Facilitators Manual - Emergency Care Institute

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NON OPIOIDNameof DrugDose rangeand routeActionContraindicationsSpecial nursingconsiderationsOther analgesicsidentifiedParacetamol500-1000 mgOral, IV, PRChildren: 15mg/kgAnalgesicAntipyreticHepaticimpairmentRectal absorptioncan be erraticNSAIDs egibuprofen200-400 mgOralChildren: 10mg/KgAntiinflammatoryGI UlcerAntihypertensivemedicationsCardiac, renaland hepaticimpairmentTake dose shortlyafter foodAspirin300-600mgOralAnalgesicAntipyreticAntiinflammatoryAntiplateletActive upperGI bleedAsthma: risk ofbronchospasm isincreased in patientswith aspirin –precipitated asthma.Children or teenagerswith chickenpox,influenza, fever,children < 12 yearsof age.23OPIOIDNameof DrugDose rangeand routeActionContraindicationsSpecial NursingConsiderationsOther analgesicsidentifiedMorphine0.1-0 .2 mg/kgIMI, IV, SCIOpioid analgesicRenal, hepaticimpairmentRespiratory depressionConstipationNausea and vomitingCodeine30-60 mgOral, IMI, SCIOpioid analgesicRenal, hepaticimpairmentRespiratory depressionConstipationNausea and vomitingTramadol50-100mgOral, IV, IMIBinds to mu opioidreceptors and alsoinhibits reuptake ofnoradrenalineand serotoninRenal, hepaticimpairmentHeadache, CNSstimulation, weakness,sweating, sleepdisorder, dyspepsia,itch, rash.Oxycodone5-15 mgOralOpioid analgesicsmimic endogenousopioids by activatingopioid receptorsin the central andperipheral nervoussystems to produceanalgesiaHepatic, renalimpairment,elderly, debilityNausea, vomiting,dyspepsia, drowsiness,dizziness, headache,orthostatichypotension, itch, drymouth, miosis, urinaryretention, constipationFentanyl 50-100microgramsIV, IMIChildren:0.5-2 mg/kgOpioid analgesicsmimic endogenousopioids by activatingopioid receptorsin the central andperipheral nervoussystems to produceanalgesiaHepatic, reanl,severe respiratoryimpairment.Short acting analgesic,nausea, vomiting andconstipation.
FACILITATORs’ <strong>Manual</strong> Transition to <strong>Emergency</strong> Nursing3.9 TRAUMAACTIVITY 43Discuss with participant.Complete the table below by discussing how blood loss in each body area may be identifiedand what interventions/definitive care would be required to STOP the bleeding.Region ofblood loss How to identify bleeding Intervention/management24ThoraxClinical assessment:Decreased symmetryIncreased work of breathingDecreased air entrySigns of shock:• tachycardia,• hypotension,• cool,• diaphoretic,• prolonged capillary refillCXR:Blood will pool posteriorly in the supine patient, leading toa ‘white out’ or water density within the affected lung. Thelung and cardiac border will merge together, obscuring thecardiac border.In the erect-positioned patient, the affected haemothoraxwill demonstrate a ‘fluid level’ and blunting of thecostophrenic angle as fluid will pool at the base of the lung.CT scan can be performed• Oxygen• IV access• Bloods including X-match, Group & hold• Chest drain• Fluid replacement and treatment ofshock• Ongoing clinical assessmentAbdomenClinical assessment:HypotensionTachycardiaAbdominal distentionBruisingPainRigidityGuardingInvestigations:FAST scan positiveDiagnostic Peritoneal LavageCT scan• IV access• Bloods including X-match, Group & hold• Fluid replacement as required• +/- surgical interventionRetroperitoneumHypotensionTachycardia# pelvis and haemodynamic instability – consider bloodin retroperitoneum• IV access• Bloods including X-match, Group & hold• Fluid replacement as required• Splinting of pelvis with sheet if pelvic # issuspected• Embolisation +/fixation if unstablepelvic #Table continued next page
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Facilitators Manual - Emergency Care Institute

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