EMS Manual Flashcards
1
Q
Medical communications with Medical Control or a receiving facility should be conducted for every ______ patient.
A
Priority 1
2
Q
Once a patient has received medications administered by any level of DCFEMS
provider, the patient is categorically considered an ____ patient.
A
ALS level
3
Q
No patient will be turned over to BLS care once ALS interventions (Medications,
Airway) have been initiated. An exception to this rule can be made in a ____________
A
Mass Casualty or disaster scenario.
4
Q
Hospitals will designate personnel to assess patients brought by EMS transport units with the goal of transferring care and releasing the unit within ______________ to the Emergency Department (ED).
A
10 minutes of the patient’s arrival
5
Q
In the event that transfer of care is delayed for longer than __ minutes, the EMS provider will contact the _____
A
20, ELO
6
Q
_______ Consent – when a competent patient or guardian is informed of the
potential benefits and risks of a process or procedure, alternatives to that
procedure, and the possible consequences related to each.
A
Informed
7
Q
________ Consent – written or verbal request to be evaluated and treated.
A
Expressed
8
Q
______ Consent – when a patient is unable to express consent because of
altered mental status or severe distress.
A
Implied
9
Q
Conduct Three Assessments: Providers should attempt to assess the following
three major areas prior to permitting a patient to refuse care and/or
transportation:
A
- Legal Capacity to Refuse Care
- Mental Capacity to Refuse Care
- Medical or situational capacity
10
Q
Who May Refuse Care (4 persons)
A
- The Patient
- Parent (For pt under 18)(18 =minor)
- Guardian
- Health Care Agent (“Attorney-in-fact”) obtain a copy of the durable power of attorney document to attach to the patient care report (PCR).
11
Q
Criteria for determining a patient should be pronounced PDOA shall include ALL of the following Primary Criteria and AT LEAST one of the following Secondary Criteria:
A
Primary Criteria (ALL must be met)
o Pulseless
o Apneic
o No signs of life (such as spontaneous movement or pupillary response)
12
Q
FEMS personnel may withhold resuscitation from a patient in cardiac arrest under “compelling reasons” when two criteria are BOTH present:
A
- End stage of a terminal condition (e.g., cancer, heart failure, dementia etc.)
- Written or verbal information from family, caregivers or patient stating that the
patient did not want aggressive resuscitation efforts such as CPR or intubation.
13
Q
Pronouncement of Death for PDOA:
A
current DC Fire and EMS Medical Director shall be listed on the EPCR as the
pronouncing physician.
“The patient was pronounced dead on date at time by Dr.
first and last name of DC Fire and EMS Medical Director by standing order.”
Immediately notify law enforcement and remain on scene until they arrive to take
custody of the body. Document the badge number of the responsible law enforcement
officer.
14
Q
Regarding DNR what is the “MOST Form”
A
“Medical Orders for Scope of Treatment Form”
15
Q
What does “ROSC” stand for? (EMS)
A
Return of Spontaneous Circulation
16
Q
the United States Park Police (USPP) Aviation Unit “______” is the primary scene
response air medical resource within the District of Columbia.
A
Eagle One
17
Q
Patient assessment and the decision to fly should take less than ___ seconds
A
60
18
Q
What does “OCME” stand for? (EMS) also what hospital number ?
A
Office of the Chief Medical Examiner ( Hospital 30)
19
Q
In cases of a _________ a reverse triage process should be utilized and
patients in cardiac arrest should be treated first.
A
lightning strike
20
Q
What does AVPU stand for?
A
➢ A —Alert
➢ V —Responsive to verbal stimulus
➢ P— Responsive to painful stimulus
➢ U —Unresponsive
21
Q
If the patient is very cold due to hypothermia, assess the pulse for ________ before determining that a pulse
is absent.
A
45 seconds
22
Q
Utilize an Impedance Threshold Device (ResQPODTM) for patients_____ of age or older in a non-traumatic cardiac arrest (If available).
A
8 Years
23
Q
What does DCAP-BTLSIC stand for?
A
➢ D – Deformities ➢ T – Tenderness
➢ C – Contusions ➢ L – Lacerations
➢ A – Abrasions ➢ S – Swelling/edema
➢ P – Penetrations/punctures ➢ I - Instability
➢ B – Burns ➢ C – Crepitus
24
Q
What does “OPQRST-I” stand for?
A
➢ Onset
➢ Provocation/Palliative
➢ Quality
➢ Region/Radiation/Referral
➢ Severity
➢ Timing
➢ Interventions
25
What does " SAMPLE" stand for?
➢ Signs/Symptoms
➢ Allergies
➢ Medication
➢ Past medical history
➢ Last oral intake
➢ Events leading up to illness or injury
26
Vital signs should be monitored at a minimum of every __ minutes for all critical patients and every __ minutes for all other patients.
