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
