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EMS captain > 2021 EMS Protocols > Flashcards

2021 EMS Protocols Flashcards

1
Q

Who is allowed to deviate from the protocols?

A

Ems captains and Trauma hawk Personnel

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2
Q

In mutual aid circumstances whose protocols should be followed?

A

The transporting agency.

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3
Q

Oxygen is to be administered only when?

A

maintain sp02 of 95% all patients
90% for COPD and asthma.

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4
Q

ET tubes shall be confirmed how? 3 methods.

A

visualization
esophageal intubation detector (if available)
continuous EtCo2

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5
Q

Ventilatory rates are the following?

A

Adults- Pulse 1 q6
No pulse 1 q10
ICP 30-35mmhg
Pediatrics Pulse 1 q3
No Pulse 1 q6
ICP- 30-35mmHg

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6
Q

EtCO2 monitoring will be performed on which pts?

A

Respiratory distress

ventilatory support
AMS
Sedated / pain medication
seizure pts
ketamine pts

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7
Q

which pt’s are required to have a 12 and 15 lead performed?

A

chest, Arm, neck, back, jaw, shoulder, epigastric pn or discomfort
palpitations
syncope, lightheadness, general weakness, fatigue
SOB, CHF, or hypotension
unexplained diaphoresis or nausea.

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8
Q

12 lead cables will remain on the pt until when?

A

turned over the ED staff when transporting.

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9
Q

12 leads will be repeated how often?

A

q 10min

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10
Q

Which pt’s shall have a BGL checked?

A

Diabetics
AMS
seizure
stroke
syncope,
lightheadedness,
dizziness
poisoning
cardiac arrest

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11
Q

A complete set of v/s consists of what and done how often?

A

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.

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12
Q

Adult hypotension is defined as?

A

systolic BP> 90.

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13
Q

When should manual BP’s be taken?

A

Initially and to confirm any abnormal or significant change in an automatic BP.

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14
Q

Pt’s that have not reached puberty shall be classified as how?

A

pediatric pts.

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15
Q

When using the Hand Tevy method, what is used for the PRIMARY reference point?

A

age

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16
Q

What type of pts’ meeting trauma alert criteria transported by AIR to St. mary’s?

A

Pregnant (visibly pregnant or by hx of gestation >20wks)

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17
Q

All intubated interfacility transfers must be ______ and ______ by the sending facility.

A

paralyzed and sedated.

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18
Q

If the sending facility physician refuses to administer paralytics for a trauma transfer then what?

A

Crew must contact the EMS Captain and follow the advanced A/W protocol, and accompany pt to the receiving facility.

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19
Q

What type of alerts go by air if ground transport is greater than what time?

A

40mminutes:
Decompression Sickness
STROKE
STEMI

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20
Q

Stroke pt with transport times greater than 20 min go where?

A

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.

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21
Q

Pediatric pts are age what?

A

less than 18.

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22
Q

Where do decompression CO, H2S and CN poisonings go?

A

Hyberbaric chamber @ st mary’s hospital.

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23
Q

Where are psychiatric pts transported?

A

stable- closest facility
unstable- closest ED for stabilization.

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24
Q

What are the criteria for someone to request a “Free Standing” ED?

A

Stable Patients
informed if admitted they will be transferred.
sign “Emergency Transport Disclaimer”

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25
Q

What are the Air Transport time criteria?

A

STEMI / Stroke >40min
Trauma > 25min
Extrication >15min
Response time >10min

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26
Q

When can air transport NOT be used?

A

Pt weighing > 500lbs or 227kg
Pt that cannot lay supine
combative and cannot be physically restrained
Hazmat contaminated pts

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27
Q

What does MICCR stand for?

A

Minimally Interrupted cardio-cerebral resusitation

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28
Q

Cardiac arrest pt’s with the use of a “Lucas” device will be placed on what?

A

Scoop stretcher and elevated 15 degrees.

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29
Q

All IVP medications for an arrest are followed by what?

A

10ml saline Flush

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30
Q

Termination efforts can be done when?

