Ambulance Victoria Clinical Practice Guidelines 2016 Edition

377 Pages·2016·16.41 MB·Italian

by  Ambulance Victoria

Clinical Practice Guidelines
Ambulance and MICA Paramedics
2016 Edition(C) COPYRIGHT
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Version 1.1 23 May 2016
ambulance.vic.gov.au
Ambulance Victoria
Clinical Practice Guidelines
for Ambulance and MICA Paramedics
2016 Edition
Version 1.1 23 May 2016
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Clinical Practice Guidelines Disclaimer
for Ambulance and MICA Paramedics These Clinical Practice Guidelines (CPGs) have National Library of Australia Cataloguing-in-Publication Data:
been approved for use by Ambulance Victoria
2016 Edition (AV) by the AV Medical Advisory Committee. The Ambulance Victoria.
January 2016 content in these CPGs is for information and Clinical Practice Guidelines / Ambulance Victoria.
Ambulance Victoria educational purposes only and is not intended to Revised ed.
serve as medical advice or treatment. AV does ISBN-13: 978-0-9806444-5-6
©Ambulance Victoria 2016 not guarantee the accuracy or currency in the
Copyright in this work is owned by Ambulance information provided in the CPG. Also AV does Includes index
Victoria. All rights reserved. This information is only not accept any responsibility for loss or damage Bibliography
provided for your general use and information. No caused by the use of the information contained First aid in illness and injury—Victoria—Handbooks, manuals, etc.
person may adapt, modify, distribute in any form in the CPG. If you rely on the information in Emergency medicine—Victoria—Handbooks, manuals, etc.
without the prior written consent of Ambulance these CPGs you are responsible for ensuring by Emergency medical technicians—Victoria.
Victoria. independent verification its accuracy, currency or
616.025
completeness.
Ambulance Victoria
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016 PDOon Bcaosxt e2r0, 0V0ic toria 3108 (C) COPYRIGHT
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Foreword
Since the last edition of the Ambulance Victoria Clinical Practice Guidelines (CPGs) many changes have been made in the way pre-
hospital care has been delivered to the Victorian community. One thing that has remained constant is the desire to provide the best
evidence-based care to our patients. The 2016 edition of the CPGs extends and expands this commitment to quality health care by
updating and adding a number of guidelines which match the best clinical evidence.
The Clinical Approach is the key assessment tool for all AV Paramedics, whether used face-to-face or via the Referral Service. This
edition of the Ambulance Victoria CPGs sees the first significant update to the Clinical Approach in many years, creating a workflow
that better represents what Paramedics actually do on scene, while also reducing the risk of clinical error.
These updated CPGs also reflect the changing nature of pre-hospital care. It has long been known that not all patients require
transport to hospital and that for many years Paramedics have been making these decisions without a formal clinical framework.
This edition introduces a suite of guidelines which aim to support non-transport decisions, including specific Treat and Refer CPGs.
There are some new and exciting additions to the AV pharmacopeia to provide better treatment options for patients in regards to
nausea and vomiting, pain relief and safely sedating the agitated patient. These new medications will improve patient outcomes as
well as streamline Paramedic practice and improve Paramedic safety. In addition a number of existing guidelines have been modified
to better match the current evidence on best management.
I would like to take this opportunity to thank the Clinical Practice Development Committee, the Medical Advisory Committee and
a number of individual Paramedics for their hard work in developing these guidelines. They have all strived to ensure that the
information contained within the pages of the CPG book is up-to-date, well-structured and translatable into practice. Every effort has
been made to ensure the accuracy of these CPGs and they are under constant review in light of new and emerging evidence. These
CPGs should only be used with appropriate education and training.
I hope that this new edition of the CPGs will enable AV’s Paramedics to continue to deliver outstanding care to the Victorian
community in an environment of rapidly-changing pre-hospital medicine.
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Foreword iii
Acknowledgements
Members of the AV Clinical Practice Development Committee Additional Support
Prof. Stephen Bernard Senior Medical Advisor, AV Prof. Matthew Naughton Respiratory Physician, Alfred Hospital
Prof. Mark Fitzgerald Medical Advisor, AV Dr Claire Wilkin Emergency Consultant, RCH
Dr John Moloney Medical Advisor, AV Rob Fergusson Clinical Support Manager
Dr Deborah Bernstein ACEM representative Kylie Dyson ALS Paramedic
Christopher Tang Paramedic representative Shayna Gamble ALS Paramedic
James Marshall Paramedic representative Jedda McGlinchey ALS Paramedic
Daniel Cudini MICA Paramedic representative Sonia Baldassarre Admin. Support Officer
Kate Cantwell MICA Paramedic representative Rebecca Williams Admin. Support Officer
Ben Meadley AAV representative Chas Spanti AV Business Manager
Ray Cornelius AAV representative
Tony Ginis Manager of Collaborative And all AV Paramedics who have provided feedback to assist in the
Emerg. Health Programs (acting) continuous improvement of these guidelines.
Trevor Weston Manager of Emerg. Co-responder
Programs
Shane Foster Clinical Support Manager
(Metro West)
David Llewellyn Clinical Support Officer
Jodie D’Arcy Curriculum Development Manager
(acting)
Russ Nelson Clinical Review Specialist
Scott Bennetts Manager Clinical Effectiveness
Paul Burke Clinical Practice Development
Specialist
Bill Barger Manager Operational Quality
Improvement
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Index
Section Page

