2021 EMS Protocols bottom top Flashcards
for the hx taking in an assessment what pneumoic is used?
OPPPQRSTA
Pallative
provoke
previous
what is the preferred access fo r pediatrics in cardiac arrest?
IO
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 type of communication is to be used with a second paramedic to ensure proper drug dose?
closed loop communication
During pregnancy what is the possibe BP drop?
5-15mmhg.
How much can a pregnant female lose with regards to blood volume?
30-35%
Only those person who have completed and approved Incident safety officer course ________ be used as a safety officer.
SHOULD
A safety office should have a working knowledge of what?
Safety concerns for fire rescue in typical incidents
Fire behavior
Building construction
EMS
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
Who’s responsibility is it to assign a safety officer?
IC
Time for Breech birth actions
if not delivered in 3 minutes
When can you insert a gloved hand into the vagina for a birth?
Breech birth
Prolapsed cord
Eclampsia is defined as ?
S/S of pre + seizures or coma
Preeclampsia is defined as?
SBP >160 DSP > 110 with :
AMS
Headache
Visual disturbances
PE
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
1st and 2nd trimester complications include?
Ectopic
Spontaneous
bleeding
hypotensive
Gravida and Para definitions
Gravida- previous pregnancies
Para- Number of Live births
Pregnant 3rd trimester trauma alerts get transported how?
Left side, 4-6 inches of padding to Right side
Maintain BP for peripheral pulses
What are the contraindications for Ceftriaxone or rocephin?
Allergy to cephalosporins
Neonates birth to 30 days
How many attempts to realign for anatomical position
2
Head injuries ETCO2 is?
30-35mmhg
Adult BP maintain BP for Head injuries is what?
SBP 110-120
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
What is the secondary site for chest decompression
2 or 3 rd intercostal space mid clavicular
What is the primary site for chest decompression?
5th intercostal space mid axillary
Criteria for chest decompression
Absent or diminshed LS
BP< 90
Respiratory distress or difficulty with BVM
Flail chest sis defined?
2 or more adjacent ribs are fractured
what is Trauma alert criteria for peds with BP?
< 50
The “ P” in Jump start triage means what ?
posturing
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
Contraindications for Finger Thoracostomy?
Unwitnessed arrest with blunt trauma
Devestating head trauma
loss of Cardiac output > 10 min
Finger Thoracostomy is done when ?
known or suspected injury to the chest and or abd
Ultrasunds in traumatic arrests are done when?
observation of cardiac motion in PEA
When does bilateral decompression get performed?
Arrest due to penetrating chest trauma
PEA is defined as?
an organized rhythm > 20 BPM
For Trauma patients not to be resuscitated what criteria is needed?
Apneic
Fixed dialted pupils
asystole
NEED ALL 3
or injuries incompatible with life
FAST ultrasounds are used to identify?
Intrabdominal hemorrage
Intrathoracic hemorrage
pericardial hemorrage
PEA motion
FAST ultrsound can be performed during transport for the following injuries?
Blunt ABD and thorax trauma
penetrating ABD and thborax traum
Undifferentiated hypotension in trauma
What does the MARCH acronym mean?
Massive hemorrage
Airway control
Respiratory
Circulation
Head injury / Hypothermia
The cyano kit uses how much? at what rate?
5g diluted in 200ml and at 5 gtts/sec
If SPCO is above what %?
>20%
Who carries a rainbow sensor ?
EMS captains and SPLOPS
CO poisoning is at what level?
35ppm
Heat stroke is classified as ?
Temp > 103 or AMS
When treating Heat stroke?
Cool First, transport second
How much NS admin for Decompression sickness?
500ml
What is the time frame for decompression sickness?
48 hours
Lidocaine in an IO for pedi dwell?
2 min
Pedi Ketamine for pain is indicated for what age and pain scale?
< 3 yrs and 7 or greater pain
How long does Lidocaine dwell in an IO for an adult?
1min
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
What are the special populations for Ketamine and the dose?
Age 65 and older
<50kg
Head trauma
Already took sedatives
200mg
What must TCA ODs be treated with immediately ?
Sodium Bicarb
Mad as a hatter
Red as a beet
Dry as bone refer to S/S of ?
TCA OD
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
Pedi cocaine OD get treated with what?
Versed
Adult Cocaine OD get treated with what?
Versed
What type of arrests are to be transported to a trauma center?
Electrouctions and lighning strikes
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
All drug overdoses are treated as what type of arrest with the exception of?
All OD’s except for Cocaine
What type of arrest is a third trimester female considered?
Secondary - and displace the uterus to the left
What are the amiodarone contraindications
Qtc >500
Blocks
Bradycardia
Hypotension
cardiogenic shock
What is the o2 setting for initial arrest
8L/min for 6 min on oxygen port
What are five protocols where on 500ml NS are used?
Decompression sickness
Calling an arrest.