A

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.

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31
Q

What is considered a “SECONDARY” arrest?

A

CHF, drowning, FBAO, OD, Hanging, lightning strike- DC current., Trauma, CN, 3rd Trimester pregnancy

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32
Q

When does a ResQpod get placed?

A

all cardiac arrest patients that are greater than 1yr old.

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33
Q

What are the contraindications for the “ResQpod”

A

Pt less than 1 yr old
Pt’s with a pulse
Cardiac arrest due to trauma
during passive oxygenation

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34
Q

If a rhythm converts back after electrical therapy was used what setting should be used ?

A

the setting that was successful in converting the rhythm.

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35
Q

Medications should be delivered when in cardiac arrest ?

A

ASAP after rhythm check and circulated for 2 min

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36
Q

What is the dose of MGSO4 in Torsades?

A

adults- 2g in 50 ml 60gtts wide open
pedi- 40mg/kg in 50ml 60gtts wide open

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37
Q

primary and secondary arrest pt’s go to which facilites?

A

primary- STEMI facility
secondary- Closest faclility

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38
Q

Spinal motion restriction for what criteria?

A

focal neurologic deficit
pain to the neck or back
distracting injury
AMS w/ an MOI
intoxication w/ MOI

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39
Q

Sager splints are used on what type fx?

A

Closed Mid shaft femur only

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40
Q

What are the oral hypoglycemic medications

A

Glipizide, Glyburide, Glimepiride

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41
Q

indications for Hyperkalemia for CaCl2?

A

Peaked T waves
Sine wave
Wide complex QRS
RRWCT
severe bradycardia
high degree blocks

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42
Q

it is more important to maintain what levels for COPD and asthma patients?

A

SPo2 at 90%

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43
Q

Auto PEEP is what?

A

When Air goes in before a patient is allowed to exhale.

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44
Q

Differences in Croup and Epiglottitis?

A

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

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45
Q

Ketamine for seizures is what and what contraindications?

A

Adults :100mg- pregnancy
penetrating eye
non traumatic chest pain
Pedi >3yrs: 1mg/kg

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46
Q

Sepsis alert criteria?

A

Adult not pregnant
suspected or documented infection
Hypotension
AMS
Tachypnea - RR>22 or ETco2 < 25mmHg

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47
Q

Which patients receive fluids despite having rales?

A

Septic pneumonia patients

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48
Q

What is the tine frame for not considering a stroke not an Alert

A

Witnessed greater than 24 hours

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49
Q

What are the precautions with Ketamine in seizure patients?

A

Respiratory distress- need for an advanced airway
HTN
Schiziophrenia

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50
Q

What is the criteria for unstable Afib/ flutter

A

Hypotension only

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51
Q

Bradycardia is defined as?

A

< 50 BPM

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52
Q

Unstable bradycardia is defined as?

A

Adult: >50 BPM w. hypotension
Pedi: >50 w/ AMS and age hypotension

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53
Q

For both adult and peds with pacing, what can be given if normotensive and no IV?

A

Versed- 5mg IN/IM only
0.2mg/kg IN/IM only

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54
Q

Pacing for a peds starts at what?

A

80 BPM

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55
Q

What is the initial treatment for bradycardia in peds?

A

Oxygenation / Ventilation
Neonate: 1 q 3 for 30 sec
Infant: 1 q 3 for 1 min

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56
Q

Which extremity is to be avoided with vascular access in chest pain?

A

Right hand and wrist.

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57
Q

STEMI alert criteria?

A

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

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58
Q

What are STEMI disqualifiers?

A

LBBB
LVH
Early Repolarization
Pacemaker with QRS > .12

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59
Q

When does NTG get withheld in CHF patients?

A

febrile patients or nursing home with pneumonia

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60
Q

Stable SVT treatment is?

A

Adults 12mg Adenosine
Pedi- 0.2mg Adenosine

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61
Q

Unstable SVT treatment is ?

A

AMS-
Adult 100, 200, 300, 360J
Pedi: 0.5J/kg and 2J/kg

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62
Q

Vtach is defined as?

