Flashcards

emNOTES is a leading pre-hospital education platform used by ambulance personnel to support their professional development and learning.

Project emNOTES began out of frustration with a lack of high-quality and relevant pre-hospital learning resources. Our team decided to fill that void.

We are building a comprehensive and yet intuitive platform that enables reflection and learning based upon real-life experiences and encounters.

By utilising/ leveraging the power of AI (artificial intelligence), we support your learning by encouraging you to ask questions!

Falls & Rhabdomyolysis Aide-Memoir
Info	Falls are the leading cause of emergency calls in the over 65s and account for 10-25% of emergency responses each year for adults aged over 65. JRCALC defines a long lie as “someone who has been on the floor for over an hour and is unable to get up".
Symptoms	Specific	Swollen ±painful muscles Confusion, agitation, delirium Anuria ±clinical dehydration Myalgia, muscle weakness Tea/ cola-coloured urine
Symptoms	Non-specific	Fever Malaise Anorexia Nausea ±vomiting
Background
Info	Rhabdomyolysis	This is a clinical syndrome associated with the breakdown of skeletal muscle fibres and cell membranes, leading to the release of muscle contents into the circulation. •. It results in multiple complications, including hyperkalaemia, arrhythmias, compartment syndrome and acute kidney injury (AKI). • It is a medical emergency that can lead to cardiac arrest if not promptly treated. Long-lasting muscle compression such as that caused by prolonged immobilisation after a fall or lying unconscious on a hard surface during illness or while under the influence of alcohol or medication are known causes. Rhabdomyolysis would be difficult to identify in the early stages but the presence of any of the above indicate a high suspicion of the condition and these patients must be conveyed to the nearest ED.
Info	Lay Time	Patients who are lying on the floor after a fall can be divided into 2 groups: • Immobile long lie (ILL) – where patients have been unable to move around on the floor • Mobile long lie (MoLL) – where patients have been able to shuffle or roll themselves around on the floor For ILL patients – the guidance is that patients should be referred to ongoing care if they have been on the floor for one hour or more. For MoLL patients – the guidance is that they should be referred to ongoing care if they have been on the floor four hours or more.

Cardiac Arrest Aide-memoire

Next, I want to make this into an editable table that opens in a new window and can then be downloaded with changes!

Cardiac Arrest Aide-Memoir
Name		Pharmacy Intervention
Sex		Epinephrine	Amiodarone
Times		:	:
Last seen	:	:	:
When found	:	:
CPR started	:	:
Defibrillation		:
Shocks	Rhythm	:
:	A \| PEA \| VF \| VT	:
:	A \| PEA \| VF \| VT	:
:	A \| PEA \| VF \| VT	:
:	A \| PEA \| VF \| VT	:
:	A \| PEA \| VF \| VT	Post ROSC Vitals
:	A \| PEA \| VF \| VT	HR	bpm
:	A \| PEA \| VF \| VT	BP	mmHg
:	A \| PEA \| VF \| VT	Temp	˚C
:	A \| PEA \| VF \| VT	CBG	mmol/L
:	A \| PEA \| VF \| VT	SpO2	%
:	A \| PEA \| VF \| VT	EtCo2	mmHg

Opioid/Opiate Equivalency & Misc.
	IV Morphine (IV-M)	Oral Oxycodone (PO-O)	Oral Morphine	Tramadol (PO-T)	Codeine (PO-C)
IV-M 1mg	1mg	1mg	1ml (2mg)	20mg	20mg
IV-M 2mg	2mg	2mg	2ml (4mg)	40mg	40mg
IV-M 5mg	5mg	5mg	5ml (10mg)	100mg	100mg
IV-M 10mg	10mg	10mg	10ml (20mg)	200mg	200mg
IV-M 20mg	20mg	20mg	20ml (40mg)	400mg	400mg
PO-C 30mg	1.5mg	1.5mg	1.5ml (3mg)	30mg	30mg
PO-C 60mg	3mg	3mg	3ml (6mg)	60mg	60mg
PO-O 10mg	10mg	10mg	10ml (20mg)	200mg	200mg
PO-T 100mg	5mg	5mg	5ml (10mg)	100mg	100mg

		Renal Impairment*		Hepatic Impairment**
Morphine		Moderate†	Severe‡	Moderate	Severe
Morphine		Reduce dose	Avoid	Normal dose	Reduce dose

Renal Impairment: morphine's clearance from the body may be reduced, leading to a longer duration of action and increased risk of drug accumulation, which could result in heightened sedation, respiratory depression, and potential adverse reactions. *Hepatic Impairment: the effects of morphine may be prolonged and intensified due to decreased liver function, potentially leading to a higher risk of drug accumulation and side effects such as respiratory depression and sedation. †Moderate: GFR < 30ml/ min. ‡Severe: GFR < 15ml/ min. GFR = "Glomerular Filtration Rate"

Toxidrome Comparison Table
Toxidrome	Feature
Toxidrome	Pupils	Skin	Tone	Reflexes	Arousal	Vitals	Other
Anti-cholinergic	Wide	Dry	Normal	Normal	Depressed, confused	Tachycardia, hypertensive, hyperthermia	± Hallucinations
Cholinergic	Narrow	Wet	Normal	Normal	Confused, obtunded	Bradycardia	± Seizures
Hallucinogen	Nystagmus, ± wide	Normal	Normal	Normal	Confused	Tachycardia	± Hallucinations
Opioid	Narrow	Dry	Normal	Normal	Confused, obtunded, somnolent	Bradypnoeic, hypotensive	± Pulmonary oedema
NMS	Wide	Wet	Increased	Decreased		± Hyperthermia	± Rigidity
Sedative-Hypnotic	Narrow	Dry	Normal	Unaffected	Stupor/ coma	Normal	± Hyperreflexia
Sedative Withdrawal	Wide	Wet	Normal	Normal			± Tremor
Serotonin Syndrome	Wide	Wet	Increased	Increased		± Hyperthermia	± Trismus, clonus
Sympathomimetic	Wide	Wet	Normal	Normal	Alert, agitated, restless	Tachycardia, hypertensive, tachypnoeic	± Tremor, hyperreflexia, seizures
Sources: https://ddxof.com/app/; https://www.jems.com/patient-care/common-poisoning-syndromes-to-know/