Patient Assessment
and Transport
Patient assessment and transport
Body measurements
Ht, Wt, BMI, Waist circ
Clinical management
as set out in CCG / HMP
It is a requirement that all clinicians document their findings in a clear and concise way.
Quality professional documentation is the cornerstone of effective communication [1].
This section is set out to assist with documentation. It is recommended that clinicians
document the page number of HMP/CCG referred to.
Presenting concern/s
The first priority is to assess whether the person is:
• seriously ill and needs immediate management or,
• is a non urgent presentation, and there is time for a complete patient history and
health education to occur
Where possible use a private setting for the patient interview.
Use open ended questions to begin with to provide general rather than more focused
information. For example, “how do you usually deal with an asthma attack?” [2].
Closed questions can be used to focus the interview, pinpoint specific areas of concern
and gain information quickly and efficiently. For example, “has this type of allergic
reaction happened before?” [2].
• Meaning and impact – what does this problem mean to the patient and what
impact does it have on their life? e.g. relative may have died at a young age
having experienced a similar problem or the person may have withdrawn from
social contact
Always ask the patient specifically if they have
• Fever?
• Pain?
• Shortness of breath?
• Diarrhoea?
• Weight loss?
This section outlines what is required for a complete patient history. The history may be
given by the patient, parent or carer in the case of a child, or legal guardian where
appointed. Consider that the patient may be visually or hearing impaired or may not
speak English. In Aboriginal and/or Torres Strait Islander communities Health Workers
will be the cultural and linguistic interpreters.
Consent is always required. The circumstances of the presentation will determine the
extent of patient history taken.
Demographic Name, address, date of birth, gender, alias, occupation, next of kin, emergency
information contact details, Medicare number, ethnic status
Medical history Have you had any illnesses / sickness in the past?
Do you have diabetes? high blood pressure? high cholesterol?
Any big worry problems? depression?
Have you ever had chest pain? heart attack? epilepsy? asthma?
For detail of special medical history such as obstetric, sexual health see related
section
Surgical history Have you had any operations? Do you know what it was for? Were there any
complications? When and where did you have the operation?
Neurological For detailed mental status examination (MSE) see Mental Health section.
system Conscious state:
(mental and 1. AVPU - A – alert / V – responds to verbal statement / P – responds to
conscious state) painful stimuli / U – no response (unresponsive)
2. Glasgow coma scale (adult, child, infant)
Glasgow coma scale (GCS)– adult, child and infant
Adult Child Infant
Child > 5 years 2-5 years 0-23 months
Eyes Open 4. Opens eyes spontaneously
3. Opens eyes on command or to speech
2. Opens eyes with pain (pinching)
1. No eye opening/no response
Best Verbal 5. Fully orientated 5. Appropriate 5. Smiles, coos, cries
Response 4. Confused, words and appropriately
disorientated: phrases 4. Cries but consolable
not sure of their name 4. Inappropriate 3. Persistent cries and/or
or where words screams
they are or what 3. Cries and/or 2. Grunts
happened screams 1. No response
3. Inappropriate: 2. Grunts
meaningless words 1. No response
2. Incomprehensible
noises: grunts, moans
1. No sounds
Best Motor 6. Obeys commands 6. Obeys commands
Response 5. Localises to pain 5. Localises pain
4. Withdraws to pain 4. Withdraws to stimuli
3. Flexor response to pain (bends arm or leg) 3. Abnormal flexion
2. Extensor response to pain (straightens arm or 2. Extensor responses
leg) 1. No response
1. No response
Score Maximum score= Eyes 4 + Verbal 5 + Motor 6 = 15 (fully alert, conscious)
Minimum score = Eyes 1+Verbal 1+Motor 1 = 3 (unconscious)
Always act - on score less than 14 / act immediately on a score of 13 or
less in a child / drop of 2 or more from last assessment / if less than 8
consider intubation
GCS not valid if – patient has - direct eye injury or periorbital swelling after head trauma; intubated
patients; immobilised limbs. In these situations it is appropriate to record the individual scores for each
measurable response (motor, verbal or eyes) [3]
Skin
Inspect Through out physical examination note:
• Colour, bleeding, bruising, rashes
• Vascularity (presence of lesions – skin tags, sores, scabies, fungal
infection, skin cancers
Palpate • Moisture - sweating, dry
• Temperature - cool, warm, hot?
