Makes No Movements

Adu

lts


14/100

14

Adult Normal Ranges & Dosages

Parameter Unit ValueHeart Rate

BPM

60

-100

Respiratory Rate BPM 12 -19

SpO2 % 95

BP Systolic mmHg 100 -170

BP Diastolic

mmHg

60-80

Blood Glucose (BM) mmol/L 5 -10.9

Energy 1st

Shock Joules 200

Energy 2nd

Shock Joules 300

Energy 3rd

Shock Joules 360

Adrenaline 1:10000 mg (ml) 1 (10)

Amiodarone mg(ml) 300 (10)

Amiodarone (Refractory VF/VT) mg (ml) 150 (5)

Adu

lts


15/10015

Normal Peak Flow Readings8

EU/EN13826 PEF Meters Only

Adu

lts


16/100


17/10017

Adu

lts

NormalPeakFlowRea

dingsChart-

Women

8


18/100

18

Adult Analgesic Ladder(12 Years and Older)

Pain Score Medical Pain

Trauma,

Orthopaedic,

Musculoskeletal &

So ssue Pain

03

Mild

Pain

Consider Entonox

+/-

Ibuprofen 400MG

Consider Entonox

+/-

Ibuprofen 400MG

46

Moderate Pain

Consider Entonox

+/-

Morphine

2.5 to 5mg

(Max 20mg)

Consider Entonox

+/-

Ibuprofen 400MG

710

SeverePain

Consider Entonox

+/-

Morphine2.5 to 5mg

(Max 20mg)

Consider Entonox

+/-

Ibuprofen 400MG

+/-Morphine

2.5 to 5mg

(Max 20mg)

For Cardiac Related Chest Pain

Morphine Should be Considered in the First Instance

Adu

lts


19/10019

Paediatrics

Paediatric Basic Life Support 20

Paediatric Advanced Life Support 21

Paediatric Cardiac Arrest 22

Newborn Advanced Life Support 23

Paediatric Chocking Treatment

24

Paediatric Glasgow Coma Scale 25

Paediatric Arrest Calculaons 26

Paediatric Normal Ranges & Arrest Dosages 27

Normal Peak Flow Readings Chart -Paediatric 28

Pain Assessment Faces

29

FLACC Scale Pain Assessment 30

Paediatric Analgesic Ladder 31


20/100

20

Paediatric Basic Life Support10

Paediatrics


21/10021

Paediatric Advanced Life Support10

Paediatrics


22/100

22

Paediatric Cardiac Arrest10

Paediatrics


23/10023

Newborn Life Support10

Paediatrics


24/10024

Paediatric Choking Treatment10

Paedi

atrics


25/10025

Paediatric Glasgow Coma Scale

Eyes

Verbal

Motor

4

Opens Eyes Spontaneously

3 Opens Eyes in Response to Speech

2 Opens Eyes in Response to Painful Smuli

1 Does Not Open Eyes

5 Smiles, Orients to Sounds, Objects, Interacts

4 Cries but Consolable, Inappropriate Interacons

3

Inconsistently Inconsolable, Moaning

2 Inconsolable, Agitated

1 No Verbal Response

6 Infant Moves Spontaneously or Purposefully

5 Infant Withdraws from Touch

4 Infant Withdraws from Pain

3 Abnormal Flexion to Pain for Infant (Decorcate)

2 Extension to Pain (Decerebrate)

1 No motor response

Paediatrics


26/100

26

Paediatric Arrest Calculaons10

WEIGHT

ENERGY

TUBE SIZE

FLUID

ADRENALINE AMIODARONE

GLUCOSE

Age Formula

012 Months Weight (kg) = (Age in Months x 0.5) + 4

15 Years

Weight (kg) = (Age in Years x 2) + 8

612 Years Weight (kg) = (Age in Years x 3) + 7

Age Formula

012 Years Joules = Weight (kg) x 4j

Age Formula

Pre Term 2.5mm

Neonates 33.5mm

110 YearsInternal diameter (mm) = (Age/4) + 4

Length (cm) = (Age/2) + 12

Type Formula (0 12 Years)

Medical Bolus (ml) = Weight (kg) x 20ml

Trauma Bolus (ml) = Weight (kg) x 10ml

Concealed Haem

Bolus (ml) = Weight (kg) x 5ml

Formula (1:10,000) (012 Years) Formula (300mg in 10ml) (0 12 Years)

Dose (mcg) =

Weight (kg) x 10mcg (0.1ml)

Dose (mg) = Weight (kg) x 5mg

Then mls = Dose (mg) / 30)

Age Formula

012 Years Dose (ml) 10% Glucose = Weight (kg) x 2ml

Resuscitaon Council UK 2010

Paediatrics


27/10027

Age

HR

(BPM

)

RR

(PM)

