Title Page
DANGER
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Is it safe to proceed?
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Continue with assessment
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Do not proceed till Danger is reduced / removed
Vitals
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AVPU
- Alert
- Confused
- Voice
- Pain
- Unresponsive
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Respiration Rate (Breaths per minutes)
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Rate per minute
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Oxygen Saturation
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Pulse
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Rate per minute
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Source
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Blood Pressure (Systolic mmHg)
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Temperature (degree C)
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BM (mmol)
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Pain Score 1-10 (10 being Worst pain ever)
- 1 (little to no Pain)
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10 (Worst pain ever or imaginable)
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Notes
SAMPLE
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Signs and Symptoms
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Allergies
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Medication
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Past Medical History
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Last Oral Intake
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Events Leading up to Incident
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Glasgow Coma Scale
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GCS Score
Drugs Formulary
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Indications
- Anaphylaxis
- Life Threatening Asthma
- Heart Attack
- Nausea and Vomiting
- Open Fracture or contaminated wound >1hr from Hospital
- Mild / Moderate Pain
- Moderate /Severe Pain
- Hypoglycaemia
- Angina or Heart Attack
- Asthma
- Seizure .5mins
- Reverse Opiate
- Serious illness or injury + abnormal vital signs
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ADRENALINE. ROUTE = IM, DOSE = Adult 0.5mg Child 6-11y 0.3mg Repeat after 5 mins. CONTRAINDICATION = NONE
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BUCCASTEM, Buccal, Adult 6mg. CONTRAINDICATIONS = Child under 12. Epilepsy
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ASPRIN, Oral, Adult 300mg, CONTRAINDICATIONS - Allergy NSAIDS, Child under 16, Stroke
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Co-amoxiclav Oral Adult 750mg Child 12-17 375mg CONTRAINDICATIONS Allergy to penacillin, History of jaundice, Child under 11
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Entonox Inhaled Self administered CONTRAINDICATIONS = Unable to elf administer. Head injury + >A on AVPU Pneumothohorax Diving within last 24hrs
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IBUPROFEN Oral Adult 400mg Child 7-11 years 200mg CONTRAINDICATIONS = Allergy NSAIDS, Shock (no radial pulse) Trauma chest pain, Taking viagra
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Paracetamol, Oral, Adult 1g, 13-17yo 750mg, 10-12y 500mg, 6-9yo 250mg CONTRAINDICATIONS = Allergy to paracetamol
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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
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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
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Glucose. Oral. 10-20mg CONTRAINDICATIONS = NONE
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GTN Spray. Under tongue. Adult 2 sprays, repeat after 10 mins. CONTRAINDICATIONS = Child under 18. Shock (No radial pulse). Trauma chest pain. Taking Viagra.
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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
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Midazolam IM Adult 10mg, 6-9yo 7.5mg. Repeat after 10 mins. CONTRAINDICATION = NONE
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Naloxone IM Adult 400mgc, Child under 6yo 400mgc CONTRAINDICATIONS = NONE
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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
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Drugs / Medication administered
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Details of drug and dose given
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Select date
Treatment
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Treatment Given
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Detail treatment given
Handover
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Handover to who
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Select date