2017 EMT skill Sheets

Question 1

What are the 3 things you need to do to prepare patient for CPAP administration? (1)

Answer 1

PPE
Systolic BP over 100
Position patient in a position that will optimize ease of ventilation

Question 2

What are the indications for a CPAP? (2)

Answer 2

Asthma
CHF
Pulmonary edema
COPD

Question 3

What are the contraindications for CPAP? (3)

Answer 3

• unconscious, unresponsive
• over 16 y/o
• inability to sit up
• respiratory arrest/ agonal respirations
• nausea/vomiting
• systolic BP under 100
• suspect pneumothorax
• cardiogenic shock
• penetrating chest trauma
• facial abnormalities, trauma, burns
• closed head injury
• active upper GI bleed or recent surgery

Question 4

What is the goal of CPAP administration?

Answer 4

10 cm h20, coach patient to breath normally

Question 5

What are the steps in reassessing patient for desired CPAP effects?

Answer 5

• decreased ventilatory distress
• spo2 greater than 92%
• decreased adventitious lung sounds
• absence of reactions I.e. Barotrauma or pnemo
• record settings, readings and document appro.

Question 6

What are the first 3 initial steps of IN medication administration? (1)

Answer 6

• assure pt. Is being ventilated adequately
• ask patient for known allergies
• clearly explain procedure to patient

Question 7

What is the equipment needed for IN medication administration? (2)

Answer 7

• medication
• syringe, needle, MAD device
• sharps container
• alcohol swabs
• sterile gauze

Question 8

When administering medication IN, what are the 6 rights of medication administration? (3)

Answer 8

• right patient
• right medication
• right dosage/concentration
• right time
• right route
• right documentation

Question 9

What do you also need to check the medication for before administration of IN? (4)

Answer 9

• clarity, expiration date
• assemble syringe/needle while staying steril
• cleanse stopper, draw med., dispel air
• reaffirm medication
• dispose needle in sharps, attach MAD
• verbalized PPE
• stop ventilation of patient
• admin 1/2 medication in each nostril
• properly dispose of syringe and MAD
• resume ventilation of patient if necessary
• verbalized need to monitor patient for desired effect and side effects

Question 10

What are the six rights of medication administration?

Answer 10

Right medication - correct medication given in standing orders, generic vs. non generic brands, check expiration

Right patient - confirm patient ID and allergies, contraindications for that patient

Right dose - check concentration, calculations, and that the correct dose has been drawn up

Right route - route is accessible and matches what standing orders and medication label list, confirm dose is correct for chosen route

Right time - medication is given over proper time duration per standing orders

Right documentation - document medication, dose, time of administration, duration of administration, route and patient response

Question 11

When administering medication IN, what else do you need to check for?

Answer 11

• clarity
• expiration date
• maintain sterility during assembly
• reaffirm medication
• dispose of needle properly and attach MAD
• verbalized PPE
• stop ventilation of pt. to administer medication
• admin 1/2 medication up each nostril
• disposes/verbalized proper of MAD & syringe
• resume ventilation of patient
• observe pt. for desired effect and side effects

*generally takes 5 minutes, side effects can be nausea

Question 12

What are the 6 rights for Aspirin administration?

Answer 12

• pt. over 25 y/o with cardiac chest pain/AMI
• Acetylsalicylic acid in blister pack tablets, check expiration date
• 81 mg tablets x4 (324 mg)
• chewed up
• dose can be repeated every 3-4 hours
• right documentation (324 mg ASA administered po and chewed @ time)

Question 13

What are the six rights of administration for EPIPEN?

Answer 13

• pt. in anaphylaxis or allergic reaction
• Epi pen or Epi pen jr. autoinjector, check expiration date, should be about 18 months
• if adult is above or equal to 30 kg (66 pounds) give both adult (0.3 mg) and jr. (0.15 mg). For cardiac arrest, pt. will be given 1 mg Epi 1:10 IV or IO.
• anterolateral thigh, hold for 10 seconds
• for adults, may repeat every 10-15 minutes as needed
• right documentation

Question 14

What are the six rights of administration for nitro?

