Innovation Presentation: Template

Name Position Facility

Issues Identified

__j Window Dama g e - Forward l__ ~---~----~(L~l~,~l~2~,~R~1~,~R~2~)~------_J~

Condition: A forward flight deck w indow has one or more of these:

• An electrical arc • A delamination • A crack

Objective:

• Is shattered .

To remove electrical power, If needed, to prevent arcing. To reduce differential pressure and descend if the inner pane is shattered or cracked .

Ll:J c Ri I GjG 1 Choose one:

W indow is d e laminated only:

Continue normal operation .

•••• W indow is arcing:

.,..,.Go t o s tep 2

Window Is crack e d or shattered:

.,..,.Go t o step 5

2 WINDOW HEAT switch (affected w indow) ...... . . .. ... . ... . . OFF

Limit a irspeed to 250 Knots maximum below 10,000 feet.

3 Pull both WINDSHIELD AIR controls. This vents conditioned air to the inside of the w indshield for defogging .

4 Continue normal operation .

•••• T Continued on next pea- T

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April 25,2013 06-27l70-7Q8·VOZ(Q8) I . I I

Strategy / Intervention

Advanced Life Support for Adults

Start CPR 3() compressions : 2 breaths

Mininise Interruptions

Attach Defibrillator I Monitor

Post Resuscitation Care

Non Shockable

CPR

Ourina CPR Mlr.TJ-a6Jrds (UIA/ ETT) OX)9EI:l W<M!iJrm ~IO!Ja¢"1 IV / 10 access ftarl acUins bebe Mm.¢ngWI\XessUIS

(e.~chatge nam1 detirra:ct) ~

Shx:i<able • ~ 1 mg af'er2" slafc

(!hen e=y l"" loop) ' AlriOcl;rone 300 rrg after ~ sllocX

Non Shcdable • lodleoalne 1 mg irlvnedia:a'y

(lhen e=y zx loop)

Consider and Correct Hypoxia Hypodaetria Hypef I h')'potalaema I ne!abcU:: disorders Hyopollelrria f l"lypEdhenria Tension~ T~ Tams Tmrnbosis ~/cnronary)

Post Resuscitation Care ~ABCtlE 12 1eadECG Treol ~~causes R...~~andverda:xn Tenpm.reooo:za (cool)

Outcomes / Results and

NO PULSE

(c••) CALL FOR HELP

Attach defibrillat or or monit or

CPR: 30 COMPRESSIONS : 2 BREATHS

<: 100 PER MINUTE

START CPR

<: 5 CM DEEP

ROTATE COMPRESSORS

MINIMISE INTERRUPTIONS

0 CRASH CART

Paddles cr pads in left '11 daxillary line over sixth intercostal space and r ight parasternal area over secord intercostal space. In patients with a PPM or lCD put paddles or pa:ls on the chest wall at least 8 CJTl from the PPM or lCD.

Airw~y adjun:ts (LMA or ETI)

High-flow oxygen

Intravenous or intraosseous ~ccess

Waveform capnography

Plan actions before interrupting compressions

If the rhythm is shockable (VF or pulseless VT) the'l shock

For al shocks use monophasic 360 J or biphasic 200 J

CPR 2 minutes

continued next page

www.ecinsw.com.au

Level 4, Sage Building , PO Box 699 T 02 9464 4674 www.ecinsw.com.au

67 Albert Avenue, Chatswood NSW 2067 Chatswood NSW 2057 F 02 9464 4728 ABN 89 809 648 636

(C•)) CALL FOR HELP

Protect airway

l ligh-flow oxygen

Attem pt IV access

.1.1.\ INFORM TEAM

If IV access then take blood tor FBC, EUC, CaMgPh, anticonvulsant levels, and cult ure

Check blood glucose (from IV or fingerprick). If blood glucose < 3.5 mmoi/L then give ......­IV dextrose 10% 5 mL/ <g, followed by infusion of IV dextrose 10% at 5 ml/kgthour, and check blood glucose again in 5 mintues.

Unless given pre-hospital. give:

IV or IM midazolam 0.15 mg/kg (see chart below, maximum 5 mg)

buccal or intranasal midazolam 0.3 mg/kg (see chart below, max1mum 10 mg)

IV diazepam 0.25 mg/kg (maximum 10 mg)

Age (years) Weight Midazolam Midazolam IV/IM Buccal/Intranasal

< 1 5 - 10kg 0.75- ' .5 mg 1.5-3mg

1. 2 10 kg 1.5mg 3mg

1-4 1 s ke 2.?<; me 4.Sme

5-6 20 kg 3 mg 6mg

7. 10 30 kg 4.5mg 9mg

11 '2 40 kg 5 mg 10mg

>13 50 kg S mg 10mg

If still fitting after 5 minutes g1ve:

IV or IM midazolam 0.15 mg/kg (see chart on previous page, maximum 5 mg)

buccal or Intranasal mldazolam 0.3 mg/kg (see chart, maximum 1 o mg)

IV diazepam 0.25 mg/kg(maximum 10 mg)

If still fitting after 5 minutes g1ve:

IV or 10 phenytoin zo mgtkg over 20 m1ntues (or IV/10 phenytion 1 o mgtkg if already on phenytoin) with ECG monitoring. Phenytoin is preferred over the next two options.

