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Pinellas County Protocol 2023 > Algorhythms (MOVAB = Monitor, 12 Lead, O2, Vitals & Vascular Access, Airway, Brearthing) > Flashcards

Algorhythms (MOVAB = Monitor, 12 Lead, O2, Vitals & Vascular Access, Airway, Brearthing) Flashcards

1
Q

What general considerations for universal approach

A

Everyone gets complete assessment

High level suspicion

Respect, dignity, privacy

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2
Q

What the minimum number of vitals required, and what assessments are required in your vitals

A

Minimum x2

HR, SBP, RR, GCS, Pain scale

5 letters in “vital”

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3
Q

What must you do you before and AFTER giving a controlled substance/sedative medication

A

4 lead
ETCO2
Vitals

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4
Q

How often to get vitals for a red vs yellow vs green pt

A

Red - 5

Yellow - 10

Green - 15

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5
Q

What should you do on a Ped pt if a ped protocol doesnt exist for the situation?

A

Use the adult protocol

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6
Q

Can you disconnect a cardiac monitor to move the pt or upload/enter data mgmt mode?

A

No. No interruptions in “continuous cardiac monitoring”

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7
Q

Minimum SPO2 to maintain

A

94%

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8
Q

Is it pt abandonment to back out of a dangerous scene?

A

No

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9
Q

Minimum time apart between vitals

A

5 minutes

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10
Q

Rx for adult mild/partial obstructions

A

Don’t mess with it. Monitor, allow pt coughing, position of comfort

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11
Q

Rx - adult severe / complete airway obstruction (responsive, unresponsive, unresponsive ALS)

A

Responsive = ab thrusts. Chest thrusts if unable

Unresponsive = CPR. Check for object each airway opening

ALS* laryngoscopy + magill forceps. No visualization = intubate > cric (last resort)

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12
Q

Blind finger sweeps. Yes or no?

A

Never

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13
Q

You intubate an unresponsive adult w/ airway obstruction, but still cant ventilate. What Rx?

A

*note the teeth mark

Deflate cuff > push all the way down > back to OG spot > reinflate and ventilate

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14
Q

Sudden onset acute respiratory distress w/ coughing, gagging, stridor, or wheezing. What’s wrong?

A

Think choking

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15
Q

How to tell if mild choking pt progresses to severe?

A

Silent cough w/ increased work of breathing or unresponsive

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16
Q

Which priority in unresponsive choking adult pt?

Transport vs multiple intubation

A

Never delay transport

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17
Q

asthma / COPD ALS Rx

A

MOVAB + ETCO2

Duoneb (2.5mg albuterol + 0.5mg Ipratropium) repeat x1

Subsequent 2.5mg albuterol PRN

Solu-medrol 125mg SIVP

All fails = CPAP + inline albuterol

All ELSE fails for *asthma= consider epi 0.3mg IM outer thigh, repeat x1 post 3-5min PRN - OLMC for epi drip

  • BVM if resp failure
  • mag sulfate 2g IV over 10min last resort
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18
Q

What precaution for giving epi to asthma/COPD pt

A

> 35 yrs or Hx cardiac

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19
Q

When to contact OLMC during asthma/COPD pt

A

Additional doses epi

Epi drip

Mag sulfate

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20
Q

What should you ask every asthma/COPD pt? Why?

A

“Have you been intubated before?”

Yes = high risk rapid deterioration

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21
Q

Your asthma /COPD pt suddenly has silent chest sounds from previous wheezing. What’s up?

A

Think pre-respiratory arrest

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22
Q

You intubate or apply CPAP to your asthma/COPD pt and they suddenly decompensate. What’s up?

A

Think tension pneumo

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23
Q

What QA measures for Asthma/COPD pt

A

lung sounds x2 (5 min apart)

Etco2

Soul-medrol

CPAP? Why or why not

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24
Q

Should you give nitro to a pt who has already had a breathing treatment (albuterol)?

A

No

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25
Q

If anything fucks up (IV, vent, tube, monitor rhythm) what should you first think of before panicking?

A

DOPE - displacement, obstruction, Pneumo (airway-related), equipment failure

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26
Q

What to do if your vent pt is in resp distress and you can’t figure out what’s wrong?

A

Disconnect vent and bag

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27
Q

Trach obstruction Rx

A

1-3cc saline & suction PRN

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28
Q

You cant clear a trach with suction and can no longer ventilate. What next?

A

Replace tube if caretaker has a spare and knows how to do it

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29
Q

Trach pt cant be ventilated nor suctioned and there’s no caretaker to use a replacement tube. What next?

A
  • insert ETT (similar size as stoma) and bags

If that fails = bag over stoma or pt’s mouth (cover stoma)

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30
Q

When can you, as a non CCT medic transport a vent pt?

A

When pt is on home ventilator and caretaker or family member can accompany to assist w/ operation

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31
Q

Your trach pt has excess secretions, no or decreased chest wall movement, cyanosis, accessory muscle use, and difficult ventilation. What’s up?

