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TEMS > AHS TEMS protocols > Flashcards

AHS TEMS protocols Flashcards

1
Q

S/S of mild to moderate dehydration? (7)

A 
Thirst
Cramping
Dry mouth
Decreased urine output
Headache
Dry skin
Dizziness
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2
Q

S/S of severe dehydration? ( 8)

A 
Cramping
Decreased or no urine output
Presyncope/syncope
Rapid HR
Rapid RR
Sunken eyes
Lethargy
Confusion, irritability
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3
Q

Dehydration Abnormal Vital Signs? (6)

A 
Resting HR > 120
RR > 20
BP > 180 Systolic
BP > 120 Diastolic
Temp > 38 or < 36
SpO2 < 94%
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4
Q

Mild to Moderate Dehydration treatment? (2)

A

1 portion electrolyte to 500ml water
or
Water PO PRN

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5
Q

Severe Dehydration treatment? (3)

A

Remove TAC member from active role
Remove from environmental factors
IV 20ml/kg NS to 1L

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6
Q

TAC member with abnormal vital signs after rehydration? (3)

A

Remove TAC member from active role
Remove from environmental factors
IV 20ml/kg NS to 1L

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7
Q

Dehydration symptoms resolved with rehydration? (2)

A

Rest 20 min

Return to active tactical role

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8
Q

Dehydration S/S with chest pain or HR > 150? (2)

A

Continue MARCHE

Tactical evacuation

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9
Q

Hemorrhage control - Direct threat care? (3)

A

Identify obvious major extremity hemorrhages
Apply tourniquets
Tactical rescue to cover

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10
Q

Hemorrhage control - Indirect threat care first step?

A

Wet check

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11
Q

Wet check order? (6)

A 
Groin
Thighs
Legs
Neck
Axilla
Arms
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12
Q

Hemorrhage control - Complete or partial amputation?

A

Apply tourniquet

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13
Q

Pt has S/S of massive extremity hemorrhage?

A

Apply tourniquet

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14
Q

Pt has S/S of massive hemorrhage not from an extremity? (4)

A

Consider junctional tourniquet
Consider wound packing
Indirect pressure control
Consider removing gauze and repacking

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15
Q

Consider wound packing for what kind of injury?

A

Wound is open and has skeletal backing

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16
Q

Signs of Massive hemorrhage? (4)

A

Spurting or pooling blood
Clothing or ground rapidly soaking with blood
Mangled limb with bleeding
Injuries associated with major bleeding but no bleeding occurring

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17
Q

MARCHE mneumonic

A 
Massive hemorrhage
Airway
Respirations
Circulation
Hypothermia
Eyes/everything else
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18
Q

Symptoms of suspension trauma? (8)

A 
Pre-syncope
Palpitations
Nausea/vomiting
Dizziness
Weakness
Paresthesia
Sweating
Confusion
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19
Q

Onset time for suspension trauma?

A

5-20 minutes of being motionless

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20
Q

Pt conscious but immobile or c/o symptoms of suspension trauma? (2)

A

Encourage pt to lift legs parallel to ground
Or
Bicycle legs to keep active

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21
Q

Pt unconscious and suspended?

A

Raise pt legs into sitting position with rope loop

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22
Q

Steps for suspension trauma rescue? (3)

A

Work with TAC to facility rescue
Do not position pt vertically if possible
Rappel to pt position to assess

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23
Q

Treatments while high angle rescue of suspension trauma pt being conducted? (2)

A

Initiate IV access

If prolonged hang time 1000ml bolus

24
Q

Suspension trauma - Once rescue completed treatment? (2)

A

IV access

If prolonged hang time or symptomatic 1000 ml NS

25
Q

Suspension trauma symptomatic patient post fluid bolus treatment? (2)

A

Sodium Bicarb - 1 mEq/kg SIVP q 1 PRN

Sodium Bicarb infusion 75 mEq in 500 ml D5W at 150 ml/hr

26
Q

Suspension trauma Sodium Bicarb infusion set-up?

