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EMS Protocols Flashcards

1
Q

Who is our medical director and assistant medical director

A

James Roach
Alex Torres

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2
Q

For unresponsive patients if ventilation is required for more than ____ what should be done

A

2 minutes
Upgrade airway

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3
Q

What is the preferred way for ventilating a pediatric patient

A

BVM in conjunction with OPA/NPA

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4
Q

Infants and children with an advanced airway during CPR should be ventilated at what rate

A

1 breath every 6 sec

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5
Q

Ped patients who’ve had recent illness with fever, stridor, or drooling should not have

A

NPA or OPA placed. Don’t stress patient

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6
Q

O2 should only be administered to maintain O2 levels of

A

95% or 90% for COPD/asthma patients

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7
Q

TBI patients shall receive what

A

15 lpm via NRB

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8
Q

Pregnancy 3rd trimester trauma patients shall receive

A

15 lpm via NRB

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9
Q

Intubation shall be confirmed by

A
  • Visualization of tube passing chords
  • Auscultation
  • Continuous EtCO2 monitoring
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10
Q

Ventilatory rates for adults with and without pulse

A

Both 1 breath every 6 sec

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11
Q

Ventilatory rates for children with and without pulse

A

1 breath every 3 sec (pulse)
1 breath every 6 sec (without)

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12
Q

Ventilatroy rate for neonates

A

40 breath/minute

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13
Q

For peds after BVM ventilation of ___ for infants/children and ___ for neonates, what should be done

A

1 minute
30 sec (neonate)
Begin compressions if heart rate still below 60 bpm

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14
Q

What patients should be monitored if EtCO2 cannula is available

A

Respiratory distress
AMS
Sedated patients
Ketamine administered
Seizure
Ventilatory support

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15
Q

Vital signs for priority 3 and priority 2 patients include

A
  • At least 2 sets and every 15 minutes (priority 3)
  • Vitals every 2 minutes
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16
Q

Adult hypotension is defined as

A

Systolic less than 100

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17
Q

How do we define a pediatric patient

A

Absence of puberty

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18
Q

Ages for adult/ped medical and adult/ped trauma

A

Medical: Adult 18 or older, Ped 17 or younger

Trauma: Adult 16 or older, Ped 15 or younger

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19
Q

What does APGAR stand for

A

Appearance
Pulse
Grimace
Activity
Respirations

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20
Q

Hypotension for neonates, infants, children 1-10, and children greater than 10

A

SBP less than 60
SBP less than 70
SBP less than 70 + age in years x2
SBP less than 90

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21
Q

Heart rates:
Newborn-3 months
3 months-2 years
2 years-10 years
Greater than 10

A

85-205
100-190
60-140
60-100

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22
Q

Describe priority 1, 2, and 3 patients

A

1: Cardiac, trauma or respiratory arrest
2: Unstable with life threats
3: Stable no life threats

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23
Q

All intubated interfacility transfers must be

A

Paralyzed and sedated

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24
Q

If child, elder, or disabled adult abuse is involved, EMS is required by law to

A

Contact Florida Department of Children and Families

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25
Q

If a witness is used to identify a patient with a DNR, what must be documented in report

A

Full name of witness
Address and number
Relationship of witness to patient

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26
Q

The granting of permission for health care without a formal agreement btwn patient and health care provider

A

Implied consent

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27
Q

What patients are able to refuse care

A
  • Those with decisional capacity
  • Adult, 18 or older
  • Emancipated minor, self sufficient, or minor in military
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28
Q

Anaphylactic shock is characterized by what

A

S/S of allergic reaction with loss of radial pulse or SBP < 100

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29
Q

Protocol for mild and moderate/severe allergic reaction

A

Mild: Benadryl 50 mg IV/IO/IM over 2 min

Moderate: Epi 1:1000 0.3 mg, may repeat x2
Albuterol 2.5 mg nebulizer
Benadryl
Solumedrol 125 mg IV/IO/IM

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30
Q

Protocol for anaphylactic shock

A

Push dose epi
Normal saline 1L
Benadryl, solumedrol, albuterol as noted for moderate reaction

