2021 EMS Protocols Flashcards
Who is authorized to make changes to protocols?
the medical director for palm beach county fire rescue.
What are the goals of the protocols?
to provide rapid assessment, stabilization, and transportation to the appropriate care facility.
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- 30-35mmHgEtCO2 monitoring will be performed on which pts?
Respiratory distress AMS Sedated / pain medication seizure pts ketamine pts
how will etco2 be monitored in that are not unresponsive?
etco2 nasal cannula device
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 should an IO be done?
For serious medical pts where IV access cannot be obtained
2 attempts or 90 sec.
A king airway is for use in which pts?
pediatric pts 2yr and above.
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
What Etco2 level must be maintained in cardiac arrest?
at least 10mmHg
What is the “optimal” Etco2 level in cardiac arrest?
20mmHg.
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
Compressions should continue in cardiac arrest until when?
the defibrillator os charged and ready to deliver energy
If a rhythm converts back after electrical therapy was used what setting should be used ?
the setting that was successful in converting the rhythm.
What is the sequence in an arrest?
compressions, rhythm check, defibrillation/ medication admin.
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
What are the steps for post resuscitation for pediatrics?
HR < 60: oxygenation and ventilation for 1 min
{30 sec for Neonate}
If HR remains <60 p 1min begin CPR
{30 sec for Neonate}
If HR remains<60 p CPR : Epi 1:10000 @ 0.01mg/kg q 3-5min
What are the pediatric minimum BP’s?
Neonate: 60mmHg
Infant : 70mmHg
Child 1-10 Age x2 plus 70
Child >10 90mmHg
Induced Cooling indications are?
Arrest pts who have ROSC and remain unresponsive to pain
Drowning w/ no suspected trauma
18 yrs and older
Induced ICE contraindications?
Arrest due to trauma
Arrest due to non-traumatic hemorage
unable to secure airway with either ET or king airway
Pregnancy
What are the fluid requirements for ICE?
30ml/kg to max of 2L in 500ml incriments
Renal/ dialysis, CHF- 500ml. repeat 1x for hypotension.