BP

(Systolic)

Weight

(kg)

Energy

(Joules)

Tube

(mm)

Fluids

(ml)

Adre

naline

(ml)

(mcg)

Amiodarone

(ml)(mg)

Glucose

(ml)

Birth

110-1

6030-40

70-90

4

20

3

80

0.40(40)

0.67(20)

8

1M

110-1

6030-40

70-90

4.5

20

3

90

0.45(45)

0.75(22.5)

9

3M

110-1

6030-40

70-90

5.5

25

3.5

110

0.55(55)

0.92(27.5)

11

6M

110-1

6030-40

70-90

7

40

4

140

0.70(70)

1.17(35)

14

9M

110-1

6030-40

70-90

8.5

40

4

170

0.85(85)

1.42(42.5)

17

12M

110-1

5025-35

80-95

10

40

4.5

200

1.0(

100)

1.67(50)

20

18M

100-1

5025-35

80-95

11

50

4.5

220

1.1(

110)

1.83(55)

22

2Yr

95-14025-30

80-100

12

50

5

240

1.2(

120)

2.00(60)

24

3Yr

95-14025-30

80-100

14

60

5

280

1.4(

140)

2.30(70)

28

4Yr

95-14025-30

80-100

16

70

5

320

1.6(

160)

2.66(80)

32

5Yr

80-12020-25

90-100

18

80

5.5

360

1.8(

180)

3.00(90)

36

6Yr

80-12020-25

80-110

25

80

6

500

2.5(

250)

4.20(125)

50

7Yr

80-12020-25

90-110

28

100

6

560

2.8(

280)

4.67(140)

56

8Yr

80-12020-25

90-110

31

100

6.5

620

3.1(

310)

5.12(155)

62

9Yr

80-12020-25

90-110

34

120

6.5

680

3.4(

340)

5.67(170)

68

10Yr

80-12020-25

90-110

37

130

7

740

3.7(

370)

6.17(185)

74

11Yr

80-12020-25

90-110

40

140

7

800

4.0(

400)

6.67(200)

80

Pae

diatricNormalRanges

&ArrestDrugDosages

2013

Paediatrics


28/100

28

Norma

lPeakFlow

Chart-Pae

diatrics8

Paediatrics


29/10029

PaediatricPainA

ssessment

Faces

Paediatrics


30/100

30

Criteria

0

1

2

Face

Noparcularexpressionor

smile

Occasionalgrimaceorfrown,

withdrawn,unintereste

d

Frequenttoconstant

quiveringchin

,clenchedjaw

Legs

Normalposionorrelaxed

Uneasy,restless,tense

Kicking,orleg

sdrawnup

Acvity

Lyingquie

tly,normal

posion,moveseasily

Squirming,shiingbackand

forth,tense

Arched,rigidorjerking

Cry

Nocry(aw

akeorasleep)

Moansorwhimpers;

occasionalcomplaint

Cryingsteadil

y,screamsor

sobs,frequen

tcomplaints

Consolability

Content,relaxed

Reassuredbyoccasional

touching,

huggingorbeing

talkedto,

distracble

Diculttoconsoleor

comfort

FLAC

CScale

Pae

diatricNon-Verb

alPainAssessme

ntTool

Paediatrics


31/10031

Paediatric Analgesic Ladder(Under 12 Years)

Pain Score Medical Pain

Trauma,

Orthopaedic,Musculoskeletal &

So ssue Pain

03

Mild

Pain

Consider Entonox

+/-

Ibuprofen &/orParacetamol

Consider Entonox

+/-

Ibuprofen &/orParacetamol

46

Moderate

Pain

Consider Entonox

+/-

Morphine

Consider Entonox

+/-

Ibuprofen &/or

Paracetamol

710

Severe

Pain

Consider Entonox

+/-

Morphine

Consider Entonox

+/-

Ibuprofen &/or

Paracetamol

+/-

Morphine

For Cardiac Related Chest Pain

Morphine Should be Considered in the First Instance

Paediatrics


32/100

32

ObstetricsAlgorithms and Charts

APGAR Score for Newborns 33

Mechanics of Normal Birth 34

Shoulder Dystocia 35

Breech Birth Delivery 36


33/10033

APGAR Score for NewbornsAppearance

Pulse

Grimace

Acvity

Respiraon

1 Blue or Pale All Over

2

Blue at Extremies, Body Pink

3 No Cyanosis, Body and Extremies Pink

1 Absent

2


34/100

34

Mechanics of Normal Birth5

Obste

trics


35/10035

Shoulder Dystocia4

The McRoberts' manoeuvreis a procedure performed to

release a baby's impacted shoulder during shoulder

dystocia. The mother's legs are held back in a exed

posion and pulled to her chest to further open the

pelvis and allow the baby's shoulder to be released. Atthe same me suprapubic pressure is applied to the

mother's lower abdomen over the pubic bone.