A

Think trach obstruction. Consider DOPE

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32
Q

A ventilator alarm shows “low pressure or apnea”. What’s wrong

A

Possible loose/disconnected circuit or air leak > poor ventilations

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33
Q

A ventilator alarm shows “high pressure”. What’s wrong?

A

Possible plugged or obstructed airway or circuit tubing by coughing or by bronchospasm

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34
Q

CO poisoning Rx (what info does Hosp want to know?)

A
  • Scene safe?
  • Extricate pt > fresh air
  • MOVAB
  • CPAP (15 LPM NRB if unable)
  • BVM PRN
  • note & inform hospital of CO readings onscene
  • seizure precaution
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35
Q

Mild vs severe CO poisoning SS

A

Mild = headache, nausea, vomit, fatigue

Severe = AMS, resp distress/arrest

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36
Q

What assessment is useless during CO poisoning

A

SPO2

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37
Q

You’re responding to a structure fire w/ smoke. What medical emergency to suspect?

A

Cyanide and CO poisoning

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38
Q

Pt pulled from smoke / industrial fire exposure is altered, lethargic, with abnormal respirations (tachy or Brady). What to suspect?

A

Cyanide poisoning

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39
Q

Cyanide poisoning/smoke inhalation Rx

A
  • scene safety
  • decon & extrication
  • MOVAB & ETCO2 ( must have IV x2)
  • hi flo O2
  • severe (AMS or bad VS) = Cyanokit 5g IV over 15min (blood samples prior)
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40
Q

Initial Cardiac Arrest approach - when to do CPR first vs go straight to MRX rhythm analysis?

A

CPR first = >4min down or bad bystander CPR

MRX first = <4min down or good bystander CPR

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41
Q

Do you need to document bystander interventions (ex. CPR) prior to your arrival?

A

Yes, all of them.

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42
Q

Your pt achieves ROSC, nad goes in and out of it multiple times. How do you document this?

A

Document ALL occurrences of ROSC

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43
Q

When would you initiate transport on a cardiac arrest pt?

A

Only when ROSC unless scene dictates early extrication

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44
Q

Cardiac arrest - What joules to defib w/ the MRX?

A

150

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45
Q

What meds for asystole/PEA (concentration, dose, route, frequency/max)

A

1mg epi (0.1mg/mL) IV or IO every 3-5min - max 3 doses

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46
Q

What meds for Vfib/ pulseless Vtach (torsades?) (concentration, dose, route, frequency/max)

A

Epi 1mg (0.1 mg/mL) IO/IV - 3-5min - max 3 dose

Amio 300mg IV/IO - then 150mg 3-5min later OR…

… if torsades = mag sulfate 2g IV/IO

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46
Q

What meds for Vfib/ pulseless Vtach/torsades (concentration, dose, route, frequency/max)

A

Epi 1mg (0.1 mg/mL) IO/IV - 3-5min - max 3 dose

Amio 300mg IV/IO - then 150mg 3-5min later OR…

… if torsades = mag sulfate 2g IV/IO

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47
Q

What main assessment to monitor progress of cardiac arrest

A

EtCO2

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48
Q

What reversible causes? (H’s and T’s)

A

H - hermes the Ox drove to cali to play
volleyball and glyde

T - Thrombo the lesbo causes tension and trauma when she tox about her tampons

Hypothermia, hydrogen (acidosis), hyper/hypo K, hypovolemia, hypoglycemia, hypoxia

Thrombosis (PE or MI), tension pneumo, toxicity, tamponade, trauma

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49
Q

Cardiac arrest w/ suspected hyper K Rx?

A

Sodium bicarbonate 8.4% (100 mEq) + calcium chloride (1g) IV/IO

Flush lines between meds

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50
Q

Cardiac arrest w/ hypoglycemia Rx?

A

D10 - 25g IV/IO repeat x1 in 3-5min PRN

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51
Q

How much narcan for cardiac arrest with Opiate Overdose? How often/ how many times can you give it?

A

Narcan 2mg IV/IO - repeat PRN per 3-5min PRN until MAX 6mg (not including IN doses)

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52
Q

Cardiac arrest w/ suspected cyanide exposure Rx?

A

Cyanokit 5g IV/IO over 15min

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53
Q

Cardiac arrest w/ suspected tension pneumo Rx?

A

Needle decompress

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54
Q

What’s a vector change and when to do it?

A

Refractory V-fib after defib x3 = new pads in different position (ant/post or apex/sternum)

NO OLMC needed

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55
Q

When and how can you call a code in the field?

A

DNR, scene safety, or minimum 20min EMS resus attempt w/out response

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56
Q

What responses are you looking for when deciding to call a code?

A

Rhythm change, ETCo2, etc

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57
Q

When would you suspect hyper K on a cardiac arrest pt?

A

Dialysis/ESRD hx
Diabetes
K sparring diuretics or supplements

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58
Q

What QA measures for a cardiac arrest?

A

CPR w/in 1min
Supraglottic
EtCO2
No transport = <35 EtCO2 and OLMC
ROSC?

