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
Non-specific Fever
Nausea ±vomiting
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.
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
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
Pupils Skin Tone Reflexes Arousal Vitals Other
Anti-cholinergic Wide Dry Normal Normal Depressed,
± Hallucinations
Cholinergic Narrow Wet Normal Normal Confused,
Bradycardia ± Seizures
Hallucinogen Nystagmus,
± wide
Normal Normal Normal Confused Tachycardia ± Hallucinations
Opioid Narrow Dry Normal Normal Confused,
± 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,
± Tremor,
Sources: https://ddxof.com/app/; https://www.jems.com/patient-care/common-poisoning-syndromes-to-know/