EMT General SOP Flashcards
True or False
It is ok to chart using abbreviations such as “CP” for cheat pain in your narritive.
False
Abbreviatios can have more than one meaning, therefore, it is only acceptable to write out the entire word.
when is the only time you don’t need to fill out a consent form for transport?
For the return trip of a round trip when the patient is always in the care of the SCTU team.
Describe a patient with an acuity level of Red
Unstable/complex patient, who requires advanced care (i.e. patient supported with IABP or several IV pressor medications)
Describe a patient with an acuity of Yellow-Unstable
Stable-complex patient requiring IV meds with some titration to maintain stability (i.e. patient on Tridil and Heparin with continuing chest pain requiring titration of Tridil)
Describe a patient with an acuity level of Yellow-Stable
Stable-complex patient requiring minimal IV meds to maintain stability (i.e. patient denies any chest pain on Tridil, requiring no titration, and Heparin
Describe a patient with an acuity level of Green
Stable patient on cardiac monitor, simple IV fluids/meds and minimal supportive care
If a patients acuity level should change during transport, what should you do?
Document in your narrative the changes in patient condition warranting change in acuity, subjective and objective facts, and time of occurrance.
If the patient does not have to capacity to consent, and it is not possible to get consent from administrative staff of sending facility, what do you do?
The on call supervisor must be notified and will make the final determination of whether the patient will be transported or not
If you need to contact medical control and are not able to reach Dr. Hummel on his cell phone, what do you do?
What is that doesn’t work?
And if that doesn’t work?
And if you can’t get a hold of the Dr. at all?
call Dr. H on his exceptional phone
if that doesn’t work call his residence
if that doesn’t work call his personal Verizon cell, you have to get the number from dispatch
If you can’t get the Dr at all, call medcom for orders
If you need orders prior to transport, what should you do?
Obtain orders from the sending physician and make sure you have a written copy in the chart
What are the 2 reasons that you would divert to a different hospital?
Cardiac or respiratory arrest
If after consulting with Medical control Dr, the physician recommends diversion and the patient, if capable, offers consent to new destination
If you divert to a different hospital or facility, after consulting with medical control, who should be notified?
Both the sending and original receiving facility
If you are transporting a BLS patient and the pt’s condition deteriorates during transport such that Advanced Life Support is deemed necessary and prudent , what are the three steps that should be taken?
Dispatch paramedics - notify dispatch of the need for ALS and have them call to dispatch paramedics
Contact medical control for direction and orders
Initiate transport to closest appropriate hospital as soon as possible. Have paramedics meet you enroute if possible.
After completing a call in which a BLS patient deteriorates and ALS needed to be initiated, what should be done?
Nursing management should be notified of incident and an incident report should be filled out including the following information
1 patient information
2 What nessesitated ALS care?
3 Time of request of paramedics
4 Time and name of medical control contacted
5 final destination of patient
6 Name of EMT management contacted
When is it OK to obtain verbal telephone orders from a physician?
Only when it is coming from Medical control
Is it OK to enact verbal orders from a sending physician?
No. Only written orders from a sending physician are acceptable.
who is responsible for the waste and disposal of controlled substances?
the Chief Transport Nurse and Medical Director
what do you do with a continuous infusion of a controlled substance after transport?
Proper documentation of the use while in transport in the narrative and documented waste/disposal or handoff with recieving nurse.
No infusions should be returned to EMT base for deposition.
what conditions should prompt you to call medical control for RSI medication orders?
if the patient has a Hx of asthma, traumatic brain injury, pregnancy, burn injury, or elevated potassium level
What is another name for a King tube?
supraglottic airway
If the patient is unable to maintain an adequate airway or without pulses, intubate using direct laryngoscopy, which should be limited to what timeframe?
30 seconds or less
what should you do if you need to intubate a patient wearing a c collar?
remove the front of the collar
When performing laryngoscopy, you should elevate the head of the head of bed to __ degrees, and the patients ear should be level with what?