A

75 mEq in 500 ml at 150 ml/hr = 25 gtts/min = 1 gtts every 2 seconds

27
Q

Suspension trauma dysrhythmia treatment? (3)

A

Calcium gluconate 3 g IV/IO
Sodium Bicarb 1 mEq/kg SIVP q 1 time
Salbutamol 5 mg Neb PRN or MDI 10 puffs q 5 min PRN

28
Q

Suspension trauma cardiac arrest treatment?

A

Treat as hyperkalemic

Utilize TEMS/IRP crush protocol

29
Q

Transport considerations for suspension trauma? (2)

A

If suspended longer than 2 hours consider facility with dialysis capabilities
>10 min motionless suspension must be transported

30
Q

Analgesia for alert pt without significant injury?

A

Acetaminophen 975 mg PO q 4-6 hrs

31
Q

Analgesia for altered LOC or weak radial pulse without vascular access? (2)

A

Ketamine 50 mg IN - 0.5ml per nare

Ketamine 50 mg IM

32
Q

Analgesia with vascular access and no S/S of shock?

A

Fentanyl 0.5 mcg/kg SIVP single max of 100 mcg q 5 to max of 250 mcg

33
Q

Analgesia with vascular access and S/S of shock? (2)

A

Treat with adult shock protocol

Ketamine 0.2 mg/kg SIVP/IO

34
Q

Thoracic trauma management initial actions? (5)

A

Remove pt from hazards or active tactical role
Follow MARCHE
Assessment and vitals
Apply O2
Move to position of comfort or position injury side up

35
Q

Suspected isolated thoracic injury, stable with minimal SOB? (2)

A

Follow MARCHE

Tactical evacuation

36
Q

Suspected open pneumothorax? (3)

A

Apply vented chest seal
Monitor for development of tension
If vent occludes or tension occurs, burp chest seal

37
Q

Suspected hemothorax?

A

1g TXA in 250ml NS over 10 min = 250 gtts/min = 4 gtts/s

38
Q

Thoracic trauma with respiratory or hemodynamic compromise?

A

Suspect tension pneumothorax

39
Q

Suspected tension pneumothorax? (2)

A

Needle decompression

Digitally manipulate tissues to align and allow decompression

40
Q

Cardiac arrest secondary to hemothorax? (2)

A

Needle decompression

Digitally manipulate tissues to align and allow decompression

41
Q

Open Pneumothorax signs? (3)

A

Wound visibly bubbling
Wound has air sucking into chest cavity
Shortness of breath

42
Q

Thoracic trauma signs of respiratory or hemodynamic compromise? (3)

A

Weak or absent radial pulse
Decreasing LOC
SpO2 < 85%

43
Q

How long is direct pressure required for wound packing? (2)

A

5 min for hemostatic gauze

10 min for gauze only

44
Q

After direct pressure on wound packing if blood continues to flow? (2)

A

Remove gauze from wound

Repack wound

45
Q

If unsuccessfully controlled bleeding after 2 attempts at wound packing?

A

Apply tourniquet

46
Q

TECC mnemonic

A

Tactical Emergency Casualty Care

47
Q

TCCC mnemonic

A

Tactical Combat Casualty Care

48
Q

STOP mnemonic

A

Situational awareness update
Triage all other casualties
Ongoing documentation
Pass up pertinent information

49
Q

MARCHE - M actions?

A

Massive Hemorrhage - control life threatening hemorrhage

50
Q

MARCHE - A actions?

A

Airway - Establish and maintain a patent airway

51
Q

MARCHE - R actions? (4)

A

Respiration - decompress
seal chest wounds
support ventilation
STOP mnemonic

52
Q

MARCHE - C actions? (2)

A

Circulation - IV/IO

Fluids

53
Q

MARCHE - H actions? (2)

A

Hypothermia/head injury - treat/prevent hypothermia

TBI protocol

54
Q

MARCHE - E actions?

A

Everything else/Eye injury - visual acuity test - cover eye with rigid shield

55
Q

Immediate action for casualties with altered level of consciousness?

A

Disarm them of weapons and communication devices

TEMS (6 decks)

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