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Adult Protocols > Adult Protocols > Flashcards

Adult Protocols Flashcards

1
Q

In adult respiratory emergencies what things should be considered that focus on the respiratory system?

A 
Assessment of chest wall movement, including rate and depth
Symmetrical chest rise and fall
Assessment of accessory muscle use
Auscultation of bilateral lung sounds
Pulse oximetry
EtCo2
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2
Q

If signs of hypoxia and respiratory distress are present what must be immediately initiated?

A

Airway and ventilatory management

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3
Q

Signs and symptoms of respiratory distress?(8)

A 
Altered mental
Tachypnea
Cyanosis
Accessory muscle use
Nasal flaring
Pursed lips
Abnormal lung sounds
Tachycardia
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4
Q

What respiratory rate, oxygen saturation and EtCo2 should alert paramedic that immediate airway and ventilatory management including placement of advanced airway?

A

Oxygen saturation below 94%
Respiratory rate below 10 or above 36 a minute
EtCo2 outside range of 35-45

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5
Q

What should be determined in chronic respiratory disease patient with respiratory distress?

A

If it is chronic or acute

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6
Q

Questions pertaining to what is adult respiratory emergencies prove to be invaluable?

A

Chief complaint and accompanying symptoms

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7
Q

In adult respiratory emergencies what should be combined with lung sounds?

A

Patient HX

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8
Q

5 causes of upper airway obstruction?

A 
Tongue
Foreign body
Swelling due to angio-neurotic edema
Allergic reaction/anaphylaxis
Trauma
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9
Q

In a responsive patient if air exchange is inadequate and there is reasonable suspicion of foreign body obstruction you should?

A

Apply abdominal thrusts until they become unresponsive or object is removed

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10
Q

What should yo do if a patient with a suspected foreign body airway obstruction becomes unresponsive?

A

Chest compressions

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11
Q

If unable to relieve a FBAO with abdominal thrusts or chest compressions you should?

A

Visualize it with a laryngoscope and extract the foreign body with magill forceps

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12
Q

What should you use if a airway obstruction is due to trauma and or edema or if uncontrollable bleeding causes life threatening ventilatory impairment?

A

Advanced airway

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13
Q

What procedure should you perform if you are unable to insert an advanced airway or adequately ventilate with BVM?

A

Cricothryroidotomy

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14
Q

What should you do with a patient with a partial airway obstruction?

A

Encourage patient to cough

Do not interfere

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15
Q

A patient should be considered to have asthma if they present with?

A

Dyspnea

Wheezing

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16
Q

What position should the asthma/bronchospasm patient be placed in?

A

Fowlers

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17
Q

What drugs can be administered for asthma/Bronchospasms?

A 
Albuterol
Atrovent
Epi 1:1000
Epi 1:10,000
Mag Sulfate
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18
Q

What is the dose of albuterol in the adult asthma patient?

A

2.5mg mixed with 2.5mg NS

Administered with nebulizer

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19
Q

How many times can you repeated albuterol int he adult asthma patient?

A

Twice

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20
Q

What is the dose of Atrovent in the adult asthma patient?

A

0.5mg

Mixed with the 1st dose of albuterol only

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21
Q

In the asthma/bronchospasm patient after giving albuterol and atrovent what may you give if the patient is still having severe respiratory distress?

A

Epi 1:000

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22
Q

What is the dose and route of Epi 1:1000 in adult asthma/bronchospasm patient?

A

0.3mg IM

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23
Q

When can you give a adult patient with asthma/bronchospasm mag sulfate?

A

When they are in severe Respiratory distress

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24
Q

What is the dose and route of mag sulfate in adult severe respiratory distress?

A

2g
IV mixed in a 50 ML of D5W
Given over 5-10 minutes
10 gtts

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25
Q

When would you give a second dose of Epi 1:1000 in the severe adult respiratory distress patient?

A

When there is no response from albuterol, atrovent, 1st dose of epi, or mag sulfate

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26
Q

When should you consider Epi 1:10,000 in the adult patient with severe respiratory distress?

A

When the patient is hypotensive with a delay in cap refill

Consider as the 2nd or 3rd dose of Epi 1:1000

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27
Q

What is the recommended location to administer epi 1:1000 to the adult patient with severe respiratory distress?

A

Lateral Thigh

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28
Q

Can you administer CPAP for asthma/bronchospasm patient?

A

Yes

2.5 - 5 PEEP

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29
Q

Can you administer a 3rd dose of Epi if no response from previous treatment in adult patient with severe respiratory distress?

A

Yes
It is a level 2 order
Also consider Epi 1:10,000

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30
Q

Can you administer Epi or Bronchodilators to a adult patient with severe respiratory distress and a HR above 140?

A

Yes

It is a level 2 order

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31
Q

Who should you be cautious in administering Epi to in adult patient?

A

Pt’s over the age of 40

History of hypertension or heart disease

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32
Q

What is dose and route of Epi 1:10,000 in adult patients in severe respiratory distress with hypotension and delay in cap refill?

A

0.5mg
Slow IV
Over 3-4 minutes

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33
Q

In the COPD patient if at anytime during transport if the patients respiratory status deteriorates what should you consider?

A

Advanced airway

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34
Q

What drug should you administer if a COPD patients respiratory status deteriorates and how should you administer it?

A

Albuterol

ET tube nebulized

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35
Q

What treatments can be used for the COPD patient?

A

Albuterol
Atrovent
CPAP

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36
Q

What level of PEEP should be used in COPD patients?

A

2.5-5

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37
Q

What should be considered for a adult patient with dyspnea and rales and or wheezing without a HX of asthma?

A

Pulmonary Edema(CHF)

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38
Q

What are possible causes of CHF?

A

Supra ventricular tachycardia
Myocardial infarction
Cardiogenic shock

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39
Q

In a patient with pulmonary edema and a BP less than 90 what protocol should be used?

A

Cardiogenic shock protocol

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40
Q

What treatments can be used for pulmonary edema patient?

A

Nitroglycerin
CPAP
Albuterol
Atrovent

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41
Q

When would you not give nitro in the CHF patient?

A

BP below 120
If patient has taken Viagra in last 24 hours
If patient has taken Levitra or Cialis in past 48 hours

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42
Q

When would you give a patient with pulmonary edema 0.8mg(2 sprays) of nitro?

A

When there BP is over 160

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43
Q

How much nitro do you give the adult CHF patient with a BP above 120 and below 160?

A

0.4mg(1 spray)

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44
Q

How often do you repeat SL nitro in the CHF patient?

A

Every 3-5 minutes as needed

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45
Q

What PEEP to you attempt to achieve when administering CPAP in the adult CHF patient?

A

10 PEEP

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46
Q

If a adult CHF patient will not tolerate 10 PEEP with CPAP what should you lower it to?

A

5-7.5

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47
Q

When should you not administered CPAP to the CHF patient?

A

When the systolic BP is below 90

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48
Q

Can you administer bronchodilators to the CHF patient?

A

Yes but it is a level 2 order

You may give albuterol and atrovent

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49
Q

When should you consider with holding nitro in the CHF patient?

A

When they have clinical signs of hypovolemia

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50
Q

What are some clinical signs of hypovolemia?

A

Poor skin turgor
Decreased cap refill
Elevated temp

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51
Q

Can you administer nitro to a CHF patient without having IV established?

A

Yes but with caution

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52
Q

What are some signs and symptoms of pneumonia?

A 
Fever
Productive cough
Possible pleuritic chest pain
Hx of being bedridden
Known immunocompromise
Diabetes
Elderly
Lung sounds indicative of consolidation(rales or rhonchi with egophony over area of concolidation)
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53
Q

Once a IV has been astablish in a patient with suspected pneumonia what should be administered?

A

250-500 CC NS

If lung sounds are clear

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54
Q

What type of drug should be avoided in pneumonia patient?

A

Diuretics

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55
Q

What are level 1 drugs in the suspected pneumonia patient?

A

Albuterol

Atrovent

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56
Q

What are you 7 H’s?

A 
Hypovolemia
Hypoxia
Hyperkalemia
Hydrogen ion acidosis
Hypothermia
Hypoglycemia
Hypocalcemia
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57
Q

What are your 6 T’s?

A 
Tablets
Tamponade cardiac
Tamponade pneumothorax
Thrombosis coronary
Thrombosis pulmonary
Trauma
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58
Q

How do you threat hypovolemia?

A

Fluid challenge 500 NS

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59
Q

How do you treat hydrogen ion acidosis?

A

Airway management, ventilate

Consider sodium bicarbonate

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60
Q

How do you treat hyperkalemia?

A

Consider calcium chloride 1g

Consider sodium bicarbonate 1mEq/kg

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61
Q

How do you treat hypoglycemia?

A

If less than 60 consider D50 or glucagon

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62
Q

How do you treat hypocalcemia?

A

Consider calcium chloride 1g

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63
Q

How do you treat overdose of tablets?

