Guidelines Flashcards
What age classifies an adult
Greater than 13 years or signs of puberty
What age classifies a pediatric patient
1 to 13 years of age or signs of puberty
What age classifies an infant patient
One month to one year of age
What age classifies a neonate patient
Birth to one month
For purposes of admission criteria, the Lee health system considers any patient less than how many years old to be pediatric
18
For purposes of trauma alert criteria, adult his age (blank) and above
16
For purposes of trauma alert criteria, pediatric age is a (blank) and below
15
What are the three things to assess during a general impression that determines sick versus not sick
Appearance, work of breathing, circulation to scan
What does the CABDE assessment stand for
Circulation Airway Breathing Disability Exposure
What are the three things assessed to gauge circulation status
Central and peripheral pulses
Major hemorrhage
Skin
When checking central and peripheral pulses assess for
Present or absent
Regular or a regular
Rate and quality
When assessing skin check for
Color, temperature, condition
What are the four categories
When checking Airway status
Natural
Artificially secured
Compromised
Obstructed
When assessing breathing status check
Work of breathing
Respirations
Auscultate lung sounds
When assessing respirations assess for
Present or absent
Regular or a regular
Rate and quality
Check these four things when assessing disability status
Defibrillation
Motor/Sensory
Blood glucose
Cervical
When assessing exposure look for
Evaluate illness or injury by removing clothing
Medical or bracelets or ID
Sample stands for
Signs/Symptoms Allergies Medications Pertinent medical history Last oral intake Events leading to present illness or injury
OPQRST stands for
Onset Provocation/palliation Quality Region/radiation/referred Severity Time
What detailed exam consist of checking AVPU, Glasgow coma scale, stroke assessment, pupil response, Pain scale, sedation scale
Neurological
A full set of vital signs consist of
Pulse, blood pressure, respirations, skin color, temperature and condition, capillary refill
Documentation related to what consists of emergency information form, medical records, medical error, DNR form, etc.
Patient’s history
How many differential Impressions of a case Should you form
Three
What is an example of a triple differential for altered mental status
Hypoglycemia vs. stroke vs. Organic brain syndrome
What is an example of a triple differential for acute coronary syndrome
STEMI vs Unstable angina
Vs Pulmonary emboli
What is an example of a triple differential for a shoulder injury
Shoulder fracture vs shoulder dislocation vs shoulder contusion
Ventilation target is what with a normal capnograph
etCO2 35mmHg - 45 mmHg
Oxygen target is what with a normal plethysmograph
Sp02 94%-99%
What is the primary approach for the pleural Needle decompression
Anterior, second or third intercostal space, midclavicular Line
What is the secondary approach for the pleural needle decompression
Lateral, fourth or fifth intercostal space, midaxillary line
What should you correct in open pneumothorax with
An appropriate vented occlusive dressing
EMTs may start IVs under the supervision of who and in the upper extremity only
A credentialed paramedic
What are the four approved insertion sites for an IO
Proximal humerus
Proximal tibia
Distal femur
Distal tibia
What is the primary site for an IO in an adult
Proximal humerus
What is the primary site for an IO in pediatrics
Distal femur or proximal humerus
First line therapy for a closed system hypotension hypo perfusion is what
Crystalloid fluid Resuscitation
What is the preferred balanced Based isotonic crystalloid
Lactated ringer’s solution
What is the BP target
Permissive hypotension, restoration of peripheral pulses
You should mitigate non-compressible hemorrhages by
Rapid transport and crystalloid Fluid resuscitation
Any Patient that receives IV or I owe medications must have what
A running. Crystalloid Infusion
No medications will be administered directly through what
A medication porch or saline lock
What is the blood glucose target
60 mg/dL - 300 mg/dL
You should splint or immobilize mobilize Fractured or dislocated limbs and what position
A natural or functional one
What is the treatment for a closed femur fracture
Traction split
What should you provide to all high acuity patients
Environmental protection and Thermo preservation
What is the temperature target Four Thermo preservation
98.6°F or 37°C
The phrase cold blood does not clot refers to what
Hitler’s method which states you should preserve body heat to mitigate the lethal Triad
What priority patient is unstable ALS that requires immediate medical attention for a life and or limb threatening illness or injury
1
What priority patient is a stable ALS patient that requires medical attention but not immediately in danger of life
2
What priority patient is a BLS patient that just requires non-emergent medical attention
3
A minimum of how many assessments are required for every patient transport
2
Transfer of care between the non-transport and transport providers is essential for what