Foreword iii
Acknowledgements iv
Index v
Guide to Abbreviations xv
Graphic Guide xviii
Section One Adult Patient 1
Section Two Paediatric Patient 163
Section Three Treat and Refer 265
Section Four Obstetric Patient 287
Section Five Newborn Patient 317
Section Six Pharmacology 331
Section Seven Further Information 389
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Index v
Index Section One Adult
Title Number Page
Assessment
Oxygen Therapy CPG A0001 1
Clinical Approach CPG A0101 5
Perfusion Assessment CPG A0102 8
Respiratory Assessment CPG A0103 11
Conscious State Assessment CPG A0104 12
Time Critical Guidelines CPG A0105 14
Mental Status Assessment CPG A0106 20
Mental Health Conditions CPG A0107 22
Clinical Flags CPG A0108 23
Clinical Frailty Scale CPG A0109 26
Ottawa Ankle Rule CPG A0110 27
Cardiac Arrest
Cardiac Arrest CPG A0201 29
ROSC Management CPG A0202 32
Withholding or Ceasing Resuscitation CPG A0203 35

Airway Management
Laryngeal Mask Airway CPG A0301 40
Endotracheal Intubation CPG A0302 42
Failed Intubation Drill CPG A0303 56
Cricothyroidotomy CPG A0304 57

Cardiac
Acute Coronary Syndromes CPG A0401 60
Bradycardia CPG A0402 64
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Pain Relief
Pain Relief CPG A0501 86
Headache CPG A0502 90

Respiratory
Asthma CPG A0601 94
COPD CPG A0602 100
Medical
Nausea and Vomiting CPG A0701 104
Hypoglycaemia CPG A0702 106
Seizures CPG A0703 108
Anaphylaxis CPG A0704 111
Inadequate Perfusion (Non-cardiogenic / Non-hypovolaemic) CPG A0705 114
Meningococcal Septicaemia CPG A0706 116
Overdose CPG A0707 118
Agitated Patient CPG A0708 127
Organophosphate Poisoning CPG A0709 130
Autonomic Dysreflexia CPG A0710 132
Stroke / TIA CPG A0711 134

Trauma
Hypovolaemia CPG A0801 138
Chest Injuries CPG A0802 141
Traumatic Head Injury CPG A0803 144
Spinal Injury CPG A0804 146
Burns CPG A0805 148
Fracture Management CPG A0806 152
Diving Related Emergencies CPG A0807 154

Environment
Hypothermia / Cold Exposure CPG A0901 158
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Index Section One Adult vii
Index Section Two Paediatric
Title Number Page

Paediatrics
Paediatric Assessment CPG P0101 163
Perfusion Assessment CPG P0101 166
Respiratory Assessment CPG P0101 167
Conscious State Assessment CPG P0101 168
Paediatric Pain Assessment CPG P0101 169
Paediatric Charts CPG P0102 172
Time Critical Guidelines CPG P0105 178

Cardiac Arrest
Cardiac Arrest (Paediatric) CPG P0201 181
Cardiac Arrest ROSC Management (Paediatric) CPG P0202 187

Airway Management
Endotracheal Intubation (Paediatric) CPG P0301 190
Failed Intubation Drill (Paediatric) CPG P0302 202

Pain Relief
Pain Relief (Paediatric) CPG P0501 206

Respiratory
Upper Airway Obstruction (Paediatric) CPG P0601 210
Asthma (Paediatric) CPG P0602 215

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Medical
Nausea and Vomiting (Paediatric) CPG P0701 224
Hypoglycaemia (Paediatric) CPG P0702 226
Seizures (Paediatric) CPG P0703 228
Anaphylaxis (Paediatric) CPG P0704 231
Meningococcal Septicaemia (Paediatric) CPG P0706 234
Overdose (Paediatric) CPG P0707 236
Organophosphate Poisoning (Paediatric) CPG P0709 244

Trauma
Hypovolaemia (Paediatric) CPG P0801 248
Chest Injuries (Paediatric) CPG P0802 251
Burns (Paediatric) CPG P0803 254

Environment
Hypothermia / Cold Exposure (Paediatric) CPG P0901 260
Environmental Hyperthermia / Heat Stress (Paediatric) CPG P0902 262
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Index Section Two Paediatric ix