Adult Protocols

Question 1

Normal SpO2

Answer 1

94% or greater

Question 2

SPO2 for COPD or emphysema

Answer 2

88%-92%

Question 3

Automatic Ventilator (PPV)

Answer 3

Demand mode- assist patients with breathing that is too shallow

Manual mode- assist patient with breathing that is too shallow and or too slow

Automatic mode- used with an advanced airway in apneic patients

Question 4

Supraglottic Airway

Answer 4

Contradicted when there is damaged tissue in the supraglottic area or there is a high risk of aspiration.

Question 5

If the patient’s condition deteriorates and or the SP02 drops to less than 94% consider the following possibilities DOPE

Answer 5

D - displacement of the device. Check for neutral head/neck position

O - obstruction of the device

P - pneumothorax. Check for bilateral breath sounds

E - equipment failure. Check Pop off valve

Question 6

If patient has a difficult airway to open( such as trismus - clenched jaw muscles) and/or has an active gag reflex

Answer 6

Versed 10 mg IV/IO

Unable Versed 10mg IM/intranasal

Question 7

Alcohol Intoxication

Answer 7

Green - Typically fire department unit will not be dispatched on green category patients but the dispatch will respond accordingly

Yellow- All yellow category patients should be transported

Red- I’ll read category patients shall be transported

Question 8

Coral snake Bites

Answer 8

Red next to yellow can kill a fellow

Red next to Black is a friend of jack (king snake, non-poisonous)

Symptoms may be delayed up to 12 hours

CNS disturbances, stroke like, respiratory paralysis

Wrap ace bandage snugly around limb. Starting at the site work towards heart proximal.

Question 9

Adult Bradycardia (unstable)

Answer 9

Administer atropine .5mg IVP/IO
Repeated 2-3 min
Max dose of 0.04mg/kg (3 mg for the average adult)

Question 10

Bradycardia is the result of a Beta Blocker or Calcium Channel Blocker excess/OD

Answer 10

Atropine 1 mg IV every 2-3 min to a max of 3 mg

Question 11

Organophosphate Overdose

Answer 11

Atropine 2 mg IVP every 5 min until the drying of secretions occurs (atropinization)

Or 2 mg IM with an atropen Auto Injector if available.

Question 12

Bradycardia

Answer 12

In a patient with an acute inferior wall myocardial infraction and a bradycardia due to high grade Mobitz two or a 3rd° heart block external pacing is preferred as the first treatment

Question 13

Heart Transplants & bradycardia

Answer 13

Patients with heart transplant and bradycardia will not respond to atropine and need external pacing to correct the heart rate

Question 14

Dialysis patients (hyperkalemia) wide complex QRS & Bradycardia

Answer 14

Treat bradycardia &

Sodium bicarbonate 1meq/kg IV/IO. May repeat with 0.5 mEq/kg in 10 minutes.

If no response flush the IV access line with at least 20 ML’s of normal saline and then administer calcium chloride 1 g IV/ IO slowly over one minute

Question 15

Cardiac Arrest

Answer 15

Do not check for a pulse unless there is an organized Rhythm on the monitor and there has been an increase in the ETCO2 level of 20 mm or more

Question 16

ET Tube

Answer 16

Attempt once after defibrillating or checking rhythm.

• suspect upper airway inhalation burns
• severe facial burns
• presence of vomitus in the mouth

Question 17

Vascular Access

Answer 17

IO preferred

IV can be attempted once if it can be performed within 30-60 seconds

Epi, atropine, narcan, can be given down the tube at 2x diluted normal saline 10ml.

Epi every 3-5 min during arrest

Question 18

Cardiac Arrest (epi)

Answer 18

Epi 1:10,000 1mg IOP/IVP (10 ml)
Or
Epi 1:1000 2 mg (2ml) diluted with normal saline to a total of 10ml via advanced airway. 5 rapid ventilation’s

Epi every 3-5 min during arrest

Question 19

Double Sequential Defibrillation (#5)

Answer 19

400 joules for MRX

560 joules if one MRX plus one LifePak AED

For 5th try