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A EMS PROTOCOLS 2019 > GENERAL INFORMATION > Flashcards

GENERAL INFORMATION Flashcards

1
Q

What are the 6 rights of drug administration

A

Right patient, right drug, right dose, right time, right route, right documentation

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2
Q

What are IO sites allowed for adults?

A

proximal humerus, proximal tibia, distal tibia

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3
Q

what are the IO sites allowed for pediatric?

A

distal femur
proximal tibia
distal tibia
proximal humerus (only if the surgical neck can e palpated)

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4
Q

Where should all IM injections be administered?

A

lateral thigh p. 12

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5
Q

What size needle should be used for IM injections in adults? Max per site?

A

21-23 gauge 1.5 inch needle

4 mL maximum per site

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6
Q

What size needle should be used for IM injections in pediatrics? Max per site?

A

23 gauge 1” needle
1 mL maximum per site
- if > 1 mL needs to be administered, split the dose between the thighs

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7
Q

What does MAD stand for?

A

Mucosal atomizaton device

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8
Q

What medications can be administered via MAD device?

A

Versed
Narcan
Fentanyl
Ketamine

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9
Q

What is the desired dose when using the MAD device? What is the max?

A

0.3 mL - 0.5 mL per nostril

max 1 mL per nostril

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10
Q

What are the dilution instructions for push-dose pressor epinephrine? (1:________). What will it yield?

A

1: 100,000
- Dilute: discard 9 mL of Epi 1:10,000 (0.1mg/mL) and draw up 9 mL of Normal Saline to create Push-dose pressor Epi 1:100,000. This will yield 10 mcg/mL.

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11
Q

What are the dilution instructions for Benadryl?

A

dilute with 9 mL normal saline for IV/IO administration

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12
Q

What are the dilution instructions for Ketamine?

A

ensure Ketamine is diluted per specific protocol

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13
Q

What patients are considered pediatric?

A

Patients who have not reached puberty

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14
Q

Who should be treated as an adult?

A

patients who have reached puberty

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15
Q

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

A

IO

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16
Q

What should be used as the primary reference point for determining the appropriate patient care for pediatrics?

A

the child’s age

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17
Q

if the child appears shorter or taller than the stated age or if the age is unknown, use the __________

A

“Handtevy” system length-based tape

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18
Q

What 4 things should be referred to the Handtevy system when treating pediatrics?

A

Medication dosages/infusions
Equipment
Electrical therapy
Vital Signs

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19
Q

Pediatric age classifications - Neonate:

A

birth to 1 month

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20
Q

Pediatric age classifications - infants

A

1 month to 1 year

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21
Q

Pediatric age classifications - children

A

1 year to puberty

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22
Q

what defines female puberty?

A

breast development

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23
Q

what defines male puberty?

A

underarm, chest or facial hair

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24
Q

Once a child reaches puberty use _________ for treatment

A

the adult guidelines

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25
Q

In AVPU what does A refer to?

A

Alert to person, place, time and event (AAO x 4)

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26
Q

In AVPU what does V refer to?

A

Verbal: responds only to verbal stimuli

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27
Q

In AVPU what does P refer to?

A

Pain: responds only to painful stimuli

28
Q

In AVPU what does U refer to?

A

Unresponsive

29
Q

Patients with AMS consider: __________

A

AEIOU-TIPS

30
Q

AEIOU-TIPS STANDS FOR?

A 
Alcohol
Epilepsy (seizures)
Insulin (hyper-/hypoglycemia)
Overdose/Oxygenation
Uremia (kidney failure)
Trauma
Infection (sepsis)
Psychiatric
Stroke/Shock
31
Q

What are the vital signs we assess?

A

Pulse (RRQ), Respirations (RQ), Temp, Pulse Ox, BP (cap refill), EtCO2, BGL

32
Q

Priority 3 patients shall receive at least ___ sets of vitals

A

2

33
Q

Priority 2 patients shall receive vitals ________

A

every 5 minutes

34
Q

When should we take a manual blood pressure?

A

to confirm any abnormal or significant changes of an automatic blood pressure cuff reading

35
Q

Prior to administration of a drug what should be done?

