Primary Clinical Care Manual 10th Edition - Royal Flying Doctors | Revised

Primary Clinical Care Manual 10th Edition - Royal Flying Doctors | Revised Criteria for early notification of trauma for interfacility transfer1 ALL trauma patients - do rapid assessment of vital signs, injuries and mechanism of injury Adult Newborn 4 weeks Infant 1 - 12 mths Child 1 - 8 years Child 9 - 15 years Respiratory rate/min 10 or 30 40 or 60 20 or 50 20 or 35 15 or 25 O 2 saturation in room air 90% 95% 95% 95% 95% Systolic BP mmHg 90 n/a 60 70 80 HR/min 120 100 or 170 90 or 170 75 or 130 65 or 120 GCS 14 Altered LOC Altered LOC Altered LOC Altered LOC Vital signs • All penetrating injuries – head/neck/chest/abdomen/pelvis/axilla • Blunt injuries – patients with significant injuries to a single region - head/neck/chest/abdomen/pelvis/axilla – patients with injuries involving 2 or more of the above body regions • Specific injuries – limb amputation/life threatening injuries – suspected spinal cord injuries – burns: adult 20% total body surface area (TBSA), child 10% TBSA – suspected respiratory tract burns – serious crush injury – major compound fractures or open dislocation – fracture to 2 or more: femur, tibia, humerus – fractured pelvis Injuries • Ejection from vehicle • Motorcyclist impact 30 kph • High speed motor vehicle collision 60 kph • Vehicle roll over • Fatality in same vehicle • Prolonged extrication 30 minutes • Pedestrian impact • Fall from height 3 metres • Struck on head by falling object 3 metres • Explosion Mechanism of injury If ANY of the above are present PROMPTLY CALL RSQ  for management support, retrieval advice and destination decision or your local/state trauma escalation service If none of the above is present, follow usual local processes for assessment and transfer of the patientCopyright Copyright i The Primary Clinical Care Manual 10th edition 2019 ISBN: 978-1--05-8 © State of Queensland (Queensland Health) 2017 and the Royal Flying Doctor Service (Queensland Section) Comments and feedback Comments and feedback to this edition are welcome. Please write or email: Executive Director Rural and Remote Clinical Support Unit PO Box 7193 Cairns, Queensland 4870 Head of Clinical Governance Royal Flying Doctor Service (Queensland Section) 12 Casuarina Street Brisbane Airport, Queensland 4006 Suggested citation Queensland Health, Royal Flying Doctor Service (Queensland Section), Primary Clinical Care Manual 10th edition 2019, the Rural and Remote Clinical Support Unit, Torres and Cape Hospital and Health Service, Cairns Controlled copies and uncontrolled copies The electronic version is the only controlled version of the Primary Clinical Care Manual and once downloaded it is no longer a controlled copy. The A5 print and downloaded versions are uncontrolled. Users are responsible for accessing the most recent version available at: Copying and reproduction This work is licensed under a Creative Commons Attribution Non-Commercial Share Alike 4.0 International licence (CC BY-NC-SA 4.0). You are free to copy, communicate and adapt the work for non-commercial purposes, as long as you attribute the State of Queensland (Queensland Health) and the Royal Flying Doctor Service (Queensland Section), you distribute any derivative work only under the same licence and you comply with the licence terms. To view a copy of this licence visit: For copyright permissions beyond the scope of this licence contact: Intellectual Property Officer, Health Innovation, Investment and Research Office, Queensland Health email:  The Primary Clinical Care Manual 10th edition 2019 is distributed by Queensland Health and the Royal Flying Doctor Service (Queensland Section) as an information source only and does not replace clinical judgment. The information is provided solely on the basis that readers will be responsible for making their own assessment of the matters presented herein and readers are advised to verify all relevant representations, statements and information. The information does not constitute clinical advice and should not be relied upon as such. Specialist advice in relation to the application of the information presented in this publication must be sought as necessary to ensure the application is clinically appropriate In no event shall Queensland Health or the Royal Flying Doctor Service of Australia (Queensland Section) be liable (including liability for negligence) for any claim, action, proceeding, demand, liability, costs, damages, expenses or loss (including without limitation, direct, indirect, punitive, special or consequential) whatsoever brought against or made upon or incurred by Queensland Health or the Royal Flying Doctor Service of Australia (Queensland Section) arising out of or in connection with a person's use of or reliance on or inability to use the information or instructions provided in this publication, or incorporated into this publication by referenceContents ii | Primary Clinical Care Manual 10th edition | Contents Endorsements x Acknowledgements 1 Introduction 7 Endorsing the PCCM in Queensland 7 The PCCM and collaborative practice 7 Recognising and responding to clinical deterioration (RRCD) in acute health care 8 Authority to administer and supply medicines 9 Health Management Protocols and Clinical Care Guidelines 10 What's new in this edition 13 1. Patient assessment and transport 17 Patient presentation - adult and child 19 Adult presentation 20 Clinical consultation 28 Patient retrieval/evacuation 29 2. Pain, nausea and vomiting 33 Acute pain management 35 Nausea and vomiting 48 3. Emergency 53 Resuscitation 54 DRS ABCD resuscitation/the collapsed patient 54 Advanced life support (ALS) 56 Oxygen delivery 64 Laryngeal mask airway (LMA) insertion 67 Intraosseous infusion 69 Critical emergencies 73 Unconscious/altered level of consciousness 73 Shock 77 Sepsis/septic shock 80 Meningitis 91 Foreign body airway obstruction (choking) 99 Anaphylaxis 102 Fits/convulsions/seizures 109 Hyperglycaemia 113 Hypoglycaemia 115 Acute asthma 119 Drowning/submersion 128 Cardiovascular emergencies