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EMS captain > 2021 EMS Protocols bottom top > Flashcards

2021 EMS Protocols bottom top Flashcards

1
Q

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

A

OPPPQRSTA

Pallative
provoke
previous

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2
Q

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

A

IO

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3
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.

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4
Q

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

A

closed loop communication

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5
Q

During pregnancy what is the possibe BP drop?

A

5-15mmhg.

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6
Q

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

A

30-35%

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7
Q

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

A

SHOULD

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8
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

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9
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

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10
Q

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

A

IC

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11
Q

Time for Breech birth actions

A

if not delivered in 3 minutes

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12
Q

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

A

Breech birth
Prolapsed cord

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13
Q

Eclampsia is defined as ?

A

S/S of pre + seizures or coma

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14
Q

Preeclampsia is defined as?

A

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

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15
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

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16
Q

1st and 2nd trimester complications include?

A

Ectopic
Spontaneous
bleeding
hypotensive

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17
Q

Gravida and Para definitions

A

Gravida- previous pregnancies
Para- Number of Live births

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18
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

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19
Q

What are the contraindications for Ceftriaxone or rocephin?

A

Allergy to cephalosporins
Neonates birth to 30 days

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20
Q

How many attempts to realign for anatomical position

A

2

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21
Q

Head injuries ETCO2 is?

A

30-35mmhg

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22
Q

Adult BP maintain BP for Head injuries is what?

A

SBP 110-120

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23
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

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24
Q

What is the secondary site for chest decompression

A

2 or 3 rd intercostal space mid clavicular

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25
Q

What is the primary site for chest decompression?

A

5th intercostal space mid axillary

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26
Q

Criteria for chest decompression

A

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

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27
Q

Flail chest sis defined?

A

2 or more adjacent ribs are fractured

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28
Q

what is Trauma alert criteria for peds with BP?

A

< 50

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29
Q

The “ P” in Jump start triage means what ?

A

posturing

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30
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

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31
Q

Contraindications for Finger Thoracostomy?

A

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

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32
Q

Finger Thoracostomy is done when ?

A

known or suspected injury to the chest and or abd

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33
Q

Ultrasunds in traumatic arrests are done when?

A

observation of cardiac motion in PEA

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34
Q

When does bilateral decompression get performed?

A

Arrest due to penetrating chest trauma

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35
Q

PEA is defined as?

A

an organized rhythm > 20 BPM

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36
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

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37
Q

FAST ultrasounds are used to identify?

A

Intrabdominal hemorrage
Intrathoracic hemorrage
pericardial hemorrage
PEA motion

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38
Q

FAST ultrsound can be performed during transport for the following injuries?

A

Blunt ABD and thorax trauma

penetrating ABD and thborax traum

Undifferentiated hypotension in trauma

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39
Q

What does the MARCH acronym mean?

A

Massive hemorrage
Airway control
Respiratory
Circulation
Head injury / Hypothermia

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40
Q

The cyano kit uses how much? at what rate?

A

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

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41
Q

If SPCO is above what %?

A

>20%

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42
Q

Who carries a rainbow sensor ?

A

EMS captains and SPLOPS

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43
Q

CO poisoning is at what level?

A

35ppm

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44
Q

Heat stroke is classified as ?

A

Temp > 103 or AMS

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45
Q

When treating Heat stroke?

A

Cool First, transport second

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46
Q

How much NS admin for Decompression sickness?

A

500ml

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47
Q

What is the time frame for decompression sickness?

A

48 hours

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48
Q

Lidocaine in an IO for pedi dwell?

A

2 min

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49
Q

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

A

< 3 yrs and 7 or greater pain

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50
Q

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

A

1min

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51
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

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52
Q

What are the special populations for Ketamine and the dose?

A

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

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53
Q

What must TCA ODs be treated with immediately ?

A

Sodium Bicarb

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54
Q

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

A

TCA OD

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55
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

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56
Q

Pedi cocaine OD get treated with what?

A

Versed

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57
Q

Adult Cocaine OD get treated with what?

A

Versed

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58
Q

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

A

Electrouctions and lighning strikes

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59
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

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60
Q

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

A

All OD’s except for Cocaine

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61
Q

What type of arrest is a third trimester female considered?

A

Secondary - and displace the uterus to the left

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62
Q

What are the amiodarone contraindications

A

Qtc >500
Blocks
Bradycardia
Hypotension
cardiogenic shock

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63
Q

What is the o2 setting for initial arrest

A

8L/min for 6 min on oxygen port

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64
Q

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

A

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

Hyperkalemia

Cardizem induced hypotension

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65
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

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66
Q

Electrocution and LIghtning strikes are what type of arrests

A

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

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67
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

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68
Q

What are the determination of death criteria

A
  1. Lividity
  2. Rigor mortis
  3. tissue decomposition
  4. Valid DNRO
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69
Q

which cardiac arrest patients MUST be transported

A

Witnesed

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70
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.