• Texture - is the skin thin / thick?
• Turgor - (elasticity / amount of fluid in skin), normal turgor is when fully
hydrated and skin snaps back to normal position; decreased skin turgor is
a late sign of dehydration. It is normal for skin turgor to decrease as skin
ages.
• Oedema - excessive fluid in subcutaneous tissues
Head and face
Inspect • The shape of the head
• Head and scalp
• Colour and distribution of hair – note any head lice, nits
• Face – eyes (position), eyebrows, ears, nose and mouth
Palpate • Head and scalp
• Lymph nodes
Eyes
Inspect • Eye lids, conjunctiva, sclera, cornea, iris, pupil, lens
Test • Visual acuity – near and distant
• Corneal reflexes
• Cover test
• Red eye reflex
If skilled • Look at the back of the eye with ophthalmoscope
Ears
Inspect • External ear – alignment, shape, colour, size and any lesions of pinna
• Ear canal, tympanic membrane (ear drum), middle ear with otoscope.
Note discharge, swelling, signs of infection, fungal infections, lumps or
bony growths, foreign body, wax
Palpate • External ear
• Mastoid bone
• Lymph nodes of neck
Test if skilled • Hearing with audiometer
• Middle ear function with tympanometer
Nose and sinuses
Inspect • The external surface of the nose
• Is the nose patent? (can the patient breath through their nose?)
• Frontal and maxillary sinuses
• Is there any discharge / foreign body?
Palpate • Frontal and maxillary sinuses (above eyebrow and each side of nose to
cheeks)
Percuss • Frontal and maxillary sinuses (above eyebrow and each side of nose to
cheeks). Tap middle finger of one hand to the middle finger of other hand
placed over the sinus. Does it make a dull or hallow sound?
Mouth and throat
Inspect • Note breath odour
• Lips, mucosa of mouth
• Gums, hard and soft palate (if applicable)
• Tongue – ask the patient to stick their tongue out
• Tonsils – swollen, red?
• Ask the patient if they have any trouble with taste? swallow? gagging?
reflux?
Palpate • Lips and mouth if indicated
Refer to the current edition of the Pathology Handbook for Rural and Remote Queensland
for information on ordering of pathology tests, labelling, collection of specimens,
pre-laboratory processing, transport of specimens and accessing of results.
It is very important when diagnostic tests have been performed that the results are
followed up, the patient informed of the results and abnormal results acted on. Consult a
Medical Officer for advice if unsure about results. MO must review all abnormal results.
To ensure the patient receives the appropriate care for their condition, collaborating with
other members of the team, often by remote consultation, is required.
Collaborative practice is the term used to describe the practice relationship between Registered
Nurses, Medical Practitioners, Aboriginal and Torres Strait Islander Health Workers and other
health professionals who use the PCCM as a guide to practice. The collaborative practice
relationship incorporates the dual notions of collaboration and delegation.
Queensland RFDS is part of the Queensland Emergency Medical System (QEMS) with
Queensland Health (QH), Queensland Ambulance Service (QAS) and Queensland
Department of Emergency Services (DES). This integrated system includes road
transport, rotary and fixed wing aircraft and reduces the impact of time and distance on the
treatment of sick and injured patients living, working or travelling in Queensland.
Queensland RFDS provides services from its network of strategically located Bases in
Brisbane, Bundaberg, Cairns, Charleville, Longreach, Mt Isa, Rockhampton and
Townsville. All RFDS Bases in Queensland, except Longreach provide aero-medical
retrieval / transport service. The RFDS Longreach base provides mental health service to
people living in central western Queensland.
Fixed-wing RFDS aircraft based in Cairns, Charleville and Mt Isa are coordinated by
RFDS Medical Officers. Fixed-wing RFDS aircraft based in Brisbane, Bundaberg,
Rockhampton and Townsville are coordinated by the QEMS Coordination Centres (QCC).
