2021 EMS Protocols REVERSE Flashcards
1
Q
Who is allowed to deviate from the protocols?
A
Ems captains and Trauma hawk Personnel
2
Q
In mutual aid circumstances whose protocols should be followed?
A
The transporting agency.
3
Q
Oxygen is to be administered only when?
A
maintain sp02 of 95% all patients
90% for COPD and asthma.
4
Q
ET tubes shall be confirmed how? 3 methods.
A
visualization
esophageal intubation detector (if available)
continuous EtCo2
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
6
Q
EtCO2 monitoring will be performed on which pts?
A
Respiratory distress
AMS
Sedated / pain medication
seizure pts
ketamine pts
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.
8
Q
12 lead cables will remain on the pt until when?
A
turned over the ED staff when transporting.
9
Q
12 leads will be repeated how often?
A
q 10min
10
Q
Which pt’s shall have a BGL checked?
A
Diabetics
AMS
seizure
stroke
syncope,
lightheadedness,
dizziness
poisoning
cardiac arrest
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.
12
Q
Adult hypotension is defined as?
A
systolic BP> 90.
13
Q
When should manual BP’s be taken?
A
Initially and to confirm any abnormal or significant change in an automatic BP.
14
Q
Pt’s that have not reached puberty shall be classified as how?
A
pediatric pts.
15
Q
When using the Hand Tevy method, what is used for the PRIMARY reference point?
A
age
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)
17
Q
All intubated interfacility transfers must be ______ and ______ by the sending facility.
A
paralyzed and sedated.
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.
19
Q
What type of alerts go by air if ground transport is greater than what time?
A
40mminutes:
Decompression Sickness
STROKE
STEMI
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.
21
Q
Pediatric pts are age what?
A
less than 18.
22
Q
Where do decompression CO, H2S and CN poisonings go?
A
Hyberbaric chamber @ st mary’s hospital.
23
Q
Where are psychiatric pts transported?
A
stable- closest facility
unstable- closest ED for stabilization.
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”
25
What are the Air Transport time criteria?
STEMI / Stroke \>40min
Trauma \> 25min
Extrication \>15min
Response time \>10min
26
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
27
What does MICCR stand for?
Minimally Interrupted cardio-cerebral resusitation
28
Cardiac arrest pt's with the use of a "Lucas" device will be placed on what?
Scoop stretcher and elevated 15 degrees.
29
All IVP medications for an arrest are followed by what?
10ml saline Flush
30
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.
31
What is considered a "SECONDARY" arrest?
CHF, drowning, FBAO, OD, Hanging, lightning strike- DC current., Trauma, CN, 3rd Trimester pregnancy
32
When does a ResQpod get placed?
all cardiac arrest patients that are greater than 1yr old.
33
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
34
If a rhythm converts back after electrical therapy was used what setting should be used ?
the setting that was successful in converting the rhythm.
35
Medications should be delivered when in cardiac arrest ?
ASAP after rhythm check and circulated for 2 min
36
What is the dose of MGSO4 in Torsades?
adults- 2g in 50 ml 60gtts wide open
pedi- 40mg/kg in 50ml 60gtts wide open
37
primary and secondary arrest pt's go to which facilites?
primary- STEMI facility
secondary- Closest faclility
38
Spinal motion restriction for what criteria?
focal neurologic deficit
pain to the neck or back
distracting injury
AMS w/ an MOI
intoxication w/ MOI
39
Sager splints are used on what type fx?
Closed Mid shaft femur only
40
What are the oral hypoglycemic medications
Glipizide, Glyburide, Glimepiride
41
indications for Hyperkalemia for CaCl2?
Peaked T waves
Sine wave
Wide complex QRS
RRWCT
severe bradycardia
high degree blocks
42
it is more important to maintain what levels for COPD and asthma patients?
SPo2 at 90%
43
Auto PEEP is what?
When Air goes in before a patient is allowed to exhale.
44
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
45
Ketamine for seizures is what and what contraindications?
