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Protocols > Adult > Flashcards

Adult Flashcards

0
Q

12 Lead - CP w/LBBB looks like

A

CP w/ LBBB (t wave opposite qrs, wide qrs >=120), rabbit ear in v6

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1
Q

Seizure

A

PHC - cspine, ABC’s - 02, 12 lead, hx,
BG <60 (Not Alert/unstable) no spinal injury = pt on side, IV Dextrose 50%, 25 gms(50ml), no IV=glucagon 1mg IM
Chk BG in 10 min,
Resp dep - Narcan 2mg IV titrated, repeat in 2-3 min,
**Actively seizing - Midazolam(10mg IM) or (5mg slow IV/IO), repeat same dose or med control

*Pregnant (eclampsia) - 2gm mag sulfate in 100-250ml NS IV/IO, doesn’t stop=midazolam(10mg IM) or (5mg slow IV/IO) (lorazepam 4mg IV/IO, diazepam 10mg IV/IO/rectal)

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2
Q

AMS

A

PHC - cspine, ABC’s - 02, 12 lead, hx,
Restraints PRN,
BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM
Check BG in 10 min
Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min

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3
Q

ABD trauma

A 
PHC - cspine, ABC’s - 02, 12 lead, hx,
spinal assess,
LOC,
Transport,
Pain mgmt, Eviscerations - sterile moist dressing then foil or plastic wrap then towel or blanket,
Knees bent,
Shock,
IV/IO - 1L wide open
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4
Q

Adult trauma

A 
PHC - cspine, ABC’s - 02, 12 lead, hx,
spinal assess,
LOC,
Transport,
Shock,
Tourniquet,
IV/IO - 1L wide open,
Pain mgmt
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5
Q

Chest trauma

A 
PHC - cspine, ABC’s - 02, 12 lead, hx,
spinal assess,
LOC
Transport
Control hemorrhage
Hi 02
Sucking wound - 3 sided occlusive (release if worsening sob or tension pneumo)
Tension Pneumo - needle decomp, control bleeding, spinal immob PRN
Shock
IV/IO - 1L wide open
Pain mgmt
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6
Q

12 Lead - LBBB caused by AMI, CHF, CAD

A

New LBBB = STEMI, requires pacemaker, (v1 wide rs w/neg deflection, v6 wide rabbit ear), LBBB - deep negative in v1, Elevation >=5mm in old LBBB = STEMI

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7
Q

ABD pain

A 
PHC - cspine, ABC’s - 02, 12 lead, hx,
exam abd,
central/distal pulse,
shock,
trauma protocol,
nothing by mouth,
n/v protocol,
pain management
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8
Q

12 Lead - Tombstone T wave

A

Widow maker

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9
Q

12 Lead - Pericarditis

A

global ST elevation, hurts more leaning forward, hx of infection

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10
Q

CVA/Stroke

A

PHC - cspine, ABC’s - 02, 12 lead, hx

AMS -
BG <60 (Not Alert or unstable) - no spinal injury = patient on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM
Recheck BG in 10 minutes
Resp depression - Naloxone 2mg IV titrated, repeat in 2-3 min

Seizure protocol

Stroke Scale

  • facial droop
  • arm drift
  • abnormal speech

Last seen normal
Transport asap
Notify hospital
IV

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11
Q

Burns - Electrical

A 
PHC - cspine, ABC’s - 02, 12 lead, hx
Protect from live wires
Spinal immobilization PRN
Assess/Treat entrance/exit wounds
IV/IO - 1 liter wide open for hypotension or severe burns >15%, repeat PRN, max 2 liters
Pain Management
Intubate PRN
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12
Q

Burns - Chemical

A 
PHC - cspine, ABC’s - 02, 12 lead, hx
Protect from contamination
Remove constricting items/clothing
Brush off dry chemicals prior to irrigation
Assess/Treat trauma
dry dressings
IV/IO - 1 liter wide open for hypotension or severe burns >15%
Pain Management
Intubate PRN
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13
Q

