EMS Standing Orders Flashcards
If ALL of the following are present , CPR may be withheld:
- Known downtime greater than (30) minutes
- Asystole
- Pupils fixed and dilated
- No respirations
- Without hypothermic mechanism for arrest
If at least ONE of the following conditions is found, CPR may be withheld:
Lividity Rigor mortis Blunt or penetrating trauma without signs of life Decomposition A valid DNR is discovered
When there are multiple critical trauma casualties and insufficient resources, choices will have to be made in regard to resource allocation:
Triage Situations
Physician in attendance: This order, verbal or in writing, must be given by a Florida licensed ____ or ____ to be legal:
MD or DO
When in doubt, especially when it is not the patient who requested our service, ____ consent should be obtained:
verbal
Exceptions to patients under the age of 18 who can refuse care:
- Emancipated minors
- Self sufficient minor
- Married minors
- Minors in the military
Patients may not refuse care under the following circumstances:
- AMS (GCS less than 15)
- Suicide attempt (verbal or actual)
- Mental retardation or deficiency
- Not acting as a reasonable person would
- Patients under the age of 18 (except exceptions)
To be considered valid, the DNR must meet the following criteria:
- The form states it is a DNRO and specifies that the patient is not to be resuscitated.
- Original is signed and dated by the patient’s physician. Photocopies are acceptable.
- The form has been signed and dated by the patient or the patient’s surrogate or proxy.
- The DNR order is not withdrawn by the patient, the patient’s attending physician, or the pt’s healthcare surrogate or proxy.
- Identity is verified by the driver’s license, other photo ID or form a witness in the presence of the patient.
In mutual aid circumstances, personnel should follow the ____ agency’s patient treatment protocols:
transporting
BLS Airway: If ventilation is required for more than ___ minutes, an LMA should be inserted:
2
Ventilation Rates: Adults
10 breaths/min (1 breath every 6 seconds)
Ventilation Rates: Children
20 breaths/min (1 breath every 3 seconds)
Ventilation Rates: Neonates
40 breaths/min
Patients with advanced airways should be ventilated at a rate of _____ breaths/minute (1 breath every 6-8 sec)
8-10
Perform MICCR (CPR for PEDS) with the patient in a ___ degree heads up position and defibrillate as needed:
30
Begin compressoins for infants and children with a pulse less than ___ with signs and symptoms of poor perfusion (altered mental status):
60
History of present illness: OPQRST:
Onset Palliative (What makes the s&s better) Provoke (What makes the s&s worse) Previous (Previous similar episodes) Quality Radiation Severity Time
Endotracheal intubation shall be confirmed by:
- Direct visualization
- Esophageal Intubation Detector (EID)
- Colormetric paper
- Continuous EtCO@ monitoring
EZ IO primary site is the:
proximal tibia
EZ IO secondary site is the:
humeral head
Which EZ IO site needs insertion by or approval of EMS 2:
humeral head
EZ IO will be established after 2 unsuccessful IV attempts.
True
The goal is having an access site within ___ seconds:
90
Only EMS 2 has the authority to insert or designate use of EZ IO in priority ___ patients:
2
EtCO2 should be applied to all patients:
- In respiratory distress or requiring vent support (ETT, etc)
- AMS with respiratory difficulty or compromise
- Sedated patients or patients receiving pain meds
All ALS patients shall have continuous EKG monitoring in 2 leads.
True
Patients who present with any of the following cardiac or possible cardiac symptoms shall have a 12 lead ECG performed:
- Chest/arm/neck/jaw/upper back/shoulder/epigastric pain or discomfort.
2 Palpitations, or rate greater than 100 or less than 60 - Syncope, lightheadedness, general weakness, or fatigue
- CHF, SOB, or hypotension
- Unexplained diaphoresis or nausea
12 lead ECG’s shall be repeated ever ___ minutes and upon a ROSC:
10
Patients under the age of 18 who weigh ___ kg or less are considered pediatric patients:
36
Patients under the age of 18 who weigh more than ___ kg or more shall be treated under the adult section of these protocols:
36
PEDS: Fluid boluses are ___mL/kg and may repeat 2x for hypotension. Max of ___mL/kg:
20, 60
The preferred method for ventilating pediatric patients is with a ___ in conjunction with an oral or nasal airway:
BVM
If there is a discrepancy between the Broselow tape and these protocols, the protocols shall supersede the Broselow tape:
True
PED Age Classifications: Neonates:
birth to 1 month
PED Age Classifications: Infants:
1 month to 1 year
PED Age Classification: Children:
1 year to puberty
Once a child reaches puberty use the adult guidelines for CPR.