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59
Q

ROSC protocol

A
  • 12-lead (call STEMI PRN)
  • BP
  • maintain ABCs & cardiac output
  • transport to PCI
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60
Q

ROSC pt < 90 SBP Rx

A

Bolus 0.9% NS > max 2L (20ml/kg if <100kg)

  • reassess lungs per 500mL
  • push dose Epi - 10mcg every 1-2 min (max 5 doses)
  • then norepi drip - 1mcg/min (w/ 2nd IV site) > titrate per 1min until SBP >90 or max 10mcg/min
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61
Q

ROSC pt w/ RONF fighting airway and ventilations. What Rx?

A

Versed (Midazolam) 2.5mg IV/IO and fentanyl 50mcg IV/IO - repeat x1 in 5min PRN

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62
Q

You’ve maxed your sedatives/pain meds on a ROSC pt w/ RONF. What next?

A

OLMC

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63
Q

ACS Rx

A
  • MOVAB
  • 12 Lead / declare STEMI alert & transmit PRN
  • ASA 324-325mg
  • Nitro 0.4mg SL per 3-5min PRN (pn resolves)
  • SBP <90 = fluids 500mL > max 2L
  • pn mgmt PRN
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64
Q

What qualifies as a STEMI

A

ST elevation >1mm in 2+ contiguous leads

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65
Q

What’s a preACT STEMI

A

ST elevation > 2mm in 2+ contiguous leads
HR <130
Age 30+
Decisional capacity
Onset <24hr
Narrow QRS
No DNR
No arrhythmia or pacer

SHADOQNN

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66
Q

When transmitting a 12-lead for STEMI/PreACT STEMI… what info required

A

Pt name and DOB w/ facility notification

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67
Q

Nitro contraindications

A

SBP < 90 mmHg

SLC 12-24-48

Stendra <12hr
Levitra, staxyn, viagra <24hr
Cialis < 48hr

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68
Q

What are angina equivalents

A

Chest (palpitations, SOB)
Head (syncope, anxiety, fatigue, diaphoresis)
Stomach (unexplained nausea, epigastric pain)
Shoulder/jaw pain
Tachypnea

Angina - think CHSSS (chessT)

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69
Q

What extra Rx for inferior wall MI

A

IV before nitro preferred

R side ECG (v4R)

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70
Q

ACS QA measures

A

12 lead w/in 5min pt side
STEMI = transmit 12 lead
Nitro and ASA?
Pn improvement?

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71
Q

Bradycardia Rx

A

MOVAB
Determine category and treat (stable-asymptomatic…. Stable -symptomatic… unstable)

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72
Q

Stable asymptomatic bradycardia Rx

A

MOVAB
Consider causes

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73
Q

Stable symptomatic bradycardia

A

MOVAB

SBP < 90 = NS bolus 500cc > max 2L (assess lungs per 500)

Atropine 1mg x 3 (every 3-5min PRN)

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74
Q

Unstable bradycardia Rx

A

MOVAB

Pace

Consider atropine 1mg but dont delay pace

Consider versed prior pacing (2.5mg IV/IM or 5mg -1/2 each nare… 2nd dose after 3-5min = same)

Epi drip last resort

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75
Q

Your bradycardic pt is still hypotensive despite fluids / atroping / pacing… what next?

A

OLMC to ask for…

Norepi drip 1-10mcg/min

Epi drip 2-5mcg/min

Calcium Chloride (if Ca channel blocker OD)

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76
Q

You suspect your bradycardic pt has a calcium channel blocker OD. What Rx?

A

OLMC > Calcium Chloride 1g SIV over 5min

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77
Q

When shouldn’t you give atropine to a bradycardic pt? why?

A

Suspected ACS ischemia or AMI. Atropine may overwork the heart and > more damage/infarct

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78
Q

Can you give atropine for blocks?

A

Type 2 and 3rd degree are ok w/ new wide QRS complex w/ no AMI/ischemia

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79
Q

Are there any precautions to versed and specific populations?

A

Consider lower dose for >60yr age or <60kg pts

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80
Q

QA measures for versed administration

A

VS before & after
EtCO2 after every dose
No Benzo and opiate mix
Waste documentation

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81
Q

Tachycardia Rx

A

MOVAB

  • check pulse
  • determine stable vs unstable - wide vs narrow
    and follow Rx plan
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82
Q

What constitutes unstable tachycardia

A

Persistent tachyarrhythmia > Chest pain/discomfort, hypotension (SBP <90 mmHg), AMS, Pulmonary edema (Acute heart failure), shock signs

CHAPS

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83
Q

Stable - Wide tachycardia Rx (torsades?)