Obste

trics


36/100

36

Breech Birth Delivery5

1

4

2 5

3 6

Obste

trics


37/10037

EquipmentInstrucons and Guidance

Laerdal Sucon Unit 38

ParaPAC Operaon 39

Fing a Collar 40

Fing a Donway 41

Fing a Donway Connued

42

Fing a KED 43

Fing a KED Connued 44


38/100


39/10039

ParaPACO

peraon

11

Equipment


40/100

40

FingaCe

rvicalColla

r9

Equipment


41/10041

FingaDonway

9

Equipment


42/100

42

FingaDonwayConnued9

Equipment


43/10043

Fing

aKED9

Equipment


44/100

44

FingaKEDConnued9

Equipment


45/10045

Assessment & History TakingAid memoirs, Acronyms and Diagnosis

Paent Assessment Triangle 46

Body Assessment -DCAPBTLS 47

Neurological Assessment -5Ps 47

Chest Assessment -TWELVEFLAPS 48

Chest Assessment ATOMFC 49Chest Trauma 49

Chest Pain -History Taking 50

Abdominal Pain -History Taking 51

Abdominal Pain Locaons 52


46/100

46

Paent Assessment Triangle

Airway &

Appearance

Circulaon/Skin

Breathing

Eort

General Impression (First View of Paent)

Normal Abnormal

A

Normal cry or speech. Responds

to parents or to environmental

smuli such as lights, keys, or

toys. Good muscle tone. Movesextremies well.

Abnormal or absent cry or speech.

Decreased response to parents or

environmental smuli. Floppy or rigid

muscle tone or not moving.

B

Breathing appears regular

without excessive respiratory

muscle eort or audible

respiratory sounds.

Increased/excessive (nasal aring,

retracons or abdominal muscle use)

or decreased/absent respiratory

eort or noisy breathing.

C

Colour appears normal for racial

group of child. No signicant

bleeding.

Cyanosis, moling, paleness/pallor orobvious signicant bleeding.

Inial Assessment (Primary Survey)

Normal Abnormal

A

Clear and maintainable. Alert on

AVPU scale.

Obstrucon to airow. Gurgling,

stridor or noisy breathing. Verbal,

Pain or Unresponsive on AVPU scale.

BEasy, quiet respiraons.

Respiratory rate within normal

range. No central cyanosis.

Presence of retracons, nasal aring,

stridor, wheezes, grunng, gasping or

gurgling. Respiratory rate outside

normal range. Central cyanosis.

C

Colour normal. Capillary rell at

palms, soles, forehead or central

body 2 sec. Strong peripheral

and central pulses with regular

rhythm.

Cyanosis, moling, or pallor. Absent

or weak peripheral or central pulses;

Pulse or systolic BP outside normal

range; Capillary rell > 2 sec with

other abnormal ndings.

Assess

ment


47/10047

Body Assessment

Body Assessment

DCAPBTLS

D

Deformity

C Contusions

A Abrasions

P Penetraons

B Burns

T Tenderness

L Laceraons

S Swelling

5Ps

P Pain

P

Paralysis (Movement)

P Paraesthesia (Sensaon)

P Pulses and Capillary Rell

P Pallor (Skin Colour and Temperature)

S Swelling

Assess

ment


48/100

48

Chest Assessment

TWELVEFLAPS

T

Tracheal deviaon (Is it central?)

WWounds / Bleeding (Check the neck, must be

sealed to prevent air embolus / haemorrhage)

EEmphysema (Surgical, may indicate tension

pneumothorax)

LLaryngeal Injury (Is there crepitus, indicang

injury?)

VVeins (Distended?, if so may indicate a tension

pneumothorax or cardiac tamponade)

E

Expose & Examine the thorax

FFeel (Flail segments, wounds, symmetrical

expansion, crepitus, fractures)

LLook (Equal rise and fall, paradoxical breathing,

bruising, wounds)

A Auscultaon (Equal sounds, absent, diminished,added sounds?)

PPercussion (Dullness, hyper-resonance,

symmetry)

S Search sides and back

Assess

ment


49/10049

Chest AssessmentATOMFC

A

Airway obstrucon (Tongue, trauma, foreign

object, vomit etc)

T Tension Pneumothorax

O Open sucking wound (Open Pneumothroax)

M Massive Haemorrhage (Haemothroax)

F

Flail Chest

C Cardiac Tamponade

Chest TraumaDierenal Diagnosis

CondionChest

ExpansionTrachea Percussion

Breath

Sounds

Pneumothorax Decreased Unchanged Resonant Reduced

Tension

Pneumothorax

Hyper

expanded

Deviated

away from

tension

Hyper

Resonant

Absent of

aected

side

HaemothoraxPossibly

reducedUndeviated Dullness

Reduced or

absent

Collapse /

consolidaonReduced

May

deviate

towards

collapse

May be dull

Reduced or

bronchial

breathing

Pleural eusion

Possiblyreduced

Undeviated

Dullness

Reduced orabsent

Assess

ment


50/100

50

Chest Pain -History Taking

SOCRATES

SSite-Where is the pain or discomfort? Can you point to the

area with one nger?

