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CMG 1 General Care
- Primary survey
- Haemorrhage control
- Oxygen therapy
- Monitor & assess as required
- Vital signs
- ECG/12 - 15 lead
- Blood Glucose
- O2 Sats
- Specific obs & assessment as per patient condition
- Treatment as required
- Cervical collar
- Pelvic splint
- Temp control
- Cannulate - IV fluids as per perfusion & hydration assessment
- Pain relief
- Notify & tx to nearest appropriate hosp Note tx is rx.
- Identify time-critical patients
- actual - based on vital signs, pattern of injury, lack of response to treatment.
- Potential - based on hx, mechanism of injury.
The following condition warrant absolute minimum scene times and urgent transport to hospital.
Cardiac arrest following penetrating trauma (ref Agonal trauma guideline)
Unrelieved upper airway obstructionhead injuries with significant deterioration in LOC
Chest injuries with respiratory deterioration
- Internal blood loss sufficient to cause significant hypotnesion
- Cardiac arrest in advanced pregnancy (>20/52)
- Prolapsed umbilical cord or complicated labour
- Continuing or worsening acute hypoxia unresponsive to treatment
- generalised seizures unresponsive to treatment
- Carbon monoxide poisoning with decreased LOC
- List is not exhuastive or exclusive
- NOTE time-critical does not just mean rapid tx
CMG2: Pain management
Relief of pain & suffering is a prime goal of ambulance care.
- Pain is what the pt says it is!
- Always offer pain relief to the pt
- Pain assessment (PQRST)
- Quantify if possible (scale & description)
- Document on case sheet
Basic care is fundamental to pharmacological managment:
cooling of burns
control of temp (esp cold)
- If possible pharmacology should be directed at the apparent underlying cause:
- GTN s/l for chest pain
- Methoxyflurane for mild to moderate pain, patients unable to have narcotics, management of labour, often best for paeds.
Morphine for ischaemic chest pain and for all other pain unless contraindicated.
Midazolam small doses may be added to analgesia for musculo-skeletal pain.
Ketamine for pain management in selected patients. May be used with alternate small doses of morphine.
- Ischaemic chest pain, limb pain, burns: aim for abolition of pain.
- Undiagnosed conditions:
- aim for control of pain to a bearable level of discomfort.