A

MOVAB

vagal

irregular = amio 150mg over 10min (repeat x1 PRN)

Regular = OLMC (adenosine or amio)

Torsades = mag sulfate 2g IV over 10min

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84
Q

Stable narrow tachycardia Rx

A

MOVAB

Vagal

Regular = adenosine 6mg RIVP > 12mg > OLMC

Regular w/ Afib hx = diltiazem 0.25mg/kg SIVP > max single dose 20mg

Irregular = same as above (diltiazem)

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85
Q

Unstable tachycardia

A

MOVAB

Versed 2.5mg - 5mg IV/IO/IN - repeat x1 in 5min PRN

Regular (narrow or wide ) > sync cardiovert 100-120-150-170J

Irregular narrow > sync cardiovert 120-150-170j

Irregular (wide or polymorphic) > defib 150j

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86
Q

Pt has unstable regular, narrow tachy. What Rx?

A

Sync cardiovert 100-120-150-170j

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87
Q

Pt has unstable wide regular tachycardia, what Rx?

A

Sync Cardiovert

100-120-150-170J

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88
Q

Pt has unstable irregular, narrow tachycardia, what Rx?

A

Sync Cardiovert

120-150-170j

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89
Q

Pt has unstable irregular wide/polymorphic tachycardia, what Rx?

A

Unsynchronized defib = 150j

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90
Q

Pt has stable wide tachycardia, what Rx

A

MOVAB

Vagal

Irregular = Amio 150mg infusion over 10min > repeat x1 PRN

Regular = OLMC for adenosine or amio

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91
Q

Pt has torsades (stable wide irregular) tachycardia

A

Mag sulfate 2g IV over 10min

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92
Q

Pt has stable narrow but regular tachycardia, what Rx?

A

MOVAB

Vagal

Adenosine 6mg RIVP > 12mg > OLMC

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93
Q

Pt has stable narrow tachycardia with hx Afib, what Rx?

A

Diltiazem 0.25mg/kg SIVP > max single dose 25mg

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94
Q

Pt has stable, narrow, irregular tachycardia, what Rx?

A

Diltiazem 0.25mg/kg SIVP > max single dose 25mg

95
Q

What HR is for primary vs secondary tachycardia?

A

Primary = Usually >150 BPM

Secondary = usually lower

96
Q

Cardiogenic shock Rx

A

MOVAB

Maintain BP via ROSC protocol (fluids + push dose epi + norepi PRN)

Transport > closest PCI

97
Q

CHF / Pulmonary Edema Rx

A

MOVAB (12-lead)

Nitro per 3-5min if…
- SBP >90 = 0.4mg SL
- SBP >120 = 0.8mg SL
- SBP >160 = 1.2mg SL

CPAP

98
Q

QA measures - CHF/Pulm edema

A

Lung sounds x2 (5min apart)
ETCO2
Nitro <5min at pt?
No nitro & albuterol mix?

99
Q

You’re not sure if pt has CHF or COPD… what can’t you mix?

A

Nitro and albuterol

100
Q

Ab pain / Nausea & Vomiting Rx

A

MOVAB (12 lead)

Nausea/Vomit = zofran 4mg SIVP or oral tab (4mg) > repeat x1 in 15min PRN

Fluids = 500mL 0.9% NS

Pn mgmt if ACUTE onset

101
Q

Why SIVP for zofran

A

Most side effects DT rapid push

102
Q

What are some reasons why pt might feel nausea

A

Heat trauma, ACS, bowel obstruction, preggo, drug effects

103
Q

When would you give pain meds to an abdominal pn pt?

A

First time acute onset

104
Q

Allergic Reaction & Anaphylaxis Rx

A

Severe = 0.5mg epi (1mg/mL) IM mid anterolateral thigh > repeat per 3-5min x max 3 doses PRN (12 lead after every epi)

Fluids > 500 mL

Benadryl = 50mg IV/IM/IO

Solu-medrol (methylprednisolone sodium succinate) = 125mg IVP

Albuterol = 2.5mg nebulized > repeat x1

105
Q

What happens if you throw the sink at an anaphylaxis/allergic reaction and it doesn’t work

A

OLMC > more epi or epi drip (1-4 mcg/min)

106
Q

SS of allergic reaction

A

Skin (hive, swell, rash)

Swollen lips/tongu/throat

Wheeze, stridor, resp distress

Tachy & hypo

Bees sting but their honey is SSWT

107
Q

Psych Rx

A

Confirm safety & PD

Restraints PRN

Rule out underlying (SNOT - sugar, seizure, stroke, narcs, oxygen, trauma, toxins)

MOVAB (EtCO2 & 12-lead)

Versed PRN (if no de-escalate)

108
Q

SOP for using restraints

A

Check & Doc PMS before/after/every 10min

No prone position

109
Q

What’s the versed (Midazolam) dose for psychs? What must you do always when giving this med?

A

If de-escalate not possible…

Potentially violent = 2.5mg IV/IM OR 5mg IN (split nares) > repeat PRN x1 in 3-5min

Actively violent w/ immediate threat = double the normal dose > repeat at normal dose x1 PRN in 3-5min

  • monitor EtCO2 & 4-lead always
110
Q

What are the precautions with Midazolam (Versed) for psychs?