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71
Q

LVAD patients go to which facility

A

JFK

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72
Q

Compressions for an LVAD device are ?

A

Not using the LUCAS
The Right of the sternum.

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73
Q

AEIOU TIPS ?

A

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

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74
Q

Torsades de point unstable is defined as and treated how?

A

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

75
Q

Torsades de point stable treatment?

A

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

76
Q

What makes RRWCT unstable ?

A

hypotension

77
Q

Treatment for RRWCT is?

A

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

78
Q

RRWCT is defined as?

A

> 0.20 or 5 boxes

79
Q

What makes a Vtach patient unstable?

A

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

80
Q

Unstable Vtach

A

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

81
Q

Vtach stable treatment?

A

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

82
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

83
Q

Unstable SVT treatment is ?

A

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

84
Q

Stable SVT treatment is?

A

Adults 12mg Adenosine
Pedi- 0.2mg Adenosine

85
Q

When does NTG get withheld in CHF patients?

A

febrile patients or nursing home with pneumonia

86
Q

What are STEMI disqualifiers?

A

LBBB
LVH
Early Repolarization
Pacemaker with QRS > .12

87
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

88
Q

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

A

Right hand and wrist.

89
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

90
Q

Pacing for a peds starts at what?

91
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

92
Q

Unstable bradycardia is defined as?

A

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

93
Q

Bradycardia is defined as?

94
Q

What is the criteria for unstable Afib/ flutter

A

Hypotension only

95
Q

What are the precautions with Ketamine in seizure patients?

A

Respiratory distress- need for an advanced airway
HTN
Schiziophrenia

96
Q

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

A

Witnessed greater than 24 hours

97
Q

Which patients receive fluids despite having rales?

A

Septic pneumonia patients

98
Q

Sepsis alert criteria?

A

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

99
Q

Ketamine for seizures is what and what contraindications?

A

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

100
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

101
Q

Auto PEEP is what?

A

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

102
Q

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

A

SPo2 at 90%

103
Q

indications for Hyperkalemia for CaCl2?

A

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

104
Q

What are the oral hypoglycemic medications

A

Glipizide, Glyburide, Glimepiride

105
Q

Sager splints are used on what type fx?

A

Closed Mid shaft femur only

106
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

107
Q

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

A

primary- STEMI facility
secondary- Closest faclility

108
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

109
Q

Medications should be delivered when in cardiac arrest ?

A

ASAP after rhythm check and circulated for 2 min

110
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.

111
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

112
Q

When does a ResQpod get placed?

A

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

113
Q

What is considered a “SECONDARY” arrest?

A

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

114
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.

115
Q

All IVP medications for an arrest are followed by what?

A

10ml saline Flush

116
Q

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

A

Scoop stretcher and elevated 15 degrees.

117
Q

What does MICCR stand for?

A

Minimally Interrupted cardio-cerebral resusitation

118
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

119
Q

What are the Air Transport time criteria?

A

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

120
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”

121
Q

Where are psychiatric pts transported?

A

stable- closest facility
unstable- closest ED for stabilization.

122
Q

Where do decompression CO, H2S and CN poisonings go?

A

Hyberbaric chamber @ st mary’s hospital.

123
Q

Pediatric pts are age what?

A

less than 18.

124
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.

125
Q

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

A

40mminutes:
Decompression Sickness
STROKE
STEMI

126
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.

127
Q

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

A

paralyzed and sedated.

128
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)

129
Q

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

130
Q

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

A

pediatric pts.

131
Q

When should manual BP’s be taken?

A

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

132
Q

Adult hypotension is defined as?

A

systolic BP> 90.

133
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.

134
Q

Which pt’s shall have a BGL checked?

A

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

135
Q

12 leads will be repeated how often?

136
Q

12 lead cables will remain on the pt until when?

A

turned over the ED staff when transporting.

137
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.

138
Q

EtCO2 monitoring will be performed on which pts?

A

Ventilatory support

Respiratory distress
AMS
Sedated / pain medication
seizure pts
ketamine pts

139
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

140
Q

ET tubes shall be confirmed how? 3 methods.

A

visualization
esophageal intubation detector (if available)
continuous EtCo2

141
Q

Oxygen is to be administered only when?

A

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

142
Q

In mutual aid circumstances whose protocols should be followed?

A

The transporting agency.

143
Q

Who is allowed to deviate from the protocols?

A

Ems captains and Trauma hawk Personnel

144
Q

what is the goal for maninging overdose and poisoning pts?