True
Resp. Rates - Neonates:
40-60 breaths/min
Resp. Rates - Infants:
30-60 breaths/min
Resp. Rates - Toddlers (1 - 3 y/o)
24-40 breaths/min
Resp. Rates - Preschooler (4 - 5 y/o)
22-34 breaths/min
Resp. Rates - School Age (6 - 12 y/o)
18-30 breaths/min
Resp. Rates - Adolescent ages (13 - 18 y/o)
12-16 breaths/min
PED HR - Newborn to 3 months:
85-205, mean 140 bpm
PED HR - 3 months to 2 years:
100-190, mean 130 bpm
PED HR - 2 years to 10 years:
60-140, mean 80 bpm
PED HR - Greater than 10 years:
60-100, mean 75 bpm
PED Hypotension - Neonates:
SBP less than 60
PED Hypotension - Infants:
SBP less than 70
PED Hypotension - Children 1 - 10 years:
SBP less than 70 + (age in years x 2)
PED Hypotension - Greater than 10 years old:
SBP less than 90
All priority 1 patients shall be transported to the closest hospital ER excluding ___.
VA
Pediatric priority one pt’s shall be transported to ____ or ___ ER department:
St. Mary’s or Palms West
Pregnant trauma patients in cardiac arrest shall be transported to SMMC Trauma Center.
True
All intubated trauma patients MUST be both ____ and ____ by the sending facility.
paralyzed and sedated
In MCI situations, only patients meeting ______ should be transported to trauma centers:
Trauma Alert Criteria
The guidelines for the Trauma Hawk include but are not limited to the following:
- Scene to trauma center by ground transport is greater than 20 minutes
- Trauma Alert with scene extrication time is greater than 15 minutes
- Ground response time to the scene greater than 15 minutes
- MCIs
The dividing line for WPBFR for transport destinations is:
Southern Blvd
For the purposes of transport, a pediatric patient is considered less than 18 y/o.
True
OB patients greater than ___ weeks and less than ___ weeks of gestation OR have anticipated complications with their pregnancy, shall be transported to St. Mary’s.
greater than 20
less than 36
OB patients ___ weeks of gestation or greater, may be transported to GSH, if there are no anticipated complications.
36
Stable psychiatric patients shall be transported to:
- WPH
- SMH
- JFK
Assist patient with Epi Pen administration under the following circumstances:
- Pt’s Ep Pen is prescribed to the pt and not expired
2. Patient presents with respiratory distress and/or hypotension (shock)
Give oral glucose to ADULTS ONLY if available.
True
Assist ventilations with a BVM and airway adjunct (NPA, OPA) for a respiratory rate less than ___ or greater than ___ with shallow respirtions.
10, 24
For respirations of ___ or less OR if tidal volume is inadequate, insert NPA/OPA and assist ventilations via BVM (1 breath every 6-8 seconds)
10
Respirations greater than ___ breaths per minute, maintain oxygen saturations at 95% or greater via NRB mast at 10-15 L/min.
24
Never apply ice directly to burns
True
For all burns, apply dry sterile dressing, a burn sheet may be used for large body surface area burns.
True
Chemical Burns: Remove pt’s clothing and ensure that the pt is ____ prior to transport.
decontaminated
Remove contact lenses, with the exception of ____ eye injuries.
penetrating
Water can be given to responsive patients with an intact gag reflex for heat exposure.
True
Bites/Stings: Remove the venom sack if still in the skin, by scraping it off.
True
Do not administer Epi (1 : 1,000) within ___ minutes of Epi-Pen administration.
15
Anaphylactic Shock is characterized by the signs and symptoms of an allergic reaction, in addition to the loss of a radial pulse AND/OR a SBP of less than ___ mm/Hg:
80
Establish a second IV/IO in anaphylactic shock.
True
Pediatric: Max dose for Benadryl ___ mg
50
Pediatric: Anaphylactic Shock is characterized by s&s of allergic reaction, in addition to the loss of ______.
distal pulses
Anyphylactic Shock: If patient remains hypotensive NORMAL SALINE 500mL may repeat ___.
3x
Pediatric Anaphylactic Shock: If patient remains hypotensive NORMAL SALINE 20mL/kg bolus IV/IO, may repeat ___ prn.
2x