2021 EMS Protocols Flashcards
Who is allowed to deviate from the protocols?
Ems captains and Trauma hawk Personnel
In mutual aid circumstances whose protocols should be followed?
The transporting agency.
Oxygen is to be administered only when?
maintain sp02 of 95% all patients
90% for COPD and asthma.
ET tubes shall be confirmed how? 3 methods.
visualization
esophageal intubation detector (if available)
continuous EtCo2
Ventilatory rates are the following?
Adults- Pulse 1 q6
No pulse 1 q10
ICP 30-35mmhg
Pediatrics Pulse 1 q3
No Pulse 1 q6
ICP- 30-35mmHg
EtCO2 monitoring will be performed on which pts?
Respiratory distress
ventilatory support
AMS
Sedated / pain medication
seizure pts
ketamine pts
which pt’s are required to have a 12 and 15 lead performed?
chest, Arm, neck, back, jaw, shoulder, epigastric pn or discomfort
palpitations
syncope, lightheadness, general weakness, fatigue
SOB, CHF, or hypotension
unexplained diaphoresis or nausea.
12 lead cables will remain on the pt until when?
turned over the ED staff when transporting.
12 leads will be repeated how often?
q 10min
Which pt’s shall have a BGL checked?
Diabetics
AMS
seizure
stroke
syncope,
lightheadedness,
dizziness
poisoning
cardiac arrest
A complete set of v/s consists of what and done how often?
Pulse,- Rate rhythm quality
Respirations-Rate and Quality
Temp
Pulse ox
BP- cap refill
ETC02
BGL
Priority 3 - at least 2 sets
Priority 2- q 5min.
Adult hypotension is defined as?
systolic BP> 90.
When should manual BP’s be taken?
Initially and to confirm any abnormal or significant change in an automatic BP.
Pt’s that have not reached puberty shall be classified as how?
pediatric pts.
When using the Hand Tevy method, what is used for the PRIMARY reference point?
age
What type of pts’ meeting trauma alert criteria transported by AIR to St. mary’s?
Pregnant (visibly pregnant or by hx of gestation >20wks)
All intubated interfacility transfers must be ______ and ______ by the sending facility.
paralyzed and sedated.
If the sending facility physician refuses to administer paralytics for a trauma transfer then what?
Crew must contact the EMS Captain and follow the advanced A/W protocol, and accompany pt to the receiving facility.
What type of alerts go by air if ground transport is greater than what time?
40mminutes:
Decompression Sickness
STROKE
STEMI
Stroke pt with transport times greater than 20 min go where?
depends- if all other criteria are met;
1. transport time to comprehensive is > 20 min
2. onset time < 2hr
3. no tpa exclusions
4. no severe headache
Primary center, if not all met, comprehensive center.
Pediatric pts are age what?
less than 18.
Where do decompression CO, H2S and CN poisonings go?
Hyberbaric chamber @ st mary’s hospital.
Where are psychiatric pts transported?
stable- closest facility
unstable- closest ED for stabilization.
What are the criteria for someone to request a “Free Standing” ED?
Stable Patients
informed if admitted they will be transferred.
sign “Emergency Transport Disclaimer”
What are the Air Transport time criteria?
STEMI / Stroke >40min
Trauma > 25min
Extrication >15min
Response time >10min
When can air transport NOT be used?
Pt weighing > 500lbs or 227kg
Pt that cannot lay supine
combative and cannot be physically restrained
Hazmat contaminated pts
What does MICCR stand for?
Minimally Interrupted cardio-cerebral resusitation
Cardiac arrest pt’s with the use of a “Lucas” device will be placed on what?
Scoop stretcher and elevated 15 degrees.
All IVP medications for an arrest are followed by what?
10ml saline Flush
Termination efforts can be done when?
EMS captain OS
persistent asystole for 15 min
Etco2< 10mmHg
No hypothermia
1 defibrillation @ 360j.
500ml NS
All ALS interventions have been completed and reversible causes
addressed.
Social support group is in place for family if needed.
What is considered a “SECONDARY” arrest?
CHF, drowning, FBAO, OD, Hanging, lightning strike- DC current., Trauma, CN, 3rd Trimester pregnancy
When does a ResQpod get placed?
all cardiac arrest patients that are greater than 1yr old.
What are the contraindications for the “ResQpod”
Pt less than 1 yr old
Pt’s with a pulse
Cardiac arrest due to trauma
during passive oxygenation
If a rhythm converts back after electrical therapy was used what setting should be used ?
the setting that was successful in converting the rhythm.
Medications should be delivered when in cardiac arrest ?
