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Lt Exam > EMS Protocols > Flashcards

EMS Protocols Flashcards

1
Q

Who is given the authority to deviate from the EMS protocols as needed?

A

EMS captains

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2
Q

Patient should arrive at the most appropriate receiving facility with a?

A
  • Patent airway
  • Oxygenated
  • Ventilated
  • A perfusing blood pressure
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3
Q

What are the six rights of drug administration?

A
  • Person
  • Drug
  • Dose
  • Time
  • Route
  • Documentation
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4
Q

IM injections: shall be administered in the lateral thigh, or deltoid:

A

adult: 21–23, gauge 1.5 inch needle with a max of four ML per site.
Pediatric : 23 gauge 1 inch needle with a max of one ML per site.
- More than 1 ML needs to be administered split the dose between two sites

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5
Q

MAD

A

Adult and pediatric: 0.1, ML – 0.5 ML with a max of 1 ML IN per nostril.

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6
Q

What medication’s can be administered via MAD?

A
  • Narcan
  • Versed
  • Fentanyl
  • Ketamine
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7
Q

Patients who have not reached puberty, are considered?

A

Pediatric patients

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8
Q

Patients who have reached puberty shall be treated as?

A

Adults

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9
Q

What is the preferred method of vascular access during pediatric cardiac arrest?

A

IO

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10
Q

Pediatric trauma alerts shall be?

A

15 years or younger

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11
Q

When using the Handtevy system, the child’s ________ should be used as a primary reference point for determining the appropriate patient care?

A

Age

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12
Q

Pediatric age classifications

A
  • Neonates: birth to 1 month
  • Infants: 1 month to 1 year
  • Children: 1 year to puberty
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13
Q

Puberty in a female is defined as?

A

Breast development

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14
Q

Puberty in a male is defined as?

A

Under arm, chest or facial hair

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15
Q

Adult and pediatric IO sites

A
  • Proximal humerus
  • Proximal tibia
  • Distal tibia
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16
Q

What are the two classifications of a vulnerable adult?

A
  • A person 60 years of age or older with functional physical or mental and ability care for self
  • and adult 18 years of age or older, who has a developmental disability, has a guardian lives in a nursing facility receives in-home services through a license, healthcare agency
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17
Q

Possible causes of AMS

A

AEIOUTIPS

  • Alcohol
  • Epilepsy
  • Insulin
  • Overdose
  • Uremia
  • Trauma
  • Infection
  • Psychiatric
  • Stroke/Shock
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18
Q

GCS

A
  • Max score is 15, min score is 3
  • GCS 8 or less consider intubation
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19
Q

Vital signs

A
  • priority 3 patients shall receive at least two sets of vitals
  • priority 2 patients shall receive vitals every 5 minutes
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20
Q

Hypo/Hyper

A
  • hypo systolic less than 90
  • hyper diastolic greater than 160
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21
Q

ROSC

A
  • upon ROSC
  • remove rescue pod
  • 12 lead immediately and repeated every 10 minutes
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22
Q

OPQRSTA

A
  • Onset
  • Pallation *
  • Provocation *
  • Previous *
  • Quality
  • Radiation
  • Severity
  • Time
  • Association *
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23
Q

ET CO2

A
  • ideal ranges are 35-45 and Spo2 greater then 90%
24
Q

Ventilatory Rates Adult and Pediatric

A

Adult-
- PULSE: 1 every 6 secs
- NO PULSE: 1 every 10 secs

Peds-
- PULSE: 1 every 3 secs
- NO PULSE: 1 every 6 secs

25
Q

When are high levels of ET CO2 acceptable?

A
  • Cardiac arrest
  • Broncospasm
26
Q

Trauma Hawk Considerations

A
  • ground transport for a trauma alert is greater than 25 minutes
  • extrication time greater than 15 minutes
  • pregnant trauma alert with a gestation
    greater than 20 weeks
  • Prehospital ground response time to scene is greater than 10 minutes.
  • Decompression sickness when ground transport is greater than 40 minutes

*** it shall not be used if the patient is estimated to be 500 pounds or greater

27
Q

Hyperbaric chamber uses

A
  • Decompression sickness
  • Carbon monoxide exposure
  • Hydrogen sulfide exposure
  • Cyanide exposure
28
Q

Stroke facilities

A
  • BHE: primary
  • DMC/Boca: comprehensive
  • St. Mary’s for PEDS
29
Q

Pediatric trauma alerts

A

Shall be 15 years or less

30
Q

K-9 suspected overdose

A

4 mg IN

31
Q

Hypo/hyper glycemia

A
  • less than 60
  • greater than 300
32
Q

Minimum age appropriate systolic blood pressures

A
  • neonates: 60
  • infants: 70
  • children 1-10 yrs 70 + (age in yrs x2)
  • children over 10 yrs old: 90
33
Q

Contraindications to CPAP

A
  • systolic BP less than 90
  • Upper airway obstruction , oral secretions, aspiration risk
  • Acute MI or unstable cardiac arrhythmia
  • Pneumothorax
  • AMS/ decreased level of consciousness
34
Q

Croup vs. epiglottitis

A

Croup:
- Less than three years old
- Sick for a few days
- Low-grade fever

Epiglottis:
- Between 3 to 6 years old
- Sudden onset
- High-grade fever

35
Q

Sepsis alerts

A

Must have at least two points on the HAT criteria max score is three points.