Burns - Thermal

A 
PHC - cspine, ABC’s - 02, 12 lead, hx
Stop the burn
Assess/Treat trauma
Burn extent/severity (rule of nines)
Remove constricting items
>15% - dry dressings
<15% - wet dressings 
NS 1L wide open, repeat PRN for hypotension or severe burns, max 2 liters
Pain Management
Intubate PRN
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14
Q

Allergic reaction/Anaphylaxis

A

PHC - cspine, ABC’s - 02, 12 lead, hx
Remove source
wheezing - pt’s epi pen
IV/IO - 1 liter wide open

Symptomatic - Benedryl 50 mg IM/IV/IO

Severe reaction (wheezing/hypotension) - epi 1:1000 0.3 mg (0.3ml) or auto injector

Profound reaction (near arrest) - epi 1:10,000 0.3mg (3ml) slow IV/IO

Prednisone (50 mg tablet) or methylprednisolone (125mg) IV

Additional epi -
* Severe (wheezing/hypotension) 1:1000 0.3mg (0.3ml) IM
* Profound (near arrest) 1:10,000 0.3mg (3ml) IV/IO

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15
Q

Combitube requirements

A

> 5’ tall - 41F - Proximal 50-75cc initial, 100cc max, Distal 15cc
4’ tall - 37F - Proximal 50-75cc initial, 85cc max, Distal 12cc
37F preferred <6’ tall
Gastric distention, suction tube opposite ventilating tube to decompress stomach

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16
Q

Helmet Removal

A

Hold c-spine while removing
Football/Hockey can leave in place if patent airway, remove face shield, if well fitting and prearranged w/med control
Leave in place unless airway cannot be controlled or face shield cannot be removed - if prearranged w/med control
If leaving in place use lateral towels, not c-collar to immobilize
Baseball, bicycle, rollerblade helmets - always remove
No prearrangement - remove

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17
Q

12 Lead - RBBB caused by MI or lung disorder (PE, corpulmonale) looks like

A

v1 rabbit ears (1 short, 1 tall), v6 slurred (sloped s)
RBBB - tall positive in v1
Any elevation = STEMI

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18
Q

12 Lead - BBB shows in leads

A

V1 & V6

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19
Q

STEMI/NSTEMI

A 
STEMI = ST elevation
NSTEMI = ST depression or t wave inversion
20
Q

Epi pen dose/weight/injection time

A

0.3mg epi-pen >32kg
0.15 epi jr 10-32kg
10 second injection time

21
Q

Epi pen cautions/location of injection

A

Caution w/heart disease, high BP, stroke

Anterolateral thigh

22
Q

Epi-Pen weight requirement

A

No if weight <10kg, call med control

23
Q

Backboarding check this

A

pms before and after

24
Q

02 dose

A

Nasal Cannula 2-6 LPM (none to moderate)
NRB 8-12 LPM (moderate - severe, cyanide, carbon monoxide, smoke inhalation)
Ped blow by - 15 LPM

25
Q

Nebulizer LPM?

A

6-7 LPM, ask them to breath deep every 5 breaths

26
Q

FBAO - Infant <1 year

A

No abd thrust due to unprotected liver
5 back blows/5 chest compressions
Unconscious = forceps

27
Q

12 lead - Scooped st segment =

A

Digoxin OD

28
Q

Report acute MI when

A

ST elevation >= 1mm in 2 contiguous leads

29
Q

12 leads for the following

A 
Chest pain or pressure
Upper abdominal pain
Syncope
Shortness of breath (not including asthma or COPD)
Pain/discomfort often associated with cardiac ischemia (jaw, neck, shoulder, left arm)
Any doubt as to origin of pain
Nausea
Vomiting
Diaphoresis
Dizziness
Patient expression of “feelings of doom”
Any doubts
30
Q

Epi pen contraindications

A

No absolute contraindications in anaphylaxis
Caution heart disease, hypertension, stroke
Under 10 kg

31
Q

Nausea & Vomiting

A

PHC - cspine, ABC’s - 02, 12 lead, hx,
NS IV/IO - 1L, wide open.
Hypotensive max of 2L, Zofran 4mg IV/IM.
Post-Med Control - Zofran 4mg IV/IM