OOnset - What were you doing when the pain rst started?

What do you think may have caused this pain or discomfort?

C

Character-Can you describe the type of pain? Is it: dull ache,

sharp, stabbing, cramping, tearing, ghtness, crushing,

burning? Is it there all the me or does it in waves?

RRadiang-Does the pain stay in one place or does it radiate?

Does it follow a certain paern?

A

Associated Symptoms - Pale, clammy, dyspnoea,

tachypnoea, SOB, dizzy, syncope, lethargy, confusion,

voming, haemoptysis, producve cough, fever,

haematemesis, pulse abnormalies, impending doom. Have

you had a recent cough or been voming? When did you last

eat? Have you had any diculty swallowing?

TTime

- How long have you had the pain? Has it been there

ever since? Have you ever had a similar episode like this

before?

E

Exacerbate / Relieve - Does anything ease the pain?

(Analgesia, paent posioning, resng. Does anything make

the pain worse? (Walking, leaning forward, lying down,

coughing, movement, inhalaon or expiraon.

S Severity-

If you were to score the pain out of 10, 1 being nopain and 10 being the worst imaginable, what would you

score it?

Previous History - Recent trauma, chest infecon or

coughing, asthma, angina, COPD, heart failure, dyspepsia,

dysphagia,

Risk Factors - Family history, smoker, overweight, heavy

drinker, sedentary life style, hypertension,hypercholesterolemia, long travel / pregnancy, diabetes.

Assess

ment


51/10051

Abdominal Pain -History Taking

SOCRATES

SSite-Where is the pain or discomfort? Can you point to the area

with one nger?

OOnset-What were you doing when the pain rst started? What

do you think may have caused this pain or discomfort?

CCharacter - Can you describe the type of pain? Is it: dull ache,

sharp, stabbing, cramping, tearing, ghtness, crushing, burning?

Is it there all the me or does it in waves?

RRadiang - Does the pain stay in one place or does it radiate?

Does it follow a certain paern?

A

Associated Symptoms- Pale, clammy, dyspnoea, tachypnoea,

SOB, dizzy, syncope, lethargy, confusion, nausea, voming,

diarrhoea? Have you noced anything abnormal when passing

water? For example: Increased or reduced frequency, dark or o

colour urine. Does it have a strong odour, burning sensaon?

Have you noced anything abnormal when passing a bowel

moon? Increased or reduced frequency, pain, loose or hard

stools, dark coloured or bright red.

TTime-How long have you had the pain? Has it been there ever

since? Have you ever had a similar episode like this before?

E

Exacerbate/Relieve-Does anything ease the pain? (Analgesia,

paent posioning, resng, applying pressure, passing wind or

bowel moon?) Does anything make the pain worse? (Lying

down, coughing, movement, inhalaon, expiraon, palpaon,

passing water or bowel moon?)

S

Severity-If you were to score the pain out of 10, 1 being no pain

and 10 being the worst imaginable, what would you score it?

Birth Bearing Age-Any chance you could be pregnant? Are there

any changes to your menstruaon cycle: early, late, abnormal

colour, odours, increased pain? Have you had any vaginal

discharge?

Previous History - Recent trauma, chest infecon or coughing,

asthma, angina, COPD, heart failure, dyspepsia, dysphagia,

Risk Factors - Family history, overweight, heavy drinker,

sedentary life style, hypertension, hypercholesterolemia, long

travel / pregnancy, diabetes.

Assess

ment


52/100

52

Abdominal Pain Locaons1

Assess

ment


53/10053

Trauma & Medical EmergenciesUseful Informaon and Charts

Rule of Nines 54Submersion/Immersion Drowning 55Key Points -Submersion/Immersion 55Shock Comparison 56Stages of Shock

57

Catastrophic Haemorrhage Tourniquet 58Removing a Helmet 59Fing a Triangular Bandage 60Routes of Drug Administraon 61


54/100

54

Rule of NinesPaediatric & Adult

Trauma&

Medical


55/10055

Submersion/Immersion Drowning

The pulse may be extremely slow if hypothermia is

present, and external cardiac compression may be

required. Bradycardia oen responds to improvedvenlaon and oxygenaon. Drugs such as adrenaline

and atropine are less eecve in HYPOTHERMIA, and

must not be repeatedly used. These drugs may pool in

the stac circulaon of the drowned casualty, and then,

aer re-warming and circulaon has been restored, act

as a dangerous bolus of drug as they are circulated.

