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PCP > BLS & ALS > Flashcards

BLS & ALS Flashcards

1
Q

BLS required Baseline Vitals (7)

A

1) HR
2) RR
3) BP
4) SP02
5) GCS
6) Pupils
7) Skin Colour & Condition

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2
Q

Initiate Cardiac Monitoring For Problems With which Systems (3)

A

Signs or Symptoms of compromised

1) Cardiovascular
2) Respiratory
3) Neurological

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3
Q

Call Types Typically Warranting Cardiac Monitor (13)

A

1) VSA (except Obviously dead)
2) Unconcious or Altered LOA
3) Collapse or Syncope
4) Suspected Cardiac Ischemia
5) CVA (Stroke)
6) Moderate to Severe SOB
7) Overdose
8) Major or Multi-system Trauma
9) Electrocution
10) Submersion Injury
11) Hypothermia or Heat Illness
12) Abnormal vital Signs (ALS PCS)
13) Requested by Sending Facility staff

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4
Q

Patching To Receiving Facility; Steps (3) & Information Required (10)

A 
Steps
1) CTAS 1-2 information report en route
2) Confirm Receiving Facility ACO Acknowledges Report
3) CTAS changes provide additional report
Info
1) Unit #
2) Patient Age
3) Patient Sex
4) CTAS Level
5) Chief Complaint
6) Pertinent History
7) Pert Assessment Findings
8) Pert Management & Response to
9) Abnormal Vitals
10) ETA
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5
Q

Patch To Base Hospital Physician; Steps/reasons (3) & Information Required during Patch (4)

A 
Steps
1) Initiate required patch OR
2) Initiate Patch if Uncertain
3) Document
During Patch 
CRAC
1) Certification
2) Report which includes info necessary to convey PT's Condition, situation, or circumstance which requires input
3) Answer all Physians questions
4) Confirm direction, authorization & orders
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6
Q

02 Therapy Sp02 Goals

A

Normal - 92-96%

COPD - 88-92%

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7
Q

Continuous High Concentration 02 for which PT (6)

A

CUSCCS

1) Confirmed/Suspected Carbon Monoxide, cyanide, or Noxious Gas Exposure
2) Upper Airway Burns
3) Scuba related Disorder
4) Cardiopulmonary Arrest
5) Compete Airway Obstruction
6) Sickle Cell Anemia Crisis

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8
Q

COPD Treatment 02 standard

A

1) Nasal Cannula, 2 litres above home Level
2) 2 Litres if not on Home 02
3) Reassess min every 10 min
4) 88-92% = Maintain
5) Deteriorating - add 2 Litres every 2-3 min
6) Be Prepared to Ventilate

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9
Q

Continuous High Concentration 02 required for (5) Critical Findings

A

ARC AA

1) Age-specific Hypotension
2) Respiratory Distress
3) Cyanosis, Ashen Colour Skin, Pallor
4) Altered LOA
5) Abnormal Pregnancy or Labour

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10
Q

Field Trauma Triage Physiological Criteria (4)

A

1) Unable to Follow Commands
2) SBP <90mmHg
3) RR <10 or >=30 or BVM Needed
( <1 year = <20)
AND Transport <30 min

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11
Q

Field Trauma Triage Anatomical Criteria (9)

A

1) Open/Depressed Skull Fracture
2) Penetrating Injury to Head, Neck, Torso, Extremities Proximal to elbow and knee
3) Chest wall Instability/ Deformity
4) Pelvic Fractures
5) Two or more proximal long bone fractures
6) Amputation proximal to wrist and ankle
7) Crushed, degloved, mangled, or pulseless extremity
8) Paralysis
AND
9) Transport Time <30 min

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12
Q

LTH criteria that must go to the closest ED?

The exception to this rule?