32
Q

Drowning/Near Drowning/Submersion

A 
PHC - cspine, ABC’s - 02, 12 lead, hx,
Temp?
**Pulse absent - submersion >1 hr = Dead on Scene,
Normothermic - CPR,
Hypothermic - Hypothermic CPR,
**Pulse present - Hypothermic/Frostbite Protocol/warm/dry,
Consider CPAP/BiPAP,
Med Control if no transport
33
Q

Excited Delirium definition

A

extreme agitation, confusion and hallucinations, erratic behavior, profuse diaphoresis, elevated vital
signs, hyperthermia, unexplained strength and endurance, and behaviors that include clothing
shedding, shouting out, and extreme thrashing when restrained. It is often found in correlation
with alcohol and illicit drug use, and in those patients with preexisting mental illness.

The most immediate threat to patients experiencing this syndrome is sudden apnea and cardiac
arrest, usually after thrashing against physical restraint.

Be vigilant if a combative patient suddenly becomes quiet.

Excited delirium can mimic several medical conditions, including hypoxia,
hypoglycemia, stroke, or intracranial bleeding. Blood glucose should be measured, when
possible

34
Q

Excited Delirium

A

Defined as an imminent physical threat to personnel and/or themselves
Restraints
Midazolam 10 mg IM or 5 mg IN
Transport. Request Law Enforcement to accompany to hospital.
Monitor vitals, cardiac closely
Treat other medical problems (hypoglycemia, vomiting, etc.) as indicated.

35
Q

EXERTIONAL HEAT STROKE

A

PHC- cspine, ABC’s - 02, 12 lead, hx,
Restraints PRN,
BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM
Check BG in 10 min
Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min

Cool body (torso) ASAP via ice or cool-water immersion/dousing. A
Cool then transport 2nd
NS IV/IO - 1L wide open, repeat PRN
Seizure protocol
ECG (lead cables can go in the water)
36
Q

HEAT STROKE:

A

PHC- cspine, ABC’s - 02, 12 lead, hx,
Restraints PRN,
BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM
Check BG in 10 min
Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min

Cool pt, remove clothing, semi fowlers, head elevated
NS IV/IO - 1L, wide open, repeat PRN

37
Q

Heat Cramps

A

PHC- cspine, ABC’s - 02, 12 lead, hx,
Restraints PRN,
BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM
Check BG in 10 min
Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min

Cool pt/oral liquids.

38
Q

HEAT EXHAUSTION

A

PHC- cspine, ABC’s - 02, 12 lead, hx,
Restraints PRN,
BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM
Check BG in 10 min
Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min

Cool pt, remove clothing, NS IV/IO - 1L, wide open.
Oral fluid if no nausea (sports/rehydration drinks). If AMS, abd pain or nausea, nothing by mouth.

39
Q

Hypothermia

A

PHC - cspine, ABC’s - 02, 12 lead, hx, Hypothermic CPR
Warm, dry,
temp >86F (30C shivering/conscious)
Heat packs to groin, axillae, neck
Warmed 02,
Alert=warm, oral fluid
**<86F (30C) = transport asap, warm NS IV/IO 1L, wide open

40
Q

Frostbite

A

PHC - cspine, ABC’s - 02, 12 lead, hx,
Warm, dry, thaw if no chance of refreezing, elevate, dry sterile dressings prevent pressure, trauma, friction,
Pain Mgmt

41
Q

APGAR

A 
A – appearance (color)
P – pulse (heart rate)
G – grimace (reflex irritability to slap on sole of foot)
A – activity (muscle tone)
R – respiration (respiratory effort)

Appearance – skin color, 0-Bluish/pale, 1-Pink/ruddy; hands/feet blue, 2-Pink/ruddy; entire body
Pulse – HR, 0-Absent, 1-Below 100, 2-100
Grimace – reflex irritability to foot slap 0-No response 1-Crying; some motion 2-Crying; vigorous
Activity – muscle tone, 0-Limp 1-Some flexion of extremities, 2-Active; good motion in extremities
Respiratory effort 0-Absent 1-Slow/Irregular 2-Normal; crying

42
Q

Arm or limb presentation – Life threatening condition.