Answer 14

• used in pt. over 25 y/o or with prescribed nitro, cardiac related chest pain, pulmonary edema with systolic BP over 100, crack/cocaine OD with chest pain.
• medication will be abbreviated as NTG, called Nitrostat. Check expiration date on bottle and proper storage.
• dose is 0.4 mg tablet given sublingually every 5 min for continued chest pain up to a total of 3 tablets.
• route is sublingually
• time is a tablet can be given every 5 min of continued chest pain up to 3 tablets
• right documentation

Question 15

What are the six rights of medication administration for Mark 1 kits?

Answer 15

• to be used following atropine in organophosphate or nerve gas poisoning for civilians and EMS personnel
• medication is pralidoxime or 2-Pam, check for expiration date
• dose is 600 mg IM for both adult and pedi greater than 20 kg
• route is anterolateral aspect of thigh, hold for 10 seconds
• time is?
• right documentation

Question 16

What are the steps for the AED station?

Answer 16

• perform initial assessment of pt. LOC
• begin CPR with 100% O2 while preparing defib at a rate of 30/2. 2 minutes if unwitnessed. 100 per minute with a depth of 1/3 chest depth.
• attach AED/ turn on AED
• place defib pads on patient
• stop CPR, allow AED to analyze
• clear and shock

Resume immediately and repeat shock after another 2 minutes of CPR

Question 17

What are the first steps for acquiring a 12 lead that must be performed in the first two minutes?

Answer 17

• expose chest
• limb lead placement and placement options
• precordial lead placement with no deviation
• when to acquire according to optional standing orders

Question 18

What do you do for the hospital with suspected MI in 12 lead acquisition?

Answer 18

• notify that you or machine suspect MI
• rapid transport
• transmit EKG

Question 19

With 12 lead artifact, what could cause it and how do you correct it?

Answer 19

• skin prep/ make sure it is dry as possible
• electrode attachment/ make sure all electrodes are in correct place with firm adhesive
• patient movement/ tell patient to stay still and not talk while taking EKG
• cable movement/ stay still
• vehicle movement/ if possible acquire EKG before transport
• EMI/ ?

Question 20

What are the indications for insertion of an LMA? (1)

Answer 20

• recommended as the primary pediatric airway except in extreme cases such as airway edema
• limited to patients who need an artificial airway that are apneic and pulse less

Question 21

What are the correct LMA sizes? (2)

Answer 21

1-neonate, infant up to 11 lb/ 4 ml air 
1.5-infants up to 22 lbs/ 7 ml of air
2-infants/children (44 lbs.)/ 10 ml of air
2.5-children (66 lbs.)/ 14 ml of air
3- children (110 lbs)/ 20 ml of air
4-adults (154 lbs)/ 30 ml of air
5-adults (220 lbs)/40 ml of air
6-adults (220 lbs)/50 ml of air

Question 22

What are the rest of the steps for LMA placement? (3)

Answer 22

• check cuff by inserting air, then withdrawing
• deflate cuff so it forms a smooth “spoon” shape
• lubricate the posterior surface of the mask with a water soluble lubricant
• hold the LMA like a pen, placing index finger at the junction of the cuff and the tube
• non trauma patient: with head extended and neck flexed, carefully flatten LMA tip against the hard palate. Trauma patient: have second person maintain inline stabilization, carefully flatten LMA tip against the hard palate.
• use the index finger to push cranially, maintaining pressure on the tube with the finger
• advance the mask until definite resistance is felt at the base of the hypopharynx
• gently maintain cranial pressure with the non dominant hand while removing the index finger
• without holding the tube, inflate the cuff with just enough air to obtain a seal. Never over-inflate.
• ventilate and check for breath sounds
• confirm sufficient cuff inflation using end tidal co2. Medications can not be given via LMA