  • H: hypotension
  • A: AMS or GCS less or equal to 14 (new onset)
  • T: Tachypnea respiratory rate is greater than 22 or ETCO2 is less than 25
36
Q

What does RACE stand for?

A
  • Rapid
  • Arterial
  • Cerebral Occlusion
  • Evaluation
37
Q

Patient positioning for oxygenation

A
  • cardiac arrest: 15°
  • stroke: 30°
  • narcotic overdose: 45°
38
Q

What are cortical signs?

A
  • Head and eye gaze deviation
  • Aphasia
  • Agnosia

** any patients exhibiting cortical signs will receive a plus to their RACE score

39
Q

Stroke scores

A
  • Max score is 11
  • score over 0 is a stroke alert
  • Any score over 5 is likely an LVO (large vessel occlusion)
40
Q

Bradycardia is defined as

A

Less than 50 bpm

41
Q

Contraindications for nitro

A
  • SBP less than 90
  • Viagra and Levitra within 24 hours
  • Cialis within 48 hours
  • positive V4R
42
Q

Synchronized cardioversion

A

Adult:
- 70j
-120j
-150j
-200j

**max of 200j

Peds:
- 0.5j/kg
- 1j/kg
- 2j/kg

** Max of 2j/kg

43
Q

Contraindications to amiodarone

A
  • marked sinus bradycardia
  • Cardiogenic Shock
  • 2nd and third-degree heart blocks
  • Hypotension
  • ** QTC greater than 460
44
Q

LVAD

A
  • May not be able to detect pulse, blood pressure, or SPO2
  • perform chest compressions to right side of the sternum
  • do not utilize mechanical CPR device
  • ** Shall be transported to JFK Medical Center
45
Q

H’s & T’s

A

H: hydrogen ion, hyperkalemia, hypoglycemia, hypoxia, hypovolemia, hypothermia

T: Toxins, tablets, tension pneumothorax

46
Q

Determination of death

A

Anyone of the following present:
- Lividity
- Rigor mortis
- Tissue decomposition
- A valid DNR order

Or all of the following are present :
- Downtime greater than 30 minutes
- Asystole confirmed in 2 or more leads
- Pupils fixed and dilated
- Apneic
-

47
Q

Field termination requirements

A
  • Asystole for at least 15 minutes
  • Normothermic
  • Failed adequate resuscitation, including:
    • Airway management
    • CPR
    • ETOC02 less than 10
    • Three rounds of medication
    • Fluid replacement of at least 500 MLs
    • Trial defibrillation at 200 J
48
Q

DNR orders

A
  • Must be signed and dated by the patient’s physician, be signed and dated by the patients surrogate or proxy, state that it is a DNR
  • A DNR order may be withdrawn by any immediate family member, the patients attending physician, or the patient’s healthcare surrogate or proxy
49
Q

Electrocution

A

Lightning strike patients have a 9 in 10 chance of surviving

Conduct triage and reverse manner from what you would normally do in an MCI , lightning, strike patients who are apneic, and in cardiac arrest, should receive priority

50
Q

Refractory V-Fib/V-tach

A

If ALL 3 of the below treatments have failed to convert:
- five or more standard defibrillation have been delivered
- Hs & Ts have been addressed
- 450 mg of amiodarone has been a ministered

51
Q

Cyanide exposure

A

Any firefighter who suffers cardiac arrest during or within 24 hours of a fire incident shall be treated for cyanide exposure

52
Q

Pain management:

A

Exception: do not administer to pregnant patients near term 32 weeks or greater as fentanyl can cause respiratory distress in newborns.

Fentanyl be given IV/IO/IM

And rare occasions fentanyl may cause hypertension. Additionally, fentanyl may cause chest wall, rigidity if administered too quickly.

53
Q

Delayed sequence intubation DSI

A
  • EMS Capt. is responsible for ensuring the airway is secured
  • For patients greater than 65 years old or suspected closed head injury: ketamine 100mg (pre-sedation)
  • Rocuronium: 1mg/kg max dose 100mg (paralytic)
  • Zofran 4mg (prophylaxis for nausea)
54
Q

If DSI has failed, how many attempts are there?

A
  • 1
    ** if second attempt is unsuccessful place SGA and ventilate with BVM
55
Q

Decompression sickness

A

Any patient with the following signs and symptoms who has used SCUBA gear or compressed air within a 48 hour period shall be considered decompression sickness patient.

  • Strokelike symptoms
  • Visual disturbances
  • Joint pain
  • AMS
  • Paralysis or weakness
  • Numbness and tingling
  • Bowel and bladder dysfunction
  • SOB

Lt Exam (11 decks)

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