30
sternal notch
When performing laryngoscopy, you should preoxygenate with the use of ___ @ __L O2 and ___ at __% for __ minutes to maintain SpO2 > __% prior to first attempt
nasal cannula 15 BVM 100% 3 95
When performing laryngoscopy, when should you inflate the cuff of the tube?
after you see the cuff of the tube pass through the vocal chords
nasaltracheal intubation can only be completed if the patient has what?
some spontaneous respirations
when performing nasaltracheal intubation, what is NOT used?
stylet
when is the use of a King tube indicated?
when endotracheal intubation cannot be performed or has been unsuccessful
what size King tube would you use for a person 6-7 feet tall
how much air to inflate?
Purple
think grape ape
60-90 ml
what size King tube would you use for a person 5-6 feet tall
how much air to inflate?
Red
think the flash
50-70 ml
what size King tube would you use for a person 4-5 feet tall?
how much air to inflate?
Yellow
think Bart Simpson
40-60 ml
what size King tube would you use for a person 41-51 inches
how much air to inflate?
Orange
Think Kenny from South Park
30-40 ml
what size King tube would you use for a person 35-45 inches
how much air to inflate?
Green
Think Great Gazoo from the Flintstones
25-35 ml
how far down should a King tube go?
until the base of the connector is aligned with the teeth or gums
after establishing a ET tube you would do a NG or OG tube, so what do you do for a King tube?
attach a maximum 18fr suction catheter to suction, and insert it into the King tubes gastric access lumen, and advance to maximum depth
while preparing to intubate, use the mnemonic SOAPP ME to prepare. What does that stand for?
Suction on and yankauer ready
Oxygen @15L via NRB or BVM
Airway adjuncts NC, BVM, OPA, NPAx2, stylet, laryngoscope handle and blades, ET tubes and 10cc syringe
Pharmacological agents pressors, analgesics, sedation and paralytics
Prepare Pressor prepare push-dose pressor
Monitoring Equipment ECG, SpO2, ETCO2, and waveform capnography, BP
before intubating, premedicate pt with ___, or you may use ___ if contraindicated
Ketamine
Versed
For hemodynamically unstable patients give push dose IV ___ __mcg/ml as needed PRN every 3 minutes until desired effect or max dose of __mcg. “___ before you ___”
epinephrine 10mcg/ml
100 mcg
resuscitate before you intubate
what are three ways to determine hemodynamic instability?
Shock index (HR/SBP) greater than or equal to 0.80 with SBP < 110mmHg
MAP < or equal to 65mmHg
SBP < or equal to 90mmHg
How do you make a syringe of push dose epinephrine?
how do you mix it?
Every 1 ml should be what dose?
draw 1 ml of 1:10,000 cardiac epinephrine (100 mcg) in a 10 ml syringe and then drawing 9 ml of NSS. Syringe should be mixed vigorously by rolling in between palms and infused by slow push. Every ml should be 10 mcg of epi.
after intubation you should be doing vital signs every __minutes
5
what is the other name for Versed?
Midazolam
roughly, what is the dosing rate for Ketamine in a hemodynamically stable pt prior to intubation?
kg x 2 = mg
a 100 kg person would get 200 mg
roughly, what is the dosing rate for Etomidate for a hemodynamically stable pt prior to intubation?
a little less than kg / 3 = mg
roughly, what is the dosing rate for Versed in a hemodynamically stable pt prior to intubation?
kg / 10 = mg
100 kg would get 10 mg
what is the dosing rate for Rocuronium in a hemodynamically stable pt prior to intubation prior to untubation?
1 kg = 1 mg
if after intubation pt is agitated or in discomfort, you may re-sedate with one of these two medications.
Ketamine or Versed
Versed may be contraindicated if pt has increased ICP or SBP < 90mmHg
post intubation pts with increased ICP or SBP < 90mmHg should not be given ___ and should instead be given ___
Versed
Ketamine
all patients that are being sedated should have a what inserted?
nasogastric tube
what are the indications for non-invasive cardiac pacing?
4
-Symptomatic bradycardia (hypotensive, acutely altered mental status, signs of shock, ischemic chest pain and respiratory distress)
- Asystole
- Second degree heart block Type II
Third degree heart block
If you do not have an order from the sending facility to initiate external pacing, and you need one, what do you do?
contact medical control
Before you initiate external pacing, if you have time, what should you give the conscious patient?
2.5mg to 5mg Versed IV push
when initiating non invasive cardiac pacing, what should your initial rate be?
