I attended the REST (Rural emergency skills training) course over the weekend. It is decided for doctors who are not emergency physicians and want to have a structured approach to an emergency situation.
Some key points I got from the course:
- Use DRSABCD in all emergency situations. Write down this on a white board and try to be prepared as much as you can.
- D: Danger
- R: Response (AVPU) Response to pain = PU = may require intubation
- S: send for help! or SHAVE = Sugar, haemorrhage, adrenaline, VT/VF and Epilepsy
- A: Airway + Cervical spine
- B: Breathing, Oxygen, Pulse oximeter, RR, Ausculation
- C: Circulation. Blood pressure, HR, Cap Refill, IV access
- D: Disability. Pupil and spine
- Must know adrenaline dose
- only use IV adrenaline in someone who is dead
- Anaphylaxis: adult 0.5 ml in 1:1000
- Anaphylaxis: paediatric 0.1ml/kg in 1: 10,000
- Arrest: adult 1 ml in 1:1000
- Arrest: paediatric 0.1 ml/kg in 10,000
- Protecting the cervical spine is important. When in doubt, put the cervical spine collar on.
- Defibrillation: 200 J. Use it early in VT/VF
- Protecting the airway is important but it doesn’t always require intubation to improve breathing. Try guedel or LMA.
- Fluid bolus formula is 20mg/kg
- Paediatric weight calculation for 1 year or above (age +4) x 2
- Don’t forget to check sugar
- intraosseous can be placed medial to tibial tuberosity 1 cm below the articular surface
- Don’t forget the 4Hs and 4Ts. Haemorrhage, hypoxia, Hypokalaemia/hyperkalaemia, Hypothermia. Tension pneumothorax, Tamponade, Toxins, Thrombosis
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