A

Transportation ASAP
Delivery should not be attempted outside the hospital.
Mom position of comfort or with hips elevated on pillow.
Maintain airway, give 02

43
Q

Obstetrical Emergencies

A

PHC - cspine, ABC’s - 02, 12 lead, hx
previous births, previous complications
duration of gestation (weeks), whether single or multiples expected
vital signs, assess contractions
wait for delivery if Multiple pregnancy, strong regular contractions, every 2 minutes or less; ruptured
membrane, bloody show, need to push or bear down, crowning
IV

**Normal Delivery
02/Suction ready for newborn,
Monitor for hypotension=position so weight of uterus is to pt’s left side,
Drape, Slow deep breaths through her mouth,
Prevent an explosive delivery, suction mouth/nose
Cord around neck - slide over head, no tug, or clamp/cut
Note time
Place head lower than the body, suction mouth/nose making
Warm/dry/stimulate (rub back, slap soles)
15L 02 for no breathing
15L 02 if breathing, until pink
Cord clamped 8” - 2 clamps 2” apart/cut between
Keep cord moist if resuscitating.
APGAR @ 1 & 5 mins
APGAR <6 = resuscitate,
Deliver placenta enroute (w/in 20 min) massage uterus
Bring placenta to hospital

**Meconium in airway
Intubate/suction (low pressure), repeat w/new tube

44
Q

Prolapsed Cord – Life Threatening Condition

A 
Mom in supine position w/hips on pillow.
Maintain airway, give 02,
sterile gloved hand, gently push baby up vagina several inches to
release pressure on cord.
DO NOT PUSH CORD BACK!
Maintain pressure on head.
45
Q

Abnormal Deliveries

A

Med control
Breech position, Buttocks/trunk deliver spontaneously, legs clear, support body w/palm of your hand, allowing head to deliver
If head doesn’t deliver immediately, transport rapidly to the hospital with
mother’s buttocks elevated on pillows with baby’s airway maintained w/gloved hand in the vagina with your palm towards the baby’s face “V” with your fingers on either side of the baby’s nose and push the vaginal wall away from baby’s face until the head is delivered.

46
Q

Multiple births

A

PHC - cspine, ABC’s - 02, 12 lead, hx
previous births, previous complications
duration of gestation (weeks), whether single or multiples expected
vital signs, assess contractions
wait for delivery if imminent Multiple pregnancy, strong regular contractions, every 2 minutes or less; ruptured
membrane, bloody show, need to push or bear down, crowning
IV
Immediate transportation
small birth weight/maintain body heat.
1st baby clamp cord, airway, dry, warm
There may be time to transport between births.

47
Q

Pre-eclampsia/Eclampsia signs/treatment

A 
BP 160/110 or higher,
Marked peripheral edema,
Diminished LOC,
Seizure (eclampsia),
Transport ASAP,
Seizure - Mag Sulfate 2 gm in 100 or 250ml NS over 10 minutes IV/IO until stops
If seizure does not stop Midazolam IM 10mg or Midazolam 5mg, Lorazepam 4mg, or Diazepam 10mg slow IV/IO push
Diazepam can be given rectal

Post Med Control
G. If seizure persists, additional Mag Sulfate 2 gms IV/IO, if available.

48
Q

Psych definitions

A

**Protective Custody - The temporary custody of an individual by a law enforcement officer
with or without the individual’s consent for the purpose of protecting that individual’s health and
safety, or the health and safety of the public and for the purpose of transporting the individual if
the individual appears, in the judgment of the law enforcement officer, to be a person requiring
treatment. Protective custody is civil in nature and is not to be construed as an arrest.
(330.1100c (7), Sec. 100c, Michigan Mental Health Code)

**Authority to Restrain - EMS personnel are able to restrain and treat and transport an
individual under authority of Sec 20969 of Public Act 368 which states: “This part and the
rules promulgated under this part do not authorize medical treatment for or transportation to a
hospital of an individual who objects to the treatment or transportation. However, if emergency
medical services personnel, exercising professional judgment, determine that the individual’s
condition makes the individual incapable of competently objecting to treatment or
transportation, emergency medical services may provide treatment or transportation despite
the individual’s objections unless the objection is expressly based on the individual’s religious
beliefs.”

Protocols (2 decks)

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