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31
Q

Doses for pediatric allergic reaction

A

Benadryl 1mg/kg max 50 mg over 2 minutes

Epi 1:1000 .01mg/kg max 0.3 single dose, repeat x2

Albuterol 2.5 mg nebulizer

Solumedrol 2mg/kg

Saline 20mL/kg

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32
Q

What does AEIOU-TIPS stand for

A

Alcohol
Epilepsy
Insulin
Overdose
Uremia
Trauma
Infection
Psych
Stroke

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33
Q

What patients should be transported regardless of post treatment glucose levels

A

Taking oral hypoglycemic meds (Glipizide, Glimepiride, Glyburide)

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34
Q

What are the ranges for hypo and hyperglycemia

A

<60 hypo
>300 hyper

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35
Q

Hypoglycemia and hyperglycemia protocols

A

Hypo: oral glucose 15g if able to swallow
D10 100mL IV

Hyper: Normal saline 1L
Zofran 4mg IV/IO/IM/PO if nauseous

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36
Q

If unable to establish IV for hypoglycemia what can be given

A

Glucagon 1mg IM

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37
Q

Doses for ped diabetic emergencies

A

Oral glucose 15G, (not for patients <2)

D10 5mL/kg max 100mL

Saline 20mL/kg
Zofran 0.1 mg/kg

Glucagon <20kg = 0.5mg, >20kg = 1mg IM

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38
Q

Characterized by intermittent spasmodic or sustained contractions of muscles in face, neck, trunk, pelvis, extremities, larynx

A

Dystonic reactions

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39
Q

Protocol for adult and ped dystonic reactions

A

Adult: Benadryl 50mg over 2 minutes

Ped: Benadryl 1mg/kg max total 50mg over 2 minutes

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40
Q

Hyperkalemia protocol adult

A

Calcium chloride 1g slow IV/IO over 2 minutes

Albuterol 10mg nebulizer

Bicarb 50mEq, slow over 2 minutes

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41
Q

Hyperkalemia protocol ped

A

Calcium 20mg/kg, slow over 2 minutes

Albuterol 10mg

Bicarb

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42
Q

Seizure protocol adult

A

Versed 5mg IV/IO/IN/IM max 10mg

If no effect after versed, Ketamine 100mg

Additional 100mg if patient to be intubated

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43
Q

Seizure protocol ped

A

Actively cool
Tylenol 15mg/kg PO if not seizing

Versed 0.1mg/kg IV/IO, 0.2mg/kg IN/IM

Ketamine if no effect 1mg/kg (diluted)

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44
Q

Temp range for sepsis

A

> 100.4 or <96.8

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45
Q

Sepsis alert criteria

A
  • Adult with suspected/confirmed infection
  • AND at least 2/3:
  • Hypotension
  • AMS
  • Tachypnea
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46
Q

Sepsis and septic shock treatment

A
  • Call sepsis alert
  • Monitor EtCO2
  • BGL
  • SpO2 at 95% or 90% (COPD)
  • Saline

Septic shock push dose EPI

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47
Q

Stroke alert criteria

A

Race 1 or greater and onset/last known well within 24 hours

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48
Q

What is max race score and why

A

Max 9
Aphasia used for deficits on right
Agnosia for deficits on left

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49
Q

What are the 2 pediatric comprehensive stroke centers in Broward

A

BHMC and JDCH

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50
Q

Stroke protocol

A
  • Transport patient 30 degree elevation
  • 2 lpm NC for sat <95%
  • 18g in A/C
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51
Q

What should be communicated to hospital for stroke alert

A
  • LKW
  • Race score
  • Patient on blood thinners
  • B/P
  • BGL
  • ETA
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52
Q

When air goes in before the patient is allowed to fully exhale. When does this occur?

A

Auto PEEP
During assisted ventilations

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53
Q

When do you assist ventilations with a BVM

A

Respiratory rate of <10 or >29 with shallow respirations

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54
Q

When is CPAP considered and examples

A

Moderate/severe respiratory distress.
COPD, asthma, pneumonia

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55
Q

When is CPAP contraindicated

A
  • Decreased LOC
  • Patients without spontaneous respirations
  • SBP <100
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56
Q

Adult respiratory distress protocol COPD

A

Albuterol 2.5mg neb
CPAP
Solumedrol 125mg IV/IM

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57
Q

Adult respiratory distress protocol asthma/severe asthma

A

Albuterol 2.5mg neb
Solumedrol 125mg IV/IM

Severe: CPAP (5-10 cm H2O)
Albuterol
Epi 1:1000 0.3mg IM may repeat x2
Mag Sulfate infusion
Solumedrol