A

Use lower dose for ETOH or drug ingestions. Monitor airway

111
Q

Every time you give a sedative, you must…

A

Document and reassess Vitals before and after (ETCo2 and SPO2) & 4-lead

112
Q

Stroke Rx

A

Gather info

MOVAB (12-lead, BGL, 20g IV R AC)

FAST-ED stroke assessment

Declare Stroke ALERT

Assess Complex Stroke criteria

Determine destination

113
Q

QA for sedatives / Versed

A

VS(Etco2, spo2) , 4-lead before/after

Waste documented

No benzo & Opiate mix

114
Q

When should you be concerned with ETCO2 and SPO2 on a sedated psych pt?

A

ETCO2 > 45 or SPO2 < 94% = decreased respiratory drive

115
Q

What info to gather during a stroke?

A

Onset/discovery (exact time)

Last known normal

SS present upon awakening from sleep?

Seizure hx?

BGL

Witness name / contact

Stroke BLOWSS

116
Q

What constitutes a stroke alert?

A

Positive stroke assessment AND

<24hrs (last normal if unwitnessed)

117
Q

Criteria for complex stroke?

A

FASTED score 4+

Suspected current or hx cranial bleed, head trauma or aneurysm

Neuro surgery last 3 mo

Bleeding disorder or blood thinners

118
Q

Where to take stroke pts? primary vs comprehensive center

A

Comprehensive = Complex or 3.5hr +

Primary = < 3.5hr and no complex

119
Q

What to do if suspected intracranial bleed?

A

30 degree head elevation

120
Q

QA measures for strokes

A

Stroke sceen & alert w/in 5min
BGL?
Scene time <15min
All info documented (onset, last normal, witness contact)

121
Q

Diabetic emergency Rx?

A

MOVAB & BGL

Follow hypo (<60mg/ dL) or hyper ( >400 mg/dL) protocol

122
Q

What is hypoglycemia criteria and what Rx?

A

Hypo < 60 mg/dL or symptomatic

15g Oral glucose if conscious w/ patent airway OR…

25g D10 (250mL) IV OR…

1mg glucagon IM (last option)

Reassess per 5-10min post Rx. Repeat x1 PRN

123
Q

What is hyperglycemia and what Rx?

A

> 400 mg/dL

1000ml fluids (check half way for pulm edema)

ETT PRN

124
Q

You cant get a line on a hypoglycemic. What next?

A

Glucagon

OLMC > IO access permission

125
Q

Drowning/ Submersion Rx

A

Consider Spinal precautions

Remove wet clothing (hypothermia)

MOVAB
- wheeze = duoneb x2 & albuterol PRN
- rales = CPAP
- resp failure = intubate

126
Q

Cold Emergency Rx

A

Extricate

Remove wet clothing & warm pt (hot pack > groin /armpit *no direct skin contact)

MOVAB (fluids & intubate PRN)

Frostbite = pn mgmt & burn center

127
Q

What if you can’t get an IV on a cold emergency pt?

128
Q

Which pt groups are susceptible to cold emergencies?

A

Geriatrics (less subQ fat)

Peds

Alcoholics & Druggies

129
Q

Heat Emergency Rx

A

Extricate & remove excess clothing

fluids

AMS = rapid cooling w/ ice packs & cool/wet sheets

MOVAB

Treat symptoms (nausea, seizures, hypotensive)

130
Q

Athletes w/ suspected heat stroke RX

A

Can delay transport max 15min if cooling / submersion treatment underway (<101.5F)

Aggressive cooling Enroute (ice water tarp wrap)

MOVAB

Treat symptoms (hypotension, seizure, nausea)

131
Q

What meds can elevate a pt’s body temp?

A

Take of your TAAUPS (dont judge me)

Tricyclic antidepressants
Anticholinergics
Alcohol
Uppers
Phenothiazines
Salicylates (aspirin)

132
Q

Can you rely on forehead/tympanic temperatures to guide care?

A

No they’re not accurate enough. Use rectal 1st, oral 2nd

133
Q

Sepsis Rx

A

MOVAB (ETCO2 & BGL)

Confirm indicators

Issue SEPSIS alert

Same as cardiogenic shock Rx (5-5-5)

  • Fluids 500cc (pressure infuser)
  • Push dose epi (10mcg per 1-2 min > max 5 dose)
  • Fluids 500cc
  • Norepi 1mcg/min (titrate > max 10mcg/min via 18g separate IV) *Last resort
134
Q

What are the indicators of SEPSIS

A

Suspected infection AND 2+ indicators below:

HR > 100
RR > 20 AND EtCO2 25 or less
SBP <90 OR cap refill >4s OR mottled skin
Acute AMS or GCS 12-

135
Q

You want to give norepi but aren’t sure if your IV site is working. Yes or no and why?

A

if in doubt, NO. norepi is highly necrotic to tissue

136
Q

What to do if you suspected infiltrated norepi line?

