Paramedic Practice

1. WHS
   1. Scene Assessment
      1. Threats/Risks/Hazards
         1. Environmental Hazards
         2. Prevention Behaviour
            1. 1. Protect you & your partner
            2. 2. Remove people from risks/Remove risks from people
            3. 3. "Help!" - Use backup & resources
      2. Options
      3. Merits of Situation
   2. Risk Management - PRARE

      Nota:

      • Protect Recognise risk Assess risk Report risks/hazards Employ accountability
2. Infection Control
   1. What Protects you?
      1. State IC Policy
      2. Ambulance IC Policy
      3. NHMRC Guidelines
      4. Health Safety Representatives (HSRs)
      5. You & your partner
   2. PPE

      Nota:

      • PPE: - Gloves - Leather/Protective Gloves - Goggles/Glasses - Helmet/Hard hat - Rain coat/pants - High-vis Vest - Boots - Uniform - Face Mask/Shield - Gown/Apron - Sun block
      1. Precautions
         1. Standard Precautions

            Nota:

            • Minimum accepted level of infeciton control
         2. Additional Precautions

            Nota:

            • Additional precautions to prevent transmission of pathogens Includes: Multi-resistant organisms (MRO) MRSA VRE
      2. Uniform

         Nota:

         • - Identifies you - Protects partly from body fluids - Protects from sun burn & exposure - Reduces abrasions to body & limbs - Insulates in poor weather
   3. Transmission

      Nota:

      • Source of transmission to Mode of transmission to Susceptible host
      1. Pathogens

         Nota:

         • Pathos = disease Gen = to produce Pathogen = Disease causing organism Types: Bacteria, Viral, Fungus
      2. Natural Body Defenses

         Nota:

         • - Skin = Barrier - Mucous membranes & secretions = Trap - Cilia (fine hairs) in nose & lungs = Move stuff - Acids in stomach = Destroys
   4. Sharps

      Nota:

      • Minimise the use No passing sharps to other people No recapping of sharps
   5. Body fluid spill procedure

      Nota:

      • Confine Contain & Dispose Use PPE Clean spill site with neutral detergent

Nota:

• Definition: Any activity requiring the use of force exerted by a person.

1. Injury Causes
   1. Wear & tear

      Nota:

      • - Poor posture - Muscle weakness - Incorrect technique
   2. Strenuous Activities
   3. Sudden Trauma
   4. Injury Risks
      1. 1. Actions & Movements
      2. 2. Working posture & position
      3. 3. Duration & frequency
      4. 4. Weight
2. Responsibility of employer & employee
3. Basic Lifting Principles

   Nota:

   • 1. Keep load close 2. Large objects need large muscle groups 3. 'stack' yourself up 4. Modify: objects, lifting area, actions, movements, forces. 5. Team lift or Mech assist if needed
   1. B-A-C-K
      1. Brains before Brawn
      2. Assess PT & Scene
      3. Communicate. then lift
      4. Keep control
4. Risk Management Pyramid

   Nota:

   • Higher = More effective Lower = Less effective Elimination Substitution Engineering Administrative Behaviour PPE

1. Kits/Bags
   1. Oxygen Kit (Green 'boot' bag)
   2. Resus Kit (Orange/Yellow)
   3. Med Kit
   4. Trauma Kit (First aid kit)
   5. Phillips Monitor (Cardiac monitor
2. Tools
   1. Stethoscope
   2. Thermometer
   3. Pupil Torch
   4. Sphygmomanometer (BP)
   5. Glucometry (BGL)
   6. Cardiac Monitor (Phillips)
   7. Pulse Oximetry
3. PT Positioning

   Nota:

   • Supine = Flat on back Prone = Flat on abdomen Fowlers = Supine w/ feet elevated Supine w/knees up Recovery Position = Lateral Recumbent Left Recovery Position = L Lat Recumbent (Pregnant) Trendelenburg = Feet up, head down Banana = Feet up, bum down, head up

1. Legalities
   1. Scope of Practice
   2. Duty of Care
   3. Consent - Informed/Implied

      Nota:

      • Informed: PT who is in a sound state of mind and is capable to understand the potential consequences of refusal of service, Implied: PT would consent is possible &/or presenting themselves and their injury
   4. Advanced Directive
      1. Do Not Resuscitate (DNR)
      2. Not For Resuscitation (NFR)
      3. End Of Life Care Plan (EOLCP)
   5. Confidentiality
   6. Intentional Tort

      Nota:

      • Knowing doing harm Assault & battery
2. Primary Survey

   Nota:

   • Systematic Approach - Find life threatening conditions first Standardised approach - avoids tunnel vision
   1. DRABCDE

1. Secondary Assessment

   Nota:

   • Golden Rules for PT Assessment - Expose PT - Continual reassessment for TRENDS - Systematic Approach - Avoids tunnel vision - Always start at head - Use mnemonic
   1. DCAP/BLTS

      Nota:

      • Decaf CAPpuccino/Bacon Lettuce Tomato Sandwich +Crepitus +LOC
   2. Mechanism of Injury (MOI)

      Nota:

      • Active Process Diaphragm & Intercostel Muscles Relax Bronchi Tree Constricts
      1. Index of Suspicion

         Nota:

         • High index of suspicion for Spinal & head injury
   3. Level of Consciousness (LOC)
      1. AVPU
      2. Glasgow Coma Scale (GCS)
   4. Head to Toe Examination
      1. Face/Head
      2. Spine/Neck
      3. Chest
      4. Abdomen
      5. Limbs

1. Respiratory System/Physiology
   1. Upper Airway (Above Neck)

      Nota:

      • - Nose/Mouth - Pharynx - Epiglottis - Larynx        - Thyroid Cartilage (Adams Apple)        - Cricoid Cartilage
   2. Lower Airway (Resp Anatomy)

      Nota:

      • - Trachea - Major Bronchi - Bronchioles - Alveoli - Diaphragm
   3. Mechanisms of Breathing
      1. Inspiration/Inhalation

         Nota:

         • Active Process Diaphragm & Intercostel Muscles Contract
      2. Expiration/Exhalation

         Nota:

         • Passive Process Diaphragm & Intercostel Muscles Relax Bronchi Tree Constricts
      3. Control of Respiration
   4. Abnormal Upper Airway Sounds

      Nota:

      • Best to Worst - Snoring              - Upper Airway Partially Obstructed              - Relaxed Pharynx or Tongue - Crowing           - Larynx Spasm - Narrows Opening of Trachea - Strider           - Harsh high pitched sound on inspiration           - Significant upper airway obstruction           - Swelling or foreign object
2. Artificial Airways (Airway Adjuncts)
   1. Oropharyngeal Airway
   2. Nasopharyngeal Airway (NPA)
   3. Laryngeal Mask (LMA)

      Nota:

      • Qualified Only (E.g. ICP)
   4. Endotracheal Tube (ETT)

      Nota:

      • Gold standard of AA
   5. Triple Airway Maneuver

      Nota:

      • - Head Tilt - Chin Lift - Jaw Thrust
3. Oxygen (O2)
   1. O2 Delivery

      Nota:

      • - Nasal Prongs - Hudson Mask - Nebuliser Mask (Hudson Mask with nebuliser unit/bowl)- Non-rebreather Mask- Venturi Mask (Elephant Mask)
   2. Uses

      Nota:

      • - Respiratory Distress & Hypoxia - Simultaneously used with drugs          - Medazalam          - Morphine          - Salbutamol (Ventalin) etc... - Obstetrics & Diving Emergencies - Hyperventilation - Supplement to maintain tissue Oxygenation
   3. Signs & Symptoms Requiring O2

      Nota:

      • - Apnoea - Cyanosis - Increased HR, RR and/or BP - Cardiac & Respiratory distress/arrest - Any Hypoxia - SPO2 <95% - Decreased LOC - Hypovolemic Shock - Med Hx: Drowning, Spinal, CVA (Stroke), Head Injury, etc.
   4. Bag-Valve Mask (BVM)

      Nota:

      • Manual Resuscitator Up to 100% O2
      1. Intermittent Positive-Pressure Ventilation