ASAP after rhythm check and circulated for 2 min
What is the dose of MGSO4 in Torsades?
adults- 2g in 50 ml 60gtts wide open
pedi- 40mg/kg in 50ml 60gtts wide open
primary and secondary arrest pt’s go to which facilites?
primary- STEMI facility
secondary- Closest faclility
Spinal motion restriction for what criteria?
focal neurologic deficit
pain to the neck or back
distracting injury
AMS w/ an MOI
intoxication w/ MOI
Sager splints are used on what type fx?
Closed Mid shaft femur only
What are the oral hypoglycemic medications
Glipizide, Glyburide, Glimepiride
indications for Hyperkalemia for CaCl2?
Peaked T waves
Sine wave
Wide complex QRS
RRWCT
severe bradycardia
high degree blocks
it is more important to maintain what levels for COPD and asthma patients?
SPo2 at 90%
Auto PEEP is what?
When Air goes in before a patient is allowed to exhale.
Differences in Croup and Epiglottitis?
Chonic vs Acute
sick for a few days vs Sudden onset
low grade fever vs high grade fever
not toxic looking vs drooling and tripod
Ketamine for seizures is what and what contraindications?
Adults :100mg- pregnancy
penetrating eye
non traumatic chest pain
Pedi >3yrs: 1mg/kg
Sepsis alert criteria?
Adult not pregnant
suspected or documented infection
Hypotension
AMS
Tachypnea - RR>22 or ETco2 < 25mmHg
Which patients receive fluids despite having rales?
Septic pneumonia patients
What is the tine frame for not considering a stroke not an Alert
Witnessed greater than 24 hours
What are the precautions with Ketamine in seizure patients?
Respiratory distress- need for an advanced airway
HTN
Schiziophrenia
What is the criteria for unstable Afib/ flutter
Hypotension only
Bradycardia is defined as?
< 50 BPM
Unstable bradycardia is defined as?
Adult: >50 BPM w. hypotension
Pedi: >50 w/ AMS and age hypotension
For both adult and peds with pacing, what can be given if normotensive and no IV?
Versed- 5mg IN/IM only
0.2mg/kg IN/IM only
Pacing for a peds starts at what?
80 BPM
What is the initial treatment for bradycardia in peds?
Oxygenation / Ventilation
Neonate: 1 q 3 for 30 sec
Infant: 1 q 3 for 1 min
Which extremity is to be avoided with vascular access in chest pain?
Right hand and wrist.
STEMI alert criteria?
2mm elevation smiley face concave in any leads
2mm elevation frown face convex on V2 and V3
1mm elevation frown face convex in any leads
What are STEMI disqualifiers?
LBBB
LVH
Early Repolarization
Pacemaker with QRS > .12
When does NTG get withheld in CHF patients?
febrile patients or nursing home with pneumonia
Stable SVT treatment is?
Adults 12mg Adenosine
Pedi- 0.2mg Adenosine
Unstable SVT treatment is ?
AMS-
Adult 100, 200, 300, 360J
Pedi: 0.5J/kg and 2J/kg
Vtach is defined as?
No p waves
QRS > .12
Concordance in all leads
Neg QRS V6
Neg in 2, 2, AVF and positive in AVL, and AVR
Vtach stable treatment?
Adult : Amiodarone 150mg in 50 15gtts
Pedi: 5mg/kg in 50 15 gtts
Unstable Vtach
Adult : Cardio version 100, 200, 300. 360J
Pedi : 0.5J/kg and 2j/kg
What makes a Vtach patient unstable?
Contraindications to Amiodarone:
Sinus bradycardia
2/3 degree blocks
cardiogenic shock
hypotension
QTC >500
RRWCT is defined as?
> 0.20 or 5 boxes
Treatment for RRWCT is?
Stable :Adult 1g cacl2
100mg bicarb
Pedi: 20mg/kg cacl2
1meq/kg bicarb
What makes RRWCT unstable ?
hypotension
Torsades de point stable treatment?
2g mgso4 in 50 60gtts
Pedi : 40mg in 50 60gtts
Torsades de point unstable is defined as and treated how?
Hypotension:
defib 200, 300, 360
defib 2J/kg and 4J/kg
AEIOU TIPS ?
Alcohol, Epilepsy, Insulin, OD, underdose
Trauma, infection, pyschosis, stroke
Compressions for an LVAD device are ?
Not using the LUCAS
The Right of the sternum.
LVAD patients go to which facility
JFK
Treatment for an LVAD ?
locate emergency bag
take all equipment to ER
verify device is working by lack of pulse or measurable BP.
LIsten for continuous humming.
Hypotensive Fluids 1L
Compressions if unresponsive and unable to restart device or not working.
which cardiac arrest patients MUST be transported
Witnesed
What are the determination of death criteria
- Lividity
- Rigor mortis
- tissue decomposition
- Valid DNRO
What if the death criteria are not there what can be used?