Adults :100mg- pregnancy
penetrating eye
non traumatic chest pain
Pedi \>3yrs: 1mg/kg
46
Sepsis alert criteria?
Adult not pregnant
suspected or documented infection
Hypotension
AMS
Tachypnea - RR\>22 or ETco2 \< 25mmHg
47
Which patients receive fluids despite having rales?
Septic pneumonia patients
48
What is the tine frame for not considering a stroke not an Alert
Witnessed greater than 24 hours
49
What are the precautions with Ketamine in seizure patients?
Respiratory distress- need for an advanced airway
HTN
Schiziophrenia
50
What is the criteria for unstable Afib/ flutter
Hypotension only
51
Bradycardia is defined as?
\< 50 BPM
52
Unstable bradycardia is defined as?
Adult: \>50 BPM w. hypotension
Pedi: \>50 w/ AMS and age hypotension
53
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
54
Pacing for a peds starts at what?
80 BPM
55
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
56
Which extremity is to be avoided with vascular access in chest pain?
Right hand and wrist.
57
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
58
What are STEMI disqualifiers?
LBBB
LVH
Early Repolarization
Pacemaker with QRS \> .12
59
When does NTG get withheld in CHF patients?
febrile patients or nursing home with pneumonia
60
Stable SVT treatment is?
Adults 12mg Adenosine
Pedi- 0.2mg Adenosine
61
Unstable SVT treatment is ?
AMS-
Adult 100, 200, 300, 360J
Pedi: 0.5J/kg and 2J/kg
62
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
63
Vtach stable treatment?
Adult : Amiodarone 150mg in 50 15gtts
Pedi: 5mg/kg in 50 15 gtts
64
Unstable Vtach
Adult : Cardio version 100, 200, 300. 360J
Pedi : 0.5J/kg and 2j/kg
65
What makes a Vtach patient unstable?
Contraindications to Amiodarone:
Sinus bradycardia
2/3 degree blocks
cardiogenic shock
hypotension
QTC \>500
66
RRWCT is defined as?
\> 0.20 or 5 boxes
67
Treatment for RRWCT is?
Stable :Adult 1g cacl2
100mg bicarb
Pedi: 20mg/kg cacl2
1meq/kg bicarb
68
What makes RRWCT unstable ?
hypotension
69
Torsades de point stable treatment?
2g mgso4 in 50 60gtts
Pedi : 40mg in 50 60gtts
70
Torsades de point unstable is defined as and treated how?
Hypotension:
defib 200, 300, 360
defib 2J/kg and 4J/kg
71
AEIOU TIPS ?
Alcohol, Epilepsy, Insulin, OD, underdose
Trauma, infection, pyschosis, stroke
72
Compressions for an LVAD device are ?
Not using the LUCAS
The Right of the sternum.
73
LVAD patients go to which facility
JFK
74
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.
75
which cardiac arrest patients MUST be transported
Witnesed
76
What are the determination of death criteria
1. Lividity
2. Rigor mortis
3. tissue decomposition
4. Valid DNRO
77
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
78
Electrocution and LIghtning strikes are what type of arrests
Primary b/c of A/C current
Secondary due to DC current
79
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
80
What are four protocols where on 500ml NS are used?
Decompression sickness
Calling an arrest.
2nd \> 15% or 3rd \> 5% degree burns
Hyperkalemia
81
What is the o2 setting for initial arrest
8L/min for 6 min on oxygen port
82
What are the amiodarone contraindications
Qtc \>500
Blocks
Bradycardia
Hypotension
cardiogenic shock
83
What type of arrest is a third trimester female considered?
Secondary - and displace the uterus to the left
84
All drug overdoses are treated as what type of arrest with the exception of?
All OD's except for Cocaine
85
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
86
What type of arrests are to be transported to a trauma center?
Electrouctions and lighning strikes
87
Adult Cocaine OD get treated with what?
Versed
88
Pedi cocaine OD get treated with what?