A

If unable to secure Airway or Survival is unlikely with current transport time
Exceptions - Penetrating Trauma to Head, Neck, Torso
AND BOTH
1) VSA & Not Subject to TOR
2) Transport Time to LTH <30 min

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13
Q

Field Trauma Triage MOI Criteria (5)

A

1) Falls
- Adult - >=6m (2 Stories)
- Child (<15) - >=3m or 2 times height
2) Auto-Crash
- Intrusion >=0.3m next to PT or >=0.5m anywhere else
- Ejection
- Death in the same Compartment
- Telemetry indicates high-risk injury
3) Bike or Pedestrian Struck or runover (>=30km/hr)
4) MotorCycle Crash >=30km/hr
AND
5) Transport <30 min

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14
Q

Field Trauma Triage Special Criteria (5)

A

1) Age - risk increase over 55 & SBP<110 can be shock at 65
2) Anticoagulation and Bleeding disorders
3) Burns
4) Pregnancy >=20 weeks
5) Transport <30 min

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15
Q

Air Ambulance Utilization

A

to be continued…..pg.27

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16
Q

SMR Consideration MOI Criteria (9)

A

PLEEDS For PT

1) Penetrating Trauma to Head, Neck, Torso
2) Lightning
3) Electrocution
4) Explosion
5) Diving/ Submersion injury
6) Sports accident
7) Falls
8) Pedestrian Struck
9) Trauma Associated with neck/back Pain

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17
Q

SMR MOI Criteria Present Check Risk Criteria (8)

A

1) >=65
2) Neck or Back Pain
3) Spine Tenderness or Deformity
4) Neuro Signs/Symptoms
5) Altered LOA
6) Suspected Drug/Alcohol
7) Distracting Painful Injury
8) High-energy MOI

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18
Q

SMR - 5 Examples of High Energy MOI

A

1) Fall >3feet/5 stairs
2) Axial load to the head
3) MVC >=100km, rollover, ejection
4) Hit by Bus/Truck
5) Bicyclist struck or collision

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19
Q

Obviously Dead Criteria (4)

A

1) Grossly Charred Body
2) Open head or torso Wound with Outpouring contents
3) Gross Rigor Mortis
4) Dependant Lividity

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20
Q

Stroke Bypass Symptoms (4)

A

IS (voice) UU(body)

1) Inappropriate words/mute
2) Slurred Speech
3) Uni Arm/Leg weakness or drift
4) Uni Facial Droop

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21
Q

Stroke Bypass Contraindications (7)

A

1) CTAS 1 or ABC Issues
2) GCS <10
3) BGL <3mmol
4) Stroke Symptoms Correct before arrival
5) Seizure at onset or Witnessed by PCP
6) Terminally ill/ Palliative care
7) Transport exceed 2 hrs or ETA over 6 from the onset

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22
Q

LAMS Scoring System

A

Face - 1 side = 1 Arms - 1 Side = 2 Grip - 1 side= 2

     - N/A= 0                - 1 side weak =1        - 1 Weak=1
                                    - N/A = 0                   - N/A= 0
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23
Q

LAMS Score Interpretation

A

Out of 5
>=4 = LVO (Large Vessel Occlusion)
LVO = EDT (Endovascular Therapy) Thrombectomy
<4 = TPA (tissue plasminogen activator)

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24
Q

Stroke Mimics (4)

A

1) Hypoglycemia
2) Drugs
3) Severe Hypertension (DBP >110, SBP >180
4) CNS infection

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25
Q

1) Stroke Respiration (if Apneic or inadequate) ETCO2 Goals With Monitor
2) Exception

A

1) 35-45 mmHg
2) Exception If signs of Cerebral Herniation
- Attempt to Hyperventilate ETC02 30-35 mmHg

26
Q

Signs of Cerebral Herniation (3)

A

1) Dilated & Unreactive Pupils
2) Asymmetric pupillary response
3) Motor shows uni or bilateral decorticate/decerebrate posturing

27
Q

Hyperventilation rates for suspected Cerebral Herniation without ETCO2 Monitoring

A

Adult - 20 BPM, 1-3 sec
Child - 25 BPM, 1-2.5 sec
Infant - 30 BPM, 1-2 sec

28
Q

Chest Pain (non-Trauma) differential Diagnoses

A

1) Acute Coronary Syndrome (NSTEMI, STEMI, Unstable Angina)
2) Dissecting Thoracic Aorta
3) Pneumothorax/ Tension Pneumo/ Other Respiratory Disorders
4) Pulmonary Embolism
5) Pericarditis

29
Q

Chest Pain (non-Trauma) Secondary Survey must include 7 chest criteria and 4 other assessments (Other than the Mandatory 12 LEAD).