1. Provision of routine and emergency medical advice and clinical support to Registered
Nurses and Aboriginal and Torres Strait Islander Health Workers
• Routine and emergency medical advice can be obtained 24 hours a day from
your nearest RFDS Base with RFDS Medical Officers (Cairns, Charleville and
Mt Isa ) by telephoning one of the contact numbers
• Rural and Isolated Practice Endorsed Registered Nurses and Authorised
Aboriginal and Torres Strait Islander Health Workers should consult with the
appropriate local Medical Officer or nearest RFDS Medical Officer as stipulated
by Health Management Protocol (HMP) and Clinical Care Guideline (CCG)
detailed in the PCCM. Other Registered Nurses are encouraged to use the
PCCM as a guide to their practice and consult as required and in accordance
with Health (Drugs and Poisons) Regulation 1996
• All requests for medical advice should be accompanied by clear presentation of
an appropriate history and examination, including basic observations as detailed
in clinical assessment and history taking section of the PCCM. It is preferable to
have the patient present in case further information is required by the Medical
Officer
• In rural and remote areas of north and western Queensland the RFDS also
provides primary care services through a network of clinic locations. Clinic
locations range from Queensland Health facilities with no resident doctor, to
small isolated properties and mines
3. Coordination of patient retrieval and transport using RFDS aircraft (and other
available resources)
• RFDS Medical Officers and RSQ Medical Coordinators are able to task RFDS
fixed wing aircraft or make use of other available resources as appropriate. All
patient transports are prioritised according to clinical need and availability of local
resources. Less urgent cases may be delayed to facilitate the transfer of urgent
cases from other locations
If it is necessary to consult with a Medical Officer (MO), try to present your findings in a
clear and methodical way.
• It is often easier if you write your findings down first (time permitting)
• It is helpful to advise the MO early that you have a patient about whom you want some
advice or alternately who you think may need evacuation
• Begin with the name and age of the patient, then the presenting concern and proceed
through the patient history, clinical observations and physical examination findings
• Say what you think is wrong – your assessment is important; after all, you are actually
with the patient
• Always consult with the MO if you are not sure. Take the opportunity to discuss
general or specific cases or issues with the MO at the next clinic visit
3. Admission details
• If the referring health professional is a Registered Nurse (RN) / Aboriginal and
Torres Strait Islander Health Worker (IHW), the RFDS Medical Officer or RSQ
Medical Coordinator will organise admission to an appropriate facility. Otherwise,
the following information is also required:
− reason for inter-hospital transfer
− receiving hospital and unit (bed availability must be confirmed prior to transfer)
− name of accepting doctor
What the RFDS Medical Officer or RSQ Medical Coordinator will tell you
1. Requirements
The RFDS Medical Officer or RSQ Medical Coordinator will discuss the patient and
confirm any requirements. Please ask if there is anything you are unsure about
2. Timeframe
A planned time frame will be given but accurate estimated time of arrival (ETA) will not
be confirmed until the aircraft is in flight. Retrievals and patient transports are
prioritised and timing is subject to amendment
3. Priority
You will be informed of significant change to planned activity such as another
more urgent case taking priority
1. General Considerations
• All patients must be adequately prepared and stabilised prior to transport. In many
cases this can be done prior to arrival of the RFDS team
• Please discuss with the RFDS Medical Officer or RSQ Medical Coordinator as
required
• Complete the RFDS Aeromedical Retrieval Checklist. This is to be completed
for all patients requiring transport with the RFDS
General
Rationale Requirement
Considerations
All patients must be accompanied by
appropriate documentation including:
• referral letter
Documentation is
• copy of medical / nursing records
required by the flight
crew and by the
• pathology results
Documentation
receiving facility in order • ECG print out
to provide appropriate • X-rays
ongoing care (where digital radiology is available, if
possible, ensure the electronic transfer
of x-rays to the receiving facility has
occurred)
Any transfer involves • The patient should receive analgesia
movement of the patient, prior to transfer
Analgesia
which may exacerbate • See Pain management inter-facility
pain transfer HMP or consult MO
• Routine use of antiemetics is not
indicated
• Vomiting will • Antiemetics considered if there history
potentially exacerbate of motion sickness
certain clinical
• Promethazine or prochlorperazine is
conditions by raising
preferred for motion sickness given 30
intracranial and
minutes prior to transfer
Antiemetic intraocular pressure
and placing the airway • Parenteral administration of an
at risk antiemetic is essential for patients with
head, spinal injury or penetrating eye
• Motion sickness is
injury
common in the aero-
medical environment • For general nausea consider
metoclopramide or ondansetron
• Consult MO
• The RFDS carries a
comprehensive but
limited range of drugs
Parenteral • Infusions are • Please prepare infusions prior to
drug administered using
transfer using RFDS compatible