In hypothermic cardiac arrest, debrillaon will be

unsuccessful where the core temperature remains low.

At 28C the ventricle may spontaneously brillate.

Debrillaon may not succeed unl the core

temperature rises above 30-32C.

Trauma&

Medical

Key Points Submersion/ImmersionEnsure own personal safety

Successful resuscitaons have occurred aer prolonged

submersion/immersion.

Near drowning is oen associated with hypothermia.

Special consideraons in cardiac arrest treatment in the

presence of hypothermia.

Severe complicaons may develop several hours aersubmersion/immersion.


56/100

56

Trauma&

Medical

Type

RR

HR

BP

CapRefll

Skin

Hypo

volaemia

>2Seconds

Pale

Clammy

Sweaty

Cardiogenic

>2Seconds

Pale

Clammy

Sweaty

S

epc

2000

ExtremeTachyc

ardia&Tachypnoe

a,

WeakPulse,DecreasedLOC&Systolic

BP


58/100

58

CatastrophicHaem

orrhageTourniquet9

Trauma&

Medical


59/10059

Removing

aHelmet

9

Trauma&

Medical


60/100

60

FingaTrian

gularBandage9

Trauma&

Medical


61/10061

Routes of Drug Administraon

Code Route Descripon

BUC Buccal

Administraon directed toward the

cheek, from within the mouth.

ET Endotracheal Administraon down the ET tube.

IM Intramuscular Administraon within a muscle.

INH Inhaled Administraon by breathing.

IO IntraosseousAdministraon within the bone

marrow.

IV IntravenusAdministraon within or into a vein

or veins.

NASAL NasalAdministraon to the nose;

administered by way of the nose.

NEB Nebulised Administraon in the form of mist.

PO OralAdministraon to or by way of the

mouth.

PR Rectal Administraon to the rectum.

SC SubcutaneousAdministraon beneath the skin;

hypodermic.

SL SublingualAdministraon beneath the

tongue.

TOPIC

topical

Administraon to a parcular spot

on the outer surface of the body.

Trauma&

Medical


62/100

62

AnatomyDiagrams and Terminology

Palpable Pulse Locaons 63

Bones -General 64

Bones Spinal Colum 65Anatomical Terms of Locaon 66

Paent Posioning

67


63/10063

Palpable Pulse Locaons

Anatomy


64/100

64

Bones -General

Anatomy


65/10065

Bones Spinal Colum

Anatomy


66/100

66

Anatomical Terms of Locaon

Term DenionAnterior

Posterior

From front (Anterior) to back

(Posterior).

Dorsal

Ventral

From top (Dorsal) to boom

opposite end of body (Ventral).

Lateral (Le)

Lateral (Right)From le to right side of the body.

Medial (Le/

Right)

From centre of organism to one or

other side

Proximal

Distal

from p of an appendage (distal) to

where it joins the body (proximal)

Anatomy


67/10067

Paent Posioning7

Anatomy


68/100

68

ECG & ETCO2 InterpretaonExamples and Explanaons

ECG Lead Placement 69

Normal ECG 70

ECG Assessment Guide 71

ECG Arrhythmias 1 72

ECG Arrhythmias 2

73



Interpretaon of ETCO2 Waveform 76


69/10069

ECG Lead Placements9

ECG&ETCO2


70/100

70

Normal ECG3

I Lateral aVR V1 Septal V4 Anterior

II Inferior

aVL Lateral

V2 Septal

V5 Lateral

III Inferior aVF Inferior V3 Anterior V6 Lateral

Interval Time in Seconds

PR Interval 0.12 to 0.22

QRS Complex 0.08 to 0.12

QT Interval 0.35 to 0.42

ECG&ETCO2


71/10071

ECG Assessment Guide3

Point Descripon

What is the rhythm? Regular, Irregular

What is the Rate? Fast, Normal, Slow

Are there P Waves

Present?

YES -Atrial Foci

NO -Junconal or Ventricle Foci

Are all the P Waves

the Same?

YES -Then Same Foci

No -Then Dierent Foci

Is there a P Wave

before each QRS?

YES -Atrial Foci

NO -Junconal or Ventricle Foci

Is there a QRS aer

every P Wave?NO -Ventricular Standsll or Possible Heart Block

Is the P-R Interval

Normal?

YES -0.12 to 0.20 Seconds (3-5 small squares)

NO -If >0.0 seconds its First Degree Heart Block

Is the QRS Normal?YES -0.04 to 0.12 secconds (1-3 small squares)

NO Bundle Branch Block

Is the ST SegmentIsoelectric?

If Elevated its Myocardial Infarcon

If Depressed its Ischemia or Angina

Is the T Wave

Normal?