Versed
89
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
90
Mad as a hatter
Red as a beet
Dry as bone refer to S/S of ?
TCA OD
91
What must TCA ODs be treated with immediately ?
Sodium Bicarb
92
What are the special populations for Ketamine and the dose?
Age 65 and older
\<50kg
Head trauma
Already took sedatives
200mg
93
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
94
How long does Lidocaine dwell in an IO for an adult?
1min
95
Pedi Ketamine for pain is indicated for what age and pain scale?
\< 3 yrs and 7 or greater pain
96
Lidocaine in an IO for pedi dwell?
2 min
97
What is the time frame for decompression sickness?
48 hours
98
How much NS admin for Decompression sickness?
500ml
99
When treating Heat stroke?
Cool First, transport second
100
Heat stroke is classified as ?
Temp \> 103 or AMS
101
CO poisoning is at what level?
35ppm
102
Who carries a rainbow sensor ?
EMS captains and SPLOPS
103
If SPCO is above what %?
\>20%
104
The cyano kit uses how much? at what rate?
5g diluted in 200ml and at 5 gtts/sec
105
What does the MARCH acronym mean?
Massive hemorrage
Airway control
Respiratory
Circulation
Head injury / Hypothermia
106
FAST ultrsound is done for
Blunt or penetrating trauma the ABD or thorax
Undifferentiated hypotension in trauma
107
FAST ultrasounds can be performed to identify?
Intrabdominal hemorrage
Intrathoracic hemorrage
pericardial hemorrage
PEA motion
108
For Trauma patients not to be resuscitated what criteria is needed?
Apneic
Fixed dialted pupils
asystole
NEED ALL 3
or injuries incompatible with life
109
PEA is defined as?
an organized rhythm \> 20 BPM
110
When does bilateral decompression get performed?
Arrest due to penetrating chest trauma
111
Ultrasunds in traumatic arrests are done when?
observation of cardiac motion in PEA
112
Finger Thoracostomy is done when ?
known or suspected injury to the chest and or abd
113
Contraindications for Finger Thoracostomy?
Unwitnessed arrest with blunt trauma
Devestating head trauma
loss of Cardiac output \> 10 min
114
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
115
The " P" in Jump start triage means what ?
posturing
116
what is Trauma alert criteria for peds with BP?
\< 50
117
Flail chest sis defined?
2 or more adjacent ribs are fractured
118
Criteria for chest decompression
Absent or diminshed LS
BP\< 90
Respiratory distress or difficulty with BVM
119
What is the primary site for chest decompression?
5th intercostal space mid axillary
120
What is the secondary site for chest decompression
2 or 3 rd intercostal space mid clavicular
121
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
122
Adult BP maintain BP for Head injuries is what?
SBP 110-120
123
Head injuries ETCO2 is?
30-35mmhg
124
How many attempts to realign for anatomical position
2
125
What are the contraindications for Ceftriaxone or rocephin?
Allergy to cephalosporins
Neonates birth to 30 days
126
Pregnant 3rd trimester trauma alerts get transported how?
Left side, 4-6 inches of padding to Right side
Maintain BP for peripheral pulses
127
Gravida and Para definitions
Gravida- previous pregnancies
Para- Number of Live births
128
1st and 2nd trimester complications include?
Ectopic
Spontaneous
bleeding
hypotensive
129
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
130
Preeclampsia is defined as?
SBP \>160 DSP \> 110 with :
AMS
Headache
Visual disturbances
PE
131
Eclampsia is defined as ?
S/S of pre + seizures or coma
132
When can you insert a gloved hand into the vagina for a birth?
Breech birth
Prolapsed cord
133
Time for Breech birth actions
if not delivered in 3 minutes
134
135
Who’s responsibility is it to assign a safety officer?
IC
136
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
137
A safety office should have a working knowledge of what?
Safety concerns for fire rescue in typical incidents
Fire behavior
Building construction
EMS
138
Only those person who have completed and approved Incident safety officer course ________ be used as a safety officer.
