Title Page

DANGER

  • Is it safe to proceed?

  • Continue with assessment

  • Do not proceed till Danger is reduced / removed

Vitals

  • AVPU

  • Respiration Rate (Breaths per minutes)

  • Rate per minute

  • Oxygen Saturation

  • Pulse

  • Rate per minute

  • Source

  • Blood Pressure (Systolic mmHg)

  • Temperature (degree C)

  • BM (mmol)

  • Pain Score 1-10 (10 being Worst pain ever)

  • Notes

SAMPLE

  • Signs and Symptoms

  • Allergies

  • Medication

  • Past Medical History

  • Last Oral Intake

  • Events Leading up to Incident

  • Glasgow Coma Scale

    GCS.JPG
  • GCS Score

Drugs Formulary

  • Indications

  • ADRENALINE. ROUTE = IM, DOSE = Adult 0.5mg Child 6-11y 0.3mg Repeat after 5 mins. CONTRAINDICATION = NONE

  • BUCCASTEM, Buccal, Adult 6mg. CONTRAINDICATIONS = Child under 12. Epilepsy

  • ASPRIN, Oral, Adult 300mg, CONTRAINDICATIONS - Allergy NSAIDS, Child under 16, Stroke

  • Co-amoxiclav Oral Adult 750mg Child 12-17 375mg CONTRAINDICATIONS Allergy to penacillin, History of jaundice, Child under 11

  • Entonox Inhaled Self administered CONTRAINDICATIONS = Unable to elf administer. Head injury + >A on AVPU Pneumothohorax Diving within last 24hrs

  • IBUPROFEN Oral Adult 400mg Child 7-11 years 200mg CONTRAINDICATIONS = Allergy NSAIDS, Shock (no radial pulse) Trauma chest pain, Taking viagra

  • Paracetamol, Oral, Adult 1g, 13-17yo 750mg, 10-12y 500mg, 6-9yo 250mg CONTRAINDICATIONS = Allergy to paracetamol

  • Fentanyl Buccal, Adult 800mg lozenge repeat after 20 mins. CONTRAINDICATIONS = Taking anti depressants. Allergy fentanyl. Breathing <10. Shock (no radial pulse). Head injury +>P on AVPU. Child under 18. Injury to mouth

  • Morphine. IM. Adult 10mg. 12-17yo 5mg. Repeat after 1 hour. CONTRAINDICATIONS = Allergy to morphine. Breathing rate >10 Shock (no radial pulse) Head injury + < on AVPU

  • Glucose. Oral. 10-20mg CONTRAINDICATIONS = NONE

  • GTN Spray. Under tongue. Adult 2 sprays, repeat after 10 mins. CONTRAINDICATIONS = Child under 18. Shock (No radial pulse). Trauma chest pain. Taking Viagra.

  • Ipratropium Bromide via Nebuliser Adult 500mcg Child 250mgc CONTRAINDICATIONS = NONE.------------------------------------------Salbutamol via Nebuliser or spacer 2-10 puffs via spacer or 5mg nebulised. Repeat after 5 mins. CONTRAINDICATION = NONE

  • Midazolam IM Adult 10mg, 6-9yo 7.5mg. Repeat after 10 mins. CONTRAINDICATION = NONE

  • Naloxone IM Adult 400mgc, Child under 6yo 400mgc CONTRAINDICATIONS = NONE

  • OXYGEN Inhaled 10-15l non-rebreather mask or 6-8l nebuliser CONTRAINDICATIONS = Does NOT require oxygen if Heart attack or stroke + SP02>94%, or heat exhaustion / heat stroke

Drugs administered

  • Drugs / Medication administered

  • Details of drug and dose given

  • Select date

Treatment

  • Treatment Given

  • Detail treatment given

Handover

  • Handover to who

  • Select date

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