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58
Q

Ped respiratory distress protocol asthma mild

A

Albuterol 2.5mg neb
Solumedrol 2mg/kg over 2 min

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59
Q

Ped respiratory distress protocol asthma moderate/severe

A

Assist vent with BVM
Albuterol
Epi 1:1000 0.01mg/kg may repeat x2
Mag sulfate infusion
Solumedrol

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60
Q

Croup/Epiglottitis protocol

A

Epi 1:1000 3mL via nebulizer
Don’t stress patient
Don’t intubate or insert OPA/NPA

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61
Q

Croup symptoms

A

Usually <3 years old
Sick for couple days
Low grade fever
Not toxic appearing

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62
Q

Epiglottitis symptoms

A

Usually 3-6 years old
Sudden onset
Tripod position
High grade fever
Drooling
Poor general impression

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63
Q

Adult and ped facilitated laryngoscopy/supraglottic airway protocol

A

Adult: Etomidate 30mg IV/IO or Ketamine 200mg diluted IV

Ped: Etomidate 0.3mg or Ketamine 1mg/kg

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64
Q

Post intubation sedation/paralysis protocol

A

Ketamine 200mg may repeat x1
Rocuronium 50-100mg IV/IO may repeat x1

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65
Q

Ped dose of rocuronium

A

1mg/kg IV/IO

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66
Q

For STEMI alerts where should the IV be placed

A

Right AC or anywhere on left arm

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67
Q

Adult chest pain protocol

A

12 lead
Aspirin 324mg, unless pt. self admin 324mg within 24 hours
Fentanyl 100mcg slow IV/IO/IM max 200mcg

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68
Q

Contraindications for aspirin

A

Allergy, active GI bleeding

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69
Q

STEMI alert protocol

A

12 lead
Aspirin 324mg
Fentanyl 100mcg slow IV/IO/IM max 200mcg

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70
Q

STEMI alert criteria

A

Elevation in 2 or more contiguous leads of 2mm or greater with concave (smiley face)

Elevation in 2 or more contiguous leads (2mm or > in V2 and V3 or 1mm in all other leads) with convex (frown face)

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71
Q

STEMI mimics

A

QRS > 0.12
LVH
Pericarditis
Early repolarization
< 2mm elevation with concave

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72
Q

CHF Protocol

A

Aspirin 324mg
CPAP 10cm H2O
Lasix 40mg IV
Nitro paste 1” to anterior upper chest

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73
Q

Contraindications for nitro

A

SBP <100
EDD within 24-48 hours
RVI

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74
Q

Condition in which heart suddenly can’t pump enough blood to meet body’s needs

A

Cardiogenic shock

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75
Q

Cardiogenic shock protocol

A

Follow CHF protocol
Hypotension: push dose epi

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76
Q

What are the 2 LVAD hospitals in Broward

A

Memorial regional
Cleveland clinic

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77
Q

Adult bradycardia protocol

A

Stable: monitor/transport

Unstable: 12 lead
Saline 1L
Atropine 0.5mg IV/IO may repeat 3-5min max 3mg
Push dose epi
Pacing starting at 60bpm

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78
Q

Bradycardia is defined as heart rate <

A

60bpm

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79
Q

In presence of chest pain and high degree AV blocks with hypotension what should be done for bradycardia

A

Directly to pacing

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80
Q

Sedation for pacing

A

Etomidate 10mg IV/IO may repeat x1
Or Versed 5mg

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81
Q

Ped bradycardia protocol

A

Stable: monitor/transport

Unstable: Oxygenate
Push dose epi
If no response pace at 80bpm

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82
Q

Ped sedation for pacing

A

Etomidate 0.15mg/kg or Versed 0.1mg/kg

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83
Q

Adult rapid A-fib A-flutter protocol

A

Stable: Cardizem 10mg IV/IO over 2 min
If HR > 120 after 5 min give 15mg IV/IO over 2 min

Unstable: Saline 1L
DO NOT CARDIOVERT

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84
Q

Contraindications for Cardizem

A

Hypotension
Wide QRS
WPW
Sick sinus syndrome
Patient taking beta blockers

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85
Q

Stable SVT adult protocol

A

Vagal maneuver
Adenosine 12mg rapid IV
Failure to convert then give Cardizem 10mg over 2 min
Cardizem 15mg if still >120

