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A Au uc ck klla an nd dH HE EM MS S P Prre eh ho ossp piitta all ssiim mu ulla attiio on n ssc ce en na arriio o Title ‘Toxicology On The Barrier’ Key learning objectives Prehospital risk assessment in toxicology Use of local resources/additional assistance to stabilize prior to transport Management of life-threatening calcium channel blocker poisoning Clinical scenario (information for participants) A 67 year old man with a background of depression and hypertension has presented to GP surgery on Great Barrier Island. Claims to have taken 60 x 120mg Diltiazem SR 3 hours ago. GP has called helicopter. Handover: Heart rate and blood pressure were initially 70/min and 130/80, have only just dropped to 48/min and 75/40. GCS15. GP has placed 16g IV cannula R antecubital fossa and giving 1000mL N saline. Equipment and Setup Mannequin on stretcher, inside (surgery treatment area). 16g cannula R antecubital fossa, 1000mL bag N saline hanging. Can assume that additional medications/IV fluids ARE available in surgery Could Consider extra person or the scenario facilitator playing the GP Events occurring during scenario Expectation is attempt to stabilize BP and HR (fluid loading, atropine, IV calcium, glucagon, insulin/glucose, catecholamines; GP may need to be asked to prescribe medications outside paramedic protocols) +/- RSI If the team seek advice via phone or internet (poisons centre, ambulance medical director, ED, toxinz.co.nz etc ) provide this note BP slowly drops until at least 4 of 6 interventions above are completed, PEA arrest (unrecoverable) if 4 interventions not performed in 20 min Scenario end point Patient stabilized for transfer (enough interventions performed) or cardiac arrest after 20 min. If team elect to depart prior to 4 interventions end scenario and inform them that patient did not survive the flight! April 2013 www.aucklandHEMS.com