A

6 rights

check blood pressure

36
Q

hypotension for adults is defined as a systolic BP

A

< 90 mmHg

37
Q

ETCO2 monitoring shall be utilized for the following patients: (7)

A
  • patients requiring ventilatory support (e.g. BVM, ET tube, SGA, CPAP)
  • patients in respiratory distress
  • patients with altered mental status
  • patients who have been sedated
  • patients who have received pain medication
  • seizure patients
  • suspected sepsis

RSV PASS

38
Q

A BGL shall be documented for patients with any of the following: (9)

A
  • history of diabetes
  • AMS
  • General weakness
  • seizure
  • syncope/lightheadedness
  • dizziness
  • poisoning
  • stroke
  • cardiac arrest

DD WSC PASS

39
Q

All ALS patients should be continuously monitored in lead

A

II

40
Q

12 and 15 lead ECG’s shall be performed on the following patients:

A
  • Chest/arm/neck/jaw/upper back/shoulder/epigastric pain or discomfort
  • palpitations
  • syncope, lightheadedness, general weakness or fatigue
  • CHF, SOB, HGN, or hypotension
  • unexplained diaphoresis or nausea
41
Q

12 and 15 lead ECG’s shall be repeated every __ minutes and upon ___

A

10, ROSC

42
Q

When transporting patients with 12 and 15 lead ECGs who have had repeated ECG’s every 10 minutes or received ROSC how long whould cables be connected to the patient.

A

until patient is turned over to the ED staff

43
Q

What does OPQRSTA stand for?

A

Onset: did the symptoms appear gradually or suddenly?
Palliative: what makes the symptoms better?
Provoke: what makes the symptoms worse?
Previous: previous similar episodes?
Quality: what kind of pain? pressure, squeezing, aching, dull
Radiation: does the pain or discomfort radiate? where?
Severity of pain; 1-10 scale (utilize faces pain scale for pediatrics)
Time:
Associated: What are the associated signs and symptoms

44
Q

Who gets an NPA?

A

Semi-conscious patients with an intact gag reflex unless contraindicated

45
Q

Who gets an OPA?

A

Unresponsive patients without a gag reflex shall have an oropharyngeal airway inserted, unless contraindicated

46
Q

DO NOT withhold oxygen if the patient is

A

dyspneic or hypoxic

47
Q

Spo2 maintain 95% for

A

all patients except COPD & asthma

48
Q

maintain spo2 90% for

A

COPD and asthma

49
Q

O2 administration for all stroke patients

A

2 Lpm n/c (increase oxygen therapy as needed)

50
Q

O2 administration 15 Lpm via NRB regardless of sp02. (5 patients)

A 
All 3rd trimester pregnancy trauma patients
All head injury patients
Decompression sickness
Carbon monoxide exposure
Cyanide exposure
51
Q

If oxygen saturation cannot be maintained….

A

ventilatory support should be provided

52
Q

In certain patients, excessive ventilation rates may be

A

harmful

53
Q

overzealous positive pressure ventilation can impair

A

venous return
cardiac output
cerebral perfusion

54
Q

ultimately the patients _____ and _____should determine the ventilation rate for the patient

A

SpO2 and EtCO2

55
Q

EtCO2 should be ___ to ____ mmHg

A

35 to 45

56
Q

Ventilatory Rates: patients with a pulse:

A

1 breath every 6 seconds

57
Q

Ventilatory Rates: patients without a pulse:

A

1 breath every 10 seconds. Coordinate compressions and ventilations to avoid simultaneous delivery

58
Q

Ventilatory Rates: patients with ICP and/or Hernation

A

Maintain EtCo2 between 30-45 mmHg and sp02 > 90% while continuously monitoring BP

59
Q

What is the preferred method for ventilating pediatric patients?

A

BVM with oral or nasal airway

60
Q

Pediatric patients who can’t protect their airway, are unable to maintain oxygen saturation despite BVM ventilation, and/or can’t be effectively ventilated with a BVM should be upgraded to a

A

Supraglottic Airway (SGA) (age-specific) followed by intubation if needed.

61
Q

DO NOT ATTEMPT TO AGGRESSIVELY NORMALIZE CAPNOMETRY/ETCO2 READINGS IN THE FOLLOWING 2 PATIENTS. Why?

A

Cardiac arrest pre/post ROSC
Bronchospasm (i.e., asthma, COPD)
High EtCO2 levels are acceptable and even desirable in these patients

62
Q

Priority 1 patients

A

patients in cardiac or respiratory arrest

63
Q

Priority 2 patients

A

unstable patients with immediately life-threatening conditions

64
Q

Priority 3 patients

A

Stable patients with no immediately life-threatening conditions

65
Q

Placing patients in the prone position is

A

contraindicated due to risks of asphyxiation

A EMS PROTOCOLS 2019 (2 decks)

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