A 
Chest 1) SubQ
          2) Accessory muscle use
          3) Urticaria
          4) Indrawing
          5) Shape
          6) Symmetry
          7) Tenderness
Other 1) Ausultate for Airentry & adventitious sounds
           2) Abdomen
           3) Leg/Ankle Edema
30
Q

STEMI Bypass Criteria (4)

A

1) >=18 Years
2) Chest Pain OR Equivalent consistent with Cardiac Ischemia/MI
3) Onset <12 hrs
4) 12 Lead Indicates STEMI/MI

31
Q

STEMI Bypass 12 Lead Criteria (3)

A

1) 2mm ST-Elevation in V1-V3 in 2 Contiguous Leads
AND/OR
2) 1mm ST-Elevation in 2 other Anatomically Contiguous Leads
OR
3) ECG Computer deems STEMI & Paramedic Agrees

32
Q

Contraindications for STEMI Bypass (5)

A

1) CTAS 1 AND unable to secure Airway or Ventilate
2) 12-Lead STEMI mimic (LBBB, Paced, ETC)
3) Transport to PCI center is >=60 min from PT contact
4) PT Experiences Complication needing Diversion
5) PT Experiencing Complication requiring ACP Diversion (ACP not Adequate)

33
Q

Contraindications for STEMI Bypass Because of the need for Diversion (3)

A

Diversion

1) Moderate-Severe Respiratory Distress/Use of CPAP
2) Hemodynamic Instability
3) VSA and no ROSC

34
Q

Contraindications for STEMI Bypass that should be consulted about still permitting PT to Interventional Program at PCI center (2)

A

1) CTAS 1 AND unable to secure Airway or Ventilate

2) 12-Lead STEMI mimic (LBBB, Paced, ETC)

35
Q

If PT Eligible for STEMI Bypass Inform CACC/ACS of need to Transport to PCI center & provide PCI Center with Information (8)

A

1) STEMI PT
2) PT Initials
3) Age
4) Sex
5) Concerns regarding Clinical Stability
6) ECG Findings
7) ETA
8) Catchment Area of PT pickup

36
Q

After Confirming STEMI Positive, First Priority is

A

PUT ON PADS

37
Q

Cardiac Ischemia Medical Directive Indications and Conditions for ASA(3) and Nitro(5)

A

ASA 1) >=18 Nitro 1) >=18

     2) Unaltered              2) Unaltered
     3) Chew & Swallow   3) SBP Normotension(>=100)
                                        4) HR 60-159 BPM
                                        5) Hx Nitro or IV Access
38
Q

Cardiac Ischemia Medical Directive Contraindications for ASA(4)

A

ASAS - ASA

1) Asthma & no Prior use
2) Sens/Allerg
3) Active Bleed (obvious & stool/Vomit)
4) Stroke/TBI in Previous 24hrs

39
Q

Cardiac Ischemia Medical Directive Contraindications for Nitro(4)

A

RAPS - Nitro

1) Right Ventricular MI
2) Allerg/Sens
3) Phosphoesterase Inhibitor use (48hrs)
4) SBP Drops 1/3 of the initial value after First Dose

40
Q

Cardiac Ischemia Medical Directive ASA Dose

A

Route - PO
Dose - 160-162mg (2 Tablets)
Max Dose - 1

41
Q

Cardiac Ischemia Medical Directive Nitro Doses

A 
SBP >=100mmHg & no RVMI & Hx of use
Route - SL
Dose - 0.3mg or 0.4mg
Dose Interval - 5 min
Max Dose for STEMI Negative - 6
Max Dose for STEMI - 3
42
Q

ACPE Indications (2)

A

1) Moderate to Severe Respiratory Distress
AND
2) Suspected ACPE

43
Q

ACPE Conditions for Nitro (3)

A

1) >=18
2) HR 60-159 BPM
3) NormoTension (>+=100mmHg)

44
Q

ACPE Contraindications for Nitro (3)

A

1) Allerg/Sens
2) Phosphodiesterase Inhibitor (48hrs)
3) SBP drops 1/3 of the Initial Value after First Dose

45
Q

ACPE Nitro Doses with NO Hx use or IV

A 
SBP >=140mmHg
Route - SL
Dose - 0.3mg or 0.4mg
Dose Interval - 5min
Max Doses - 6
46
Q