SHOULD
139
How much can a pregnant female lose with regards to blood volume?
30-35%
140
During pregnancy what is the possibe BP drop?
5-15mmhg.
141
What type of communication is to be used with a second paramedic to ensure proper drug dose?
closed loop communication
142
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.
143
what is the preferred access fo r pediatrics in cardiac arrest?
IO
144
for the hx taking in an assessment what pneumoic is used?
OPPPQRSTA
145
Ems captains and Trauma hawk Personnel
Who is allowed to deviate from the protocols?
146
The transporting agency.
In mutual aid circumstances whose protocols should be followed?
147
maintain sp02 of 95% all patients
90% for COPD and asthma.
Oxygen is to be administered only when?
148
visualization
esophageal intubation detector (if available)
continuous EtCo2
ET tubes shall be confirmed how? 3 methods.
149
Adults- Pulse 1 q6
No pulse 1 q10
ICP 30-35mmhg
Pediatrics Pulse 1 q3
No Pulse 1 q6
ICP- 30-35mmHg
Ventilatory rates are the following?
150
Respiratory distress
AMS
Sedated / pain medication
seizure pts
ketamine pts
EtCO2 monitoring will be performed on which pts?
151
chest, Arm, neck, back, jaw, shoulder, epigastric pn or discomfort
palpitations
syncope, lightheadness, general weakness, fatigue
SOB, CHF, or hypotension
unexplained diaphoresis or nausea.
which pt's are required to have a 12 and 15 lead performed?
152
turned over the ED staff when transporting.
12 lead cables will remain on the pt until when?
153
q 10min
12 leads will be repeated how often?
154
Diabetics
AMS
seizure
stroke
syncope,
lightheadedness,
dizziness
poisoning
cardiac arrest
Which pt's shall have a BGL checked?
155
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.
A complete set of v/s consists of what and done how often?
156
systolic BP\> 90.
Adult hypotension is defined as?
157
Initially and to confirm any abnormal or significant change in an automatic BP.
When should manual BP's be taken?
158
pediatric pts.
Pt's that have not reached puberty shall be classified as how?
159
age
When using the Hand Tevy method, what is used for the PRIMARY reference point?
160
Pregnant (visibly pregnant or by hx of gestation \>20wks)
What type of pts' meeting trauma alert criteria transported by AIR to St. mary's?
161
paralyzed and sedated.
All intubated interfacility transfers must be ______ and ______ by the sending facility.
162
Crew must contact the EMS Captain and follow the advanced A/W protocol, and accompany pt to the receiving facility.
If the sending facility physician refuses to administer paralytics for a trauma transfer then what?
163
40mminutes:
Decompression Sickness
STROKE
STEMI
What type of alerts go by air if ground transport is greater than what time?
164
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.
Stroke pt with transport times greater than 20 min go where?
165
less than 18.
Pediatric pts are age what?
166
Hyberbaric chamber @ st mary's hospital.
Where do decompression CO, H2S and CN poisonings go?
167
stable- closest facility
unstable- closest ED for stabilization.
Where are psychiatric pts transported?
168
Stable Patients
informed if admitted they will be transferred.
sign "Emergency Transport Disclaimer"
What are the criteria for someone to request a "Free Standing" ED?
169
STEMI / Stroke \>40min
Trauma \> 25min
Extrication \>15min
Response time \>10min
What are the Air Transport time criteria?
170
Pt weighing \> 500lbs or 227kg
Pt that cannot lay supine
combative and cannot be physically restrained
Hazmat contaminated pts
When can air transport NOT be used?
171
Minimally Interrupted cardio-cerebral resusitation
What does MICCR stand for?
172
Scoop stretcher and elevated 15 degrees.
Cardiac arrest pt's with the use of a "Lucas" device will be placed on what?
173
10ml saline Flush
All IVP medications for an arrest are followed by what?
174
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.
Termination efforts can be done when?
