Interview

• Full primary survey (CABCDE) • Obtain RR and sats • Respiratory assessment • If silent chest, 0.5mg IM Adrenaline • If expiratory wheeze, salbutamol 5mg via nebuliser with 6-8L oxygen • Reassess, if no improvement 500mcg ipratropium bromide • Reassess, if no improvement administer 100mg IV/IM hydrocortisone and repeat salbutamol • If still no improvement, pre-alert to nearest ED

• Bronchi become inflammed causing narrowing • muscles surrounding the bronchi contract, causing further narrowing • inflammation causes secretions which causes further narrowing

Works on the beta2 receptors, acting similarly to adrenaline, relaxes smooth muscle and moistens airways

bronchodilator, antimmuscarinic (relaxes smooth muscle)

Relieves bronchospasm Vasoconstriction Reduces release of histamine

Reduces inflammation Restores blood pressure and volume, mimics cortisol

Disease of the adrenal glands where the adrenal glands do not produce sufficient cortisol and aldosterone

• patients with addisons will be on long term Glucocorticoids and will be dependent on them • adrenal crisis is a lack of cortisol causing hypotension, nausea/vomiting, abdo pain

• IM/IV 100mg hydrocortisone, flush with 10ml NaCl • consider IV fluids

HOTT principles Hypovolaemia: apply pelvic binder, tourniquet, traction splints, wound packing, bilateral IV access with fluids + TXA Oxygenation: definitive airway, BVM Tension Pneumothorax: bilateral chest decompression Tamponade: ECT management, consider mechanism of injury Then go to ALS

• peripheral pitting oedema • pulmonary oedema (bubbly sound on auscultation) • SOB • coughing pink frothy sputum

• IV furosemide 40mg slow over 2 mins • Consider GTN for ischaemic chest pain • convey

V3 + 4

II, III and aVF

I, aVL, V5, V6

V1, V2

• Identify type of stemi, if inferior do V4R check, if anterior depression do posterior ECG • Pads on • Administer aspirin 300mg + GTN 800mcg if in pain • Administer morphine 10mg IV, flush with 10ml • Oxygen if sats <94% • Rapid extrication and phone call to PPCI • Pre alert to hospital

Right Patient Right Dose Right Medication Right Reason Right Documentation Right Route

Excellence, Integrity, Compassion, Inclusivity, Accountability

Accountability: Must be accountable for our own actions and our colleagues, duty of candour, recognising our own limitations and speaking up when we need help Excellence: Ensuring quality of practice, evidence based practice, engaging in CPD and looking to reflect on every job and learn from any mistakes

Right patient care, right place at the right time, with a skilled and committed workforce, in partnership with local health economies

Keep focus during a high pressure situation, able to cope with the stressful nature of the job and have coping strategies in place, keeping focus if mistakes are made then taking action to learn from them in future

Overall complaints went down last year based on the previous year Mean response times for Cat 1s and Cat 2s met the targets in 24/25 Providing 3rd manning shifts for NQPs Every truck has a para