Required Skills & Knowledge
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Essential knowledge:
- Specialised anatomical, physiological and pharmacological terminology
- Advanced concepts underpinning human anatomy and physiology, including:
- human life processes
- homeostasis and the relationship between cellular imbalance and pathology
- Advanced concepts underpinning pharmacology, pharmacokinetics and pharmacodynamics
- Comprehensive understanding of pathology to the structure, physiology and normal functioning of all body systems, in relation to potential impact of client assessment procedures practised including:
- chemical composition
- cells, tissues and organs
- integumentary system
- musculo-skeletal system
- nervous system
- the special and somatic senses
- endocrine system
- cardiovascular system
- lymphatic system
- immune system
- respiratory system
- digestive system
- urinary system
- reproductive system, pregnancy and human development
- Specialised knowledge of fluid, electrolyte and acid base balance
- Specialised knowledge of pharmacological processes and drug actions, indications and contraindications
Essential skills:
- Conduct a comprehensive advanced clinical assessment
- Describe in detail and articulate using appropriate and accurate terminology, the inter-relationships and associated pathophysiology of body systems, in relation to specific advanced client assessment procedures practised
- Explain the key factors necessary to re-establish healthy functioning body systems
- Identify variations from normal functioning and potential interactions between body systems and other internal and external factors
- Seek assistance from an appropriate medical authority in relation to variations from normal functioning
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Range Statement
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Pathophysiological concepts include:
- Cellular injury and change:
- physical, chemical, and infectious agents
- inflammatory process
- hypertrophy, hyperplasia, atrophy, necrosis, and gangrene
- tumour, neoplasm, benign, malignant, metastasis, and anaplasia
- Immunology:
- immune response and immunoglobulins, including:
- hypersensitivity
- anaphylaxis
- tissue rejection
- blood mismatch
- Acquired Immune Deficiency Syndrome
- Hepatitis B
- oncogenes
- auto-immunity
- malignant disease
Fluid and electrolyte imbalance includes:
- 'Electrolyte', 'non electrolyte', 'solvent' and 'solute'
- Role of electrolytes
- Potential problems of electrolyte imbalance:
- sodium, potassium, calcium, phosphate, magnesium and chloride
- Mechanisms of fluid movement through the body:
- Tonicity
- diffusion, active transport, osmosis, hydrostatic pressure, facilitated diffusion, and filtration
- Maintenance of normal fluid volume:
- antidiuretic hormone, sodium, negative feedback, sex hormones and thirst
- Oedema
- States of fluid imbalance:
- normovolaemia', 'hypovolaemia' and 'hypervolaemia'
- burns, sweating, 3rd space shift, diarrhoea and vomiting
Acid base imbalance includes:
- pH, acidosis, alkalosis, physiological acidosis
- Physiological effects of acidosis and alkalosis
- Buffer systems and compensation
- pH imbalances:
- Respiratory acidosis
- respiratory alkalosis
- metabolic acidosis
- metabolic alkalosis
Advanced assessment includes:
- Capture, interpret and record comprehensive information regarding a client's health status to support advanced clinical care.