A

Consult poison control

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64
Q

How do you treat cardiac tamponade?

A

Fluid challenge

Dopamine drip

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65
Q

How do you treat tension pneumothorax?

A

Consider chest decompression

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66
Q

How do you treat coronary thrombosis?

A

Consider AMI

Cardiogenic shock

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67
Q

What should you consider in Asystole/PEA patients?

A

Criteria for death/no resuscitation

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68
Q

How should you oxygenate patients in asystole/PEA?

A

BVM with appropriate airway device
15-25 LPM
8-10 BPM

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69
Q

What should be done while monitoring is being attached in asystole/PEA patients?

A

Compressions at a rate of 100 per minute for 2 minutes

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70
Q

What is paramount for patient survival in CPR?

A

Continuous uninterrupted compressions

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71
Q

How do you confirm asystole?

A

In 2 leads

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72
Q

How and when do you confirm advanced airway placement?

A

EtCo2 monitoring

Confirm on scene, during transport, and during transfer at hospital

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73
Q

Once IV has been established in PEA patient what should you consider giving?

A

Infusing saline wide open in PEA

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74
Q

What class of drug should be given first in asystole/PEA patients?

A

Vasopressor

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75
Q

What 2 vasopressors can be given in asystole/PEA?

A

Epi 1:10,000

Vasopressin

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76
Q

What is the dose of Epi is asystole/PEA?

A

1mg 1:10,000
IV/IO
Repeated every 3-5 minutes

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77
Q

What is the dose of vasopressin in asystole/PEA?

A

40 units

IV/IO

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78
Q

When can vasopressin be given in asystole/PEA?

A

As a replacement for the 1st or 2nd dose of epi

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79
Q

In the asystole/PEA patient who is taking calcium channel blockers or has known renal failure you should give?

A

Calcium Chloride 10%
1g
IV/IO

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80
Q

What should be done as soon as a asystole/PEA patient regains spontaneous circulation?

A

See return of spontaneous circulation and therapeutic hypothermia protocol

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81
Q

What is the compression to ventilation ratio in adults with asystole/PEA?

A

30:2

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82
Q

Once a advanced airway is in place in asystole/PEA how often do you provided ventilations?

A

One every 6 seconds

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83
Q

When should you use ET tube as a route for epi or vaso?

A

As a last resort when IV/IO is unavailable

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84
Q

How do you administer epi or vasopressin via ET tube?

A

Mix Epi 1:1000 2 mg in 8ml of NS or vaso and inject directly into tube

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85
Q

Which epi do you use when administering in asystole/PEA via ET tube?

A

Epi 1:1000

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86
Q

During CPR a EtCo2 of less than ___ should prompt you to attempt to improve CPR

A

10

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87
Q

What is the goal during resusicitation when measuring EtCO2?

A

12-25

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88
Q

During CPR what EtCo2 should prompt you to check for ROSC?

A

35-45

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89
Q

If ROSC if achieved what should you do?

A

Wean down oxygen to maintain a Sp02 equal to or greater than 94%

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90
Q

What HR is considered bradycardia?

A

Less than 50

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91
Q

Who gets treated for bradycardia?

A

Pt with HR less than 50 and who are symptomatic

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92
Q

12 potential causes of bradycardia?

A 
AMI
Head injury
Atrio ventricular block
Hypoxia
Hypoglycemia
Medications(beta blockers)
Calcium channel blockers
Clonidine
Digitalis
Toxins
Sinus sick syndrome
Spinal cord lesion
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93
Q

What should you perform if a inferior wall MI is identified?

A

Perform additional 12 lead to rule out concurrent right ventricular MI

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94
Q

What classifies a patient as unstable in bradycardia?

A 
Altered mental status
Ischemia chest pain/discomfort
Acute heart failure
Hypotension(less than 90)
Dyspnea
Heart blocks or ischemia/infarction
Other signs of shock that persist despite adequate airway and breathing
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95
Q

What shall be done while preparing to pace a patient with symptomatic bradycardia?

A

Administer atropine

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96
Q

What is the dose of atropine in bradycardia?

A

0.5mg IV/IO

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97
Q

How often may atropine be repeated in unstable bradycardia?

A

Every 3-5 minutes

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98
Q

What is the max dose of atropine in bradycardia?

A

3 mg

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99
Q

What should you consider doing prior to giving max dose of atropine in bradycardia?

A

Pacing

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100
Q

What other medication can be used for bradycardia if unresponsive to atropine?

A

IV infusion of primary B-adrenergic agonist(dopamine) with rate accelerating effects

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101
Q

What may be the cause of bradycardia with hypotension?

A

Right ventricular MI

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102
Q

How can you treat a patient with hypotension, a inferior wall MI and clear lung sounds?

A

500 CC NS fluid challenge

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103
Q

How many times may you repeat a fluid challenge un a patient with a inferior wall MI and hypotension?

A

Once

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104
Q

What should be avoided in a patient with inferior wall MI?

A

Nitrates and morphine

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105
Q

What may improve a patients hemodynamic status if bradycardia and hypotension exist?

A

Pacing and IV fluids prior to use of atropine

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106
Q

What drug should you give if a bradycardia patient has persistent hypotension/cardiogenic shock?

A

Dopamine

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107
Q

What drugs can be administered prior to pacing if patient is conscious and aware of situation?

A

Benzodiazepines
Versed
Valium

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108
Q

What is the dose and route of valium to be given prior to pacing?

A

5mg
May be repeated once
Max dose 10
IV, IO, IN

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109
Q

What is the dose and route of versed to be given prior to pacing?

A

2mg increments
IV, IO, IN
Max dose 10mg

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110
Q

When do you omit atropine in the bradycardia patient?

A

2nd degree type 2 AV block

3rd degree AV block

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111
Q

Can you use atropine in the presence of myocardial ischemia?

A

Yes but you must use caution

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112
Q

How should benzodiazepines be administered?

A

Slowly, titrated to effect and being aware of associated hypotension

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113
Q

What may also be helpful in differential interpretation of narrow complex tachycardia?

A

Atrial rate

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114
Q

What is the sinus tachycardia rate?

A

100 - 160

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115
Q

What is the junctional tachycardia rate?

A

100 - 180

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116
Q

What is the atrial tachycardia rate?

A

150 - 250

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117
Q

What is the atrial flutter rate?

A

250 - 350

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118
Q

What is the atrial fibrillation rate?

A

Starts at 350

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119
Q

What should wide complex tachycardia with a QRS greater than 0.12 initially be considered?

A

Ventricular in origin unless proven otherwise(documented QRS morphology consistent with preexisting BBB)

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120
Q

Patients with SVT may have evidence of what?

A

Cardiovascular dysfunction

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121
Q

How should you treat narrow complex tachycardia patients who present with borderline symptomatic signs and symptoms?

A

With medications

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122
Q

How should patients with narrow complex tachycardia patients who present as unstable be treated?

A

Cardioverted immediately

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123
Q

What 4 signs and symptoms classify a patient as borderline symptomatic(stable)?

A

Alert and oriented
SBP equal to or greater than 90
Mild chest discomfort
SOB

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124
Q

What signs and symptoms classify a patient as being critical(unstable)?

A 
Decreased LOC
SBP below 90
Chest pain
SOB
Diaphoresis
Pulmonary edema/CHF
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125
Q

For all patients with HR greater than 150 and narrow who are borderline symptomatic you should?

A

Conduct initial assessment
Determine hemodynamic stability
Consider H’s and T’s

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126
Q

For SVT patients who are asymptomatic you should?

A

Provide supportive care

Transport immediately

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127
Q

What should you attempt first for patients with SVT who are asymptomatic?

A

Vagal maneuvers

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128
Q

In stable patients with SVT that is not resolved with vagal maneuvers you should?

A

Administer adenosine

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129
Q

How should the first dose of adenosine be administered in stable SVT adult patient?

A

6mg IVP

Followed by rapid 20mL NS flush

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130
Q

If SVT is not resolved by 6mg adenosine you should?

A

Give a second dose of 12 mg IVP

Followed by 20 mL flush

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131
Q

What medication can be used to treat stable SVT if vagal maneuvers and adenosine do not convert?

A

Diltiazem(Cardizem)

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132
Q

What must you do prior to administering Cardizem in stable SVT patient?

A

Consult medical direction, it is a level 2 order

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133
Q

What is the dose of cardizem as a level 2 order for stable SVT?

A

0.25 mg/kg IV/IO

20mg for the average patient

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134
Q

How many minutes should you administer Cardizem over in the stable SVT patient?

A

2 minutes

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135
Q

What should you consider if a borderline symptomatic atrial fibrillation or atrial flutter patient has a BP of 90 to 100?

A

Other causes of hypotension

Hypovolemia or sepsis

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136
Q

What medication should be administered for the borderline symptomatic atrial fibrillation or atrial flutter?

A

Diltiazem(cardizem)

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137
Q

What is the initial dose of cardizem for the stable atrial fibrillation/atrial flutter patient?