A

Check The pearls of SEPSIS protocol for antidote steps: they’ll need an adrenergic blocking agent to cover the area

137
Q

What QA measures for sepsis

A

BGL?
IV & fluids?
Minimum 1000cc fluids if time w/ pt >20min
Nor epi used?
Sepsis alert declared?
Final SBP >90

138
Q

Pre-Eclampsia / Eclampsia Rx

A

MOVAB (ETCO2)

Fluids PRN

Fast transport (L Lateral) > OB hosp

Seizure = mag sulfate 4g IV over 10min, versed 2.5mg IV/IO per 5min > max 10mg

OR 5mg IN repeat x1 per 5-10min

139
Q

What SS of pre-eclampsia? When do preggos typically have it?

A

HTN, headache, vision change, RUQ pn, Peripheral edema, dark urine

After wk 20 to 2 wks postpartum

140
Q

What extra thing can you do for a preggo that displays severe SS pre-eclampsia, but hasn’t seized yet?

A

OLMC > pre-emitve mag sulfate 4g over 10min

141
Q

What questions to ask a preggo?

A

Gravidity & parity?
Prenatal acre/complications?
ETA delivery & gestation length
High risk pregnancy?

142
Q

What to assess for during an OB emergency

A

Contractions (length and frequency)
Membrane rupture?
Vaginal bleeding?

143
Q

When’s the only time you should check the perineum?

A

Mandatory to check if contracts present and regular in obviously pregnant female

144
Q

What to do if prolapsed umbilical cord?

A

Elevate hips > trendelenburg position or knee-chest

Gloved hand into vagina

Wrap gently in moist gauze

Rapid transport

145
Q

During OB emergency, Breech presentation Rx?

A

Pt into knee-chest position
Rapid transport

146
Q

What to do if baby fails to deliver fully

A

Hyperflex hips

Try to deliver in all 4s position

Deliver >1-2min still = rapid transport

147
Q

Your pt is in active labor but you see no crowning. What to do?

A

Rapid transport to nearest OB

148
Q

Poisoning / OD Rx

A

MOVAB (BGL)

Understand what toxidrome and treat accordingly

149
Q

What are the main toxidromes?

A

Sympathomimetic

Opioid / sedative

Cholinergic

Anticholinergic

Opiate/benzo/ETOH withdrawal

150
Q

Someone OD’ed on an upper. What Rx

A

MOVAB + Supportive care

151
Q

How much and what route narcan for an opiate/opioid OD?

A

MOVAB

Narcan 4mg IN, repeat x1 after 3min PRN

OR

Narcan 0.5mg IV/IO, repeat per 3min to max 6

152
Q

Number one goal of pit crew model

A

CPR & early defib

153
Q

Pt has immune response and rash of bumps on face and body. What new possible disease?

A

Monkey pox

154
Q

Monkey pox transmission?

A

Droplet - 6 feet, mucous, direct contact

Starts 5 days prior to rash onset.

155
Q

Monkey pox precautions

A

Gown, N95, gloves, eyes, face

156
Q

In pitcrew model, where are the positions?

A

Head = airway
Side = CPR
Leg = meds & access

157
Q

when should you suspect hyper K in a cardiac arrest?

A

Hx renal failure/dialysis or diabetes

Meds - K sparring diuretics or K supplements

158
Q

What dose of push dose epi for a ROSC pt and when to give it?

A

If pt hypotensive after INITIAL 500ml NS bolus

10 mcg per 1-2min (max 5 doses) until SBP > 90 mmHg

159
Q

What dose of norepi and when to give it for a ROSC pt?

A

If pt hypotensive after 1000cc fluids (or fluid overload)

1mcg/min (with secondary IV site) > titrate per 1min until SBP > 90 or max 10mcg/min

160
Q

When to give fluids and how much for a ROSC pt?

A

If SBP < 90 mmHg

Continue giving it in conjunction to other interventions

Max 20ml/kg (or 2000cc) or until fluid overload (assess lungs every 500cc fluids)

161
Q

What is classified as severe anaphylaxis

A

2+ affected organ systems

Or Shock

162
Q

What’s your goal onscene time & max time for a stroke?

A

Goal <10min

Max <15min

163
Q

Which types of pts get hypoglycemic really easily?

A

ETOH

Insulin pumps

164
Q

Hypoglycemic emergency pt has an insulin pump running. Can you turn it off?

165
Q

What should you expect for drowning/submersion pts?

A

A lot of VOMITTING. Monitor airway

166
Q

What to be carful if applying hotpack to a hypothermic pt?

A

No direct skin contact > trauma risk

167
Q

Where to take extreme hot and cold emergencies?

A

Trauma center (burn center for extreme injury)

168
Q

What EtCO2 are you trying to maintain on a SEPSIS pt

169
Q

How much fluids to give to a SEPSIS pt?

A

Aim for SBP 90

Max 2000cc or 20ml/kg for kids

170
Q

What dose and when to give push dose epi on a SEPSIS pt? How many doses max?

A

If initial 500cc NS fluids dont work on BP…

10mcg per 1-2min (max 5 doses) until SBP > 90

171
Q

What dose and when to give norepi on a sepsis pt?

