Pocket Paramedic 2013

Pocket Paramedic 2013 By Jason Houghton

A collaboration of useful guidelines In a quick reference pocket book; tailored for pre-hospital care.

PocketParamedic.org [email protected]

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Pocket Paramedic 2013 “An elegant solution to a simple problem” A collaboration 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 times - whenever you may need it. Pocket Paramedic is 100% non-profit. Sold at cost. Hopefully, this will mean more people can benefit from it. Download the FREE electronic edition from: PocketParamedic.org I hope you find it useful.

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Jason Houghton - Paramedic [email protected]

Contents Adults Algorithms and Charts Paediatrics Algorithms and Charts Obstetrics Useful Information and Charts Equipment Instructions and Guidance Assessment & History Taking Aid memoirs, Acronyms and Diagnosis Trauma & Medical Emergencies Useful Information and Charts Anatomy Diagrams and Terminology ECG & ETCO2 Interpretation Examples and Explanations Major Incidents Acronyms and Plan of Action Infection Prevention & Control Useful Information Key Contacts Phone Numbers Notes Extra Space References Credits and Information Sources

4 19 32 37 45

53 62 68 77 91 96 97 99 3

Adults Algorithms and Charts

4

Adult Basic Life Support Adult Advanced Life Support Adult Cardiac Arrest

5 6 7

Adult Bradycardia

8

Adult Tachycardia (With Pulse)

9

Adult Chocking Treatment

10

In Hospital Resuscitation

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

Adults

Adult Basic Life Support 10

5

Adults

Adult Advanced Life Support 10

6

Adults

Adult Cardiac Arrest 10

7

Adults

Adult Bradycardia 10

8

Adult Tachycardia (With Pulse) 10

9

Adults

Adults

Adult Choking Treatment 10

10

Adults

In Hospital Resuscitation 10

11

Adults

AED Algorithm 10

12

Adult Glasgow Coma Scale 4

Opens Eyes Spontaneously

3

Opens Eyes in Response to Voice

2

Opens Eyes in Response to Painful Stimuli

1

Does Not Open Eyes

Adults

Eyes

Verbal 5

Oriented, Converses Normally

4

Confused, Disoriented

3

Utters Inappropriate Words

2

Incomprehensible Sounds

1

Makes No Sounds

Motor 6

Obeys Commands

5

Localizes Painful Stimuli

4

Flexion / Withdrawal to Painful Stimuli

3 2 1

Abnormal Flexion to Painful Stimuli (Decorticate) Extension to Painful Stimuli (Decerebrate) Makes No Movements 13

Adults

Adult Normal Ranges & Dosages Parameter

Unit

Value

Heart 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

st

Joules

200

nd

Joules

300

rd

Energy 3 Shock

Joules

360

Adrenaline 1:10000

mg (ml)

1 (10)

Amiodarone

mg (ml)

300 (10)

Amiodarone (Refractory VF/VT)

mg (ml)

150 (5)

Energy 1 Shock Energy 2 Shock

14

Normal Peak Flow Readings 8 Adults

EU/EN13826 PEF Meters Only

15

16

Normal Peak Flow Readings Chart - Men 8

Adults

Adults

Normal Peak Flow Readings Chart - Women 8

17

Adult Analgesic Ladder Adults

(12 Years and Older)

Pain Score

Medical Pain

Trauma, Orthopaedic, Musculoskeletal & Soft tissue Pain

0–3 Mild Pain

Consider Entonox +/Ibuprofen 400MG

Consider Entonox +/Ibuprofen 400MG

4–6 Moderate Pain

Consider Entonox +/Morphine 2.5 to 5mg (Max 20mg)

Consider Entonox +/Ibuprofen 400MG

7 – 10 Severe Pain

Consider Entonox +/Morphine 2.5 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

18

Paediatrics Paediatric Basic Life Support Paediatric Advanced Life Support Paediatric Cardiac Arrest

20 21 22

Newborn Advanced Life Support

23

Paediatric Chocking Treatment

24

Paediatric Glasgow Coma Scale

25

Paediatric Arrest Calculations

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

19

Paediatrics

Paediatric Basic Life Support 10

20

Paediatrics

Paediatric Advanced Life Support 10

21

Paediatrics

Paediatric Cardiac Arrest 10

22

Paediatrics

Newborn Life Support 10

23

Paediatrics

Paediatric Choking Treatment 10

24

Paediatric Glasgow Coma Scale 4

Opens Eyes Spontaneously

3

Opens Eyes in Response to Speech

2

Opens Eyes in Response to Painful Stimuli

1

Does Not Open Eyes

Paediatrics

Eyes

Verbal 5

Smiles, Orients to Sounds, Objects, Interacts

4

Cries but Consolable, Inappropriate Interactions

3

Inconsistently Inconsolable, Moaning

2

Inconsolable, Agitated

1

No Verbal Response

Motor 6

Infant Moves Spontaneously or Purposefully

5

Infant Withdraws from Touch

4

Infant Withdraws from Pain

3

Abnormal Flexion to Pain for Infant (Decorticate)

2

Extension to Pain (Decerebrate)

1

No motor response 25

Paediatric Arrest Calculations 10 Resuscitation Council UK 2010

Paediatrics

WEIGHT Age 0 – 12 Months 1 – 5 Years 6 – 12 Years

Formula Weight (kg) = (Age in Months x 0.5) + 4 Weight (kg) = (Age in Years x 2) + 8 Weight (kg) = (Age in Years x 3) + 7