A

0.25 mg/kg
20 mg average dose
Over 2 minutes

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138
Q

How long after giving the initial dose of Cardizem should you administer a second dose of Cardizem if not resolved?

A

15 minutes
0.35 mg/kg
25 mg average patient

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139
Q

For a patient to be considered critical/unstable symtpomatic narrow complex tachycardia they must have HR above __ and BP below __ along with __________?

A

HR above 150
BP below 90
Evidence of impending cardiac arrest

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140
Q

Signs and symptoms of impending cardiac arrest?

A 
Diaphoresis
Shortness of Breath
Decreased LOC
Chest pain
Pulmonary edema
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141
Q

How much NS should you administer to a unstable SVT patient with clear lung sounds?

A

500 CC

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142
Q

What should be done immediately for unstable SVT patients?

A

Cardioverted

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143
Q

What is the recommended cardioversion joules for unstable narrow SVT or A-flutter?

A

50 - 100

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144
Q

What is the recommended joules for cardioversion of unstable irregular Atrial fibrillation?

A

120 - 200

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145
Q

What medication should not be given to patients with know A-FIB/A-Flutter?

A

Adenosine

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146
Q

Patients with a known HX of wolf parkison white syndrome should not be given what medication?

A

Cardizem

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147
Q

What medication should be considered for patients with wolf parkison white syndrome?

A

Amiodarone

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148
Q

What medication is recommended for treatment of hemodynamically stable VT and prevetion of recurrent VF?

A

Amiodarone

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149
Q

How should patients with asymptomatic PVC’s be treated?

A

Treatment is not recommended
Give supportive care
Oxygen 100% NRB 10-15 LPM

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150
Q

If a patient with PVC’s becomes symptomatic what should you do?

A

Contact physician for orders

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151
Q

What medication should be given to a stable patient with a wide complex tachycardia and a pulse?

A

Amiodarone

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152
Q

What is the dose of Amiodarone for stable patients with wide complex tachcyardia and a pulse?

A

150 mg in a 50 ml bag of D5W
Given over 10 minutes
10 gtts
1 drop a second

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153
Q

How do you treat a stable patient with torsades de pointes?

A

Mag sulfate

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154
Q

What is the dose of mag sulfate for stable patients with tosades de pointes?

A

2 g in 50 ml bag of D5W

Infused over 1-2 minutes

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155
Q

If 2 grams of mag sulfate successfully converts torsades de points you should?

A

Start a mag sulfate maintenance infusion

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156
Q

What is a mag sulfate maintenence infusion for conversion of torsades de pointes?

A

1g in 250 ml bag of D5W
30-60 gtts/min
60 gtts set

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157
Q

How do you treat wide complex tachycardia unstable with a pulse that is monomorhic?

A

Synchronized cardioversion

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158
Q

What is the starting and subsequent dose of joules for synchronized cardioversion of unstable wide complex tachycardia with a pulse?

A

100, 200, 300, 360

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159
Q

When should you defibrillate a unstable patient with a wide complex tachycardia with a pulse?

A

If irregular/unstable
Polymorphic
Tosades

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160
Q

What should be administered to a patient who has been cardioverted but was not administered any antiarrthythmic prior to cardioversion?

A

Amiodarone

150mg in 50mL of D5W over 10 minutes

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161
Q

What should be checked prior to giving Amiodarone after cardioverting someone?

A

That there BP is over 100

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162
Q

How many times and when can you repeated amiodarone 150 over 10 minutes after cardioverting?

A

Once

After 10 minutes

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163
Q

What is the initial joules setting for wide complex tachycardia without a pulse?

A

200

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164
Q

What is the second setting of joules for wide complex tachycardia without a pulse?

A

300

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165
Q

What is the 3rd setting of joules for wide complex tachycardia without a pulse?

A

360

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166
Q

What antiarrthymic is used for wide complex tachycardia without a pulse and how much?

A

Amiodarone
300 1st dose
150 second dose after 3 - 5 minutes

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167
Q

When should amiodarone be administered?

A

During CPR

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168
Q

What medication should be given to a patient with wide complex tachycardia that is torsades de pointes without a pulse?

A

Mag sulfate
2g in 50 mL bag of D5W
Infused over 1-2 minutes

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169
Q

When can you stop treatment of a wide complex tachycardia without a pulse?

A

ROSC
A rhythm change
Termination of efforts

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170
Q

In a patient without a pulse and tosades de pointes who was successfully converted with mag sulfate you should?

A

Start a mag sulfate maintenance infusion of

2g in 500 mL NS at 30-60 gtts/min

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171
Q

What are your immediate goals of post resuscitation care?

A

Provide cardio respiratory support to optimize tissue perfusion especially to brain

Institute antiarrthymic therapy to prevent recurrence of the arrest

Attempt to identify precipitating causes of arrest

Rapidly transport to closest facility

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172
Q

If a ROSC patient has a BP of less than 90 you should?

A

Check lung sounds, if clear give
500 NS
May be repeated once

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173
Q

If ROSC patients BP remains under 90 after giving fluids you should?

A

Give dopamine

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174
Q

In ROSC patients dopamine should be titrated to maintain a BP greater than or equal to?

A

90

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175
Q

When should you give amiodarone in the ROSC patient?

A

When it wasnt given prior to converting

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176
Q

When would you administer a Amiodarone drip in the ROSC patient?

A

Frequent runs of VT
Frequent PVC’s
Transport time over 30 minutes

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177
Q

A amiodarone drip is?

A

150 mg in 50 mL of D5W
Equals 3:1 concentration
Use a 60 gtts and initiate flow at 1 gtt every 3 seconds

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178
Q

In ROSC patient when would you not administer amiodarone?

A

HR less than 60
2nd degree type 2 block
3rd degree block
Hypotension

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179
Q

Why do patients with a ROSC often have a poor neurological outcome?

A

Cerebral reperfusion therapy

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180
Q

What temperature should patients with ROSC be cooled to?

A

32 - 34 Celsius

89.6 - 93.2 F

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181
Q

How long should ROSC patients be cooled to 32-34 degrees celsius(89.6-93.2 F)?

A

12 - 24 hours

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182
Q

What must have the initial rhythm have been for ROSC to be cooled using therapeutic hypothermia?

A

VF

Pulseless VT

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183
Q

For a ROSC patient to recieve theraputic hypothermia the EtCo2 must be atleast?

A

20

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184
Q

For a ROSC to receive therapeutic hypothermia systolic BP must be greater than?

A

90

Before or after vasopressor

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185
Q

What age must a ROSC patient be to receive Therapeutic hypothermia?

A

16

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186
Q

For a ROSC patient to receive therapeutic hypothermia they must?

A 
Non traumatic cardiac arrest
Compressions and defibrillation performed
Advanced airway in place
EtCo2 greater than 20
remain comatose
SBP greater than 90
16 or older
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187
Q

Therapeutic hypothermia may not be executed in ROSC patient if?

A 
Pt is pregnant
Tramatic cardiac arrest
Significant head trauma
Actual or suspected hemorrhage
Initial temp less than 34/93.2
Obvious pulmonary edema
SBP less than 90
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188
Q

What level of Sp02 should be maintained in Therapeutic hypothermia?

A

94%

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189
Q

In therapeutic hypothermia patient you should attempt to maintain EtCo2 of?

A

35 to 45

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190
Q

What type of assessment should be conducted on therapeutic hypothermia patients?

A

Neurological assessment

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191
Q

When conducting a neurological assessment on therapeutic hypothermia patients you should check?

A

Pupils(Size, reactivity, equality)

Motor response to pain

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192
Q

What should be removed when conducting therapeutic hypothermia?

A

Clothing

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193
Q

Where should ice packs be placed when conducting therapetuic hypothermia?

A

Groin
Axillary
Head

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194
Q

Why would you want to administer a benzodiazepine in therapeutic hypothermia patients?

A

To prevent shivering

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195
Q

What is the dose of cold saline in therapeutic hypothermia?

A

30mL/kg

Max of 2 liters

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196
Q

What should you label the saline bag being used for therapeutic hypothermia?

A

Hypothermia

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197
Q

For therapeutic hypothermia patients when would you start a dopamine drip?

A

When BP drops below 90

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198
Q

What would you run dopamine drip at for therapeutic hypothermia patient who’s BP drops below 90?

A

10 mcg/kg/min

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199
Q

For a therapeutic hypothermia patient who is being given dopamine because of a BP below 90 what would you attempt to maintain there BP above?

A

110

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200
Q

What should be done if at anytime during therapeutic hypothermia you lose ROSC?

A

Stop

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201
Q

What may preclude initiation of therapeutic hypothermia?

A

Short transport times

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202
Q

What medication can be considered if during therapeutic hypothermia a patient has persistent shivering or is allergic to benzodiazepines?

A

Morphine

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203
Q

If giving morphine to prevent shivering in therapeutic hypothermia what is the dose and how often should you give it?