IV or 10 phenobarbitone 20 mgt kg (or IV/10 phenobarbitone 10 mglkg if already on phenobarbitone)

if no IV or 10 access give PR paraldehyde 0.4 mllkg diluted 50:50 with NSaline or olive oil (do not give IV or 10 or IM)

If seizures continue:

seek expert advice

consider rapid sequence induction w1t h thiopentone or propofol

consider pyridoxine

arrange PICU transfer

lnflllte cuff to 20 to JO cmll 20

Check tube placement:

end-tidal co, (If us1ng eolounmeter then "go for go d. w1th1n SIX breaths)

auscultation

Secure tube

Record position at lips (approximately 21 em in females. 23 em in males)

IF ASTHMA OR COPD THEN GO TO PAGE 34 (OBSTRUCTIVE STRATEGY)

INITIAL VENTILATOR SETTINGS FOR LUNG-PROTECTIVE STRATEGY

Mode VC-SIMV

VT 6 mL/kg of ideal body weight

5' 5'2" 5 '4" 5'6" 5'8" 5'10" 6' 6'2" 6 '4" Height

1~cm1~cm1~cm1~cm1ncm 1ncm 1~cm1~cm1~cm

VTmale 305 320 3€0 385 415 440 470 490 520

VT female 275 295 330 360 385 415 440 470 490

VT pregnant 370 390 440 480 510 550 585 625 650

RR 18 /min

Pmax40cmH,O

20

"~~ 2 60 RR 18/min

FiO, start at FiO, 100% and PEEP 5, then titrate to saturations 88 to 95%

FiO,(%)

PEEP (cmH,U)

I:E 1:1 .5

40 40

s

Autoflow on with slope.../

continued next page

so 8

50 EO 70 70 70

1U 1U lU 12 14

80

14

90

14

(C•)) CALL FOR HELP .. 0 CRASH CART

If newborn is term gestation, breathing or crying and good tone, then:

routine care

prevent heat loss

stay with mother

ongoing evaluation

If not term gestat ion, breat hing or crying, or good tone, then:

prevent heat loss

ensure open airway

stimulate

If heart rate > 100 and laboured breathing or persistent cyanosis. then:

ensure open airway

monitor oxygen saturations

ron~irlPr CPAP

If he~rt r~te < 100, gasping or apnoea, then for 30 seconds:

positive pressure ventilation

monitor oxygen saturations

It heart rate < 1 oo then tor 30 seconds:

ensure open airway

reduce leaks

constder increasing pressure and oxygen

If he~rt r~te < 60 then for 30 seconds:

add chest compressions (three compressions then a breath, at a rate of one compression every half a second)

100% oxygen

consider intubation or LMA

If heart rate< 60 then:

continue chest compressions

intravenous or intraosseous access (consider umbilical vein catheter; the umbilical stump has one vein and two arteries)

IV adrenaline 10 to 30 meg/kg (0.1 to 0 .3 ml /kg of 1:10,000 adrenaline, ~ 1 mL of 1:10,000 adrenaline for an average term nevtborn)

consider volume expansion (IV normal sa ine 10 ml/kg)

If heart rate< 60 after a few minutes then:

repeat IV adrenaline 10 to 30 meg/kg (0.1 to 0.3 mUkg of 1 :10,000)

consider volume expansion (IV normal sa ine 10 ml/kg)

seek expert advice

Target pre-ductal (right hand) oxygen saturations after birth:

1 minute 60.70 'lo

2 minutes 65.86 'lo

3 minutes 70.90 'lo

4 minutes 75 · 90 'lo

5 minutes 80 · 90 'lo

10 minutes 85. 90 'lo

Airwoy .. ....... .. ............ 1

Anar>hyl.:>xis . .. . . . . .. 1 0

Asystole. .. ... .. .. . ........ 1 ~ BrudyLardta .. .. ......... 1 7

f'EA. ...... .. . ... ............. 19

Sratus Fpl/cptkus ....... 73 svr . ........................... .. 2~ TdchycanJia .................. 26 1 orsa<.1es ...... ..... ........ . 79

Ventilation ............. .. ... 30

VF ......................... ...... :Jg VT ...... . ...................... 4~ VT- PuJsete..,s .......... . . 4S

ACI

PAEDIATRIC

Rrc~dyc f( It l PFA

'>tdtu EpiiL·ptt '-'> <,vr TcJch).( rc/1

VI

VJ

VT f>t (>/

NEWBORN

...

~ Emergency ~ Care Tnslitute

~

60 .63

.b8

11

16

18 .. ..... 80

83 .88

91