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
A common pitfall in ventilation is to over ventilate patients by providing
Too much Tidal volume or too fast minute rate
When they normally breathing patient takes a breath, and intrathorasic pressure does what
It decreases allowing air to be drawn into the lungs
In patients that receive positive pressure ventilation, intrathoracic pressure is
Increased
Unregulated PPV will have a dramatic adverse effect on
Circulation and perfusion
When attention is not paid to PPV volume and rate, the patient can be harmed as a result of the imbalance between what
Alveolar ventilation and pulmonary capillary blood flow
An imbalance Between alveolar ventilation and pulmonary capillary blood flow is known as
Ventilation/ perfusion (VQ) miss matching
Iatrogenic V/Q Miss matching can be mitigated by the use of what two things
Controlled mechanical ventilation (CMV) Devices or automated transport ventilators
(ATVs)
Ventilation volume in rate should be guided by the use of what and in concert with American heart Association guidelines
Wave form capnography or ET CO2
Supine positioning can result in a market reduction in what respiratory factor
Functional residual capacity
Pulmonary patients should be transported in what position
Semi Fowler’s
What two devices are preferential to bag mask ventilation (BVM)
Controlled mechanical ventilation (CMV) or automated transport ventilator (ATV)
What two things are required for all advanced airway/ ventilation cases
Waveform capnography (ET CO2) and pulse oximetry
What can be used for initial CO2 detection when continuous waveform capnography is not immediately available
Color metric ET CO2 device
What is the treatment for a partial FBAO
Encourage coughing and reevaluate
What is the treatment for a complete and conscious FBAO in an adult
Abdominal thrusts
What is the treatment for a complete and conscious FBAO In an infant
Five back slabs and five Chest thrusts
In an unconscious adult with an FBAO that you can’t ventilate what is the treatment
Laryngoscopy , McGill forcep removal, Surgical/needle Cricothyroid otomy
The use of patient restraints is authorized in all instances where a patient’s behavior may
Jeopardize the safety of the patient or crew
What may be used when a patient Lacks decisional capacity to make rational decisions and exhibits behavior that may disallow necessary medical treatment
Restraints
Patients will not be restrained and what position
Prone
Distal neurovascular function she’ll be checked and documented after application of restraints and every how many minutes after
10
After restraint application what must be checked every 10 minutes
Pulse
Motor
Sensation
When a patient is restrained, distal pulses and capillary refill time of less than how many Seconds should be obtained
2 seconds
In the event of a short transport time, the results of a minimum of how many sets are to be documented before you reach the facility with a Restrained patient
2
First consideration for transport is
The facility of the patient’s choice
What is the key to delivering the right patient, to the right facility, the first time
Informed consent
Mode of transport (ground, air or water) is determined by who
The highest medical authority providing direct patient care
Status of transport (lights and siren Use) is determined by who
The EMS transport provide her with the highest medical authority providing direct patient care
The decision to run lights and sirens should be justified by the need of what
Time sensitive medical intervention that is beyond the capabilities of the transport unit
Patients, regardless of age, were transported in cardiopulmonary arrest or deteriorate to cardiopulmonary arrest in transit, shall be transported where
To the closest facility
Stroke alert patient should be transported to
The closest. STEMI/percutaneous coronary intervention (PCI) facility
Stroke alert patient should be transported to the closest
Comprehensive stroke center
Trauma alert patients, regardless of age or pregnancy status, shall be transported where
The closest trauma center
Septic alert patients may be transported
To any admit facility
Adults with simple extremity fractures (SEFx) Or dislocations May be transported to
Any facility
Children with simple extremity fractures (SEFx) or dislocations, excluding the elbow, may be transported to
Any facility
The term to describe an isolated, closed, distal extremity below the elbow or knee) fracture or dislocation without neurovascular compromise or need for surgical intervention is
Simple extremity fracture
SEFx
True or false, elbow fractures or dislocations in children are not considered SEFx
True
Adults that may require orthopedic surgery or have a neurovascular injury should be transported to the closest
Adult orthopedic admit the facility
Adults that have a high probability for general medical surgical admission (GMSA) can be transported to
Any facility
Children that have a high probability for general medical surgical admissions (GMSA) should be transported to the closest
Pediatric admit facility
Possible appendicitis, bowel obstruction and or any signs of peritoneal irritation in any pediatric are all high probability for what
To be a general medical surgical admission
GMSA
Obstetrical patients greater than or equal to 20 weeks gestation shall be transported to an
OB/GYN receiving facility
Where should high risk Obstetrical patients be transported to