A 
Morphine
2mg increments
IVP
Every 5 mins
Max dose of 6mg
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204
Q

Cardiogenic shock protocol is used for patients with BP less than?

A

90 with signs and symptoms that are cardiac in origin

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205
Q

In cardiogenic shock when would you administer 500 CC NS and how many times may you repeat it?

A

If lungs sounds are clear

May be repeated once

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206
Q

When would you administer dopamine in cardiogenic shock?

A

If fluid challenge does not improve BP or if patient is experiencing pulmonary edema

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207
Q

What is your mcg/kg/min for dopamine in cardiogenic shock?

A

5 to 20

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208
Q

What is the minimum and maximum BP you want to achieve with a dopamine infusion?

A

Min 90

Max 120

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209
Q

When would you avoid giving fluids in the cardiogenic shock patient?

A

Anterior wall MI is suspected

Unclear lung sounds

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210
Q

Anterior wall MI is evidence by?

A

ST elevations in lead I, AVL, V1- V6

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211
Q

Max dose of dopamine?

A

20 mcg/kg/min

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212
Q

Dopamine infusion concentration?

A

1600 mcg/mL

15-60 gtts/min with 60 gtts

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213
Q

What amount of oxygen should be administered for chest pain with o2 sat above 94%?

A

4 LPM via NC

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214
Q

What amount of oxygen should be administered to a chest pain patient with oxygen saturation below 94% and respiratory distress?

A

15 LPM via NRB

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215
Q

When should you not administer nitro to the chest pain patient?

A

BP below 90

Erectile dysfunction meds taken

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216
Q

Aspirin dose for chest pain patients?

A

162 mg up to 324 mg PO

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217
Q

What should be done with a 12 lead ECG as soon as possible when suspecting AMI?

A

Transmit to hospital

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218
Q

What is the max dose of nitro in chest pain patients and how often can it be administered?

A
  1. 2mg is max dose

0. 4 can be administered every 3-5 minutes

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219
Q

What medication can be given to chest pain patient who is normotensive after giving nitro?

A

Morphine
2mg increments
Every 3-5 minutes

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220
Q

AMI is probable when there is ST elevation of ___ in two or more leads?

A

1mm

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221
Q

A new onset of left BBB on ECG is suggestive of?

A

AMI

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222
Q

Cardiac alert on scene time should be minimized to less than?

A

10 minutes

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223
Q

Hypertensive emergencies are defined as?

A

Systolic BP greater than 180
Diastolic BP greater than 110
Signs and symptoms of organ failure

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224
Q

Neuralgic end organ damage due to uncontrolled BP may include?

A

Hypertensive encephalopathy

Cerebral vascular accident

225
Q

Cardiovascular end organ damage from hypertension may include?

A

Myocardial ischemia/infarction
Acute left ventricular dysfunction
Acute pulmonary edema
Aortic dissection

226
Q

What may be affected by uncontrolled hypertension?

A

Acute renal failure

Eclampsia

227
Q

What should you focus on in hypertensive emergency?

A

Patient presentation

Not BP itself

228
Q

In chronic hypertension what may cause more harm than good?

A

rapid reduction in BP

229
Q

Hypertension in thrombotic stroke is a normal response and lowering the BP may?

A

Extend the area of injury

230
Q

What is the poison control number?

A

18002221222

231
Q

Pt with altered mental status with unknown etiology and blood glucose above what gets NS?

A

300

232
Q

What must accompany a blood glucose above 300 in the altered mental status patient with known etiology for a patient to receive NS?

A

Signs and symptoms of dehydration

233
Q

What is the dose of dextrose for the altered mental status patient of unknown etiology?

A

Dextrose 50%
25g dextrose in 50 mL
Slow IV

234
Q

How can narcan be administered in altered mental status patient with unknown etiology?

A

2 mg
IV, IM, IN
ET as last resort

235
Q

Can dextrose 50% be given twice in patient with altered mental status of unknown etiology?

A

Yes

As long as blood glucose remains under 60

236
Q

How do you avoid infiltration and resultant tissue necrosis when administering dextrose 50%?

A

Give it slow with intermittent aspiration of line to confirm patency followed by saline flush

237
Q

How should narcan be administered to patient with altered mental with unknown etiology when hx is unknown or there is a possibility of chronic narcotics?

A

0.4 mg/min

Slowly

238
Q

What may be induced when giving narcan to patients with HX of chronic use of narcotics?

A

Withdrawl or violent behavior

239
Q

The therapeutic goal in administering narcan to a patient with known or possibility of chronic narcotic use is to?

A

Restore adequate ventilatory support

240
Q

What should yo consider when administering narcan to a patient with known or possibility of chronic narcotic use?

A

Physical restraints

241
Q

What protocol should the violent and/or impaired patient protocol be used in conjunction with?

A

Behavioral Emergencies

242
Q

What should be used if a patient poses a threat to self, EMS, or bystanders?

A

Use restraints

243
Q

If a patient is non violent you should?

A

Be observant for possibility of violence

Avoid provoking patient

244
Q

When should particular caution be used in the violent or impaired patient?

A

When any nonlethal law enforcement devices have been used

245
Q

What should be closely monitored in the violent/impaired patient?

A

Blood glucose

246
Q

When it is appropriate you may have the police ______ the violent/impaired patient?

A

Baker Act

247
Q

What act should you refer to if a person has been baker acted by the police?

A

Impaired/Incapacitated act

248
Q

What non-psychiatric causes must be ruled out in a violent/impaired patient?(5)

A 
Drug overdose
CVA
ETOH
Hypoxia
Hypoglycemia
249
Q

If a violent/impaired patient is showing signs of bizarre or aggressive behavior, dilated pupils, high body temp, Inchoherent speech, inconsistent breathing patterns, fear and panic, profuse sweating, shivering or nudity you should?

A

Refer to ExDs protocol

250
Q

Which medications can be used to physical restrain a adult patient?

A

Valium
Versed
Diphenhydramine

251
Q

Dose of Benadryl for chemically restraining a patient?

A

50mg IM or IV

252
Q

What must be started once a patient has been sedated because of being violent or impaired?

A

Cardiac monitoring

Est IV and give NS wide open

253
Q

What should you check for in the violent/impaired patient?

A

Temp

Cool as nessessary

254
Q

How do you cool a patient who is violent or impaired?

A

Use “cool” normal saline

Apply ice packs to groin and axillae

255
Q

How should you transport a violent/impaired patient?

A

Code 3 to the closest appropriate facility

256
Q

Why might you choose IM or IN for route of administration of medication in a violent/impaired patient?

A

Because IV route might present safety concerns

257
Q

Excited delirium is a state in which a person is?

A

Psychotic and extremely agitated

258
Q

The excited delirium patient is mentally what?

A

Unable to focus or process rational thoughts

259
Q

What happeneds to the organs in a ExDs patient?

A

They are functioning at such a excited rate they will begin to shut down

260
Q

What 3 things essentially bring on ExDs?

A

Overdose
Drug Withdrawl
Mental subject who is off a medication for a significant amount of time

261
Q

Overdose on what types of medication can cause ExDs?

A

Stimulant or Hallucinogen

262
Q

What does priority stand for in the ExDs patient?

A 
Psychological issues
Recent drug/alcohol use
Incoherent speech
Off clothes and sweating
Resistant to presence/dialogue
Inanimate objects/shiny/glass=violent
Tough, unstoppable, super human strength
Yelling
263
Q

What happends in a ExDs patient prior to onset of death?

A

Instant tranquility

264
Q

What medication should be administered as quickly and safely as possible in the ExDs patient?

A

Valium
Versed
Diphenhydramine

265
Q

The decision of an ExDs patient to be transported is the sole discretion of who?

A

The patient based on the information that EMS personnel provide during the physical exam

266
Q

What 3 situations should the seizure protocol be used in?

A

When seizures are witnessed
When patient has Continuous convulsions
When patient has repeating episodes without regaining consciousness or sufficient respiratory compromise

267
Q

What should be considered in seizure patients?

A 
Underlying etiology
Hypoglycemia
Overdose
Head injury
Fever
268
Q

When would you administer mag sulfate in a seizure patient?

A

If the patient is eclamptic female

269
Q

What is the mag sulfate dose for eclamptic female seizure patient?

A

4g IV in 50 mL of D5W

Given over 5 to 10 minutes

270
Q

What medication should be given to no eclamptic seizure patients?

A

Benzodiazepines

271
Q

Can versed be given IM in the seizure patient?

A

No
IV, IO, IN
IN concentration 10mg/2mL

272
Q

Can valium be given IO in the seizure patient?

A

No

IV, IM, IN

273
Q

When should you assume that a female patient who is seizing is having eclampsia?

A

When she is in her 2rd or 3rd trimester of pregnancy

Over 20 weeks

274
Q

How long post partum can eclampsia occur?

A

6 weeks

275
Q

Can more than than 10mg of valium be given in the seizure patient?