A

When pt hypotensive after 1000cc fluids

1mcg/min (w/ second IV 18g AC)

Titrate per 1min till SBP > 90 or max 10 mcg/min

172
Q

Why shouldn’t you try to reposition a prolapsed cord

A

Severe compression = hypoperfusion to fetus

173
Q

What ALS treatment on an OB emergency . What sbp should you give fluids? How much initially?

A

MOVAB

IV fluids TKO

SBP < 100 mmHg = 250cc bolus

174
Q

What’s a cholinergic and what treatment?

A

Cholinergic = pesticides, neurotoxin

Atropine 2mg IV, repeat per 2min until secretions dry

OLMC for duodote kit

175
Q

What’s an Anticholinergic and what RX?

A

Red as a beet, blind as a bat, dry as a hare, mad as a hatter

Supportive care & MOVAB

176
Q

What Rx for pt in withdrawals (drugs, benzos, alcohol)

A

HR > 120 or SBP > 140mmHg = versed 2.5mg IV/IM, repeat per 3-5min x1

Seizing = seizure protocol

177
Q

What causes acute dystonic reation and what Rx?

A

Psych and nausea drugs

Rx = benadryl 50mg IV, versed 2.5mg IV/IM repeat x1 per 3-5min

178
Q

Pepper spray Rx?

A

Remove contaminated stuff

Flush w/ saline

179
Q

What drugs would cause a widened QRS? What phenomenon is that called? What Rx?

A

Sodium Channel Blockade

Anticholinergics, antihistamines, tricyclic antidepressants

Sodium Bicarb 1 mEq/kg IV

180
Q

Pain MGMT protocol

A

MOVAB (EtCO2 & SPO2)

Moderate = ketorolac or Acetaminophen

Severe = Fentanyl

181
Q

Ketorolac contraindications?

A

No active/recent bleed risk

Kidney disease

Cardiac ACS/active disease

Pregnant/nursing mom

NSAID <8hr

Allergy

182
Q

Ketorolac dose and indication

A

Moderate acute pain

15mg IV/IM x1 (no repeat)

183
Q

Acetaminophen contraindications

A

Liver disease

Previous Tylenol < 6hrs

Allergy

184
Q

Acetaminophen indications and dosage

A

Moderate acute pain

> 50kg = 1g IV over 15min (no repeats)

<50kg = 15mg/kg IV over 15min (no repeats)

185
Q

Indication and dose for fentanyl

A

Severe acute pain

1mcg/kg IV/IO to max SINGLE dose of 100mcg
Repeat per 10 min to max total of 3mcg/kg OR

1mcg/kg IN (max single dose 100mcg). Repeat per 5 min to max of 3mcg/kg

186
Q

What other med should you avoid mixing with opioids? Why?

A

Benzodiazepines > increase risk resp. Depression

187
Q

Pn mgmt QA

A

Vitals & pn scale before & after each admin

ETCO2

Waste documented

188
Q

Seizure Rx

A

MOVAB (15lpm, EtCO2)

Protect pt from trauma

BGL

Versed (2.5mg IV/IM or 5mg IN… repeat per 3-5min until max dose 10mg)

189
Q

When should you call PD on a seizure?

A

If they were driving prior

190
Q

Impaled objects Rx

A

Stabilize in place ( DONT remove)

191
Q

Wet or dry dressings for burns? For eviscerations?

A

Burns = dry

Eviscerations = wet

192
Q

What to do with amputated body parts

A

Moist sterile inner packaging, ice/cold outer

193
Q

When to do needle decompress

A

suspected TENSION pneumo

194
Q

What to do for active herniation of head

A

Hyperventilate 20 BPM to maintain 30-35 mmHG EtCO2

195
Q

What SBP to maintain for trauma?

A

Depends:

Major/multi-system = SBP 80-90mmHg

Major head = SBP 100-110 mmHg

196
Q

What are the H-bombs of TBI’s? What’s the significance?

A

Hypoxia, hypotension, hyperventilation/hypocarbia

Short period of any of these = increased mortality

197
Q

Which traumas specifically need OLMC contact

A

Replant services

Crush/compartment syndrome mgmt

198
Q

General Trauma QA

A

Scene time < 10min

Trauma alert < 5min

O2 & IV

199
Q

Traumatic arrest Rx

A

XABCDE

Chest decompress if chest trauma

Fluids

ACLS

200
Q

How much fluids for a trauma arrest?

A

Adult = 2000cc

14-15 = 1500cc

13 - = handtevy

201
Q

Where do you take a traumatic arrest

A

NOT a free standing

202
Q

Electrocution / lightning strike (not in arrest) Rx

A

Consider spinal & burns

MOVAB

203
Q

Electrical / lightening burn Rx

A

Significant = Fluids

Adults = 2000cc

14-15 years = 1500

13- = handtevy

204
Q

Cardiac arrest from lightning/electrocution Rx.

A

Fluids (adult 2000, 14-15 = 1500, younger = handtevy)

MOVAB

ACLS

205
Q

Eye injury Rx

A

Help pt remove contacts PRN

Stabilize impaled objects

Irrigate PRN

IV & pn mgmt

206
Q

Pt has eye injury after using power tools or welding… why shouldn’t they sign a refusal?