A

No p waves
QRS > .12
Concordance in all leads
Neg QRS V6
Neg in 2, 2, AVF and positive in AVL, and AVR

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63
Q

Vtach stable treatment?

A

Adult : Amiodarone 150mg in 50 15gtts
Pedi: 5mg/kg in 50 15 gtts

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64
Q

Unstable Vtach

A

Adult : Cardio version 100, 200, 300. 360J
Pedi : 0.5J/kg and 2j/kg

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65
Q

What makes a Vtach patient unstable?

A

Contraindications to Amiodarone:
Sinus bradycardia
2/3 degree blocks
cardiogenic shock
hypotension
QTC >500

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66
Q

RRWCT is defined as?

A

> 0.20 or 5 boxes

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67
Q

Treatment for RRWCT is?

A

Stable :Adult 1g cacl2
100mg bicarb
Pedi: 20mg/kg cacl2
1meq/kg bicarb

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68
Q

What makes RRWCT unstable ?

A

hypotension

69
Q

Torsades de point stable treatment?

A

2g mgso4 in 50 60gtts
Pedi : 40mg in 50 60gtts

70
Q

Torsades de point unstable is defined as and treated how?

A

Hypotension:
defib 200, 300, 360
defib 2J/kg and 4J/kg

71
Q

AEIOU TIPS ?

A

Alcohol, Epilepsy, Insulin, OD, underdose
Trauma, infection, pyschosis, stroke

72
Q

Compressions for an LVAD device are ?

A

Not using the LUCAS
The Right of the sternum.

73
Q

LVAD patients go to which facility

A

JFK

74
Q

Treatment for an LVAD ?

A

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.

75
Q

which cardiac arrest patients MUST be transported

A

Witnesed

76
Q

What are the determination of death criteria

A
  1. Lividity
  2. Rigor mortis
  3. tissue decomposition
  4. Valid DNRO
77
Q

What if the death criteria are not there what can be used?

A

Known down time of >30min
Apneic
Without mechanism for Hypothermia
Asystolic
Fixed and dilated pupils

78
Q

Electrocution and LIghtning strikes are what type of arrests

A

Primary b/c of A/C current
Secondary due to DC current

79
Q

When can an arrest be called?

A

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

80
Q

What are four protocols where on 500ml NS are used?

A

Decompression sickness
Calling an arrest.
2nd > 15% or 3rd > 5% degree burns

Hyperkalemia

81
Q

What is the o2 setting for initial arrest

A

8L/min for 6 min on oxygen port

82
Q

What are the amiodarone contraindications

A

Qtc >500
Blocks
Bradycardia
Hypotension
cardiogenic shock

83
Q

What type of arrest is a third trimester female considered?

A

Secondary - and displace the uterus to the left

84
Q

All drug overdoses are treated as what type of arrest with the exception of?

A

All OD’s except for Cocaine

85
Q

What are the indications for Esmolol and doses?

A

Immediately after Double sequential
40 mg IV/IO initially over 1 min
Then:
60mg on 15gtts over 10min 1,25gtts/sec

86
Q

What type of arrests are to be transported to a trauma center?

A

Electrouctions and lighning strikes

87
Q

Adult Cocaine OD get treated with what?

A

Versed

88
Q

Pedi cocaine OD get treated with what?

A

Versed

89
Q

What are the criteria to administer narcan?

A

RR below 10
Etco2 >45
02 sat < 92%
if not meeting above Supplemental 02 or BVM 2 min

90
Q

Mad as a hatter
Red as a beet
Dry as bone refer to S/S of ?

A

TCA OD

91
Q

What must TCA ODs be treated with immediately ?

A

Sodium Bicarb

92
Q

What are the special populations for Ketamine and the dose?

A

Age 65 and older
<50kg
Head trauma
Already took sedatives
200mg

93
Q

What is the sequence for Combative pts and Ketamina

A

400mg IM
BVM or supplemental 02 for Laryngospasms
0.5mg Atropine for Salivations x3
Ice packs, 1L cold saline and 100meq Sodium Bicarb

94
Q

How long does Lidocaine dwell in an IO for an adult?