A

Yes but it is a level 2 order

276
Q

When should yo refer to a suspected stroke protocol?

A 
AMS
Slurred speech
Loss of function of any body part
Hemiplegia
Loss of vision
Weakness of facial muscles
Loss of sensation
Drooling
277
Q

What should be ruled out in suspected stroke patients?

A

Hypoglycemia
Drug overdose
Hypoxia

278
Q

Differential diagnosis for a patient with HX of stroke/TIA and impaired understanding of speech?

A

TIA

279
Q

DD for paitent with previous neurological deficit with aphasia/dysarthria and weakness/hemiparesis is?

A

Seizure

Hypoglycemia

280
Q

DD of patient with hypertension and facial drop?

A

Drug ingestion

281
Q

DD of patient with hx of heart disease and poor coordination/balance?

A

Tumor

282
Q

DD of patient with hx of diabetes and loss of peripheral vision?

A

Trauma

283
Q

DD of patient with HX of anticoagulant medications with syncope, dizziness/vertigo?

A

Stroke

284
Q

To meet stroke alert criteria time of onset of symptoms must be less than or equal to?

A

4.5 hours

285
Q

To meet stroke alert criteria there must be abnormal findings on what?

A

Cincinnati stroke scale
or
Expanded neurological examination

286
Q

What must deficits not be due to to meet stroke alert criteria?

A

Head trauma
Stroke mimic
Blood glucose less than 60

287
Q

How should a stroke alert patient be positioned?

A

Supine

Head elevated 30 degree unless patient cannot tolerate it

288
Q

How much o2 should be given to the stroke alert patient with Sp02 above 94%?

A

None

289
Q

How much oxygen should be given to stroke alert patient with Sp02 below 94%?

A

2 LPM NC

290
Q

Whens should you administer high flow 02 and assist ventilations in a stroke alert patient?

A

If Sp02 cannot be maintained at 94% with NC at 2 LPM
or
Patient is in respiratory distress

291
Q

What should be determined and documented in stroke alert patients?

A

Time of onset of symptoms

Defined as last time the patient was seen without symptoms

292
Q

What should a neurological exam in a stroke alert patient consist of?

A

Level of consciousness
GCS
Cincinnati prehospital stroke scale

293
Q

What should be continually done during transport of the stroke alert patient?

A

Reassess of the patient and there sysmptoms

294
Q

What should you be considering when a patients chief complaint is syncopal episode?

A 
Med side effect
Glucose imbalance
Inner ear disorder
CVA
TIA
MI
295
Q

What information should be obtained from patient or bystanders in adult toxicologic disorders?

A 
Which drug, poison or other substances was patient exposed to
Route of exposure
When and how much
Duration of symptoms
Depressed or suicidal
Exposure accidental
Nature of accident
Duration of exposure
296
Q

What 2 things should be transported with adult toxicologic patients?

A

Pill bottles

Suicide notes

297
Q

When treating a patient with a snake bite how often should you make the level of swelling with a pen?

A

Every 15 minutes

298
Q

How should yo position the snake bit patient?

A

Supine

299
Q

How should the snake bit victims extremity be kept?

A

At a neutral level

300
Q

What should be done with all jewelry from a snake bite patient?

A

Remove and secure

301
Q

How should you treat a snake bite patient?

A

Splint affected area
Keep patient quiet
Wash area with copious amounts of water

302
Q

Should yo attempt to identify a snake in a snake bite victim?

A

Yes, if safe to do so

303
Q

How do you treat dog, cat and wild animal bites?

A

Would care, BLS

Clean wound with soap and water

304
Q

When would you not use hydrogen peroxide on animal bite patients?

A

When wounds are deep or fat is exposed

305
Q

What should yo advise dispatch to do in animal bite cases?

A

Contact animal control and police dept for identification and quarantine of animal

306
Q

How should yo attempt to remove a stinger from a insect sting patient?

A

Scrapping patients skin with edge of flat surface

307
Q

Why should you not attempt to remove a stinger by pulling it from a insect sting patient?

A

This may release more venom

308
Q

How should you clean a insect sting patients wound?

A

Soap and water

309
Q

How can you attempt to relieve pain of a marine animal envenomation?

A

Immerse punctures in non scalding hot water to tolerance

310
Q

What temperature of water should be used to help relief pain from a marine animal envenomation?

A

110 - 113

311
Q

How long should you attempt to immerse a marine animal envenomation in 110 -113 degree water?

A

30 to 90 minutes

312
Q

What should be done with any visible pieces of the spine or sheath of a marine animal?

A

Remove
Gently wash with soap and water
Irrigate with water(avoid scrubbing)

313
Q

For marine animal stings you should?

A

Rinse with sea water
Do not use fresh water, ice, do not rub skin
Apply acetic acid 5% vinegar until pain is relieved

314
Q

What can be used to treat marine animal stings if vinegar is unavailable?

A

Paste of baking soda or unseasoned meat tenderizer

315
Q

What should be sued to remove large tentacle fragments in marine animal stings?

A

Forceps

316
Q

What can you apply to skin a marine animal sting to be shaved off with flat edge of credit card?

A

Shaving cream

or Paste of baking soda

317
Q

Signs and symptoms of CNS depressant overdose?

A 
AMS
Resp depression
Hypotension
Pulmonary edema
Bradycardia
Coma
Constricted pupils(opioids only)
318
Q

When would you administer sodium bicarbonate in CNS depressant overdose?

A

When the QRS of an ECG is wide(greater than 0.10)

1mEq/kg IV

319
Q

When should you administer narcan in the CNS depressant overdose?

A

When respiratory is depressed

320
Q

When should narcan be repeated in CNS depressant to maintain its effects?

A

Every 20 - 30 minutes

321
Q

Signs and symptoms of CNS stimulant overdose?

A 
Dilated pupils
Agitation
Paranoia
Bizarre behavior
PVC
Tachycardia
Hypertension
Seizures
322
Q

What should be done for the CNS stimulant overdose patient who is hot to the touch?

A

Aggressively cool patient

323
Q

What drugs are contraindicated in cocaine overdose?

A

Beta blockers

324
Q

Signs and symptoms of digitalis toxicity?

A

Bradycardia
AV block with rapid ventricular response
SVT
Ventricular ectopy

325
Q

Other ECG changes that may be associated with digitalis toxicity include?

A

Wide PR interval greater than 0.20
Short QT interval(rate dependent)
Spoon shaped ST segment
Peaked T waves

326
Q

Contact with what type of tree can cause digitalis type toxicity?

A

Oleander tree

327
Q

What medication should be avoided in digitalis toxicity patients with tachydyhythmias?

A

Calcium Chloride

328
Q

How should you treat unstable tachycardia in the digitalis toxicity patient?

A

Synchronized cardioversion

329
Q

How should you synchronize cardiovert a patient with digitalis toxicity?

A

With 5 - 20 joules

330
Q

When would you administer sodium bicarbonate in the digitalis toxicity patient with unstable bradycarida?

A

When the QRS is wide(greater than 0.10)

331
Q

What are some signs and symptoms of hallucinogen overdose?

A 
Poor perception of time and distance
Paranoia
Anxiety
Panic
Unpredictable behavior
Emotional instability
Possible flashbacks
Dilated pupils
Rambling speech
332
Q

What should you attempt to do to the hallucinogen overdose patient?

A

Talk them down

333
Q

Signs and symptoms of tricyclic antidepressant overdose?

A 
CNS depression
Tachycardia
Dilated pupils
Respiratory depression
Slurred speech
Twitching and jerking
Seizures
ST segment and T waves changes
Wide QRS complex
R waves in lead AVR
S waves in lead AVL and lead 1
Shock
334
Q

What questions should be asked to the pregnant patient?

A 
Number of previous pregnancies including miscarriages
Number of previous liver births
Due date
Hx of complications
Duration and frequency of contractions
Evidence of blood or spotting
Did water break
Have urge to push
Feel like have to move bowels
335
Q

What does gravida mean?

A

Number of previous pregnancies including miscarriages

336
Q

What does Para mean?

A

Number of previous live births

337
Q

When asking if a pregnant patient if her water broke what other questions should accompany this?

A

When
What color
Odor

338
Q

How are duration of contractions measured?

A

Timed from when the contraction starts to when it ends

339
Q

How are frequency of contractions measured?

A

From the beginning of one to the beginning of the next

340
Q

When should an external visual examination for crowning be performed in the pregnant patient?

A

If the patient complains of uterine contractions to determine if delivery is imminent

341
Q

How should a mother with a prolapsed cord be positioned?

A

Knee to chest position

or Supine with pillows under buttocks

342
Q

How should the cord be cared for prolapsed cord delivery?

A

Wrapped in warm sterile soaked dressing

Do not attempt to push cord back

343
Q

What should be checked for in prolapsed cord?

A

Pulse with a gloved hand

344
Q

If there is no pulse in a prolapsed cord what should you do?