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86
Q

If hypotension occurs after Cardizem what should be done

A

Saline 1L
Calcium chloride 1g IV/IO over 2 min

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87
Q

For WPW with rapid ventricular response what should be done

A

Amiodarone infusion

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88
Q

Unstable adult SVT protocol

A

Unstable = hypotension
Patient alert: Adenosine 12mg rapid IV

Altered patient: Cardioversion 200J
Consider sedation prior

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89
Q

Ped stable SVT protocol

A

Vagal
Adenosine 0.1mg/kg rapid IV
If no change in 1 min adenosine 0.2mg/kg rapid IV

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90
Q

Unstable ped SVT protocol

A

Unstable = age appropriate hypotension
Patient alert: Adenosine

AMS: Cardioversion 1J/kg, increase to 2J/kg if not effective
Etomidate 0.15mg/kg IV/IO over 15-30 sec

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91
Q

SVT rate in infants and children

A

Infant >220 bpm
Children >180 bpm

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92
Q

Treatment for really wide complex tachycardia

A

NO AMIODARONE
Calcium 1g IV/IO over 2 min
Bicarb 50mEq IV/IO over 2 min

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93
Q

Adult stable wide complex tach protocol

A

Amiodarone infusion 150mg in 50mL over 10 min
If ami no available then Lidocaine 100mg IV/IO, may repeat x1 after 5 min if no effect

94
Q

Adult unstable wide complex tach protocol

A

Cardiovert 200J
Failure to convert Amiodarone infusion
If unstable after infusion cardioversion every 2 min prn

95
Q

Ped stable wide complex tach protocol

A

Ami infusion or lidocaine 1mg/kg

96
Q

Ped unstable wide complex tach protocol

A

Cardioversion 1J/kg, if no response 2J/kg, then 4J/kg
Etomidate 0.15mg/kg

97
Q

Adult poly v-tach (torsades) protocol stable/unstable

A

Stable: Mag sulfate 2g in 50mL, 10 drop set wide open

Unstable: Etomidate 10mg IV/IO
Defibrillation 200J
Mag Sulfate 2g in 50 mL

98
Q

Ped poly v-tach protocol

A

Stable: Mag sulfate 40mg/kg in 50mL

Unstable: Etomidate 0.15mg/kg
Defibrillation 2J/kg, 4J/kg, 10J/kg
Mag Sulfate

99
Q

All cardiac arrests shall be worked on scene for how long

A

20 minutes

100
Q

Minimizing interruptions in compressions to

101
Q

The ResQPOD shall be used for what patients

A

Pulseless adult patient w/out chest trauma and ped patients >1

102
Q

When can you terminate efforts after resuscitation has started

A

Persistent Asystole/PEA for 20 min
EtCO2 <10 mmHg
H’s and T’s addressed
(Ultrasound w/no heart wall motion for PEA)

103
Q

EtCO2 above ____ is ideal for resuscitation

104
Q

What are the H’s and T’s

A

Hydrogen ion
Hyperkalemia
Hypoxia
Hypoglycemia
Hypovolemia
Hypothermia
Tamponade
Thrombosis
Trauma
Tablets/toxins
Tension pneumo

105
Q

When is the AutoPulse applied

A

After 3 rounds of 220 compressions

106
Q

What should be given for hyperkalemia

A

Calcium 1g IV/IO over 2 min
Albuterol 10mg nebulizer
Bicarb 50mEq over 2 min

107
Q

Agitated delirium cardiac arrest special consideration

A

Bicarb 50mEq over 2 min
Cold Saline 30mL/kg max 1L

108
Q

What should be done for 3rd trimester cardiac arrest patients

A

Manually displace uterus to left

109
Q

Post resuscitation protocol

A

RATE
RHYTHM
BLOOD PRESSURE
12 Lead
Remove ResQPOD
Ice pack axilla and groin
Saline 1L for hypotension
Stop Epi drip

110
Q

What are the age ranges for Jump Start triage system

111
Q

on scene times for level 1 trauma should be

A

< 10 min
If > 10 min needs to be documented in EPCR

112
Q

GCS Motor response

A

1 no response
2 extension to pain
3 flexion to pain
4 withdrawal from pain
5 localize pain
6 obeys commands

113
Q

GCS verbal response

A

1 no verbal response
2 incomprehensible
3 inappropriate words
4 confused
5 orientated