ACPE Nitro Doses with Hx use or IV

A 
SBP <=100mmHg to <140mmHg
Route - SL
Dose - 0.3mg or 0.4mg
Interval - 5min
Max Doses - 6

SBP >=140 mmHg
Dose - 0.6 or 0.8 mmHg
Rest is same as above

47
Q

Medical Cardiac Arrest Conditions for Manual Defibrillation

A

Age >=30 days
LOA - Altered (GCS3)
VF or Pulseless VT

48
Q

Medical Cardiac Arrest Conditions for Medical TOR

A

TORS are the WORST

1) Witnessed by NO EMS
2) Origin believed to be CARDIAC
3) ROSC NOT Achieved
4) Shock NOT Delivered
5) TOR is Indicated if 18

49
Q

Medical Cardiac Arrest Doses

A

Dose - 1 Shock
Interval - 2min
Max Dose - 4

> =30 to <8 years
1st shock - 2j/kg
Sebsequent - 4j/kg

>8 
120j
150j
200j
200j
50
Q

Medical Cardiac Arrest Clinical Considerations for Early Transport After 1st Analysis(6)

A

1) Pegancy >=20 weeks (fundus above umbilicus, uterus displaced to left)
2) Hypothermia
3) Airway Obstruction
4) Suspected Pulmonary Embolus
5) Overdose
6) Other Reversible Causes

51
Q

Medical Cardiac Arrest Clinical Considerations for Early Transport After 3rd Analysis (2)

A

1) Refractory Ventricular Fibbulation
AND
2) Pediatric Cardiac Arrest

52
Q

Trauma Cardiac Arrest Indications and Treatment

A

Indications - Cardiac Arrest Secondary to Severe Blunt or Penetrating Trauma
Treatment
- 1 Analysis/Shock
-Transport OR PATCH for TOR

53
Q

Trauma Cardiac Arrest Conditions (4) and Contraindication (1)for TOR

A 
Conditions
1) >=16 Years
2) No Palpable pulses AND No Shock
AND 
3) HR=0 (Asytole)
OR
4) HR>0 (PEA) with ED >=30min
Contraindications
1) HR >0 (PEA) & ED <30 min
54
Q

Hypoglycemia Medical Directive Indications (4)

A

Double ASS

1) Agitation OR
2) Altered LOA OR
3) Seizure OR
4) Stroke Symptoms

55
Q

Hypoglycemia Medical Directive Conditions (2) & Contraindications (2) for Glucagon IM

A 
Conditions
1) Altered LOA
2) HypoGlycemic
Contraindications
1) Allerg/Sens
2) Pheochromocytoma
56
Q

Hypoglycemia Medical Directive Conditions (2) & Contraindication for Dextrose IV

A 
Conditions
1) >=2 years
2) Altered LOA
3) Hypoglycemia
Contraindication
1) Allerg/Sens
57
Q

Hypoglycemia BGL

A

<2 Years - <3.0 mmGh

>=2 Years - <4.0 mmGh

58
Q

Pheochromocytoma Definition

A

(Usually) Benign tumor arising from catecholamine producing chromaffin cells in the adrenal medulla causing too much release of Epi & Norepi

59
Q

Hypoglycemia Medical Directive Glucagon IM Doses

A

<25kg (8years/55lbs)
Dose - 0.5 mg
Dose Interval - 20 min
Max Doses - 2 (2nd BLG before 2nd dose)

> =25kg
Dose - 1 mg
Dose Interval - 20 min
Max Dose - 2 (2nd BLG before 2nd dose)

60
Q

Hypoglycemia Medical Directive Dextrose IV Doses

A 
D10W
Dose - 0.2g/kg(2 ml/kg)
Max Single Dose - 10g (100ml)
Dose Interval - 10 min
Max Doses - 2
D59W
Dose - 0.5g/kg (1ml/kg)
Max Single Dose - 25g (50ml)
Dose Interval - 10 min
Max Doses - 2
61
Q

Hypoglycemia Clinical Considerations (3)

A

1) If PT responds well to Dextrose or Glucagon, may receive oral glucose or simple carbs
2) Only Mild Sign Exhibited - May Skip to oral glucose or simple carbs
3) If PT Initiates informed refusal of transport, attempt final set vitals & BGL

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