pocket paramedic 2013
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Pocket Paramedic
2013By Jason Houghton
A collaboraon of useful guidelines
In a quick reference pocket book;
tailored for pre-hospital care.
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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
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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
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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
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Adult Basic Life Support10
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Adult Advanced Life Support10
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Adult Cardiac Arrest10
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Adult Bradycardia10
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AdultTachycardia(WithPulse)
10
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Adult Choking Treatment10
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In Hospital Resuscitaon10
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AED Algorithm10
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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
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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)
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Normal Peak Flow Readings8
EU/EN13826 PEF Meters Only
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NormalPeakFlowRea
dingsChart-
Women
8
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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
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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
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Paediatric Basic Life Support10
Paediatrics
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Paediatric Advanced Life Support10
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Paediatric Cardiac Arrest10
Paediatrics
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Newborn Life Support10
Paediatrics
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Paediatric Choking Treatment10
Paedi
atrics
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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
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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
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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
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28
Norma
lPeakFlow
Chart-Pae
diatrics8
Paediatrics
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PaediatricPainA
ssessment
Faces
Paediatrics
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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
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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
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32
ObstetricsAlgorithms and Charts
APGAR Score for Newborns 33
Mechanics of Normal Birth 34
Shoulder Dystocia 35
Breech Birth Delivery 36
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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
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34
Mechanics of Normal Birth5
Obste
trics
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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
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Breech Birth Delivery5
1
4
2 5
3 6
Obste
trics
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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
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ParaPACO
peraon
11
Equipment
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40
FingaCe
rvicalColla
r9
Equipment
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FingaDonway
9
Equipment
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42
FingaDonwayConnued9
Equipment
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Fing
aKED9
Equipment
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FingaKEDConnued9
Equipment
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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
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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
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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
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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
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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
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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
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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
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Abdominal Pain Locaons1
Assess
ment
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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
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Rule of NinesPaediatric & Adult
Trauma&
Medical
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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.
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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
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58
CatastrophicHaem
orrhageTourniquet9
Trauma&
Medical
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Removing
aHelmet
9
Trauma&
Medical
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60
FingaTrian
gularBandage9
Trauma&
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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
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AnatomyDiagrams and Terminology
Palpable Pulse Locaons 63
Bones -General 64
Bones Spinal Colum 65Anatomical Terms of Locaon 66
Paent Posioning
67
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Palpable Pulse Locaons
Anatomy
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64
Bones -General
Anatomy
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Bones Spinal Colum
Anatomy
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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
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Paent Posioning7
Anatomy
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ECG & ETCO2 InterpretaonExamples and Explanaons
ECG Lead Placement 69
Normal ECG 70
ECG Assessment Guide 71
ECG Arrhythmias 1 72
ECG Arrhythmias 2
73
ECG Arrhythmias 3 74
ECG Arrhythmias 4 75
Interpretaon of ETCO2 Waveform 76
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ECG Lead Placements9
ECG&ETCO2
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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
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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
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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
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ECG Arrhythmias 23
ECG&ETCO2
Atrial
Fibrillaon
Atrial Fluer
Asystole
Bundle Branch
(Determine
Le/Right from
12 Lead)
Sinus
Bradycardia
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ECG Arrhythmias 33
ECG&ETCO2
Idioventricular
Rhythm
Junconal
Rhythm
Mulfocal
Premature
Ventricular
Contracon
Compensatory Pause
Premature
Atrial
Contracon
Paced Rhythm
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ECG Arrhythmias 43
Compensatory Pause
Premature
Junconal
Contracon
Super
Ventricular
Tachycardia
Unifocal
Premature
Ventricular
Contracon
Ventricular
Fibrillaon
Ventricular
Tachycardia
ECG&ETCO2
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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
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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
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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
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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
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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
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Primary Triage
MajorIn
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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
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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
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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
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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
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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
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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 (
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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
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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.
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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
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Infecon Prevenon & ControlUseful Informaon
Mops and Buckets 92
Hand Washing Technique 93
Hand Hygiene 94
Protecve Clothing 94
Sharp/Splash Injury Procedure
95
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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
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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
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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.
Wear gloves, plasc apron
and sleeve protectors.
Wear gloves, plasc apron
and sleeve protectors.
Infecon
Control
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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
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Key ContactsPhone Numbers and Addresses
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Notes
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Notes
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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
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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