5, 15
27
Major trauma and burn patients less than __ years of age should be transported to
Children’s National Medical Center (H02).
15
28
Major trauma and burn patients __ years of age or greater (adult sized) should be
transported to a trauma or burn facility capable of handling adult patients.
15
29
Medical or minor trauma patients less than __ years of age should be transported to a medical facility capable of handling pediatric patients.
18
30
Sexual assault patients less than __ years of age should be transported to Children’s National Medical Center (H02)
18
31
Pediatric doses apply to pediatric patients weighing less than __ kg (100 lbs.).
45
32
For pediatric patients equal to or greater than __ kg (100 lbs.), utilize adult dosing.
45
33
Suctioning Time Limits
Adult
__seconds
Child
__ seconds
Infant
__seconds
Adult 15
Child 10
Infant 5
34
Nebulized medications shall be driven by a flow rate of __ liters per minute (lpm) or _____________
10, as prescribed by the manufacturer’s recommendations.
35
_________ is one who presents in extremis and or is at risk of rapidly
deteriorating to the point of cardiac arrest shortly after the arrival of EMS. Often referred to as a “pre-code” or “peri-arrest” patient.
“Crashing Patient”
36
______________ is a cardiac arrest that occurs after the arrival of EMS. Often referred to as an “EMS-witnessed” cardiac arrest.
Post-Arrival Respiratory/Cardiac Arrest (PARCA)
37
Two person BVM is more effective than one person BVM. The __ ___ ___ technique
is more effective than the traditional C-E technique and thus is the preferred method.
2 thumbs down
38
Minimize interruptions in chest compressions. All interruptions in CPR shall be as short as possible and no greater than __ seconds.
10
39
Switch chest compressors every __ ____ (or after 5 cycles of compressions and
ventilations at a ratio of 30:2) to prevent a decrease in the quality of compressions.
2 minutes
40
The ____ shall NOT be placed until all Pit Crew positions are in place, first
rhythm analysis has occurred, and at least two cycles of manual CPR have been
performed.
LUCAS
41
If ROSC has not been achieved after__ ____ of resuscitation in a medical cardiac arrest, consider termination of resuscitative efforts as detailed in the Termination of Resuscitation Medical Cardiac Arrest Protocol.
30 minutes
42
_____ is a main cause of PEA. Pulseless Electrical Activity (PEA)
Hypoxia
43
Pulse should only be checked for a maximum of __ ____s, if no definite pulse is felt, assume the patient is in cardiac arrest and start CPR)
10 second
44
_______ __ __ ____: the failure to achieve sustained return of spontaneous
circulation (ROSC) after treatment with 3 defibrillations and administration of an
antiarrhythmic medication IV/IO. (e.g., amiodarone).
Refractory VF or pVT (ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).
45
All adult patients that are successfully resuscitated from a medical cardiac
arrest, regardless of initial cardiac arrest rhythm and 12-lead EKG findings, MUST be transported directly to a__________ receiving facility.
STEMI/ROSC
46
For ROSC Goal is to maintain an ETCO2 of __ __ mmHg.
35-45
47
(ROSC) Titrate PEEP as necessary to maintain target O2 saturation of __ __.
94-98%
48
(ROSC) Keep the head of stretcher elevated __ __ degrees during transport to improve pulmonary function
and decrease risk of micro aspiration.
35-45
49
(ROSC) Repeat your primary survey and obtain serial vital signs every __ __ minutes.
3-5
50
What does APGAR stand for, and at what time intervals should it be done?
A- Activity
P- Pulse
G- Grimace
A- Appearance
R- Respirations
1min and 5 min
51
___ ____ ____: cardiac rhythm with a rate greater than 100 BPM and a
QRS width greater than or equal to 120 ms.
Wide complex tachycardia
51
__________:Heart rate less than 50-60 BPM in adults who are NOT well conditioned athletes.
BradyCardia
52
___ _____ ______: cardiac rhythm with a rate greater than 100 BPM and
a QRS width less than 120 ms.
Narrow complex tachycardia
53
What are Washington Metropolitan VAD Centers:
George Washington University Hospital (H8)
➢ MedStar Washington Hospital Center (H13)
➢ Inova Fairfax Hospital (H29)
54
The two most common causes of VAD pump failure are ___________
disconnection of the powersource and failure of the driveline.
55
(VAD Patients) DO NOT USE THE ____ ____, when CPR is indicated, perform only manual chest compressions
LUCAS DEVICE
56
( Airway Obstruction) If the patient is experiencing an incomplete / partial airway obstruction, encourage the patient __ ____ in an attempt to relieve the obstruction.
to cough
57
Albuterol
___ mg nebulized
and
Atrovent (Ipratropium Bromide)
____ mcg nebulized
2.5, 500
58
Continuous Positive Airway Pressure Device (CPAP) and start at a pressure of _ cmH2O with an in-line nebulizer.