A

Reposition mother and recheck

If not pulse is restored you should insert a gloved hand into the vagina and lift the fetal head or other presenting part off of the umbilical cord while gently pushing the fetus into the uterus

With the other hand push on the lower abdomen in an upward or cephalic direction

Push fetus back far enough to regain a pulse in the umbilical cord

Transport patient immediately while maintaining fetal position so as to maintain umbilical pulse

345
Q

How should a breech birth be delivered?

A

Do not pull on newborn

Allow for normal delivery supporting with the palm of your hand and arm allowing head to deliver

346
Q

In a breech birth if the head is not delivered in 3 minutes you should?

A

Place a gloved hand into the vaginal with your palm towards the face of the newbord

Form a V with your index fingers on either side of the newborns nose

Push the vaginal wall away form the newborns face to create an airspace for the newborn until delivery of the head

Suction may be provided as needed

Transport immediately while maintaining the airspace for the newborn

347
Q

In a delivery with limb presentation how should you position the mother?

A

Knee to chest position

or supine with pillows under buttocks

348
Q

What should be done immediately in limb presentation delivery?

A

Transport immediately

349
Q

When is a delivery of a newborn considered shoulder dystocia?

A

When the head delivers normally and then retracts back into the perineum because the shoulders are trapped between the symphysis pubis and sacrum(turtle sign)

350
Q

How can you facilitate delivery in shoulder dystocia?

A

Have mother drop her buttock off end of the bed and flex her thighs upward

Apply firm pressure with an open hand immediately above the symphysis pubis

If delivery does not occur you should transport immediately

351
Q

What is evidence of imminent delivery?

A

Crowning at the vaginal opening

352
Q

What position should a patient with signs of imminent delivery be placed in?

A

Comfortable, supine

353
Q

How should you assist expulsion of the newborn from the birth canal in its natural descent?

A

Gently and carefully

354
Q

Upon complete presentation of a newborns head you should?

A

Instruct mother to stop pushing
Clear airway by gently suctioning
Inspect newborns neck for umbilical cord
Instruct mother so start pushing once airway has been cleared

355
Q

In what order do you suction a newborns airway?

A

Mouth then nose

356
Q

If a newborns umbilical cord is wrapped around the neck and you are unable to unwrap it what should you do?

A

Clamp it twice and cut between clamps

357
Q

Upon complete delivery of newborn where should you keep the newborn and why?

A

Level with the vagina

To prevent over or under transfusion of blood from the cord

358
Q

How are umbilical clamps applied?

A

8 inches from naval

2 inches apart

359
Q

Do you ever milk the umbilical cord?

A

No

360
Q

How should you avoid holding the newborn and why?

A

By the legs allowing for the head to hang below the body

This may cause cerebral hemorrhage

361
Q

What should you do if meconium is noted in the newborns airway?

A

See newborn resuscitation protocol

362
Q

How should a newborn be cared for?

A

Wrapped in a blanket to preserve body heat

363
Q

What is a major area of heat loss in newborns?

A

Head

364
Q

When should APGAR be performed?

A

1 and 5 minutes

365
Q

When performing APGAR when number would tell you begin resuscitation?

A

Less than 7

366
Q

What is normal for a mothers vagina to do after delivery of a baby?

A

Ooze blood

Do not pull on umbilical cord

367
Q

If active hemorrhage is noted from a mothers vagina you should perform?

A

Continuous uterine fundus massage

368
Q

What will breastfeeding for the mother do after delivery of a newborn?

A

Aid in contraction of the uterus
Help stop bleeding
Facilitate delivery of the placenta

369
Q

Should you wait for delivery of the placenta before transporting?

A

No necessary

370
Q

After delivery of the newborn you should clean and inspect the vagina for?

A

Inspect the perineal area for tears and active bleeding

371
Q

What can be given to manage pain in uncomplicated delivery?

A

Nitronox

It is a ALS level 2 order

372
Q

Causes of nontraumatic vaginal bleeding?

A 
Anterpartum hemmorrhage
Postpartum hemorrhage
Ruptured ectopic pregnancy
Ruptured ovarian cyst
Spontaneous abortion
373
Q

What should be place in a plastic bag and brought to hospital after delivery?

A

All products of delivery

374
Q

When should you administer a fluid challenge of 250-500 of NS in non traumatic vaginal bleeding?

A

Hypotensive with a BP of less than 100

375
Q

What are 3 signs of toxemia in pregnancy?

A

Proteinuria(dark colored urine)
Excessive weight gain
Hypertension

376
Q

How may signs of toxemia in pregnancy should a patient have to be classified as pre-eclampsia?

A

2 of 3

377
Q

What demonstrates need for immediate treatment in the toxemia of pregnancy patient?

A

Witnessed continuous convulsions
Repeated episodes with regaining conciousness
Sufficient respiratory decompensation

378
Q

Can mag sulfate be repeated in the toxemia of pregnancy patient?

A

Yes

2g mixed in 50 mL of D5W given over 5-10 minutes

379
Q

If a toxemia of pregnancy patient continues to seizure after 2 doses of mag sulfate what should you do?

A

Administer benzodiazepine

380
Q

What skin signs and symptoms of allergic reaction?

A 
Flushing
Itching
hives
Swelling
Cyanosis
381
Q

Respiratory signs and symptoms of allergic reaction?

A 
Dyspnea
Sneezing
Coughing
Wheezing
Stridor
Laryngeal edema
Laryngealspasm
Bronchospasm
382
Q

Cardiovascular signs and symptoms of allergic reaction?

A

Vasodilation
Increased HR
Decreased HR

383
Q

Gastrointestinal signs and symptoms of allergic reaction?

A

Nausea
Vomiting
Diarrhea
Abdominal cramping

384
Q

CNS signs and symptoms of allergic reaction?

A

Dizziness
Headache
Convulsions
Tearing

385
Q

What are the severity level of allergic reactions?

A

Mild
Moderate
Severe or anaphylaxis

386
Q

Signs and symptoms of a mild allergic reaction?

A

BP greater than 110
No dyspnea
Stable vitals
Redness and or itching

387
Q

How do you treat mild allergic reaction

A

Diphenhydramine

388
Q

What is the dose of diphenhydramine IV in mild allergic reactions?

A

25mg

389
Q

What is the dose of diphenhydramine IM in mild allergic reactions?

A

50mg

390
Q

Signs and symptoms of moderate allergic reaction?

A 
Edema
Hives
Dyspnea
Wheezing
Lump in throat
Difficulty swallowing
Facial swelling
BP greater than 90
391
Q

Drugs that may be given in moderate allergic reactions?

A

Diphenhydramine
Epi 1:1000
Albuterol
Atrovent

392
Q

Dose of diphenhydramine in moderate allergic reactions?

A

50 mg

IM or IV

393
Q

Dose and route of Epi in moderate allergic reactions?

A

0.3
1:1000 IM
May be repeated once

394
Q

How many times may albuterol be repeated in moderate allergic reactions?

A

Twice

395
Q

What may you administer in no other means of Epi are available?

A

Epipen

396
Q

If a allergic reactions HR is above 140 you must call orders to administer what?

A

Bronchodilators

397
Q

What medication do you not give if a moderate allergic reaction patients HR is above 140?

A

Albuterol

Atrovent

398
Q

Severe allergic reactions signs and symptoms?

A 
Edema
Hives
Severe dyspnea
Wheezing
Unstable vital signs
Systolic BP less than 100
Cyanosis
Laryngeal edema
399
Q

What should be considered in severe allergic reaction?

A

Advanced airway

400
Q

Can Epi 1:10,000 be given in severe allergic reactions?

A

Yes

It is a level 2 order

401
Q

What is the dose of Epi 1:10,000 in severe allergic reactions?

A

0.3 mg
Slow IV
0.1 mg increments over 2 minutes

402
Q

Blood glucose above _____ and below __ is considered a diabetic emergency?

A

Above 300

Below 60

403
Q

In the abdominal pain patient you should ask the patient to point to the paint and you should palpate this area?

A

Last

404
Q

Palpate abdominal pain patient for?

A 
Tenderness
Rebound tenderness
Distention
Rigidity
Guarding
Pulsating masses
Flank for CVA tenderness
405
Q

All patients of childbearing age with abdominal paint should be considered to be having?

A

Ectopic pregnancy

406
Q

How much fluid should you administer to the abdominal pain patient who is hypotensive?

A

500 Ml NS

407
Q

Sickle cell anemia is?

A

Chronic hemolytic anemia characterized by presence of sickle shaped blood cells

408
Q

Who does sickle cell anemia patients almost always exclusively occur in?

A

African americans

409
Q

What does sickle cell crisis occur from?

A

Occlusion of blood vessel by masses of misshaped blood cells

410
Q

What is the principle manifestation of a sickle cell anemia crisis?

A

Pain in the joints and back

411
Q

Hepatic, pulmonary, or central nervous system pain can occur in what type of anemia crisis?

A

Sickle cell anemia

412
Q

Sickle cell disorder patients have high incidence of what?