A good patient outcome
What takes precedence over patient care in apparatus
Provider safety
What are the six medication right before the administration of any medication
Patient Drug Dose Route Time Documentation
What should you perform before the administration of any medication and or critical procedure
A partner cross check
The maximum dose of pediatric medication should never exceed
The maximum adult dose except when specifically stated
What is a clinical mindset in a constellation of skills, tools and techniques that are deployed to establish and or manage non-natural airways
Airway management
The primary goal of progressive airway management is to
Start simple, work through the various levels and stop with the airway is patent
When placing an Advanced airway, every effort must be made to avoid
Iatrogenic hyper/hypocapnea
Hypotension
Bradycardia
SPO2 desaturation events
What is associated with worse outcomes among pediatrics, closed head traumatic brain injuries and poly trauma patients
Endotracheal intubation
True or false endotracheal intubation is also associated with interruptions and chest compressions during CPR
True
Indications for prehospital endotracheal intubation can be narrow to the following
Inability to ventilate and or oxygenate
Inability to manage secretions
Laryngeal Edema
If endotracheal intubation is required providers will adhere to what
The two and out philosophy
What is preferential To direct laryngoscopy
Video laryngoscopy
What is defined as passing the Laryngoscope blade and or endotracheal tube beyond the teeth with the intent to intubate the trachea
An endotracheal intubation attempt
What is the mechanical aspect of breathing in which air moves into the lungs and CO2 moves out of the lungs
Ventilation
Proper ventilation requires both
Adequate title volume and respiratory rate
What is defined as the addition of oxygen to any system, including the human body
Oxygenation
Oxygenation may also refer to the process of treating a patient with oxygen or
Combining a medication or other substance with oxygen
Considerations in determining a patient’s need for supplemental oxygen are determined from the patients
Presenting condition coupled with history and physical exam
What is a condition where a patient’s respiratory volume and rate can create uncertainty
Hyperventilation
During hyperventilation The lack of adequate CO2 causes a (blank) in the acid levels resulting in alkalosis
Drop
CO2 is a potent vasodilator or constrictor
Vasodilator
When CO2 drops as a result of iatrogenic hyperventilation blood vessels do what
Constrict
In the case of a brain injured patient, iatrogenic hyperventilation will
Reduce blood flow to the injury/ischemic zone (penumbra)
What is the Progressive airway management path in escalating order
Natural airway
Head positioning Airway axis alignment
Basic mechanical airways
Advanced airways
Cricothyroidotomy
The maneuvers of head tilt chin lift, John thrust, sniffing position, moving the head of the bed up, and ramping fall under
Head positioning and airway axis alignment
Extra glottic or endotracheal airways are what kind
Advanced
What are the three types of cricothyroid otomy
Needle , percutaneous, surgical
The primary treatment goals for patients suffering from inadequate oxygenation include
Preventing or correcting hypoxia
Optimizing ET CO2 and SPO2
Minimizing the effects of secondary and or iatrogenic injury
Decreasing airway resistance
What is an effective way to improve oxygenation in patients that are non-invasively or invasively ventilated
Positive and expiratory pressure for PEEP
What stents Open closed alveoli and recruits long thus increasing surface area for gas exchange
PEEP
PEEP increases (blank), Which improves pulmonary reserve between breaths
Functional reserve capacity
In prehospital care, the range of PEEP is generally what
5-15 cmH2O
Classic settings for PEEP are
5,7.5,10,12.5,and 15
Tight lung patients, reactive airway disease, typically do better at what PEEP setting
5 cmH20
Wet lung patients typically require what PEEP setting
7.5 -15 cmH20
PEEP greater than 15cmH20 Can result in an increase in intrathoracic pressure thus causing
A decrease in venous return and cardiac output
PEEP Is contra indicated in what type of patients
Cardio pulmonary arrest and grossly hypotensive
What has been shown to improve oxygen saturation in apneic patients during advanced airway management placement
Apneic nasal oxygenation
Nasal cannula at 15lpm
What is the escalating desired pathway for progressive ventilation and oxygenation management
Eupneic
Truncal positioning-airway axis alignment
Passive oxygenation
Non invasive ventilation /oxygenation
Invasive ventilation/oxygenation
Nasal cannula, high flow nasal cannula, nonrebreather mask, nebulizer, controlled mechanical ventilation, bag mask ventilation fall under what type of oxygenation
Passive
CPAP, Controlled mechanical ventilation, bag mask ventilation fall under what type of oxygenation
Non-invasive ventilation/oxygenation
Controlled mechanical ventilation, PEEP, bag mask ventilation-PEEP fall under
Invasive ventilation/oxygenation