A

1min

95
Q

Pedi Ketamine for pain is indicated for what age and pain scale?

A

< 3 yrs and 7 or greater pain

96
Q

Lidocaine in an IO for pedi dwell?

A

1 min

97
Q

What is the time frame for decompression sickness?

A

48 hours

98
Q

How much NS admin for Decompression sickness?

A

500ml

99
Q

When treating Heat stroke?

A

Cool First, transport second

100
Q

Heat stroke is classified as ?

A

Temp > 103 or AMS

101
Q

CO poisoning is at what level?

A

35ppm

102
Q

Who carries a rainbow sensor ?

A

EMS captains and SPLOPS

103
Q

If SPCO is above what %?

A

>20%

104
Q

The cyano kit uses how much? at what rate?

A

5g diluted in 200ml and at 5 gtts/sec

105
Q

What does the MARCH acronym mean?

A

Massive hemorrage
Airway control
Respiratory
Circulation
Head injury / Hypothermia

106
Q

FAST ultrsound is done for

A

Blunt or penetrating trauma the ABD or thorax
Undifferentiated hypotension in trauma

107
Q

FAST ultrasounds can be performed to identify?

A

Intrabdominal hemorrage
Intrathoracic hemorrage
pericardial hemorrage
PEA motion

108
Q

For Trauma patients not to be resuscitated what criteria is needed?

A

Apneic
Fixed dialted pupils
asystole
NEED ALL 3
or injuries incompatible with life

109
Q

PEA is defined as?

A

an organized rhythm > 20 BPM

110
Q

When does bilateral decompression get performed?

A

Arrest due to penetrating chest trauma

111
Q

Ultrasunds in traumatic arrests are done when?

A

observation of cardiac motion in PEA

112
Q

Finger Thoracostomy is done when ?

A

known or suspected injury to the chest and or abd

113
Q

Contraindications for Finger Thoracostomy?

A

Unwitnessed arrest with blunt trauma
Devestating head trauma
loss of Cardiac output > 10 min

114
Q

Jump start triage initial is ?

A

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

115
Q

The “ P” in Jump start triage means what ?

A

posturing

116
Q

what is Trauma alert criteria for peds with BP?

A

< 50

117
Q

Flail chest sis defined?

A

2 or more adjacent ribs are fractured

118
Q

Criteria for chest decompression

A

Absent or diminshed LS
BP< 90
Respiratory distress or difficulty with BVM

119
Q

What is the primary site for chest decompression?

A

5th intercostal space mid axillary

120
Q

What is the secondary site for chest decompression

A

2 or 3 rd intercostal space mid clavicular

121
Q

Intercrainial pressure and herniation signs are?

A

GCS decline of 2 or more points
sluggish or non reactive pupil
Paralysis or weakness on 1 side of the body
Cushings Triad

122
Q

Adult BP maintain BP for Head injuries is what?

A

SBP 110-120

123
Q

Head injuries ETCO2 is?

A

30-35mmhg

124
Q

How many attempts to realign for anatomical position

A

2

125
Q

What are the contraindications for Ceftriaxone or rocephin?

A

Allergy to cephalosporins
Neonates birth to 30 days

126
Q

Pregnant 3rd trimester trauma alerts get transported how?

A

Left side, 4-6 inches of padding to Right side
Maintain BP for peripheral pulses

127
Q

Gravida and Para definitions

A

Gravida- previous pregnancies
Para- Number of Live births

128
Q

1st and 2nd trimester complications include?

A

Ectopic
Spontaneous
bleeding
hypotensive

129
Q

3rd Trimester complications include

A

Placenta previa-painless vaginal bleeding bright red
Abrupto PLacenta-severe pain sudden onset
Uterine rupture- - intense abd pain and Vaginal bledding

130
Q

Preeclampsia is defined as?