Known down time of >30min
Apneic
Without mechanism for Hypothermia
Asystolic
Fixed and dilated pupils
Electrocution and LIghtning strikes are what type of arrests
Primary b/c of A/C current
Secondary due to DC current
When can an arrest be called?
EMS captain on scene
persisent asystole for >15min
ALS interventions
Etco2< 10
H and T’s or reversible causes treated
1 defib
500 ml NS
Normothermic
support group
What are four protocols where on 500ml NS are used?
Decompression sickness
Calling an arrest.
2nd > 15% or 3rd > 5% degree burns
Hyperkalemia
What is the o2 setting for initial arrest
8L/min for 6 min on oxygen port
What are the amiodarone contraindications
Qtc >500
Blocks
Bradycardia
Hypotension
cardiogenic shock
What type of arrest is a third trimester female considered?
Secondary - and displace the uterus to the left
All drug overdoses are treated as what type of arrest with the exception of?
All OD’s except for Cocaine
What are the indications for Esmolol and doses?
Immediately after Double sequential
40 mg IV/IO initially over 1 min
Then:
60mg on 15gtts over 10min 1,25gtts/sec
What type of arrests are to be transported to a trauma center?
Electrouctions and lighning strikes
Adult Cocaine OD get treated with what?
Versed
Pedi cocaine OD get treated with what?
Versed
What are the criteria to administer narcan?
RR below 10
Etco2 >45
02 sat < 92%
if not meeting above Supplemental 02 or BVM 2 min
Mad as a hatter
Red as a beet
Dry as bone refer to S/S of ?
TCA OD
What must TCA ODs be treated with immediately ?
Sodium Bicarb
What are the special populations for Ketamine and the dose?
Age 65 and older
<50kg
Head trauma
Already took sedatives
200mg
What is the sequence for Combative pts and Ketamina
400mg IM
BVM or supplemental 02 for Laryngospasms
0.5mg Atropine for Salivations x3
Ice packs, 1L cold saline and 100meq Sodium Bicarb
How long does Lidocaine dwell in an IO for an adult?
1min
Pedi Ketamine for pain is indicated for what age and pain scale?
< 3 yrs and 7 or greater pain
Lidocaine in an IO for pedi dwell?
1 min
What is the time frame for decompression sickness?
48 hours
How much NS admin for Decompression sickness?
500ml
When treating Heat stroke?
Cool First, transport second
Heat stroke is classified as ?
Temp > 103 or AMS
CO poisoning is at what level?
35ppm
Who carries a rainbow sensor ?
EMS captains and SPLOPS
If SPCO is above what %?
>20%
The cyano kit uses how much? at what rate?
5g diluted in 200ml and at 5 gtts/sec
What does the MARCH acronym mean?
Massive hemorrage
Airway control
Respiratory
Circulation
Head injury / Hypothermia
FAST ultrsound is done for
Blunt or penetrating trauma the ABD or thorax
Undifferentiated hypotension in trauma
FAST ultrasounds can be performed to identify?
Intrabdominal hemorrage
Intrathoracic hemorrage
pericardial hemorrage
PEA motion
For Trauma patients not to be resuscitated what criteria is needed?
Apneic
Fixed dialted pupils
asystole
NEED ALL 3
or injuries incompatible with life
PEA is defined as?
an organized rhythm > 20 BPM
When does bilateral decompression get performed?
Arrest due to penetrating chest trauma
Ultrasunds in traumatic arrests are done when?
observation of cardiac motion in PEA
Finger Thoracostomy is done when ?
known or suspected injury to the chest and or abd
Contraindications for Finger Thoracostomy?
Unwitnessed arrest with blunt trauma
Devestating head trauma
loss of Cardiac output > 10 min
Jump start triage initial is ?
Breathing NO- open A/W - breathing - IMMEDIATE
Breathing NO- open A/W - NO PULSE - DECEASED
Breathing NO-open A/W- Pulse - 5 breaths-no- DECEASED
Breathing NO- open A/W- Pulse- 5 breaths- Yes- IMMEDIATE
Breathing YES- <15 or >45- IMMEDIATE
The “ P” in Jump start triage means what ?
posturing
what is Trauma alert criteria for peds with BP?
< 50
Flail chest sis defined?
2 or more adjacent ribs are fractured
Criteria for chest decompression
Absent or diminshed LS
BP< 90
Respiratory distress or difficulty with BVM
What is the primary site for chest decompression?
5th intercostal space mid axillary
What is the secondary site for chest decompression
2 or 3 rd intercostal space mid clavicular
Intercrainial pressure and herniation signs are?