114
Q

GCS eye response

A

1 no eye opening
2 opening to pain
3 opening to verbal
4 spontaneous

115
Q

Level 2 trauma criteria

A

1 Falls >12 adult, >6 peds
2 Extrication > 15 min
3 Rollover
4 Death of occupant in same passenger compartment
5 Major intrusion
6 Separation from bicycle
7 Fall any height on blood thinners
8 Paramedic judgement

116
Q

Rule of 9’s for adult burns

A

Head - 9
Torso - 18
Back - 18
Each arm - 9 front/back
Each leg - 18 front/back
Groin - 1

117
Q

Treatment 1st and 2nd degree burns < 15% or 3rd degree <5%

A

Apply dry sterile dressing or burn sheet

118
Q

Treatment 2nd degree burns >15% or 3rd degree >5%

A

Apply dry sterile burn sheet
Saline 1L

119
Q

Dry and liquid chemical burns treatment

A

Liquid chemical: irrigate with water/saline
Dry chemicals: brush off prior to irrigation

120
Q

BSA percentages for ped

A

Head and neck - 21%
Each arm - 10%
Back - 13%
Abdomen - 13%
Buttocks - 5%
Each leg - 13.5%
Groin - 1%

121
Q

What is Cushing’s Triad

A

Widening pulse pressure
Irregular respirations
Bradycardia

122
Q

What is the preferred site for needle decompression

A

3rd intercostal space midclavicular

123
Q

Where is finger thoracostomy performed

A

3rd intercostal space mid axillary

124
Q

What should not be done for impaled objects in the abdomen

A

Palpation of the abdomen as it may cause further injury

125
Q

What should be done for abdominal evisceration

A

Cover protruding tissue with moist sterile dressing, then cover with dry sterile dressing
Keep patient calm

126
Q

What can be used for junctional wounds

A

Israeli bandage

127
Q

How many attempts can be made to place extremity back to anatomical positions

A

No more than 2

128
Q

What makes it difficult to assess for shock in pregnant patients

A

Heart rate increases in 3rd trimester
Blood pressure decreases in 2nd
Cardiac output increases

129
Q

All 3rd trimester pregnancy trauma patients shall receive

A

15 lpm via NRB

130
Q

Trauma patients in cardiac arrest should have what performed

A

Bilateral needle decompression or finger thoracostomy

131
Q

If trauma patient does not regain pulses after decompression or thoracostomy what should be done

A

Resuscitation efforts terminated

132
Q

What is the Marches protocol and what is it used for

A

Used for hemorrhagic shock
Massive bleeding control
Airway
Respiratory
Circulation
Hypothermia care
Eye injuries
Spinal motion restriction

133
Q

What are signs and symptoms of neurogenic shock

A

Skin warm/dry
Hypotension w/bradycardia
Paralysis

134
Q

What is tranexamic acid and what does it do

A

Antifibrinolytic
Stabilizes fibrinogen and decreases plasmin formation

135
Q

Contraindications for TXA

A

Injuries > 3 hours
Age < 5
Non traumatic bleeding

136
Q

What is adult and ped dose for TXA

A

Adult: 2g in 100mL 3 drops per sec over 5 min

Ped: 15mg/kg in 100mL, 3 drops per sec over 5 min

137
Q

Dose for adult and ped whole blood

A

Adult: 1-2 units (500mL = 1 unit)

Ped: 15mL/kg

138
Q

In the event whole blood is not available what can be used as a substitute

A

Low titer liquid plasma or O+ PBRC

139
Q

What are the contraindications for whole blood

A

Religious objection
Women of childbearing age should have confirmed hemorrhagic shock

140
Q

LTOWB has a ____ shelf life

141
Q

Adult beta blocker overdose protocol

A

If hypotensive Saline 1L
Poison control
Glucagon 1mg/min IV/IO
Pace @60 bpm for refractory bradycardia
Etomidate 10mg for sedation
Push dose epi

142
Q

Pediatric beta blocker overdose protocol

A

Saline 20mL/kg
Poison control
Glucagon 1mg/min until hypotension resolves (0.5mg for pts. <20kg)
Etomidate 0.15mg/kg sedation
Pace @80 bpm
Push dose epi

143
Q

Adult calcium channel blocker overdose protocol

A

If hypotensive Saline 1L
Calcium chloride 1g slow over 2 min
Etomidate 10mg sedation
Pace @60 bpm for refractory bradycardia
Push dose epi

144
Q

Ped calcium channel blocker overdose protocol

A

If hypotensive Saline 20mL/kg
Calcium chloride 20mg/kg slow over 2 min
Pace @80 bpm for refractory bradycardia
Etomidate 0.15mg/kg for sedation
Push dose