A

These appear ok at first, but can actually be super severe

207
Q

Stingray Rx

A

Control bleed

Hot water (w/ soap or ammonia) or hot pack to wound

Look for a barb (DONT remove)

Pn mgmt

208
Q

Jellyfish / man-o-war Rx

A

HAZARD, beware contamination

Script w/ rigid edge & rinse w/ seawater or NS fluid (baking soda/fluid to water)

a lot of rubbing alcohol

Pn mgmt

209
Q

Snakebite Rx

A

Identify/photograph snake

Remove constricting clothes/jewelry

Mark area

Splint below heart level

Pn mgmt

210
Q

Insect sting Rx

A

Identify / photograph

Rigid edge for stinger (no tweezer)

Cold pack

Pn mgmt

211
Q

What shouldn’t you do for a snake bite?

A

NO tourniquet of cold pack

212
Q

Burns Rx

A
  1. Stop burning/decon (undress contaminated)
  2. Cover burns (dry dressing)
  3. MOVAB (prep adv airway & EtCO2)
  4. Fluids
  5. Consider pn mgmt, Cyanokit, Co poisoning
213
Q

What to do for chemical burns

A

Brush it off then flush generously

214
Q

How to determine burn destination

A
  1. 2nd or 3rd degree >15% BSA w/ multisystem trauma = trauma alert > Tampa general if equidistant to closest trauma center
  2. 2nd or 3rd degree at high risk (hands, feet, face, airway, circumferential = trauma alert > Tampa General
  3. Isolated 2nd or 3rd degree >15% = trauma alert > Tampa General
215
Q

A burn pt has 2nd and/or 3rd degree burn > 15% BSA but no trauma. What destination?

A

Tampa General w/ trauma alert

216
Q

Burn pt with 2nd or 3rd degree burn to face/airway, hands, feet, perineum, circumferential chest/extremities… what destination?

A

Trauma alert to Tampa General hospital

217
Q

What BSA % and what burn degree qualifies someone to go to a burn center?

A

15% and 2nd or 3rd degree burns

218
Q

How much fluids to give to a burn pt?

A

Adult = 20ml/kg (max 2000cc)

14-15 = 20ml/kg (max 1500cc)

13 years minus = handtevy

219
Q

Barotrauma / diving injury Rx

A

MOVAB (high flo O2, EtCO2)

Fluids

Nausea = zofran (12-lead before)

220
Q

What history to obtain on a dive/ barotrauma injury?

A

“D’FAC is barotrauma?”

Depth / length of dive

Frequency in <24 hrs

Air travel in <24 hrs

Compressed air type

221
Q

How much fluids to give to a barotrauma or diving injury pt?

A

Adult = 2000cc

14-15 = 1500cc

13 younger = handtevy

222
Q

How long after a dive can SS of a diving injury occur?

A

Up to 48 hrs after

223
Q

How does barotrauma affect the body

A

Ears = ruptured drum, vertigo, tinnitus

Lungs = Pneumothorax, mediastinal emphysema

stomach = nausea / vomiting

224
Q

What’s decompression sickness and how does it affect the body?

A

Gas bubbles block blood flow = joint pain, headache, vision, clots (PE, MI, CVA)

225
Q

Restrictive vs Obstructive lung disease

A

Restrictive = mechanically cant get air in (fibrosis, chest wall, amyloidosis)

Obstructive = cant expel CO2 (COPD/asthma)

226
Q

What lung disease interfere with gas exchange (diffusion) in the alveoli?

A

Pneumonia

Edema/CHF

227
Q

What do reverse shark fin capno’s mean?

A

Leak in a vent circuit

228
Q

Great ways to differentiate COPD vs CHF

A

CHF pts will present with…

Cool pale diaphoretic

Pedal / sacral edema

Square (not shark fin) capno

Higher blood pressure

Rales

229
Q

Quick way to know push dose epi

A

Sepsis, ROSC hypotension, Cardiogenic shock

5-5-5

500 fluids > 5 push dose epi’s > 500 fluids > norepi (last resort)

230
Q

How to draw push dose epi

A
  1. Waste 1cc of a 10cc NS flush
  2. Inject 1cc of 1:10,000 into the flush via 3way stopcock
  3. Use the saline flush @ 10mcg/ml
231
Q

What is the trauma triad of death ? Why is it important?

A

These 3 factors compound each other during a trauma > high mortality rate:

Coagulopathy

Hypothermia

Acidosis

232
Q

What examples of coagulopathy in the trauma triad of death?

A

Bleeding

Saline dilutes blood

Blood thinners

Drugs/alcohol

233
Q

What can cause hypothermia in trauma pts?

A

Cold pavement

Saline infusions

Bleeding

234
Q

What causes acidosis in trauma pts

A

Hypoperfusion to organs > lactate acids build up in body

Pinellas County Protocol 2023 (9 decks)

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