YES 3 Times the Height of the P Wave

NO Inverted?

ECG&ETCO2


72/100

72

ECG Arrhythmias 13

Normal Sinus

1st Degree

Heart Block

Missing QRS Complex

2nd Degree

Heart Block

Type 1

Mulple Missing QRS Complexes

2nd Degree

Heart BlockType 2

3rd Degree

Heart Block

ECG&ETCO2


73/10073

ECG Arrhythmias 23

ECG&ETCO2

Atrial

Fibrillaon

Atrial Fluer

Asystole

Bundle Branch

(Determine

Le/Right from

12 Lead)

Sinus

Bradycardia


74/100

74

ECG Arrhythmias 33

ECG&ETCO2

Idioventricular

Rhythm

Junconal

Rhythm

Mulfocal

Premature

Ventricular

Contracon

Compensatory Pause

Premature

Atrial

Contracon

Paced Rhythm


75/10075

ECG Arrhythmias 43

Compensatory Pause

Premature

Junconal

Contracon

Super

Ventricular

Tachycardia

Unifocal

Premature

Ventricular

Contracon

Ventricular

Fibrillaon

Ventricular

Tachycardia

ECG&ETCO2


76/100

76

Interpretaon of ETCO2 Waveform

Sudden loss of

waveform, ETCO

near zero.

ET Tube,

disconnected,

dislodged, kinked or

obstructed.

Loss of circulatory

funcon.

Decreasing ETCO

with loss of plateau.

ET tube cu leak or

deated cu

ET tube in

hypopharynx

Paral obstrucon

CPR Assessment.

Aempt to maintain

minimum of

10mmHg

Sudden Increase in

ETCO2.

Return of

spontaneous

circulaon

ECG&ETCO2


77/10077

Major IncidentsAcronyms and Plan of Acon

Approach -Think STEP 123 78

Approach -Scene Assessment -CSCATTT 78

Dynamic Operaonal Risk Assessment 79

Plan of Acon -SitRep -METHANE 80

Plan of Acon-Brieng Structure

-IIMARC

80

Primary Triage 81

Triage Categories 82

Pre-Alert -ASHICE 83

Handover -Trauma MIST 84

Handover Medical MIST

84

EH20 Escape Hood 85

NAAK Presentaon 86

NAAK Indicaons 87

NAAK Direcons for Use 88

Electronic Personal Dosimeter (EPD) 89

EPD Alarm Descripons 90


78/100

78

Approach

Think STEP 123

S

Safety

T Triggers for

E Emergency

P Personnel

1 Casualty, approach using normal procedures

2Casuales, approach with cauon, consider all

opons

3Casuales or more, without obvious cause, do

not approach scene

Scene Assessment -CSCATTT

C Command and Control

S Safety

C Communicaon

A

Assessment

T Triage

T Treatment

T Transport

MajorIn

cidents


79/10079

Dynamic Operaonal Risk Assessment

A dynamic risk assessment is undertaken and applied to

tasks or situaons that are in the main unforeseeable or

unpredictable or during which the circumstances,environment or behaviour of the paent or those at

scene may be subject to rapid change.MajorIn

cidents


80/100

80

Plan of Acon

Situaon Report to Control -METHANE

M

Major Incident Standby or Declared

E Extracon Locaon

T Type of Incident

H Hazards (Present and Potenal)

A Access (Egress)

N Number of Casuales

E Emergency Services (On Scene or Required)

Brieng Structure -IIMARC

IInformaon Overview of incident, locaon,

what is involved and when it happened

I Intenon What are we going to do

M Method How are we going to achieve it

A Administraon What records are required

RRisks DORA, hazards, Minimising them and

conngency plans

CTalk groups, mobile phones, de-brief

arrangements

MajorIn

cidents


81/10081

Primary Triage

MajorIn

cidents


82/100

82

Triage Categories

Tag Colour Denion

EXPECTANT

/ DEAD

Vicm unlikely to survive given severity

of injuries, level of available care, or

both.

Palliave care and pain relief should be

provided

Priority 1

Vicm can be helped by immediate

intervenon and transport

Required medical aenon within

minutes for survival (up to 60)

Includes compromises to paents

Airway, Breathing, Circulaon

Priority 2

Vicms transport can be delayed

Includes serious and potenally life

threatening injuries, but status not

expected to deteriorate signicantly

over several hours

Priority 3

Vicm with relavely minor injuries

Unlikely to deteriorate over days

May be able to assist in own care

Walking wounded

MajorIn

cidents


83/10083

Pre-Alert

ASHICE

A

Age

S Sex

H History

I Illness / Injuries / Intervenon

C

Condion HR, RR, SpO2 Air / O2, BP, BM,

Temp, GCS, ECG.

E Esmated Time of Arrival

RED

Cardiac Arrest.