145
Q

Adult cocaine overdose protocol

A

Versed 5mg IV/IO/IN/IM, may repeat x1

Agitated pts:
Ketamine 200-400mg IM or 200mg IV

146
Q

What are some common tricyclic antidepressants

A

Amitriptyline, Desipramine, Doxepin

147
Q

What is the pneumonic for TCA overdose

A

Mad as a hatter
Red as a beet
Hot as hell
Dry as a bone
Blind as a bat

148
Q

Adult TCA overdose protocol

A

If hypotensive Saline 1L
For pts. with QRS >.01 seconds, bicarb 50mEq slow over 5 min
Max 150mEq

149
Q

Ped TCA overdose protocol

A

If hypotensive Saline 20mL/kg
For pts. with QRS >.08 seconds, bicarb 8.4%/4.2% 1mEq slow

150
Q

Adult Narcotic overdose protocol

A

Maintain SpO2 95%
Narcan 0.5-2mg max 10mg

151
Q

Ped narcotic overdose protocol

A

Maintain SpO2 95%
Narcan 0.5mg or 1mg IN Max 10mg

152
Q

Restrained patients shall be positioned

153
Q

When Ketamine is not available for adult violent patients what can be given

A

Haldol 5mg IM and Benadryl 50mg IM

154
Q

Chemical restraint protocol

A

Ketamine 200-400mg IM. may repeat x1 max single dose 400mg
Allow patient to hyperventilate
Don’t hold patient in prone position or hands cuffed behind back

155
Q

What is an adverse reaction to Ketamine and treatment

A

Hypersalivation: give Atropine 0.5mg
Laryngospasm: almost always resolves with high flow O2

156
Q

Rapid cooling for temp >103 degrees

A

Ice pack to axilla and groin
Cold Saline 1L
Bicarb 50mEq IV/IO over 2 min

157
Q

What are the special considerations for ketamine and what should be done instead

A

Over 65
Head Trauma
<50kg
Other sedatives on board

Give 200mg IM for these patients

158
Q

Pain management can be given to all patients with the exception of

A

Pregnant women near term (32 weeks or greater) or active labor

159
Q

What is the front line medication for pain

A

Fentanyl, Ketamine is preferred for hypotensive patients and opiate contraindications

160
Q

Adult pain management protocol

A

Fentanyl 100mcg slow may repeat x1 after 5 min
Zofran 4mg for nausea/vomiting secondary to fentanyl

161
Q

For continued pain management what should be given

A

Ketamine given after Fentanyl for severe pain
Dose: 25mg may repeat x2 every 5min. Max 75mg

162
Q

Ped pain management protocol

A

Fentanyl 1mcg/kg IV/IO
1.5mcg/kg IN/IM
Zofran 0.1mg/kg

163
Q

What are the 2 hyperbaric chamber hospitals we transport to?

A

Mercy hospital Miami
St. Mary’s Palm Beach

164
Q

What is the max height a decompression sickness patient can be transported in air rescue

A

Max 500 ft.

165
Q

No drowning victim is to be pronounced dead on scene if

A

Possibility of hypothermia exists

166
Q

What is the immediate priority in fatal/non fatal drownings

A

Ventilation

167
Q

Adult and ped heat cramps and exhaustion protocol

A

Move patient to shaded area or A/C
Hydrate
Monitor for AMS
Saline 1L

168
Q

Adult and ped heat stroke protocol

A

Move patient to rescue ASAP
Obtain temp
Temp <103, Saline 1L
Temp >103, apply ice packs and chilled Saline 1L

169
Q

Adult and ped snake bite protocol

A

Mark edema with pen
If dead snake on scene take pictures
If hypotensive Saline 1L
Benadryl

170
Q

Adult and ped dog, cat, wild animal bite protocol

A

Wound care
Clean wound with soap and water
Pain management

171
Q

Insect stings protocol

A

Consider allergic reaction
Scrape stinger off
Clean with soap and water
Pain management
Zerym spray

172
Q

Adult and ped marine envenomation protocol

A

Consider allergic reaction
Immerse in non-scalding water
Wash with soap and water
Zerym spray
Pain management

173
Q

Marine animal sting protocol

A

Consider allergic reaction
Rinse with sea water
Zerym spray
Remove large tentacles with forceps
Pain management