5
59
If the patient presents with respiratory distress with clinical evidence of croup, administer Normal Saline__ ml via Nebulizer. Repeat __ additional times as necessary if the patient improves with the initial administration.
3, 2
60
Naloxone (Narcan):
BLS: ___ mg IN only, may repeat ___ at
the same dose
2, twice
61
up to __% of patients with anaphylaxis do NOT present with hives or skin manifestations. This contributes to providers failing to diagnose anaphylaxis.
20
62
Adult : BLS or ALS: ___ mg IM via adult auto- injector in the anterolateral thigh for Epi
0.3
63
PEDS : Age ≤ 9 yo
BLS or ALS: ___ mg IM via pediatric auto-
injector in the anterolateral thigh
Age > 9 yo
BLS or ALS: ___ mg IM via adult auto-
injector in the anterolateral thigh
0.15, 0.3
64
If signs of anaphylaxis persist following the first dose of epinephrine, additional IM epinephrine can be repeated by all providers every __-___ min as needed
5-15
65
If the FAST exam is positive, transport should be immediately expedited. Limit scene time to __ __ minutes.
less than 15
66
(Stroke) What does FAST stand for?
F - Facial
A - Arm/Leg weakness
S - Speech
T - Time
67
A properly performed FAST exam misses approximately __% of strokes, so even if the FAST exam is negative,
15
68
( Stroke) If supine is not tolerated by the patient, elevate head of stretcher __-___
degrees.
15-30
69
Stroke is the ___ leading cause of death in the United States and a leading cause of long- term disability.
5th
70
The most common cause of shock of unclear cause is ___ _____
Septic Shock
71
(Adult) Acetaminophen: ___ mg chewable tablet x 4 for a total of ___ mg by mouth
160, 640
72
_____ ______: a seizure occurring between 6 months and 5 years of age, associated
with fever but without evidence of intracranial infection (i.e., meningitis) or other defined cause.
Febrile Seizure
73
Febrile seizures are divided into two categories, ____ and _____, based on clinical features.
simple or complex
74
Simple Febrile Seizure: most common type, characterized by a generalized
seizure that lasts ____ ___ ___ ____ and does not recur in a 24-hour period.
less than 5 minutes
75
Complex Febrile Seizure: characterized by a seizure that has a focal onset (e.g.,
shaking limited to one limb or one side of the body), lasts ___ ___ ___ _____,
or occurs more than once in 24 hours.
longer than 5 minutes
76
(Behavioral Psychological Emergencies) Do not transport the patient in a_______ or __________
prone position or restrict the patient in taking full tidal volume breaths.
77
(Nausea and Vomiting) __-__ cm from the pts nose, Inhale alcohol prep pads ___ times through the nose every 15 minutes, as tolerated.
1-2, 3
78
(Hyperglycemia) _______: they attempt to compensate for their metabolic acidosis by breathing off CO2 by increasing the rate and volume of respiration.
Kussmaul’s respirations)
79
Hypothermia is defined as a core temperature below __°F.
95
80
Contact Poison Control on channel H-__ or call 1-800-222-1222 for assistance in managing specific overdoses.
H-11
81
(Excited Delirium) Patients that are restrained should never be placed in the ____ or __ ___ position nor have external pressure on the Chest that may impede respiration.
Prone or Face Down
82
If patient has reported oral cyanide ingestion or has a history of known exposure immediately progress to the administration of ____________ without
delay.
Hydroxocobalamin (Cyanokit)
83
Once delivery is accomplished, clamp the cord at ___ and __ from the navel and cut between the clamps.
6” and 8”
84
(Breech Presentation) If the head is not delivered within 3 minutes, place a gloved hand in the vagina, with your palm toward the newborn’s face utilizing a ____ technique with your fingers.
"V"
85
(General Trauma Management) What does "MARCH" stand for?
Massive Hemorrhage
Airway
Respiratory / Breathing
Circulation
Head Injury / Hypothermia Prevention
86
(General Trauma Management) What does “AT-MIST” stand for?
➢ A – age
➢ T – time of incident
➢ M – mechanism
➢ I – injuries noted
➢ S – symptoms/signs
➢ T – treatments provided
87
MCI protocol if greater than ___ patients.
9
88
What are the 4 types of blast injuries?
Primary injury
Secondary injury
Tertiary injury
Quaternary
89
Adult Burn percentages: ?
Head-9%
Front and Back Torso - Each 18%
Each Arm - 9%
Gentile - 1%
Each Leg - 18%
90
Peds Burn Percentages:?
Head-18%
Front and Back Torso - Each 18%
Each Arm - 9%
Gentile - 1%
Each Leg - 14%
91
(Burns: Electrocution and Lightning) patients sustaining injury as a result of high voltage electricity (>____ volts) or lightning strikes.