A

Life threatening disorders at a young age

413
Q

How much oxygen should be given to the sickle cell anemia crisis patient?

A

15 LPM via NRB

414
Q

How much fluid should be given to the sickle cell anemia crisis patient?

A

500-1000 mL NS

415
Q

What medication should be given to the sickle cell anemia crisis patient to help relief pain?

A

Morphine

416
Q

What should you initial effort be for the patient in an Enviromental emergency?

A

Remove patient from the harmful enviroment

417
Q

What causes barotrauma and decompression illness?

A

Surrounding atmospheric pressure beyond the bodies ability to compensate for excess gas load

418
Q

Barotrauma and decompression illness are mostly commonly associated with the use of what?

A

Self contained underwater breathing apparatus

419
Q

SCUBA emergencies can occur at what depth?

A

Any depth

420
Q

When do most serious dive injuries symptoms occur?

A

After a dive

421
Q

If a patient took a breath from any compressed gas source while greater than how many feet could the patient be a victim of barotrauma?

A

3 feet

422
Q

Barotrauma may cause several injuries to include?

A 
Arterial gas embolism
Pneumothorax
Pneumomedistium
Subcutaneous emphysema
The squeeze
423
Q

Decompression illness may also include?

A

Decompression sickness(bends)

424
Q

How much oxygen should be given to the barotrauma/decompression illness patient?

A

15 LPM

425
Q

What position should the barotrauma/decompression illness patient be placed in?

A

Supine

426
Q

What should be completed on all dive accidents?

A

Dive accident checklist

427
Q

Who may be helpful in answering dive history questions?

A

Dive buddy

428
Q

Who should secure the dive victims gear?

A

Legal authority
Police
Marine patrol or coast guard

429
Q

Why should you make sure dive gear is handled in the proper chain of custody?

A

For testing, analysis and other measure

430
Q

Where should dive accident patients be transported to?

A

Closest emergency trauma center with a helipad

431
Q

What altitude must dive accident victims stay under during air transport?

A

1000 feet

432
Q

Who should you contact for dive accidents?

A

Divers alert network at duke university

919 684 4326

433
Q

If available what should be brought to the hospital with dive accident victims?

A

Dive computer

434
Q

Some factors that predispose and/or cause a patient to develope hypothermia?

A 
Geriatric
Pediatric
Poor nutrition
Diabetes
Hypothyroidism
Brain tumors
Head trauma
Sepsis
Alcohol
Certain drugs
Prolonged exposure to water
Prolonged exposure to low temp
435
Q

3 categories of hypothermia?

A

Mild
Moderate
Severe

436
Q

Body temp considered mild hypothermia?

A

94 - 97

437
Q

Moderate hypothermia body temp?

A

86 - 94

438
Q

Severe hypothermia body temp?

A

Less than 86

439
Q

most oral thermometers wont ready temp below?

A

96

440
Q

What will some tympanic thermometers read temps between?

A

68 and 108

441
Q

Mild ot moderate hypothermia patients will generally present with?

A

Shivering
Lethargy
Stiff
Uncoordinated muscles

442
Q

Severe hypothermia patients will typically present with?

A

Disorientation
Confusion
To the point of stupor or coma

443
Q

What level of hypothermia will shivering usually stop and physical activity will become uncoordinated?

A

Severe

444
Q

What changes on ECG will sometimes be seen in severe hypothermia?

A

Osborn wave or J wave

445
Q

What should be removed from all cold related emergency patients?

A

Wet clothing

446
Q

What should you protect hypothermia patient from?

A

Heat loss and wind chill

447
Q

What position should the hypothermia patient be placed in?

A

Horizontal

448
Q

What should you avoid with the hypothermia patient?

A

Rough movement and excessive activity

449
Q

Where should heat be added to the hypothermia patient?

A

Head, neck, chest, groin

450
Q

What fluids should be given to the hypothermia patient?

A

Warm

451
Q

When would you not treat dysrhythmias in the cardiac arrest patient?

A

Body temp is below 86 degrees

452
Q

How do you treat frostbite?

A

Bandage with dry sterile dressing

Transport without rewarming

453
Q

How can hypothermia manifest?

A

Heat cramps
Heat exhaustion
Heat stroke

454
Q

What drugs can cause increase in body temp?

A

Drugs like cocaine and ecstasy

455
Q

Signs and symptoms of heat cramps?

A 
Muscle cramps of fingers, legs and abdomen
Sweaty
Hot skin
Weakness
Dizziness
Tachycardia
Normal BP
Normal temp
456
Q

Signs and symptoms of heat exhaustion?

A 
Cold clammy skin
Profuse sweating
Nausea/vomiting
Diarrhea
Tachycardia
Weakness
Dizziness
Transient syncope
Muscle cramps
Headache
Positive orthostatic vitals
Normal or slightly elevated temp
457
Q

Signs and symptoms of heat stroke?

A 
Hot dry skin
Confusion and disorientation
Rapid bounding pulse followed by slow weak pulse
Hypotension
Low or absent diastolic reading
Rapid and shallow respirations which may later slow
Seizures
Coma
Elevated temp
458
Q

What temperature should you cool a heat stroke patient to?

A

102

459
Q

If a heat stroke patient has a systolic BP less than 90 with IV fluids what should you avoid using?

A

Vasopressors and anticholinergic drugs

They may potentiate heat stroke by inhibiting sweating

460
Q

Drowning is the process resulting in primary respiratory impairment from?

A

Submersion in a liquid medium

461
Q

When possible who should remove a patient who is still in the water upon arrival of EMS?

A

Dive rescue

462
Q

Why should non fatal drownings be transported to the hospital regardless of how well they seem to have recovered?

A

Because death or complications due to pulmonary edema or aspiration pneumonia are not uncommon

463
Q

Electrical emergencies can occur from?

A

Direct contact
An arc
Flash of electricity
Splash from lightening

464
Q

Why should c-spine be protected in the electrical emergency patient?

A

Movement of electricity current through the body can cause violent muscle contractions that can lead to fractures

465
Q

Thermal energy causes what type of burns?

A

External and internal

466
Q

In most cases of electrical energy causes what type of burns?

A

Internal

467
Q

What is common in electrical emergencies besides burns?

A

Dysrhythmias

468
Q

What should be done in all electrical emergencies before initiating treatment?

A

Be sure patient is no longer in contact with electrical current

469
Q

What should you try to determine with electrical emergencies?

A

Amps, Voltage, and duration of contact

470
Q

What is common presentation with lightening strikes?

A

Asystole

These patients should be aggressively resuscitated unless injuries are incompatible with life

471
Q

What causes most patients who have had an electronic controlled device used on them?

A

The events that led up to the device being used on them

472
Q

When responding and evaluating patients who have had electronic control device used on them you should use this seven step approach

A

Find out what happened before the patient was subdued to give you some information on there mental status

Approach patient with caution

Complete a thorough physical exam

Consider potential for sudden unexpected death syndrome

During transport be very conscientious of patients whom exhibit on or more of the following symptoms
ExDs
Persistent abnormal vitals
Hx of physical findings consistent with amphetamine or hallucino
Cardiac Hx
ALOC or aggressive violent behavior
Evidence of hypothermia
Abnormal subjective complaints
473
Q

Who should remove probes from taser?

A

Not EMS

Transport with them attached, cut wires

474
Q

Probes should be treated as?

A

Contaminated sharp

475
Q

What care should all patients who a taser is used on receive?

A

Supportive and ALS level 1

476
Q

What should be determined about the energy used on patients from a taser?

A

How many 5 seconds cycles of energy the individual was exposed to

477
Q

ALS level 1 for electronic control devices?

A

Cardiac monitoring
Glucose
Use hyperthermic protocol if exhibiting signs of ExDs

478
Q

What should priority be given to in trauma alert patients?

A

Airway management
Rapid preparation for transport
Control of gross hemorrhage

479
Q

In a trauma patient who is hypovolemic(BP less than 90) how much fluid should be given?

A

1 to 2 L

20mL/kg

480
Q

What is the max total fluids that should be given in trauma alert patients?

A

3 liters

481
Q

When should physician consult be used prior to administering large amounts of fluids to a trauma alert patient?

A

When patient has a transport time of less than 20 minutes

482
Q

How should a female in her second or third semester(greater than 20 weeks) of pregnancy be transported?

A

Left side

If on backboard tilt it to side

483
Q

What can happen to a pregnant patient who is not positioned on her side?

A

Hypotension due to decreased venous return

484
Q

In the head and spine injury patient if patient is not hypotensive(systolic BP greater than 100) you should?

A

Elevate backboard 30 degrees

485
Q

Signs and symptoms of brain stem herniation?

A

Pupillary dilation
Asymmetric pupillary reactivity
Motor posturing

486
Q

What should you do to the patient who presents with signs and symptoms of brain stem hernation?