174
Q

Human bites protocol

A

Clean with soap and water
DLE for investigation
Pain management

175
Q

CO is toxic to humans when encountered in concentrations

A

Above 35 parts per million

176
Q

For any suspected CO exposure what should be done

A

Administer high flow O2 and transport to closest ED with helipad

177
Q

Cyanide exposure protocol

A

O2 NRB @ 15lpm
Alert battalion
Cyanokit 5g over 10-15 min, may repeat x1
Cyanokit given in separate/dedicated line

178
Q

Ped Cyanide exposure protocol

A

O2 NRB @ 15lpm
Cyanokit 70mg/kg over 10-15 min, may repeat x1
Cyanokit given in separate/dedicated line

179
Q

What history should be obtained for pregnant patients

A

previous viable births (para)

previous preg (gravida)
# previous births (para)
Last menstrual cycle
Water break
Due date
Frequency/length contractions
Feeling to push

180
Q

Patients <20 weeks can be transported to

A

Closest ED

181
Q

Patients >20 weeks w/abdominal or pelvic pain can be transported to

A

Closest ED

182
Q

Patients >20 weeks w/minor concerns can be transported to

A

Closest ED

183
Q

Stable patients >20 weeks can be transported to

A

OB hospital of choice within 40 minutes

184
Q

> 20 weeks and in cardiac arrest transported to

A

Closest OB hospital

185
Q

> 20 weeks and trauma transported to

A

Trauma/OB hospital

186
Q

What is Breech birth

A

Buttocks presentation

187
Q

Breech birth protocol

A

If head does not deliver in 3 minutes place mother knee to chest position

188
Q

This usually occurs in first trimester and may present with sudden onset severe lower abdominal pain/vaginal bleeding

A

Ectopic pregnancy

189
Q

S/S of ectopic pregnancy

A

Pain to left shoulder
Grey turner’s sign
abdominal distention/tenderness

190
Q

Usually occurs before 20 weeks gestation

A

Spontaneous abortion

191
Q

For spontaneous abortion if gestational age is >22 weeks and fetus is not out of placenta what should be done

A

Separate fetus and start neonatal resuscitation

192
Q

What are some third trimester complications

A

Abruptio placenta
Placenta previa
Uterine rupture

193
Q

S/S of abruptio placenta

A

Sudden onset sever pain
Painful uterine contractions
Vaginal dark red bleeding
May present in shock

194
Q

S/S of placenta previa

A

Painless vaginal bleeding
Bright red blood

195
Q

S/S of uterine rupture

A

Sudden, intense abdominal pain and vaginal bleeding

196
Q

Pre eclampsia is characterized by what symptoms

A

HTN
AMS
Visual disturbances
Headache
Pulmonary edema

197
Q

Eclampsia is characterized by what symptoms

A

Any S/S of pre eclampsia with seizure or coma

198
Q

What is the criteria to determine if a patient is pre eclamptic or eclamptic

A

2 consecutive BP, SBP >160 or DBP >110 5 min apart
AND one of following S/S: AMS, Headache, Visual disturbances, P Edema

199
Q

Pre eclampsia protocol

A

Mag Sulfate 2g in 100mL wide open
Labetalol 20mg IV, 1 dose max

200
Q

Eclampsia protocol

A

Mag sulfate 4g in 100mL wide open
Mag sulfate 2g IM, lateral thigh
Labetalol 20mg IV
Follow seizure protocol if seize

201
Q

If upon delivery of the head there is meconium staining present, what should be done

A

Use bulb syringe to clear mouth FIRST then nose before delivering shoulders

202
Q

What is the procedure upon delivery of the newborn

A

Dry, warm, stimulate baby
Wait for cord to stop pulsating (3-5 min)
Clamp and cut cord

203
Q

What is the proper way to cut the umbilical cord

A

Place first clamp 4” away from newborn
Milk cord away from newborn
Place 2nd clamp 2” away from from first towards mother
Cut between clamps

204
Q

When do we record an APGAR and what does it stand for

A

At 1 and 5 minutes
Appearance
Pulse
Grimace
Activity
Respirations

205
Q

Nuchal cord protocol

A
  • Check for presence after delivery of head
  • If around neck gently hook finger under loop and pull over baby’s head
  • If unable to, clamp cord in 2 places and cut between clamps
206
Q