200
92
Irrigate the eye(s) immediately with normal saline for a minimum of __ minutes
20
93
Viable fetus: gestational age ≥ __ weeks
20
94
Pre-viable fetus: gestational age < __ weeks
20
95
For moderate/severe TBI(Traumatic Brain Injury), elevate the head of the stretcher __ degrees to reduce intracranial pressure.
30
96
If a patient with suspected TBI is comatose (unconscious and unresponsive) AND one or
more of the following signs of brain herniation is present, hyperventilate the patient at a rate
of: Adult____ ? Peds____?
Adult Pediatric
20 breaths per min. 25 breaths per min.
97
(Traumatic Brain Injury) Transport patients < __ years old to Children’s National Hospital (H2).
15
98
Level 1 Trauma Center: ? 5 Centers
o Hospital 2 (Children’s National Hospital) ***PEDIATRIC ONLY***
o Hospital 4 (Medstar) ***ALSO ADULT BURN CENTER***
o Hospital 5 (Howard University Hospital)
o Hospital 8 (George Washington University Hospital)
o Hospital 29 (Inova Fairfax Hospital)
99
(Emergencies in Children with Gastrostomy Tubes) Transport the child and the tube to the nearest facility capable of replacing the tube; this is _____________ transport.
not an emergency
100
All Fire/EMS personnel are required to report cases of suspected child / elder abuse or neglect to the Police agency responsible for the area in which the call occurred or the _______________
DC Child and family Services Agency
101
(Electrical Control Device Removal) Grasp the dart itself firmly with one hand and pull to remove one dart at a time. Place the other hand on the patient’s skin at least ____ inches away from the puncture.
4
102
_______ Casualty Incident: <9 patients (does not need to be declared)
Multiple
103
____ Casualty Incident: 9 or more patients (needs to be declared)
Mass
104
( Triage) Patients will be categorized into the five following groups :
RED(Immediate)
YELLOW(Delayed)
GREEN(Minor)
GRAY (Expectant)
BLACK(Deceased)
105
What does "SALT" triage stand for?
Sort
Assess
Lifesaving Interventions
Treatment/Transport
106
Administer pre-packaged Nerve Agent Antidote Kits (NAAK) every 10-15 minutes,
to a maximum of a total of ____ doses of auto-injectors.
3
107
________________ contains 2mg of Atropine and 600 mg of Pralidoxime Chloride (2-PAM Chloride) combined in one auto-injector
DoudoteTM Auto-injector
108
_________ consisting of two components:
I. Atropine 2 mg auto-injectors IM
II. 2-PAM Chloride 600 mg I
Mark 1 NAAK
109
_________ stores:
I. Atropine 0.5 mg auto-injectors IM
II. Atropine 1 mg auto-injectors IM
III. Multidose vials of 2-PAM Chloride 1 gram Injectable
IV. Multidose vials of Atropine Injectable
CHEMPACK
110
(Biological and Radiological Weapons) _______ is an acute infectious disease caused by the spore-forming bacterium Bacillus Anthracis.
Anthrax
111
(Biological and Radiological Weapons) ____ is a very potent protein toxin made from mash left over after processing castor beans for oil.
Ricin
112
(Viral Pandemic Care Modifications) Metered Dose Inhaler Albuterol Dosages:
Adult
BLS or ALS: 8 “puffs” with a spacer. May repeat once in 5 minutes.
113
(Viral Pandemic Care Modifications) Metered Dose Inhaler Albuterol Dosages:
PEDS
BLS or ALS: 4 “puffs” with a spacer. Contact med control for a repeat dose
114
A reading of >__% indicates mild carbon monoxide inhalation.
12
115
A reading of >__% indicates severe carbon monoxide inhalation.
25
116
Smokers: Heavy smokers may have a baseline SpCO level up to __%.
10
117
Continuous Positive Airway Pressure (CPAP) Patient is ≥__ years of age.
15
118
(Positive End Expiratory Pressure (PEEP) Set PEEP to __ cm H2O.
5
119
(Positive End Expiratory Pressure (PEEP) For patients NOT in cardiac arrest, increase PEEP by 5 cm H2O every ____ minutes as needed to improve hypoxia and achieve the clinically indicated SpO2.
3-5
120
All interruptions in CPR shall be as short as possible and no greater than __ seconds.
10
121
Pit Crew CPR roles shall be pre-planned prior to arriving at the patient’s side and include the following assignments:
CPR Leader/Coach-position shall be the responsibility of the first arriving company officer.
Runner/Compressor-First member to arrive at the patient's side.
Ventilator-Opens and clears the airway.
Paramedic
EMS Supervisor
122
Reassess tourniquet efficacy after moving patient, and at least every __ minutes thereafter.
15