infusion infusion pumps or
equipment if possible
syringe pumps. Time
is saved if infusion is
prepared prior to
RFDS arrival
• All ventilated patients and
Nasogastric / orogastric
patients with bowel obstruction should
catheters allow drainage
have an NGT/OGT inserted and
of stomach contents and
Nasogastric secured prior to transfer
reduce the risk of
catheter
vomiting and aspiration
• Conscious, alert and cooperative
spinal injured patients do not require a
nasogastric tube
• Consult MO
General
Rationale Requirement
Considerations
• A urinary catheter is required for
There are no toilet facilities on all incontinent or potentially
RFDS aircraft. The use of incontinent patients. Those who
Urinary
bedpans is avoided due to wear a continence pad may not
catheter
limitations of space and waste require catheterisation
disposal • All patients should have their
bladders empty prior to transfer
• Critically ill and disturbed patients
Venous access may be should have 2 patent IV cannulae
Venous difficult to achieve during inserted and secured prior to
cannula transfer due to space transfer
limitations and turbulence • The majority of patients should
have one IV cannula
Confined space in the aircraft Advise RFDS Medical Officer/ RSQ
Infectious limits the ability to isolate Nursing or RSQ Medical
conditions patients with infectious Coordinators of infectious conditions
conditions when requesting aerial transfer
• Seating availability is often
limited, particularly if more
than one patient is carried
Patient • There are strict weight An escort will be carried if possible,
escort restrictions for take off and at the discretion of the pilot
landing which influence
amount of fuel and
passengers numbers
• Space and weight
• Maximum baggage allowance is 1
restrictions limit the
small bag with a weight of 8 kg
capacity to carry baggage
(B200 aircraft) and 5kg (PC12
Baggage • Baggage is carried in the aircraft)
same area as medical
• Medical aids and additional
equipment, which must be
baggage will be carried at the
easily accessible at all
pilot’s discretion
times
• Patients who have been
appropriately stabilised and
prepared may be handed over to
Where clinically appropriate,
the RFDS crew at the airport
Handover airport handover of the patient
location reduces time and increases • Critical and unstable patients will
aircraft availability be retrieved from the health
facility. Handover location will be
discussed during the coordination
process
Special
Rationale Requirement
Considerations
• All patients with proven or • All ventilated spinal injured
suspected spinal injuries are patients require a nasogastric
transported on a vacuum tube
Spinal injury
mattress • A nasogastric tube should be
• Insertion of a urinary catheter is considered for all spinal injured
necessary to monitor urine patients who are uncooperative or
output and maintain have an altered level of
immobilisation consciousness. Consult MO
• All patients with bowel obstruction
should have a nasogastric
• Trapped gas will expand in
catheter inserted. Leave
volume at altitude and cause
nasogastric tube on free drainage
Bowel pain
or attach anti-reflux valve. Do not
obstruction • A nasogastric catheter may
spigot nasogastric tube
allow escape of trapped gas
• Administer parenteral antiemetic
and reduce vomiting
as indicated and adequate
analgesia prior to transfer
• Trapped gas in the pleural • All patients with proven
cavity will expand at altitude pneumothorax should have an
and may result in respiratory intercostal catheter inserted and
Pneumothorax compromise (Underwater seal connected to a Heimlich valve or
drains are avoided due to the Portex ambulatory chest drainage
risk of retrograde flow during system. Suspected pneumothorax
transfer) must be excluded by X-ray
• All patients with proven or
• Trapped gas in the globe will
suspected penetrating eye injury
expand at altitude and
must receive a parenteral
Penetrating eye potentially worsen the injury
antiemetic
injury • Vomiting may also worsen
• They will be transported at
injury by raising intraocular
reduced cabin altitude
pressure
• Mental health emergency patients
are transported in daylight hours
with no other patients on board the
• Mental health emergency aircraft. They require physical
patients are a potential threat to restraint and reliable intravenous
aviation safety access +/- appropriate sedation
Mental illness
• Appropriate physical +/- • A Medical Officer or additional
chemical restraint is used to escort trained in restraint is also
reduce this threat required
• All cases must be discussed in full
with the RFDS Medical Officer or
RSQ Medical Coordinator
Special
Rationale Requirement
Considerations
• An aircraft is not an
appropriate place for
delivery
Women in • Transport may occur if • All cases must be discussed in full
labour is suppressed, with the RFDS Medical Officer or
labour
otherwise it may be more RSQ Medical Coordinator
appropriate to deliver
locally and transport mother
and baby as required
References
If required, originals of this document can be obtained from your nearest RFDS service
Related topics:
Glasgow coma scale, page 15
Poisoning and drug emergencies (Opiates), page 194
2. Immediate management:
• Identify the patients self reported level of pain 1-10 and pre-existing medical
condition / complaint
0 1 2 3 4 5 6 7 8 9 10
3. Clinical assessment:
• Obtain patient history including presenting complaint – e.g. cancer patient
• Perform standard clinical observations + Glasgow coma scale (GCS)
• Inspect the size of the patient’s pupils
• Is the patient able to swallow?