ENERGY Age 0 – 12 Years

Formula Joules = Weight (kg) x 4j

TUBE SIZE Age Pre Term Neonates

Formula 2.5mm 3 – 3.5mm Internal diameter (mm) = (Age/4) + 4 Length (cm) = (Age/2) + 12

1 – 10 Years

FLUID Type Medical Trauma Concealed Haem

Formula (0 – 12 Years) Bolus (ml) = Weight (kg) x 20ml Bolus (ml) = Weight (kg) x 10ml Bolus (ml) = Weight (kg) x 5ml

ADRENALINE

AMIODARONE

Formula (1:10,000) (0 – 12 Years)

Formula (300mg in 10ml) (0 – 12 Years)

Dose (mcg) = Weight (kg) x 10mcg (0.1ml)

Dose (mg) = Weight (kg) x 5mg …Then ml’s = Dose (mg) / 30)

GLUCOSE Age 0 – 12 Years 26

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

Paediatrics HR (BPM) 110-160 110-160 110-160 110-160 110-160 110-150 100-150 95-140 95-140 95-140 80-120 80-120 80-120 80-120 80-120 80-120 80-120

RR (PM) 30-40 30-40 30-40 30-40 30-40 25-35 25-35 25-30 25-30 25-30 20-25 20-25 20-25 20-25 20-25 20-25 20-25

BP Weight Energy Tube Fluids Adrenaline (Systolic) (kg) (Joules) (mm) (ml) (ml) (mcg) 70-90 4 20 3 80 0.40 (40) 70-90 4.5 20 3 90 0.45 (45) 70-90 5.5 25 3.5 110 0.55 (55) 70-90 7 40 4 140 0.70 (70) 70-90 8.5 40 4 170 0.85 (85) 80-95 10 40 4.5 200 1.0 (100) 80-95 11 50 4.5 220 1.1 (110) 80-100 12 50 5 240 1.2 (120) 80-100 14 60 5 280 1.4 (140) 80-100 16 70 5 320 1.6 (160) 90-100 18 80 5.5 360 1.8 (180) 80-110 25 80 6 500 2.5 (250) 90-110 28 100 6 560 2.8 (280) 90-110 31 100 6.5 620 3.1 (310) 90-110 34 120 6.5 680 3.4 (340) 90-110 37 130 7 740 3.7 (370) 90-110 40 140 7 800 4.0 (400)

Amiodarone Glucose (ml) (mg) (ml) 0.67 (20) 8 0.75 (22.5) 9 0.92 (27.5) 11 1.17 (35) 14 1.42 (42.5) 17 1.67 (50) 20 1.83 (55) 22 2.00 (60) 24 2.30 (70) 28 2.66 (80) 32 3.00 (90) 36 4.20 (125) 50 4.67 (140) 56 5.12 (155) 62 5.67 (170) 68 6.17 (185) 74 6.67 (200) 80

Paediatric Normal Ranges & Arrest Drug Dosages 2013 Age Birth 1M 3M 6M 9M 12 M 18 M 2 Yr 3 Yr 4 Yr 5 Yr 6 Yr 7 Yr 8 Yr 9 Yr 10 Yr 11 Yr

27

28

Normal Peak Flow Chart - Paediatrics 8

Paediatrics

Paediatric Pain Assessment Faces

29

Paediatrics

30 Kicking, or legs drawn up

Arched, rigid or jerking

Crying steadily, screams or sobs, frequent complaints Difficult to console or comfort

Uneasy, restless, tense

Squirming, shifting back and forth, tense Moans or whimpers; occasional complaint

Reassured by occasional touching, hugging or being talked to, distractible

Normal position or relaxed

Lying quietly, normal position, moves easily

No cry (awake or asleep)

Content, relaxed

Activity

Cry

Consolability

Frequent to constant quivering chin, clenched jaw

2

Legs

Occasional grimace or frown, withdrawn, uninterested

1

No particular expression or smile

0

Face

Criteria

Paediatric Non-Verbal Pain Assessment Tool

FLACC Scale

Paediatrics

Paediatric Analgesic Ladder

Pain Score

Medical Pain

Trauma, Orthopaedic, Musculoskeletal & Soft tissue Pain

0–3 Mild Pain

Consider Entonox +/Ibuprofen &/or Paracetamol

Consider Entonox +/Ibuprofen &/or Paracetamol

4–6 Moderate Pain

Consider Entonox +/Morphine

Consider Entonox +/Ibuprofen &/or Paracetamol

Consider Entonox +/Morphine

Consider Entonox +/Ibuprofen &/or Paracetamol +/Morphine

7 – 10 Severe Pain

Paediatrics

(Under 12 Years)

For Cardiac Related Chest Pain Morphine Should be Considered in the First Instance

31

Obstetrics Algorithms and Charts

32

APGAR Score for Newborns Mechanics of Normal Birth

33 34

Shoulder Dystocia

35

Breech Birth Delivery

36

APGAR Score for Newborns 1

Blue or Pale All Over

2

Blue at Extremities, Body Pink

3

No Cyanosis, Body and Extremities Pink

Obstetrics

Appearance

Pulse 1

Absent

2