60 bpm
troubleshooting external pacer
If ECG is too low, what will you see?
If ECG is too high, what will you see?
If poor capture, what is probably the problem?
Failure to capture is associated with what?
too low, pacer will operate asynchonous
too high, artifact may inhibit pacing
check pads for adherence to chest wall for poor capture
failure to capture is associated with position changes
All patients transported by Exceptional SCTU will have IV access with the exception of these three conditions.
- Stable pediatric patients when the sending physician deems IV unnecessary. If at any time the condition of the patient deteriorates the transport RN will start one
- Stable patients being transported to a psychiatric facility
- Stable vent dependent patients being discharged to a LTC facility.
To treat the patient with respiratory compromise due to the effects of a tension pneumothorax with the intent of physically expanding the affected lung, what technique would you use?
Chest decompression
Chest decompression should only be performed under the direction of ___ ___. It should only be done by standing orders in the case of ___ ___.
medical control
radio failure
In-services will be conducted on chest decompression on a ___ basis unless needed more often.
Yearly
What are the nine items you would need in order to perform chest decompression?
12 - 14 G needle 10 cc syringe Heimlich valve, three-way stopcock and connecting tube betadine swab 4x4 sterile saline tape sterile gloves benzoin if available
What is the first step in chest decompression?
High flow O2 via NRB, BVM, or King tube
What is step 2 in chest decompression?
contact medical control
Step 3 of chest decompression involves the preparation of equipment, what are they?
Attach 10cc syringe to the needle stylet hub of the over the needle catheter.
Attach Heimlich valve to connecting tube
Attach connecting tube to 3 way stopcock
Ensure that Heimlich valve and 3-way stopcock valve are correctly aligned
Moisten inside of Heimlich valve with saline
The approved site for chest decompression is what?
2nd or 3rd intercostal space at the midclavicular line, at a 90 degree angle over the superior border of the third or fourth rib.
How should you position a patient prior to chest decompression?
at a 45 degree angle if C spine injury is not a question. If pt is on a longboard raise the entire board.
While performing chest decompression, how can you tell when you are in the air pocket?
withdraw the plunger and when air freely enters the syringe. You may also feel a “pop” as the needle passes through the pleura
While performing chest decompression, what do you after you have found the air pocket?
When air freely enters the syringe, withdraw the syringe with the needle attached approximately 1 cm, and advance the catheter as if advancing an IV, then completely withdraw needle and syringe. You may feel a rush of air from the catheter at this time.
While performing chest decompression, after having established air coming from the catheter, what are your final steps?
Secure catheter with tape and do not kink the catheter. Secure Heimlich valve to patients chest.
If you have completed chest decompression and tension pneumothorax redevelops, do you need new orders for a repeat procedure at a different site?
Yes
SOP for Intra-Aortic Balloon pump section in procedures 2.0.56 will be skipped during this section
it’s going to be it’s own stack once app is reviewed
Restraints may be used when the patient is considered what?
a danger to himself or others
Before using restraints, what should you try first?
alternative measures starting with the least restrictive first
What can you use to restrain a patient?
should be limited to those devices manufactured specifically for the purpose of restraining patients.
When should you use leather restraints to restrain a patient?
They should only be used for the aggressive patient who cannot be restrained appropriately with soft restraints.
Before using restraints, what should you attempt to obtain?
a physicians order
Restraint checks should include what? and how often?
circulatory checks q 15 minutes and must be documented.
When transporting a patient with a chest tube what should you be assessing for?
(8)
Respiratory status respiratory rate work of breathing breath sounds SpO2 dressing/ drainage Subcutaneus emphysema tube migration
All chest tubes must be connected to one of two things, what are they?
either a pleur-vac or a Heimlich valve
If you chest tube patient’s chest tube was connected to suction at the sending hospital, what should you do?
maintain suction during transport at the same setting
where should you always keep a chest tube patients pleur-vac?
below the patients chest in an upright position
If the patients chest tube becomes dislodged, what should you NOT do?
What should you do
do not reposition the tube, connect to suction and observe the patient for tension pneumothorax. If TpneThorx should develop, initiate appropriate care with needle chest decompression and notify Medical Director.