• Do they have a patent IV cannula insitu?
• Obtain history of current episode of pain
− onset and duration (when did it start? gradual or sudden onset?)
− duration (how long has the patient had the pain? have they experienced
pain like this before?)
− intensity (using a scale of 1-10 with 0 being no pain and 10 being the
worst pain you can imagine, rate the pain you are experiencing now? [2]
− site and radiation (eg. where is the pain? Does the pain go elsewhere?)
− character (eg. sharp pain, dull pain, burning pain)
− associated features (eg. nausea, vomiting)
− what makes it better or worse (eg. Lying down, sitting up)
• Previous methods / analgesics used to control pain? what has worked / what
hasn’t? has there been any side effects?
• Take medication history – current medications / allergies / is the patient taking
any over the counter medications?
Sedation Score
0 = awake
1 = mildly drowsy, responsive to voice stimuli
2 = moderately drowsy, responds to touch only
3 = severely drowsy, not responding
4. Management:
• Perform GCS, BP, pulse, respirations and pain score and sedation score prior to
and post administration of analgesia
• If further doses are required, GCS must be 14 or above, systolic blood pressure
>90mmHg, respiratory rate >10 and sedation score 1 or less prior to each dose
• Consult MO if observations outside these parameters
• If patient develops a depressed level of consciousness, respiratory depression
or severe hypotension following the administration of Morphine or Fentanyl see
Poisoning and drug emergencies (opiates)
• Monitor vital signs, pain score and sedation scores at intervals appropriate to
analgesia given
Pain score 1-3, and clinical assessment indicates mild pain. If not allergic
consider paracetamol (paracetamol is rapidly absorbed after oral administration, with
a peak concentration in 10 to 60 minutes)
DTP
Schedule 2 Paracetamol
NP / IHW
Authorised Indigenous Health Workers may proceed
Nurse Practitioner may proceed
Route of
Form Strength Recommended Dosage Duration
Administration
Tablet 500mg Oral Adults: 1-2 tabs every 4 Stat and as ordered
hrs to maximum 8 by MO or NP up to
tabs/day 48 hours only
Provide Consumer Medicine Information if available:
Management of Associated Emergency: Consult MO
OR
Pain score 4-6, and clinical assessment indicates moderate pain. If not allergic
consider give paracetamol 500mg / codeine phosphate 30mgs. (Codeine is well
absorbed from the gastrointestinal track peak onset of action is 1-2 hours). [3]
And / or
If not allergic and does not have asthma, renal disease, heart disease, GI bleeding
conditions, dehydration, in the 3rd trimester of pregnancy, lactation, significant liver
disease or coagulation disorder or on ACE-inhibitors, diuretics, warfarin, lithium
consider Ibuprofen
DTP
Schedule 4 Ibuprofen
NP / IHW
Authorised Indigenous Health Workers may proceed
Nurse Practitioner may proceed
Route of Recommended
Form Strength Duration
Administration Dosage
Tablet 400mg Oral Adult: 400 mg Stat and repeat in 6
hours if required
Precautions – do not use in patients with - asthma, renal disease, heart disease, GI bleeding
conditions, dehydration, in the 3rd trimester of pregnancy, lactation, or on ACE-inhibitors, diuretics,
warfarin, lithium
Provide Consumer Medicine Information if available
Management of Associated Emergency: Consult MO see Poisoning: Opiates HMP
DTP
Schedule 4 Metoclopramide
IHW / RIN / NP
Authorised Indigenous Health Workers must consult MO
Rural and Isolated Practice Endorsed Registered Nurses may proceed
Nurse Practitioners may proceed
Route of Recommended
Form Strength Duration
Administration Dosage
Ampoule 10 mg in 2 mL IM Adults only: Stat
or 10 mg Further doses should
IV (IHW may not only be given on MO’s
administer IV) orders
Provide Consumer Medicine Information if available: Not for use in patients with Parkinson’s disease or children