Standard methods and protocols may include:
- Clinical practice guidelines
- Organisation protocols
- Skills manuals
- State/territory ambulance authority regulations and/or operational procedures
- Internationally recognised scales, charts, guidelines and surveys (e.g. Glasgow coma scale, dermatome charts, blood pressure reading scales, National Asthma Guidelines)
Pharmacodynamics includes but is not limited to:
- Drug interactions
- Pharmacological response of drugs associated with the state/territory ambulance service protocols/ guidelines
- Duration and magnitude of response associated with the state/territory ambulance service protocols/ guidelines
Critical questioning refers to:
- Purposeful, informed open questioning in the clinical setting to make sense of the information presented at the scene of injury or illness
Diagnostic reasoning refers to:
- Using critical questioning and interpretation in the clinical setting which requires careful identification of key problems, issues, and the risks involved in responding to client needs
Poor states of perfusion involves:
- Shock:
- pathophysiology of shock
- aerobic to anaerobic metabolism
- classifications of shock
- stages of shock
Specific client conditions, disorders and injuries to be assessed must include but are not limited to:
- Burns:
- burn classification
- assessing burn area
- potential systemic complications
- assessment of time criticality
- burns of different aetiology
- Head injuries:
- types and causes of head injuries
- primary and secondary injury
- aetiology of head injuries including Monroe-Kellie doctrine
- cerebral perfusion and blood flow
- assessment of a client with a head injury
- Maxillofacial trauma:
- levels of mortality and morbidity
- specialised knowledge of associated structures
- Thoracic, abdominal and pelvic trauma:
- detailed knowledge of internal and external thoracic, abdominal and pelvic structures
- detailed assessment of blunt vs penetrating trauma
- Environmental:
- cold and heat disorders
- pressure disorders e.g. barotrauma
- drowning and near drowning
- lightning injuries
- Acute coronary syndrome:
- progression of coronary artery disease
- ischaemic disorders:
- angina
- unstable angina
- Prinzmetal angina
- myocardial infarction
- heart failure
- valvular disease
- hypertensive emergencies
- other cardiovascular emergencies, e.g. peripheral vascular disease, pericarditis and endocarditis
- ECG recognition:
- specialised knowledge of cardiac conduction
- comprehensive ECG rhythm analysis
- 12 lead ECG capture and assessment:
- axis determination
- bundle branch and fascicular blocks
- STEMI/non-STEMI
- Infarct imposters
- Visceral disorders:
- specialised knowledge of the thoracic, pelvic, gastrointestinal and associated organs and related disorders
- detailed knowledge of urogenital and reproductive disorders
- Special circumstances:
- medico-legal and ethical considerations
- Neurological:-
- diseases: e.g. dementia, ms, motor neurone, cerebral palsy,
- behavioural emergencies
- pathogenesis:
- common pharmacolog
- Infections e.g. meningitis, encephalitis, tetanus
- Conditions: e.g. seizures and epilepsy, CVA, tumours, brain abscess
- Spinal injury:
- Specialised knowledge of sensory and motor functions
- Reflex arc e.g. autonomic dysreflexia
- Cardio-vascular changes
- Respiratory impairment
- Respiratory:
- detailed knowledge of the respiratory system and its function e.g. mechanics of ventilation, inspiration and expiration, respiratory control and impact of gas laws
- Ventilation perfusion (V/Q)
- conditions and diseases e.g. asthma, chronic airways Limitation, pneumonia, PE, hyperventilation.
- respiratory assessment
- Pain:
- pain pathways and perception
- physiological and psychological effects associated with pain
- therapeutic effect of drugs e.g. narcotics, steroidals and non-steroidals, anxiolytics, anti-emetics, over the counter medications
- pain assessment and documentation according to standard methods and protocols
- chronic pain management
Specific categories of clients to be assessed must include but are not limited to:
- Adult client (male and female)
- Obstetric client:
- specialised knowledge of foetal development:
- foetal distress
- neonatal physiology
- congenital abnormalities
- abnormal pregnancy:
- pregnancy induced hypertension, gestational diabetes, eclampsia, ectopic pregnancy, hyperemesis gravidarum
- threatened abortion, spontaneous abortion, supine hypotensive syndrome, ante-partum bleeding
- pre-existing congestive cardiac failure, pre-existing hypertension, pre-existing diabetes
- stages of labour
- normal presentation:
- pre/post haemorrhage
- normal at-term infantt/premature infant
- abnormal presentation:
- multiple/breech/still birth
- limb presentation
- prolapsed cord
- assessment of the newborn:
- APGAR
- post delivery treatment and evaluation
- other obstetric problems and gynaecology:
- post partum bleeding, dysmenorrhoea, menorrhagia, pelvic infections, displacement of pelvic organs, urinary problems, endometriosis
- paediatric client:
- detailed knowledge of differences in paediatric and adult anatomy and physiology as related to assessment of the paediatric client
- developmental stages of childhood e.g. psychosocial issues
- issues surrounding paediatric assessment
- specific paediatric conditions e.g. croup, epiglottitis, febrile convulsions
- geriatric client:
- detailed knowledge of the normal anatomical and physiological changes associated with ageing as related to assessment of the geriatric client
- pre-existing medical problems and pharmacology are considered
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