Neonatal intensive care receiving facility
Where should patients within an Imminent Obstetrical emergency Be transported to
The closest
OB/GYN facility
Oncology alert patients (on or receiving chemotherapy with a fever 100.4°F or greater) shall be transported to
An oncology admit facility
Following appropriate prehospital Decontamination, patient exposed to hazardous materials can be transported to
Any facility
Patients with a high probability for hyperbaric oxygen therapy can be transported to
Any facility
Venomous snake and spider bites or stings can be transported to
Lee Memorial Hospital and all Collier County facilities
Mammal and Marine bites or stings can be transported to
Any facility
Lee Memorial Hospital
Trauma alert
Adult ortho
Golisano Children’s hospital of SWFL
Pediatric admit
OB under 18 years of age
OB less than 20 weeks gestation
Ped ortho
Lehigh regional medical center
Adult ortho
Cape Coral Hospital
OB/GYN
Adult ortho
Golf Coast medical center
STEMI alert/ PCI
Stroke alert (comprehensive)
Adult ortho
Oncology alert
Health Park medical center
STEMI alert PC
OB/GYN
neonate
For mixed transports (i.e. parent and child), both parents shall be transported to
Health Park
Naples community Hospital
STEMI alert/ PCI
Stroke alert comprehensive
Adult ortho
Oncology alert
Physicians regional medical center PR
STEMI alert PCI
Stroke alert
Adult ortho
Naples community Hospital
Stroke alert comprehensive
Ped
OB/GYN
Neonate
Adult ortho
Ped ortho
Physicians regional medical center. CB
Adult ortho
Fossett Memorial Hospital
STEMI alert PCI
Stroke alert comprehensive
Adult ortho
Oncology alert
Bayfront health Punta Gorda
Oncology alert
Bayfront health Port Charlotte
STEMI alert PCI
Stroke alert comprehensive
Ped
OB/GYN
Neonate
Adult ortho
Ped ortho
Inglewood community Hospital
STEMI alert PCI
Adult ortho
Bayfront health Venice regional
STEMI alert PCI
Sarasota Memorial Hospital
STEMI alert PCI
Stroke alert comprehensive
Trauma alert
Ped
OB/GYN
Neonate
Adult ortho
Ped ortho
Oncology alert
D1
Lee Memorial Hospital
D2
Golisano children’s hospital of SWFL
D3
Lehigh regional medical center
D4
Cape Coral Hospital
D5
Golf Coast medical center
D7
Health Park medical center
D6
Naples community hospital baker DT
D13
Physicians regional Medical Center PR
D14
Naples community Hospital North
D15
Physicians regional Medical Center CB
D9
Fawcett Memorial Hospital
D10
A front health Punta Gorda
D11
Bayfront health Port Charlotte
D8
Inglewood community Hospital
D12
Bayfront health Venice regional
D16
Sarasota Memorial Hospital
What county does Lee Memorial Hospital, Golisano Children’s Hospital of SWFL, Lehigh regional Medical Center, Cape Coral Hospital, golf Coast medical center, and health Park medical center reside in
Lee
What county does Naples community hospital baker, physicians Regional medical center PR, Naples community Hospital North, and physicians regional medical centerCB reside in
Collier
What county does faucet Memorial Hospital bayfront health contact order and pay front health Port Charlotte reside in
Charlotte
What county does Inglewood community Hospital, bayfront health Venice regional, and Sarasota Memorial Hospital reside in
Sarasota
D31
Coconut point
D32
NCH Bonita
D35
Bayfront a Cape Coral
D34
NCH north east
D33
Northport ER
Northport ER
Ped
OB/GYN
Adult ortho
Ped ortho
Oncology alert
What county does Coconut point NCH Bonita and bayfront Cape Coral standalone ER’s reside in
Lee
What is the only standalone ER in Collier County
NCH Northeast
What is the only standalone ER in Sarasota County
Northport ER
Air medical transport should be used when it critically ill and or injured patient will benefit from
Faster transport and reduced out of hospital time
You should place air medical transport on standby when
The call information obtained by Dispatch suggests the need for it
You should request air medical transport within the first how many minutes of patient contact
2
Request air medical transport within the first two minutes of patient contact if they fall under these two priorities
Priority 1: patients exceed ground transport time of 30 minutes
Priority 2: Patients that are in accessible by roads
True or false, any on scene first responder may request air medical transport
True
Who, weather on scene or not, may request air medical transport based on available information at that time
Any LCEMS supervisor
Lee control may provide information to Air medical transport and request a what to expedite response time
an Auto launch
Air medical crews may request information from Lee control and decide to
Auto launch
True or false, after initial assessment, the highest medical authority providing direct patient care should cancel air medical transport if the patient’s condition does not warrant the service or meet the criteria
True
The following patients are not appropriate for air medical transport
CPR in progress
Hazmat patients
Priority 3 patients
Contact Lee control and notify them if you have more than one patient because what needs to happen
Additional air resources need to be requested
Who is responsible for determining if the weather will permit the mission to be accepted By the air resource
The pilot
Who is responsible for preparing and securing landing zones
The fire department
Who occupies the controller roll on an LZ
Fire department personnel
All LZ’s should be a minimum of what dimensions day or night
100x100