175
CHF, drowning, FBAO, OD, Hanging, lightning strike- DC current., Trauma, CN, 3rd Trimester pregnancy
What is considered a "SECONDARY" arrest?
176
all cardiac arrest patients that are greater than 1yr old.
When does a ResQpod get placed?
177
Pt less than 1 yr old
Pt's with a pulse
Cardiac arrest due to trauma
during passive oxygenation
What are the contraindications for the "ResQpod"
178
the setting that was successful in converting the rhythm.
If a rhythm converts back after electrical therapy was used what setting should be used ?
179
ASAP after rhythm check and circulated for 2 min
Medications should be delivered when in cardiac arrest ?
180
adults- 2g in 50 ml 60gtts wide open
pedi- 40mg/kg in 50ml 60gtts wide open
What is the dose of MGSO4 in Torsades?
181
primary- STEMI facility
secondary- Closest faclility
primary and secondary arrest pt's go to which facilites?
182
focal neurologic deficit
pain to the neck or back
distracting injury
AMS w/ an MOI
intoxication w/ MOI
Spinal motion restriction for what criteria?
183
Closed Mid shaft femur only
Sager splints are used on what type fx?
184
Glipizide, Glyburide, Glimepiride
What are the oral hypoglycemic medications
185
Peaked T waves
Sine wave
Wide complex QRS
RRWCT
severe bradycardia
high degree blocks
indications for Hyperkalemia for CaCl2?
186
SPo2 at 90%
it is more important to maintain what levels for COPD and asthma patients?
187
When Air goes in before a patient is allowed to exhale.
Auto PEEP is what?
188
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
Differences in Croup and Epiglottitis?
189
Adults :100mg- pregnancy
penetrating eye
non traumatic chest pain
Pedi \>3yrs: 1mg/kg
Ketamine for seizures is what and what contraindications?
190
Adult not pregnant
suspected or documented infection
Hypotension
AMS
Tachypnea - RR\>22 or ETco2 \< 25mmHg
Sepsis alert criteria?
191
Septic pneumonia patients
Which patients receive fluids despite having rales?
192
Witnessed greater than 24 hours
What is the tine frame for not considering a stroke not an Alert
193
Respiratory distress- need for an advanced airway
HTN
Schiziophrenia
What are the precautions with Ketamine in seizure patients?
194
Hypotension only
What is the criteria for unstable Afib/ flutter
195
\< 50 BPM
Bradycardia is defined as?
196
Adult: \>50 BPM w. hypotension
Pedi: \>50 w/ AMS and age hypotension
Unstable bradycardia is defined as?
197
Versed- 5mg IN/IM only
0.2mg/kg IN/IM only
For both adult and peds with pacing, what can be given if normotensive and no IV?
198
80 BPM
Pacing for a peds starts at what?
199
Oxygenation / Ventilation
Neonate: 1 q 3 for 30 sec
Infant: 1 q 3 for 1 min
What is the initial treatment for bradycardia in peds?
200
Right hand and wrist.
Which extremity is to be avoided with vascular access in chest pain?
201
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
STEMI alert criteria?
202
LBBB
LVH
Early Repolarization
Pacemaker with QRS \> .12
What are STEMI disqualifiers?
203
febrile patients or nursing home with pneumonia
When does NTG get withheld in CHF patients?
204
Adults 12mg Adenosine
Pedi- 0.2mg Adenosine
Stable SVT treatment is?
205
AMS-
Adult 100, 200, 300, 360J
Pedi: 0.5J/kg and 2J/kg
Unstable SVT treatment is ?
206
No p waves
QRS \> .12
Concordance in all leads
Neg QRS V6
Neg in 2, 2, AVF and positive in AVL, and AVR
Vtach is defined as?
207
Adult : Amiodarone 150mg in 50 15gtts
Pedi: 5mg/kg in 50 15 gtts
Vtach stable treatment?