Peri-Arrest.

Any paent elicing MTC outcome

using Major Trauma Pathnder.

Currently ng.

GCS 12 or less.

PPCI.

AMBER

Cardiac chest pain

New Stroke (regardless of symptom

me).

Any other clinical concern.

MajorIn

cidents


84/100

84

Handover

Trauma -MIST

M

Mechanism of Injury

I Injuries

S Signs (Vitals)

T Treatment

Medical -MIST

M Medical History (PMH/Allergies)

I Illnesses (PC/HPC)

S Signs (Vitals)

T Treatment

MajorIn

cidents


85/10085

EH20 Escape Hood2

For use when the crew believe that they have been

potenally exposed to a form of hazardous

contaminaon. One size ts all. It will provide 20

minutes of respiratory protecon to escape the scene.

MajorIn

cidents


86/100

86

NAAK Presentaon

Services carry a supply of 10 packs of Nerve Agent

Andote Kits on every Emergency ambulance for self-

administraon by the crew in the event of accidental

exposure to nerve agents.

They consist of 2 prelled automac intramuscular

injecon devices linked by a plasc clip and housed in a

foam pouch. Atropen containing 2.0mg of Atropine and

a Combopen containing 600mg Pralidoxime Chloride.

MajorIn

cidents


87/10087

NAAK Indicaons

The Nerve Agent Andote Kit (NAAK) should be self-

administered or assisted by their crew mate if they areincapacitated on occasions where they suspect that they

have been accidentally exposed to nerve agents such as

Organo Phosphates (deliberate or accidental release),

and are suering the eects listed below.

Clinical Diagnosis:

History of exposure

Miosis

Respiratory distress

Bronchorrhoea

Depressed level of consciousness

Bronchospasm

Muscle Twitching

Convulsion

Including one or more of the following:

Bronchorrhoea

Bronchospasm

Severe Bradycardia (


88/100

88

NAAK Direcons for Use

1

Remove Pen No 1 marked ATROPINEfrom

the plasc holder this removes the safety

cap and extreme care must be taken.

2

Place the GREEN cap of the auto injector

against the upper quadrant of the thigh

making sure that that it is clear of anythingin the trouser pocket. Press hard unl the

injector funcons, count to ten slowly and

then withdraw. Bend the needle on any

hard surface unl it breaks o. Record me

of administraon.

3

Remove Pen No 2 marked PRALIDOXIME

from the plasc holder this removes the

safety cap and extreme care must be

taken.

4

Place the BLACK cap of the auto injector

against the upper quadrant of the thigh

making sure that that it is clear of anything

in the trouser pocket. Press hard unl the

injector funcons, count to ten slowly and

then withdraw. Bend the needle on a hard

surface unl it snaps o. Record me of

administraon. Hold both injectors in your

hand unl help arrives.

MajorIn

cidents


89/10089

Electronic Personal Dosimeter (EPD)

An Electronic Personal Dosimeter (EPD) is a small pager sized

device that will monitor for the presence of ionising radiaon.

It is designed to allow for normal every day background levelsof radiaon, but should it detect a rise in levels of radiaon in

the vicinity of the wearer it will acvate an internal audible

alarm to alert the wearer to look at the display and take acon

according to the reading and the perceived local

circumstances.

Default Screen

This example shows the Dose Rate

on the display screen in micro-

Sieverts/hour (Sv/h).

Test Display Screen

At the beginning of every shi the

wearer should perform a

condence test. From the default

display screen press and hold the

operang buon unl TEST is

displayed.

Condence Test Display

Double press the operang buonto iniate the condence test,

which conrms operaon of visual

display and the visual and audible

alarms. The display screen will

show all icons at once, the audible

alarm will sound and the visual

indicator will ash.

MajorIn

cidents


90/100

90

EPD Alarm DescriponsAlert Descripon

Low Baery

Warning

There is a low baery warning, which is an

intermient slow tone. This indicated there is

about ten hours baery life le. This will be

the most common warning heard (the data in

the EPD will be stored for about a month

without a baery).

Alarm 1

Primary Alert

Signal

The rst tone or Primary Alert Signalis an

intermient double fast chirp and the LED

will illuminate RED and indicates the presenceof a level of radiaon just above background.

This tone will also sound whenever the

baery is replaced and is a funcon of the

auto test process. It also acts as a reminder of

the alerts for the wearer. The user should be

aware of this facility and is NOT to change

baeries at incident sites. The Primary AlertSignal should be the only acvaon alarm the

wearer will ever hear whilst performing their

dues, the most common will be the low

baery warning.

Alarm 2

Secondary

Alert Signal

The second tone, the Secondary Alert Signal is

a slow two-tone alarm and indicated a level of

radiaon approximately equivalent to thatreceived annually by normal means. Under

normal circumstances where this level of

radiaon is present, Ambulance sta will not

be deployed forward to assist casuales.