A

Consider placement of advanced airway

Hyperventilation

487
Q

In the patient presenting with signs and symptoms of brain stem herniation what EtCo2 should you hyperventilate to?

A

30 to 40

488
Q

What should you avoid giving to the patient with head and spine injuries who is seizing?

A

glucose containing solutions and medications

489
Q

Who should remove the patients contact lens in eye injuries?

A

Patient

490
Q

How do you care for a penetrating object to the eye?

A

Stabilize object and cover entire eye with rigid device
Cover both eyes to minimize eye movement
Avoid direct pressure on either eye or object

491
Q

If patient with eye injures eyeball has been forced out of socket you should?

A

Cover it with a ridged container
Avoid contact with exposed globe
Apply pressure with sterile dry dressing if bleeding is present

492
Q

How do you treat an eye injury if you suspect exposure to chemicals or foreign body?

A

Irrigate with normal saline

493
Q

Tetracaine cannot be given to?

A

Penetrating eye injuries

Patients with allergies to lidocaine

494
Q

Penetrating injuries to the chest or upper back should be?

A

Covered immediately with an occlusive dressing

495
Q

How many sides should an occlusive dressing be secured on?

A

3

496
Q

What should you monitor for in the penetrating chest injury?

A

Tension pneumothorax

497
Q

How can you attempt to relieve/prevent tension pneumothorax in a penetrating chest injury patient?

A

Burp the dressing

498
Q

If a penetrating object is large and unwieldy in the chest injury you should?

A

Attempt to cut it to no less than 6 inches from chest

499
Q

In a tension pneumothorax you should attempt to decompress the chest on which side?

A

Affected side

500
Q

In a patient with a massive flail chest without severe compromise you should attempt to stabilize it by?

A

Placing the patients ipsilateral arm in a sling and swathe

501
Q

For traumatic asphyxia you should establish?

A

2 large bore IV’s

502
Q

In traumatic asphyxia if the crushing object is still on the patient you should do what prior to attempt the object off the patient?

A

Infuse a minimum of 1 L fluid

Amin sodium bicarb 1 mEq/kg

503
Q

For traumatic asphyxia you should admin what?

A

Sodium bicarbonate 1 mEq/kg IV

504
Q

Blunt injuries such as pulmonary contusion and cardiac contusion may causes?

A

Respiratory insufficiency

Myocardial infarction

505
Q

How do you treat patients with abdominal evisceration?

A

Cover organs with saline soaked sterile dressing
Cover with occlusive dressing
Do not attempt to place back inside

506
Q

How do you get patients with suspected pelvic fracture onto stretcher?

A

Use scoop

Do not roll

507
Q

If pelvic fracture is suspected you should attempt to stabilize patient with a?

A

Sheet sling

508
Q

Closed angulated fractures should be?

A

Aligned using proximal and distal traction during splinting

509
Q

When would you not align closed angulated fractures?

A

If it involves a joint(splint in position found)

510
Q

When should traction splints be used?

A

Closed femur fractures unless pelvic fracture is suspected

511
Q

Amputations should be dressed with?

A

Bulky dressings

512
Q

A amputated limb should be?

A

Placed in a plastic bag and placed on ice for transportation to hospital

513
Q

If bleeding is not controlled with direct pressure in an amputation you should?

A

Apply a tourniquet

514
Q

What should determine if a traumatic arrest is resuscitated?

A

Paramedic judgment

Possibility of organ harvest

515
Q

Avoid use of what medications in cases of suspected hypovolemia in traumatic arrest?

A

Vasopressors

516
Q

Burn patients are volume?

A

Depleted

517
Q

Many burn injuries are associated with?

A

Inhalation injuries

518
Q

Signs and symptoms of inhalation injuries?

A

Nasal and oropharyngeal burns
Abnormal lung sounds
Respiratory distress

519
Q

In inhalation injuries the paramedic should consider the need for early intubation because?

A

Swelling to the airway can cause complete obstruction

Early intubation can help avoid complete airway obstruction that requires Cricothyroidotomy

520
Q

How do you stop the burning process in thermal burns?

A

Lavage the burned area with tepid water to cool the skin

Do not attempt to wipe off semi solids

521
Q

How do you stop the burning process in dry chemical burns?

A

Brush off dry powder

Lavage with copious amounts of tepid water for 15 minutes

522
Q

Should you remove clothing form burned patient?

A

Yes from around the burned area

Do not peel off skin or tissue

523
Q

When should you use dry sterile dressing or water gel to cover burns?

A

Equal to or greater than 20% 2nd degree burns or 5% 3rd degree burns

524
Q

If there is less than 20% second degree burns or less than 5% of 3rd degree burns you should apply?

A

Wet sterile dressing to burned area for 15 minutes to aid in pain control

525
Q

Prevent hypothermia in the burn patient by?

A

Keeping them warm and ensuring all outer layers of dressing are dry

526
Q

Obtaining a Hx of a patient with specials needs includes asking parent or caregiver?

A 
Normal vitals
Actual weight
Developmental level of patient
Allergies including latex
Pertinent medications/therapies
527
Q

Home mechanical ventilators may be indicated for?

A

Chronically ill adults with abnormal respiratory drive
Severe chronic lung disease
Severe neuromuscular weakness

528
Q

The need for home mechanical ventilators may either be?

A

Continuous or intermittent

529
Q

Home mechanical ventilators may either be?

A

Volume or pressure limited

530
Q

All home mechanical ventilators are equipped with?

A

Alarm

531
Q

Types of home mechanical ventilator alarms?

A 
Lower pressure or apnea
Low power
High pressure
Setting error
Power switchover
532
Q

What can a low pressure or apnea alarm be caused by?

A

Loose of disconnected circuit

Air leak in the circuit or tracheostomy resulting in inadequate ventilation

533
Q

Low power mechanical ventilator alarm may be caused by?

A

Depleted power

534
Q

High pressure mechanical ventilator alarm may be caused by?

A

Plugged or obstructed airway or circuit tubing

Coughing or bronchospasm

535
Q

A setting air alarm in a home mechanical ventilator may be caused by?

A

Settings outside the normal capacity

536
Q

When does a power switchover alarm occur in a home mechanical ventilator?

A

When the unit switches from alternating current to battery power

537
Q

What can you do for a patient on a home mechanical ventilator who is in respiratory distress and the cause cannot be easily determined?

A

Remove the ventilator and provide assisted ventilations with BVM

538
Q

What are tracheostomies used for?

A

Long term ventilatory support to bypass an upper airway obstruction
Aid in the removal of secretions

539
Q

Tracheostomies can either be?

A

Single or double lumen

540
Q

Signs of tracheostomy obstruction?

A 
Excess secretions
No chest wall movement
Cyanosis
Assessor muscle use
No chest wall rise with BVM
541
Q

Special attachments to a tracheostomy include?

A

Inject 1 to 3 mL NS into the tube and suction as needd

542
Q

If unable to clear an obstruction from a tracheostomy tube with saline and suctioning you should?

A

Remove it and replace it with another of the same size of one smaller

543
Q

If unable to insert a new or one is unavailable in tracheostomy you should?

A

Insert ET tube of a smaller size into stoma and ventilate with BVM

544
Q

How do you ventilate a patient with a stoma?

A

Over the stoma or over the mouth while covering the stoma

545
Q

What are central venous lines used for?

A 
Admin of medications
Delivery of chemotherapy
Nutritional support
Infusion of blood products
Blood draws
546
Q

Types of central venous lines?

A

Broviac/Hickman
Port a cath/Med a port
Percutaneous intravenous catheters

547
Q

Types of central venous line emergencies?

A 
Catheter coming out
Bleeding at site
Catheter broken in half
Blood embolus
Thrombus
Air embolus
Internal bleeding
548
Q

Can you use SQ ports for IV access?

A

No, these require special training

549
Q

Signs of blood embolus, thrombus, internal bleeding the central venous line patient include?

A

Chest pain
Cyanosis
dyspnea
Shock

550
Q

Under sterile conditions can PIC or CVP line be used in emergency conditions?

A

Yes

551
Q

If a central venous catheter has come completely out you should?

A

Apply direct pressure to the site

552
Q

If a central venous catheter is broken in half you should?

A

Clamp the end of the remaining tube

553
Q

If blood embolus, thrombus, or internal bleeding is suspected you should?

A

Clamp the line

554
Q

If air embolus is suspected in the central venous line patient you should?

A

Clamp the line and place the patient on his left side

555
Q

What are some potential complications of feeding tubes?

A

Leaks
Bleeding around the site
Displacement of tube

556
Q

Feeding tubes are used for patients who?

A

Have the inability to swallow

557
Q

If a feeding tube has come completely out you should?

A

Cover the site with vaseline gauze and apply direct pressure

558
Q

Types of feeding tubes?

A

Nasogastric(temp)

Gastrostomy(G tubes)

559
Q

Types of G tubes?

A 
PEG tubes(percutaneous endoscopic)
J tubes(jejunal tubes)

Adult Protocols (2 decks)

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