2nd > 15% or 3rd > 5% degree burns
Hyperkalemia
Cardizem induced hypotension
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
Electrocution and LIghtning strikes are what type of arrests
Primary b/c of A/C current
Secondary due to DC current
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
What are the determination of death criteria
- Lividity
- Rigor mortis
- tissue decomposition
- Valid DNRO
which cardiac arrest patients MUST be transported
Witnesed
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.
LVAD patients go to which facility
JFK
Compressions for an LVAD device are ?
Not using the LUCAS
The Right of the sternum.
AEIOU TIPS ?
Alcohol, Epilepsy, Insulin, OD, underdose
Trauma, infection, pyschosis, stroke
Torsades de point unstable is defined as and treated how?
Hypotension:
defib 200, 300, 360
defib 2J/kg and 4J/kg
Torsades de point stable treatment?
2g mgso4 in 50 60gtts
Pedi : 40mg in 50 60gtts
What makes RRWCT unstable ?
hypotension
Treatment for RRWCT is?
Stable :Adult 1g cacl2
100mg bicarb
Pedi: 20mg/kg cacl2
1meq/kg bicarb
RRWCT is defined as?
> 0.20 or 5 boxes
What makes a Vtach patient unstable?
Contraindications to Amiodarone:
Sinus bradycardia
2/3 degree blocks
cardiogenic shock
hypotension
QTC >500
Unstable Vtach
Adult : Cardio version 100, 200, 300. 360J
Pedi : 0.5J/kg and 2j/kg
Vtach stable treatment?
Adult : Amiodarone 150mg in 50 15gtts
Pedi: 5mg/kg in 50 15 gtts
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
Unstable SVT treatment is ?
AMS-
Adult 100, 200, 300, 360J
Pedi: 0.5J/kg and 2J/kg
Stable SVT treatment is?
Adults 12mg Adenosine
Pedi- 0.2mg Adenosine
When does NTG get withheld in CHF patients?
febrile patients or nursing home with pneumonia
What are STEMI disqualifiers?
LBBB
LVH
Early Repolarization
Pacemaker with QRS > .12
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
Which extremity is to be avoided with vascular access in chest pain?
Right hand and wrist.
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
Pacing for a peds starts at what?
80 BPM
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
Unstable bradycardia is defined as?
Adult: >50 BPM w. hypotension
Pedi: >50 w/ AMS and age hypotension
Bradycardia is defined as?
< 50 BPM
What is the criteria for unstable Afib/ flutter
Hypotension only
What are the precautions with Ketamine in seizure patients?
Respiratory distress- need for an advanced airway
HTN
Schiziophrenia
What is the tine frame for not considering a stroke not an Alert
Witnessed greater than 24 hours
Which patients receive fluids despite having rales?
Septic pneumonia patients
Sepsis alert criteria?
Adult not pregnant
suspected or documented infection
Hypotension
AMS
Tachypnea - RR>22 or ETco2 < 25mmHg
Ketamine for seizures is what and what contraindications?
Adults :100mg- pregnancy
penetrating eye
non traumatic chest pain
Pedi >3yrs: 1mg/kg
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
Auto PEEP is what?
When Air goes in before a patient is allowed to exhale.
it is more important to maintain what levels for COPD and asthma patients?
SPo2 at 90%
indications for Hyperkalemia for CaCl2?
Peaked T waves
Sine wave
Wide complex QRS
RRWCT
severe bradycardia
high degree blocks
What are the oral hypoglycemic medications
Glipizide, Glyburide, Glimepiride
Sager splints are used on what type fx?
Closed Mid shaft femur only
Spinal motion restriction for what criteria?
focal neurologic deficit
pain to the neck or back
distracting injury
AMS w/ an MOI
intoxication w/ MOI
primary and secondary arrest pt’s go to which facilites?
primary- STEMI facility
secondary- Closest faclility
What is the dose of MGSO4 in Torsades?
adults- 2g in 50 ml 60gtts wide open
pedi- 40mg/kg in 50ml 60gtts wide open
Medications should be delivered when in cardiac arrest ?
ASAP after rhythm check and circulated for 2 min
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 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
When does a ResQpod get placed?
all cardiac arrest patients that are greater than 1yr old.
What is considered a “SECONDARY” arrest?
CHF, drowning, FBAO, OD, Hanging, lightning strike- DC current., Trauma, CN, 3rd Trimester pregnancy
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.
All IVP medications for an arrest are followed by what?
10ml saline Flush
Cardiac arrest pt’s with the use of a “Lucas” device will be placed on what?
Scoop stretcher and elevated 15 degrees.
What does MICCR stand for?
Minimally Interrupted cardio-cerebral resusitation
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 are the Air Transport time criteria?
STEMI / Stroke >40min
Trauma > 25min
Extrication >15min
Response time >10min
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”
Where are psychiatric pts transported?
stable- closest facility
unstable- closest ED for stabilization.