208
Adult : Cardio version 100, 200, 300. 360J
Pedi : 0.5J/kg and 2j/kg
Unstable Vtach
209
Contraindications to Amiodarone:
Sinus bradycardia
2/3 degree blocks
cardiogenic shock
hypotension
QTC \>500
What makes a Vtach patient unstable?
210
\> 0.20 or 5 boxes
RRWCT is defined as?
211
Stable :Adult 1g cacl2
100mg bicarb
Pedi: 20mg/kg cacl2
1meq/kg bicarb
Treatment for RRWCT is?
212
hypotension
What makes RRWCT unstable ?
213
2g mgso4 in 50 60gtts
Pedi : 40mg in 50 60gtts
Torsades de point stable treatment?
214
Hypotension:
defib 200, 300, 360
defib 2J/kg and 4J/kg
Torsades de point unstable is defined as and treated how?
215
Alcohol, Epilepsy, Insulin, OD, underdose
Trauma, infection, pyschosis, stroke
AEIOU TIPS ?
216
Not using the LUCAS
The Right of the sternum.
Compressions for an LVAD device are ?
217
JFK
LVAD patients go to which facility
218
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.
Treatment for an LVAD ?
219
Witnesed
which cardiac arrest patients MUST be transported
220
1. Lividity
2. Rigor mortis
3. tissue decomposition
4. Valid DNRO
What are the determination of death criteria
221
Known down time of \>30min
Apneic
Without mechanism for Hypothermia
Asystolic
Fixed and dilated pupils
What if the death criteria are not there what can be used?
222
Primary b/c of A/C current
Secondary due to DC current
Electrocution and LIghtning strikes are what type of arrests
223
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
When can an arrest be called?
224
Decompression sickness
Calling an arrest.
2nd \> 15% or 3rd \> 5% degree burns
Hyperkalemia
What are four protocols where on 500ml NS are used?
225
8L/min for 6 min on oxygen port
What is the o2 setting for initial arrest
226
Qtc \>500
Blocks
Bradycardia
Hypotension
cardiogenic shock
What are the amiodarone contraindications
227
Secondary - and displace the uterus to the left
What type of arrest is a third trimester female considered?
228
All OD's except for Cocaine
All drug overdoses are treated as what type of arrest with the exception of?
229
Immediately after Double sequential
40 mg IV/IO initially over 1 min
Then:
60mg on 15gtts over 10min 1,25gtts/sec
What are the indications for Esmolol and doses?
230
Electrouctions and lighning strikes
What type of arrests are to be transported to a trauma center?
231
Versed
Adult Cocaine OD get treated with what?
232
Versed
Pedi cocaine OD get treated with what?
233
RR below 10
Etco2 \>45
02 sat \< 92%
if not meeting above Supplemental 02 or BVM 2 min
What are the criteria to administer narcan?
234
TCA OD
Mad as a hatter
Red as a beet
Dry as bone refer to S/S of ?
235
Sodium Bicarb
What must TCA ODs be treated with immediately ?
236
Age 65 and older
\<50kg
Head trauma
Already took sedatives
200mg
What are the special populations for Ketamine and the dose?
237
400mg IM
BVM or supplemental 02 for Laryngospasms
0.5mg Atropine for Salivations x3
Ice packs, 1L cold saline and 100meq Sodium Bicarb
What is the sequence for Combative pts and Ketamina
238
1min
How long does Lidocaine dwell in an IO for an adult?
239
\< 3 yrs and 7 or greater pain
Pedi Ketamine for pain is indicated for what age and pain scale?
240
2 min
Lidocaine in an IO for pedi dwell?
241
48 hours
What is the time frame for decompression sickness?
242
500ml
How much NS admin for Decompression sickness?
243
Cool First, transport second
When treating Heat stroke?
244
Temp \> 103 or AMS
Heat stroke is classified as ?
245
35ppm
CO poisoning is at what level?
246
EMS captains and SPLOPS
Who carries a rainbow sensor ?
247
\>20%
If SPCO is above what %?