GCS decline of 2 or more points
sluggish or non reactive pupil
Paralysis or weakness on 1 side of the body
Cushings Triad
Adult BP maintain BP for Head injuries is what?
SBP 110-120
Head injuries ETCO2 is?
30-35mmhg
How many attempts to realign for anatomical position
2
What are the contraindications for Ceftriaxone or rocephin?
Allergy to cephalosporins
Neonates birth to 30 days
Pregnant 3rd trimester trauma alerts get transported how?
Left side, 4-6 inches of padding to Right side
Maintain BP for peripheral pulses
Gravida and Para definitions
Gravida- previous pregnancies
Para- Number of Live births
1st and 2nd trimester complications include?
Ectopic
Spontaneous
bleeding
hypotensive
3rd Trimester complications include
Placenta previa-painless vaginal bleeding bright red
Abrupto PLacenta-severe pain sudden onset
Uterine rupture- - intense abd pain and Vaginal bledding
Preeclampsia is defined as?
SBP >160 DSP > 110 with :
AMS
Headache
Visual disturbances
PE
Eclampsia is defined as ?
S/S of pre + seizures or coma
When can you insert a gloved hand into the vagina for a birth?
Breech birth
Prolapsed cord
Time for Breech birth actions
if not delivered in 3 minutes
Who’s responsibility is it to assign a safety officer?
IC
All safety officers will have the authority to ?
Identify and correct safety and heath hazards
To alter,suspend, or terminate un -safe acts that involve an imminent hazard to personnel
Inform the IC of the 2 items above
A safety office should have a working knowledge of what?
Safety concerns for fire rescue in typical incidents
Fire behavior
Building construction
EMS
Only those person who have completed and approved Incident safety officer course ________ be used as a safety officer.
SHOULD
How much can a pregnant female lose with regards to blood volume?
30-35%
During pregnancy what is the possibe BP drop?
5-15mmhg.
What type of communication is to be used with a second paramedic to ensure proper drug dose?
closed loop communication
what are the sites for IO insertion for an adult and pediatric?
proximal humorous
Proximal Tibia
distal tibia
PEDI: All of the above and Distal Femur.
what is the preferred access fo r pediatrics in cardiac arrest?
IO
for the hx taking in an assessment what pneumoic is used?
OPPPQRSTA
what is the goal for maninging overdose and poisoning pts?
Support ABCs
Terminate arrhymthmmias
Terminate seizures
reverse effects with antidotes or medication
what classes of medications are responsible for dystonic reactions?
antipsychotics
antiemetics
Antidepressants
What are the APGAR score interpretations?
0-3 severe
4-6- Moderate
7-10- excellent
advanced a/w procedures shall be considered for which patients with respiratory involvement?
hoarse voice,
Singed nose hairs
carbonaceous sputum in nose or mouth
stridor
Facial burns
Infants are evaluated when in JUMP start ?
in secondary triage
what is to be documented in the medical report upon administration of Ketamine per the memo?
Correct dose
high flow 02 15L/min
IV after sedation
Cardiac monitor
12/15 lead
Continous SP02
Continous Etc02
BGL
Respiratory rate
temp
minimum 2 sets V/S
GCS w/ V/S
AVPU w/ GCS
What information should be obtained on a dive hx with decompression sickness ?
Depth of dives
Air mixture
Number of dives
What range can the HR be above in Third Trimester pregnancies?
15-20 BPM
Grey Turners sign is?
ecchymosis of the flanks
when can a patient be assisted with an epi pen ?
a/w swelling
respiratrory distress
bronchospasm
tounge or facail swelling
loss of a radial pulse
pedatric age classifications are?
Neonates: birth to 1month
infancts: 1 month to 1 year
children: 1 year to puberty
SAMPLE stand for:
S/S
Allergies
medications
last oral intake
events preceeding
If a 2nd TQ does not stop the bleeding what is the next step?
Celox rapid for 2 minute.
Marine animal stings gets rinsed with what type of water?
Sea water
snake bites what should be documented?
picture of the head including the eyes
benadryl is to be administered over what period of time for IV/IO use?
2min
All medications are administered with the exception of adenosine over 2 minutes or greater. Which one is adminstered in less time?
Push pressor epi 1 min/ ml
ASA is contraindicated at what age?
< 16 years old
How long should a burn be cooled for and what type of liquid?
2min and NS
1st, 2nd degree burns > 15% TBSA or 3rd < 5% get what type of dressing?
Dry sterile
2nd degree burns > 15% TBSA and 3rd > 5% get what type of dressing?
Burn Sheet
Head injured patients mortality rates increases by what percent with a single instance of hypotension?
150%
What pregnant trauma patients are required to have 02?
All 3rd Trimester