Where do decompression CO, H2S and CN poisonings go?
Hyberbaric chamber @ st mary’s hospital.
Pediatric pts are age what?
less than 18.
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.
What type of alerts go by air if ground transport is greater than what time?
40mminutes:
Decompression Sickness
STROKE
STEMI
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.
All intubated interfacility transfers must be ______ and ______ by the sending facility.
paralyzed and sedated.
What type of pts’ meeting trauma alert criteria transported by AIR to St. mary’s?
Pregnant (visibly pregnant or by hx of gestation >20wks)
When using the Hand Tevy method, what is used for the PRIMARY reference point?
age
Pt’s that have not reached puberty shall be classified as how?
pediatric pts.
When should manual BP’s be taken?
Initially and to confirm any abnormal or significant change in an automatic BP.
Adult hypotension is defined as?
systolic BP> 90.
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.
Which pt’s shall have a BGL checked?
Diabetics
AMS
seizure
stroke
syncope,
lightheadedness,
dizziness
poisoning
cardiac arrest
12 leads will be repeated how often?
q 10min
12 lead cables will remain on the pt until when?
turned over the ED staff when transporting.
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.
EtCO2 monitoring will be performed on which pts?
Ventilatory support
Respiratory distress
AMS
Sedated / pain medication
seizure pts
ketamine pts
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
ET tubes shall be confirmed how? 3 methods.
visualization
esophageal intubation detector (if available)
continuous EtCo2
Oxygen is to be administered only when?
maintain sp02 of 95% all patients
90% for COPD and asthma.
In mutual aid circumstances whose protocols should be followed?
The transporting agency.
Who is allowed to deviate from the protocols?
Ems captains and Trauma hawk Personnel
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
Purpose or Goal or DSI is?
Not to blunt spontaneous ventilation or airway reflexes
Primary goal of any airway or respiratory emergency is maintaining?
Ventilation
Oxygenation
Perfusion
Indications for an advanced airway are:
Airway protection
Respiratory failure
Prolonged respiratory suppport
What equipment MUST be in place fro DSI?
Suction unit
Cardiac monitor, BP, SPO2, ETCO2
Positioning for DSI is?
Ear to the sternal notch
Head parallel with the ceiling
Stretcher elevated 15-30 degrees
The Pre-oxygenation step includes?
Maintaining of SP02 for 3min:
Positioning head
NC @ 15L/min
BVM w/ peep @ 10cm/h20
BVM with face seal
Definition of apenic in DSI?
Respirations < 4/min
The only time to give ventilations in the pre-oxygenate phase is?
Patient becomes apneic.
To fix perfusion in adult and infants for DSI what is used?
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
What is the contraindications for push pressor epi?
Hypotension secondary to blood loss.
DSI paralysis indications are?
Apneic Status epilepticus
Trismus
EMS captain or flight crew discretion
Contraindications to DSI paralysis is?
Allergy
Predicted difficult intubation
Inability to ventilate with a BVM
Major facial trauma
What are the doses for rocuronium for adult and pediatrics?
Adults 100mg
Pediatric 1mg/kg
What is the warning for rocuronium with patients?
Asthmatic patients may have a drop in BP that may result in Cardiac arrest.
Post intubation placement is ?
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
Post intubation medications are MANDATORY for any?
ET tube or Igel
What are the post intubation medications that can be used for DSI?
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.)
Failed airway in adults or pedi is?
Surgical cric >13 yrs of age
Needle Cric < 12 yrs of age
What is the precursor for the cyano kit?
Hydroxocabalamine
What is the half life of the cyano kit
26-31 hours
what is the onset time for the cyano kit?
2-15min
Classification of esmolol
selective b1 class 2 antiarrhythmic
what is the half life of esmolol?
2-9min
what is the duration of etomidate?
3-5 min.
what medication from the pharmacolgy medications has the longest list of side effects?
Etomidate
What are ketamines mechanism of actions?
antagonist for NMDA and blocks these receptors
works on Na and Ca channels for pain relief
dissociation between the limbic and cortical systems
what is the half life for Ketamine?
1-2 hours
what is the duration of ketamine?
IV -10-15min
IM- 20-30 min
contraindications of ketamine
pregnant females
Penetrating eye injures
Non- traumatic chest pain
significant HTN
indications for Ketamine
Sezures
Violent/ impared
pain 7 or higher
pre sedation
post sedation
CPR induced consciousness
What class of medication is rocuronium?
Non-depolarizing agent
what si the mechanism of action for rocuronium?
binds to the cholinergic receptors in the motor end plate
what is the onset of rocuronium?
30-60 sec
What is the durations and half life of rocuronium?
Duration 30-60min
Half life- 14-18 hours
What are the contraidications for rocuronium?
Allergy
predicted difficult intubation
inability to use a BVM
major facial or laryngeal trauma
per CQI, what other recommendation is added for ketamine?
High flow 02 per Scheppke