A

SBP >160 DSP > 110 with :
AMS
Headache
Visual disturbances
PE

131
Q

Eclampsia is defined as ?

A

S/S of pre + seizures or coma

132
Q

When can you insert a gloved hand into the vagina for a birth?

A

Breech birth
Prolapsed cord

133
Q

Time for Breech birth actions

A

if not delivered in 3 minutes

134
Q
A
135
Q

Who’s responsibility is it to assign a safety officer?

A

IC

136
Q

All safety officers will have the authority to ?

A

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

137
Q

A safety office should have a working knowledge of what?

A

Safety concerns for fire rescue in typical incidents
Fire behavior
Building construction
EMS

138
Q

Only those person who have completed and approved Incident safety officer course ________ be used as a safety officer.

A

SHOULD

139
Q

How much can a pregnant female lose with regards to blood volume?

A

30-35%

140
Q

During pregnancy what is the possibe BP drop?

A

5-15mmhg.

141
Q

What type of communication is to be used with a second paramedic to ensure proper drug dose?

A

closed loop communication

142
Q

what are the sites for IO insertion for an adult and pediatric?

A

proximal humorous

Proximal Tibia

distal tibia

PEDI: All of the above and Distal Femur.

143
Q

what is the preferred access fo r pediatrics in cardiac arrest?

A

IO

144
Q

for the hx taking in an assessment what pneumoic is used?

A

OPPPQRSTA

145
Q

what is the goal for maninging overdose and poisoning pts?

A

Support ABCs

Terminate arrhymthmmias

Terminate seizures

reverse effects with antidotes or medication

146
Q

what classes of medications are responsible for dystonic reactions?

A

antipsychotics

antiemetics

Antidepressants

147
Q

What are the APGAR score interpretations?

A

0-3 severe

4-6- Moderate

7-10- excellent

148
Q

advanced a/w procedures shall be considered for which patients with respiratory involvement?

A

hoarse voice,

Singed nose hairs

carbonaceous sputum in nose or mouth

stridor

Facial burns

149
Q

Infants are evaluated when in JUMP start ?

A

in secondary triage

150
Q

what is to be documented in the medical report upon administration of Ketamine per the memo?

A

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

151
Q

What information should be obtained on a dive hx with decompression sickness ?

A

Depth of dives

Air mixture

Number of dives

152
Q

What range can the HR be above in Third Trimester pregnancies?

A

15-20 BPM

153
Q

Grey Turners sign is?

A

ecchymosis of the flanks

154
Q

when can a patient be assisted with an epi pen ?

A

a/w swelling

respiratrory distress

bronchospasm

tounge or facail swelling

loss of a radial pulse

155
Q

pedatric age classifications are?

A

Neonates: birth to 1month

infancts: 1 month to 1 year
children: 1 year to puberty

156
Q

SAMPLE stand for:

A

S/S

Allergies

medications

last oral intake

events preceeding

157
Q

If a 2nd TQ does not stop the bleeding what is the next step?

A

Celox rapid for 2 minute.

158
Q

Marine animal stings gets rinsed with what type of water?

A

Sea water

159
Q

snake bites what should be documented?

A

picture of the head including the eyes

160
Q

benadryl is to be administered over what period of time for IV/IO use?

A

2min

161
Q

All medications are administered with the exception of adenosine over 2 minutes or greater. Which one is adminstered in less time?

A

Push pressor epi 1 min/ ml

162
Q

ASA is contraindicated at what age?

A

< 16 years old

163
Q

How long should a burn be cooled for and what type of liquid?

A

2min and NS

164
Q

1st, 2nd degree burns > 15% TBSA or 3rd < 5% get what type of dressing?

A

Dry sterile

165
Q

2nd degree burns > 15% TBSA and 3rd > 5% get what type of dressing?

A

Burn Sheet

166
Q

Head injured patients mortality rates increases by what percent with a single instance of hypotension?

A

150%

167
Q

What pregnant trauma patients are required to have 02?

A

All 3rd Trimester

168
Q
A

EMS captain (25 decks)

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