and caution in use in women less than 20 years of age
Management of Associated Emergency: Dystonic reactions eg. oculogyric crisis are extremely rare (unless
repeated doses or in children). If oculogyric crisis develops give Benztropine 2 mg IMI or IVI as per Mental
health emergencies
DTP
Schedule 8 Morphine Sulphate
IHW / RIN / NP
Authorised Indigenous Health Workers must consult MO
Rural and Isolated Practice Endorsed Registered Nurses may proceed
Nurse Practitioners may proceed
Route of
Form Strength Recommended Dosage Duration
Administration
Ampoule 10 mg/mL IM Adults only: 0.1-0.2 mg/kg up to Stat
a maximum of 10 mg Consult the Medical
Ampoule 10 mg/mL IV Adults only: 2.5 mg increments Officer if the patient
(IHW may not slowly, repeated every 10 min if requires more than the
administer IV) required to a maximum of 10 mg recommended dose
Provide Consumer Medicine Information if available: Advise can cause nausea and vomiting, drowsiness
Management of Associated Emergency: caution – in the elderly and those with significant renal / liver disease -
Respiratory depression is rare. If it should occur give Naloxone as per Poisoning: Opiates HMP NB: as
Naloxone counteracts the narcotic, it may cause the return of severe pain
If allergic to Morphine or significant renal disease give Fentanyl: N.B. Fentanyl has a rapid
onset of action
DTP
Schedule 8 Fentanyl
IHW / RIN / NP
Authorised Indigenous Health Workers must consult MO
Rural and Isolated Practice Endorsed Registered Nurses may proceed
Nurse Practitioners may proceed
Route of
Form Strength Recommended Dosage Duration
Administration
Ampoule 100 IM Adults only: 1.5 Stat. Consult the MO if
microgram/ micrograms / kg / dose up the patient requires
2 mL to a maximum of 100 more than the
microgram recommended dose
Ampoule 100 IV Adults only: 25 microgram Stat. Consult the MO if
microgram/ (IHW may not increments slowly, the patient requires
2 mL administer IV) repeated every 10 min if more than the
required to a max. of 100 recommended dose
microgram
Ampoule 100 Intranasal Adult only Stat. Consult the MO if
microgram/ 1.5 microgram/kg the patient requires
2 mL undiluted up to a maximum more than the
of 100 microgram recommended dose
Administration instructions for intranasal fentanyl. Draw up dose into 1ml or 2 ml syringe. If using a
mucosal atomisation device (MAD) attach to the syringe. Position patient sitting up at a 45 degree
angle or with head resting to one side. Position the atomiser or syringe into the nostril loosely, aiming
for the centre of the nasal cavity. Depress the syringe plunger quickly. If 100microgram / 2 ml is being
used split the dose between both nostrils to minimise loss due to sneezing or swallowing.
Intranasal fentanyl may be unreliable if patient has blocked nose.
Provide Consumer Medicine Information if available: Advise can cause nausea and vomiting, drowsiness
Management of Associated Emergency:
Respiratory depression is rare. If it should occur give Naloxone as per Poisoning: Opiates HMP NB: as
Naloxone counteracts the narcotic, it may cause the return of severe pain
5. Follow up:
Monitor patient’s response to analgesia and document vital signs including GCS, BP,
pulse and respirations, pain and sedation score
If sedation score is 3 or respiratory rate < 8 administer Naloxone give O via Hudson
mask and consider need to assisted ventilation ie bag/valve/mask.
6. Referral / Consultation:
Consult MO if further analgesia is required and maximum dose has been administered
References
1. International Association for the Study of Pain Subcommittee on Taxonomy, Classification of
chronic pain syndromes and definitions of pain terms. Pain, 1986. 3(Suppl. 3): p. S1-S226.
2. Estes M and Schaefer KP, Health assessment & physical examination. 2nd ed. 2002,
Albany, NY: Delmar.
3. MIMS Online. Prescribing information. 2009 [cited 14/5/09]; Available from: https://www-
mims-hcn-net-au.