A

Support ABCs

Terminate arrhymthmmias

Terminate seizures

reverse effects with antidotes or medication

145
Q

what classes of medications are responsible for dystonic reactions?

A

antipsychotics

antiemetics

Antidepressants

146
Q

What are the APGAR score interpretations?

A

0-3 severe

4-6- Moderate

7-10- excellent

147
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

148
Q

Purpose or Goal or DSI is?

A

Not to blunt spontaneous ventilation or airway reflexes

149
Q

Primary goal of any airway or respiratory emergency is maintaining?

A

Ventilation
Oxygenation
Perfusion

150
Q

Indications for an advanced airway are:

A

Airway protection
Respiratory failure
Prolonged respiratory suppport

151
Q

What equipment MUST be in place fro DSI?

A

Suction unit

Cardiac monitor, BP, SPO2, ETCO2

152
Q

Positioning for DSI is?

A

Ear to the sternal notch
Head parallel with the ceiling
Stretcher elevated 15-30 degrees

153
Q

The Pre-oxygenation step includes?

A

Maintaining of SP02 for 3min:
Positioning head
NC @ 15L/min
BVM w/ peep @ 10cm/h20
BVM with face seal

154
Q

Definition of apenic in DSI?

A

Respirations < 4/min

155
Q

The only time to give ventilations in the pre-oxygenate phase is?

A

Patient becomes apneic.

156
Q

To fix perfusion in adult and infants for DSI what is used?

A

Adults:
1L saline
Infants:
20ml/Kg

If neither work - push press epi- 1:100,000 at 1ml/min. Max 30 ml . Concentration is 10mcg/ml

157
Q

What is the contraindications for push pressor epi?

A

Hypotension secondary to blood loss.

158
Q

DSI paralysis indications are?

A

Apneic Status epilepticus

Trismus

EMS captain or flight crew discretion

159
Q

Contraindications to DSI paralysis is?

A

Allergy

Predicted difficult intubation

Inability to ventilate with a BVM

Major facial trauma

160
Q

What are the doses for rocuronium for adult and pediatrics?

A

Adults 100mg
Pediatric 1mg/kg

161
Q

What is the warning for rocuronium with patients?

A

Asthmatic patients may have a drop in BP that may result in Cardiac arrest.

162
Q

Post intubation placement is ?

A

ETCO2 continually- initially, continuously, and upon transfer of care

Wave form with no less than 3 boxes

Auscultation of bi-lateral breath sounds

Placement of a gastric tube

163
Q

Post intubation medications are MANDATORY for any?

A

ET tube or Igel

164
Q

What are the post intubation medications that can be used for DSI?

A

Ketamine Versed Fentanyl
Adult: 200mg 5mg 100mcg. (Contraindication of pregnancy near term >32 weeks)
Pedi: 2mg/kg 0.1mg/kg 1mcg/kg (Contraindication of <6mo.)

165
Q

Failed airway in adults or pedi is?

A

Surgical cric >13 yrs of age
Needle Cric < 12 yrs of age

166
Q

What is the precursor for the cyano kit?

A

Hydroxocabalamine

167
Q

What is the half life of the cyano kit

A

26-31 hours

168
Q

what is the onset time for the cyano kit?

169
Q

Classification of esmolol

A

selective b1 class 2 antiarrhythmic

170
Q

what is the half life of esmolol?

171
Q

what is the duration of etomidate?

172
Q

what medication from the pharmacolgy medications has the longest list of side effects?

173
Q

What are ketamines mechanism of actions?

A

antagonist for NMDA and blocks these receptors

works on Na and Ca channels for pain relief

dissociation between the limbic and cortical systems

174
Q

what is the half life for Ketamine?

175
Q

what is the duration of ketamine?

A

IV -10-15min

IM- 20-30 min

176
Q

contraindications of ketamine

A

pregnant females

Penetrating eye injures

Non- traumatic chest pain

significant HTN

177
Q

indications for Ketamine

A

Sezures

Violent/ impared

pain 7 or higher

pre sedation

post sedation

CPR induced consciousness

178
Q

What class of medication is rocuronium?

A

Non-depolarizing agent

179
Q

what si the mechanism of action for rocuronium?

A

binds to the cholinergic receptors in the motor end plate

180
Q

what is the onset of rocuronium?

181
Q

What is the durations and half life of rocuronium?

A

Duration 30-60min

Half life- 14-18 hours

182
Q

What are the contraidications for rocuronium?

A

Allergy

predicted difficult intubation

inability to use a BVM

major facial or laryngeal trauma

183
Q

per CQI, what other recommendation is added for ketamine?

A

High flow 02 per Scheppke

EMS captain (25 decks)

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