Alarm 3

Terary Alert

Signal

The third alert tone, the Terary Alert Signal

is a connuous single high tone. This tone

indicated that the wearer has been exposed

to a potenally signicant or high dose.

MajorIn

cidents


91/10091

Infecon Prevenon & ControlUseful Informaon

Mops and Buckets 92

Hand Washing Technique 93

Hand Hygiene 94

Protecve Clothing 94

Sharp/Splash Injury Procedure

95


92/100

92

Mops and Buckets

Mops and their corresponding colour coded buckets

must not be interchanged. If any mop becomes

contaminated with blood or body uids, then the

head should be discarded as clinical waste and areplacement ed immediately. All mop heads

should be rounely replaced every month.

Infecon

Control


93/10093

Hand Washing Technique12

Good and ecient hand hygiene is the single most important

factor in the prevenon and control of the spread of infecon.

Second to hand washing, consistent use of barrier methods,

especially wearing gloves, is the most important step in

prevenng cross-contaminaon of sta and paents.

Infecon

Control


94/100

94

Hand Hygiene12

Use the hand washing technique:

Protecve ClothingCircumstance/Acvity Appropriate PPE

Circumstance/Acvity

Appropriate PPE

Circumstance/Acvity

Appropriate PPE

Exposure to blood/body

uids ancipated, but low

risk of splashing.

Wear gloves, plasc apron

and sleeve protectors.





Infecon

Control


95/10095

Sharp/Splash Injury ProcedureInoculaon/blood splash injuries include any sharp

object that pierces the skin, bites or any other exposure

to blood or body uids.

Bleed itApply pressure, but DO NOTsuck the wound.

Wash itWash with soap under warm running water for

2 minutes.

Dry itDo not scrub the injury or pat it dry.

Dress itCover the injury with a dressing.

For splashes to the eyesIrrigate with saline or water.

For splashes to the mouthRinse with copious amounts

of water and wash your face.

DonorIdenfy and document the source of the

inoculaon injury include: Name, DOB and home address

if possible.

InformContact EOC and inform them of the situaon.

AendGo to the nearest Emergency Department

without delay.

Report itReport the incident to occupaonal health as

soon as possible. Telephone your local Occupaonal

health service. Write Numbers Below:

Infecon

Control


96/100

96

Key ContactsPhone Numbers and Addresses


97/10097

Notes


98/100

98

Notes


99/10099

1. Ansari, P (2012) Acute Abdominal Pain [Online] URL: hp://

www.merckmanuals.com/professional/gastrointesnal_disorders/acute_abdomen_and_surgical_gastroenterology/

acute_abdominal_pain.html

2. Avon Protecon Systems (2011) EH20 Data Sheet, Melksham/England: Avon

Protecon Systems.

3. Evans, S (2004) A Guide Through the Maze of ECGs, 3rd Edion, Somerset/

England: Associaon of Professional Ambulance Personnel.

4. Fikac, L (2000) Shoulder Dystocia [Online] URL: hp://

www.capefearvalley.com/outreach/outreach/peapods/obemergencies/

shoulderdystocia.htm

5. Kochenour, N (1997) The Mechanism of Normal Labor [Online] URL: hp://

library.med.utah.edu/kw/human_reprod/lectures/physiology_labor/#2

6. Laerdal (2013) Laerdal Sucon Unit: Instrucon Manual, Kent/England:

Laerdal Medical Limited

7. Medtrng (2012) Postures and Direcon of Movement [Online] URL: hp://

www.medtrng.com/posturesdirecon.htm

8. Peak Flow (2004) Mini-Wright Peak Flow Meter: Predicve Normal Values

(Nomogram, EU scale), Essex/England: Clement Clarke Internaonal.

9. Queensland Ambulance Service (2011) Clinical Pracce Manual [Online] URL:

hp://www.ambulance.qld.gov.au/medical/CPM.asp

10.Resuscitaon Council UK (2010) Resuscitaon Guidelines 2010, London/

England: RCUK.

11.Smiths Medical (2008) Emergency Transport and Venlaon [Online] URL:

hp://www.smiths-medical.com/Upload/products/product_relateddocs/

EmergencyTransport.pdf

12.World Health Organisaon (2009) Clean Care is Safer Care: Clean Your

Hands, Geneva/Switzerland: WHO.

References and Credits


100/100

Handover

A collaboraon of useful guidelines in a quick

reference pocket book tailored for pre-

hospital care.

This handy pocket book resulted from my quest

to consolidate the most relevant and useful

guidance into a single source; something that

can be carried in your pocket at all mes -

whenever you may need it.

Download the FREE electronic edion from:

PocketParamedic.org

Pocket Paramedic 2013

Documents