Hard surface LZs must be illuminated at the corners with
Strobe and or a steady burn light source
Once established, the LC controller will ensure what other task The duration of the event
LZ security
What is provided in the LZ report From the controller to the pilot
The type of surface
(Hard or soft)
Wind direction and speed
Any potential hazards
(Wires, fences , signs )
Ground to air radio traffic should be limited to
LZ information only, no patient information
The LZ controller Should clear the aircraft for takeoff by
Looking around the LZ into the sky for any Other Air craft traffic in the vicinity
If at any time the LZ becomes unsafe for takeoff or landing, the LZ controller will transmit what phrase
Abort, abort, Abort
Ground providers shall comply with who’s instructions regarding patient packaging and aircraft loading and offloading
The air crew member’s
A patient shall be defined as any individual who meets one or more of the following criteria
Medical or trauma complaint
Illness or injury
New altered mental status
Any individual in the same event that Is significantly ill and or injured
Demonstrates a high index of suspicion for illness or injury
Who is a designated decision maker when a patient is not of decisional capacity or has legally transferred their healthcare decision making to another party
Responsible party
What are the two phrases used when the unit arrives in the vicinity of a given location but no event or person involved could be found or located
Unable to locate
No patient found
What is the phrase used when the unit arrives on scene and the person involved does not meet “patient” criteria
No Care required
What is the phrase for the instance when a unit arrives on scene, makes contact with the person involved, the PI is determined to be a patient, and evaluation and/or intervention is performed and the patient ultimately declines to be transported to the hospital (refusal form required)
Treated, no transport
What is the phrase used when the unit arrived on scene, makes contact with the person involved, the PI is determined to be a patient, ultimately refuses evaluation, treatment and declines to be transported to the hospital ( refusal required)
Treatment and transport refused
What are the three components to a valid refusal of care
Competence
Decisional capacity
Informed refusal
Competence to refuse care is defined by
- 18 years of age or older, or legally emancipated
2. A parent or legal guardian get refuses on behalf of their minor child
Decisional capacity to refuse care is defined by
Orientation
Gate and or coordination
Speech pattern
Insight and judgment
Psychiatric decompensation
All patients undergoing the refusal process must be oriented defined by
Being awake, alert, and oriented x 4 (Person Place time and situation)
Staggering gate, or inability to stand and ambulate may indicate in an impairment That alters
Decision making capacity
Slurred, incoherent or otherwise inappropriate speech patterns me indicate an impairment that alters
Decision making capacity
(Blank): Patients being able to express good insight into the nature of their condition, and convey a reasonable plan to deal with the condition is acceptable as Decisional capacity to refuse care.
Insight and judgment
Patient experiencing suicidal or homicidal ideation’s or gestures, audio or visual hallucinations, and/or other forms of delusional behavior that alters decision making capacity reveals (blank) , rendering someone unable to refuse Carr
Psychiatric decompensation
What is defined by patients being fully informed about their medical condition, the risks and benefits associated with the proposed treatment and the risks associated with refusing evaluation, treatment, and or transportation
Informed refusal
Medical emancipation:
Are you female who is (blank) May consent to medical care relating to her pregnancy and can make medical decisions on behalf of the unborn were born child
18 years of age who is unmarried, pregnant and or has a minor child
What are the three categories of legal emancipation
18 years of age or at least 16 who is married
Is enlisted in military service
Or has been declared emancipated by court order
No mine are less than how many years of age can be emancipated in Florida
16
Patient able to refuse care must be
Competent
Have decisional capacity
Informed of all the risks
Patient unable to refuse care
Incompetent < 18 yo
Lacks decisional capacity
AMS
Suicidal ideation’s or gestures
Mental defect disability or deficiency
Severely altered or impaired vitals
If a patient is determined to be incompetent and relax decisional capacity, they may be evaluated, treated and transported under what term
Implied consent
What a reasonable individual would consent to under the same circumstances is called
Implied consent
If the patient is evaluated, treated and transported on the basis of implied consent, providers should use reasonable measures to ensure safe transport to
The closest appropriate facility
True or false, to obtain a refusal of care you have to perform a primary assessment, history and physical examination; including a complete vital sign assessment
True
True or false, to obtain a refusal of care procedure you must fully informed the patient or responsible party about his or her medical condition, the risks and benefits associated with the proposed treatment and the risk associated with refusing evaluation, treatment, and or transportation
True