Prolapsed cord protocol

A
  • Place mother in knee to chest position
  • Gloved hand into vagina, push newborn up and away from cord
  • Wrap exposed cord in moist sterile dressing
207
Q

How do you transmit a 12 lead to hospital

A
  • Turn on hotspot
  • Take 12 lead
  • Locate open envelope with 12 on it to left and select it
  • Scroll down to and select the destination
  • Transmit
208
Q

Blood alcohol sampling procedure

A

Must be done in back of rescue
Only use DLE blood draw kit
Never use alcohol prep

209
Q

What should the EMS run report contain when doing a blood alcohol sampling

A
  • Blood sampling kit used
  • Name DLE officer requesting blood sample
  • Time of draw
210
Q

What should be obtained for every vital set taken

A

4 lead snapshot

211
Q

The Zoll X series utilizes what kind of energy which allows what?

A

Rectilinear biphasic energy
Allows shocks at lower energy with greater efficacy

212
Q

An adult bougie will allow ET tubes down to what size

213
Q

Contraindications for the AutoPulse

A

Traumatic cardiac arrest
Patients weight >300 lbs.
Under 18
Can be used on patients <18 with adult body characteristics

214
Q

Cardioversion is generally unnecessary for heart rates less than

215
Q

What are the needle sizes and weight for IO needles

A

15mm (pink) 3-39kg
25mm (blue) 3kg and >
45mm (yellow) 40kg and >

216
Q

IO infusion pain management conscious

A

Lidocaine 40mg slow over 2 min
Allow to sit for 60 sec
5-10mL Saline flush
May repeat Lidocaine 20mg

217
Q

What are some types of nerve agent auto injectors

A

Mark 1
Atropen
CANA kit

218
Q

What are the tag color for START and JumpSTART triage and what do they mean

A

Green - Ambulatory
Yellow - Delayed
Red - Immediate
Black - Deceased
Blue - HAZMAT exposure

219
Q

What are the respiratory rates needed for JumpSTART triage

A

Between 15 and 45 times a minute

220
Q

The Stryker power pro stretcher is powered by what kind of battery

221
Q

How do you dilute Benadryl

A

1mL Benadryl in 9mL Saline = 5mg/mL

222
Q

How do you dilute Fentanyl

A

2mL Fentanyl in 8mL Saline = 10mcg/mL

223
Q

How do you dilute Ketamine

A

Dilute 5mL (500mg) Ketamine in 50mL Saline = 10mg/mL

224
Q

How do you dilute Bicarb

A

Discard 25mL of 8.4% Bicarb, draw up 25mL Saline = 4.2% Bicarb

225
Q

What are some simple asphyxiants

A

CO2
Propane
Nitrogen
Methane

226
Q

Inhalation exposure protocol for Ammonia, Hydrogen Chloride and Chlorine

A

Albuterol 2.5mg nebulizer
Bicarb 3mL of 8.4% with additional 3mL saline via nebulizer

227
Q

Adult level 1 trauma red criteria

A
  • Active airway assistance
  • No radial w/ sustained HR >120 or BP <90
  • Multiple long bone fractures
  • 2nd or 3rd degree burns > 15% BSA
  • Penetrating injury to head, neck, torso
  • BMR 4 or less/presence of paralysis
  • Paramedic judgement
  • GCS 12 or less
228
Q

Adult level 1 trauma blue criteria

A
  • Sustained respiratory rate 30 or >
  • Sustained HR 120 or >
  • Single long bone FX due to MVA or fall 10ft or >
  • Major degloving >5 inches or GSW to extremities
  • BMR = 5
  • Ejection from vehicle/deformed steering wheel
  • Blood thinner >55 years
  • Blunt abdominal injury
229
Q

Pediatric level 1 trauma red criteria

A
  • Assisted or intubated
  • AMS, paralysis, suspected spinal injury, loss sensation
  • Faint/non palp carotid/femoral pulse
  • SBP <50
  • Any open long bone FX or multiple FX
  • Major soft tissue, amputation proximal to wrist/ankle
  • 2nd/3rd burns to 10%
  • Penetrating injury to head, neck, torso
  • Paramedic judgment
230
Q

Pediatric level 1 trauma blue criteria

A
  • Amnesia or reliable HX of LOC
  • Carotid or femoral palp, no pedal pulse or SBP <90
  • Single closed long bone FX
  • Blunt abdominal injury
  • Red, purple <11kg (24 lbs.)

LT Test (5 decks)

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