248
5g diluted in 200ml and at 5 gtts/sec
The cyano kit uses how much? at what rate?
249
Massive hemorrage
Airway control
Respiratory
Circulation
Head injury / Hypothermia
What does the MARCH acronym mean?
250
Blunt or penetrating trauma the ABD or thorax
Undifferentiated hypotension in trauma
FAST ultrsound is done for
251
Intrabdominal hemorrage
Intrathoracic hemorrage
pericardial hemorrage
PEA motion
FAST ultrasounds can be performed to identify?
252
Apneic
Fixed dialted pupils
asystole
NEED ALL 3
or injuries incompatible with life
For Trauma patients not to be resuscitated what criteria is needed?
253
an organized rhythm \> 20 BPM
PEA is defined as?
254
Arrest due to penetrating chest trauma
When does bilateral decompression get performed?
255
observation of cardiac motion in PEA
Ultrasunds in traumatic arrests are done when?
256
known or suspected injury to the chest and or abd
Finger Thoracostomy is done when ?
257
Unwitnessed arrest with blunt trauma
Devestating head trauma
loss of Cardiac output \> 10 min
Contraindications for Finger Thoracostomy?
258
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
Jump start triage initial is ?
259
posturing
The " P" in Jump start triage means what ?
260
\< 50
what is Trauma alert criteria for peds with BP?
261
2 or more adjacent ribs are fractured
Flail chest sis defined?
262
Absent or diminshed LS
BP\< 90
Respiratory distress or difficulty with BVM
Criteria for chest decompression
263
5th intercostal space mid axillary
What is the primary site for chest decompression?
264
2 or 3 rd intercostal space mid clavicular
What is the secondary site for chest decompression
265
GCS decline of 2 or more points
sluggish or non reactive pupil
Paralysis or weakness on 1 side of the body
Cushings Triad
Intercrainial pressure and herniation signs are?
266
SBP 110-120
Adult BP maintain BP for Head injuries is what?
267
30-35mmhg
Head injuries ETCO2 is?
268
2
How many attempts to realign for anatomical position
269
Allergy to cephalosporins
Neonates birth to 30 days
What are the contraindications for Ceftriaxone or rocephin?
270
Left side, 4-6 inches of padding to Right side
Maintain BP for peripheral pulses
Pregnant 3rd trimester trauma alerts get transported how?
271
Gravida- previous pregnancies
Para- Number of Live births
Gravida and Para definitions
272
Ectopic
Spontaneous
bleeding
hypotensive
1st and 2nd trimester complications include?
273
Placenta previa-painless vaginal bleeding bright red
Abrupto PLacenta-severe pain sudden onset
Uterine rupture- - intense abd pain and Vaginal bledding
3rd Trimester complications include
274
SBP \>160 DSP \> 110 with :
AMS
Headache
Visual disturbances
PE
Preeclampsia is defined as?
275
S/S of pre + seizures or coma
Eclampsia is defined as ?
276
Breech birth
Prolapsed cord
When can you insert a gloved hand into the vagina for a birth?
277
if not delivered in 3 minutes
Time for Breech birth actions
278
279
IC
Who’s responsibility is it to assign a safety officer?
280
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
All safety officers will have the authority to ?
281
Safety concerns for fire rescue in typical incidents
Fire behavior
Building construction
EMS
A safety office should have a working knowledge of what?
282
SHOULD
Only those person who have completed and approved Incident safety officer course ________ be used as a safety officer.
283
30-35%
How much can a pregnant female lose with regards to blood volume?
284
5-15mmhg.
During pregnancy what is the possibe BP drop?
285
closed loop communication
What type of communication is to be used with a second paramedic to ensure proper drug dose?
286
proximal humorous
Proximal Tibia
distal tibia
PEDI: All of the above and Distal Femur.
what are the sites for IO insertion for an adult and pediatric?
287
IO
what is the preferred access fo r pediatrics in cardiac arrest?
288
OPPPQRSTA
for the hx taking in an assessment what pneumoic is used?
