JRCALC Clinical Guidelines 2022

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Standby CPD: evidence-based discussions on a wealth of anatomy, physiology, pathology and pharmacology topics. Recently published articles include CPR-induced consciousness, accidental hypothermia and falls in older people. A new issue is published every month. The guidance is updated to place more emphasis on administering hydrocortisone for trauma as well as medical conditions, due to the physiological stress on the body for steroid dependent patients. This follows a coroner’s inquest where a patient died as a result of an acute adrenal crisis, caused by Addison’s disease and precipitated by the trauma of a fall and fractured hip. Insufficient administration of steroid medication by medical professionals was found to be a contributory factor in this patient’s death. ParaPass is the perfect way to test your knowledge of the guidelines and will count towards your CPD Portfolio. JRCALC is best known for the production of clinical guidelines for UK paramedics, often referred to as just the ‘JRCALC guidelines’. The guidelines are produced by JRCALC for NHS ambulance service paramedics, on behalf of the Association of Ambulance Chief Executives (AACE ). Working closely alongside the National Ambulance Service Medical Directors (NASMeD) who represent all UK Ambulance Services, JRCALC effectively fulfils the liaison role of its title.

Initial dose: 50 mcg (0.05 mg) IV/IO. (0.5 ml from a 1:10,000 pre-filled 10 ml adrenaline syringe). Consider the administration of honey in children over the age of 12 months provided it is immediately available, the child is able to swallow and it is less than 12 hours since ingestion. Dose: 10 mL (2 teaspoons) every 10 minutes for up to 6 doses. DO NOT DELAY HOSPITAL TRANSFER Dosage and administration: If stronger analgesia is required, patient can cover dilutor hole on the activated carbon chamber with finger during use. (New image included) The contributors provide a breadth of experience and perspectives, working on the road, in primary care and healthcare education.Joint Royal Colleges Ambulance Liaison Committee, Association of Ambulance Chief Executives. (2019). JRCALC Clinical Guidelines. Cited from: iCPG (2016) (Version XX) [Mobile application software]. Bridgwater: Class Publishing Ltd. Accessed XX. Reviewed and updated in line with RCUK. New section on advance care planning included and more guidance added to clarify decisions around ARDT, lasting power of attorney and DNACPR, expected and unexpected deaths. Removal of wording in indications. The indication for TXA in women with post-partum hemorrhage if the patient continues to bleed remains. The following text has been removed: Updated and inclusion of guidance for preterm babies, in line with the British Association of Perinatal Medicine (BAPM) framework for practice:

In ‘Headache’ Table 3.62 Assessment and Management, bullet point removed: ‘Avoid morphine due to potential side effects, which could worsen the patient’s condition and/or hinder further assessment.’ New caution added: Current evidence does not support the use of TXA for gastrointestinal haemorrhage We will endeavour to answer your question promptly having consulted with JRCALC experts as necessary. Of the questions we receive there are often common themes; below is a searchable facility to review the questions and answers given.Access all available content during your subscription period. New content will continue to be released and made available to anyone who has a current subscription. Additional wording for clarity has been added to Table 7.5 – High levels of supplemental oxygen for adults with critical illnesses: During the prehospital phase of care vital signs may not normalise and therefore patients with abnormal vital signs should continue to be administered high flow oxygen until hospital arrival. Indications for IV paracetamol amended to relief of moderate to severe pain. Updated text in IV dosage table, ‘IV paracetamol is only used when managing moderate and severe pain (use an oral preparation when managing fever with discomfort).

Do not give nitrous oxide for patients with chest injuries and a clinically suspected pneumothorax. Aim for a systolic blood pressure (SBP) > 100 mmHg. Administration of fluids and adrenaline detailed. (See adrenaline above). New guidance to go in the ‘Special Situations’ section. Includes Safety Triggers for Emergency Personnel (STEP) 1-2-3 Plus, CRESS tool (consciousness, respiration, eyes, secretion, skin), specific agents: nerve agents, cyanide, opiates, atropine toxicity, corrosive substances, Individual Chemical Exposure (ICE), ionising radiation and decontamination, illicit drugs labs.The Joint Royal Colleges Ambulance Liaison Committee has representatives nominated by their respective organisation/specialties/colleges. The committee formally convene three times a year, with the majority of the guidance review and development transpiring between meetings. Although 250 – 500ml of IV (or IO) fluid may support the circulation, it may take several minutes to administer. If hypotension is present during or after this fluid administration, provide additional circulatory support using careful administration of an adrenaline bolus, repeated as required, every 3-5 mins to maintain the systolic BP > 100 mmHg.

Reviewed and updated by NARU. Updated guidance on Conducted Energy Devices (Tasers) and for their assessment, management and removal, Reference list entry:Brown, S.N., Kumar, D.S., James, C. andMark, J. (eds.)(2019) JRCALCclinical guidelines 2019.Bridgwater: Class Professional Publishing.There have been a number of JRCALC Clinical Guidelines editions since the early 2000s, with the 2006 version being superseded in 2013, 2016 and 2019 – and then most recently in 2022 with the current edition. Most notable in this latest print edition is the removal of the medicines, that do however remain fully accessible on the JRCALC apps. Includes the 4AT Screening tool for delirium. Includes guidance on which patients may need admission or if a community referral is appropriate. There is no evidence that cooling patients post-ROSC is of benefit, but extremes of temperature are harmful. Some patients post-ROSC will have a mild hypothermia. Ensure that patients do not become colder by using no more clothing/blankets than is necessary. Vehicle heating is only required to provide a comfortable ambient temperature.