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KChan Saves the World > KC Diaster > Flashcards

KC Diaster Flashcards

1
Q

*List 5 interventions that PCP can do

A

CPR
Supraglottic airway
AED
Naloxone
Nitro spray

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2
Q

*List 5 interventions that ACP can do

A

Intubation
Place IVs
Needle decompression
Give IV fluid
Synchronized cardioversion
BiPAP

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3
Q

*List 5 interventions that CCP can do

A

Foley cath placement
NG tube placement
Blood gas analysis
Give blood products
Monitor art lines
Monitor TV pacing

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4
Q

*List 5 medications that all levels of paramedic may administer

A

Epinephrine
Naloxone
ASA
Glucose
Nitroglycerin
Ventolin
Supplemental O2

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5
Q

*List 5 specialized teams of paramedics

A
  • Critical Care Paramedic
  • Tactical paramedic
  • Community paramedic
  • Search and Rescue
  • HAZMAT
  • Incident response paramedic
  • Paramedic specialist
  • Infant transport team paramedic
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6
Q

*What are 4 generally accepted criteria for TOR in the field by EMS?

A
  • Age >= 18 years
  • Unwitnessed by EMS/bystander
  • No AED or shock delivered
  • No ROSC
  • No bystander CPR
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7
Q

*What are the components of the Canadian derived decision rule for BLS providers to terminate resuscitation in the field for traumatic cardiac arrest?

A

BLS TOR rule:
(I) arrest was not witnessed by EMS personnel; (II) no return of spontaneous circulation (ROSC) was observed in the field; and (III) no shocks were delivered.

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8
Q

What criteria must be met for a patient to refuse transport to hospital

A

Paramedics are able to appropriately relay risks and harms
Patient must have capacity: understand the consequences of actions and appreciates risk
Patient has ability to care for themselves
Patient agrees to sign a form of refusal for medical car

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9
Q

Contrast the skill set of PCPs, ACPs, and critical care paramedics with respect to: medications, ventilatory support, cardiac support, and procedures

A

see photo

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10
Q

What are single tier vs multi tier EMS systems

A

Single tier - every response receives the same type of personal expertise and equipment
Multi-tier - combination of ACP and PCP depending on the call

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11
Q

What is off-line vs. online EMS support

A

Off-line - Paramedics practice under the indirect authority of the off lined MD via standing orders
- Requires: medical director, medical directives, CQI, training
- Paramedics are not a regulated health profession and therefore cannot perform any controlled acts unless delegated by a physician
On-line - Direct and concurrent medical supervision/orders from a physician
- Used in scenarios outside of the scope of standing orders, when variance is required, or for medico-legal issues
Ex. A high risk low volume procedure ex. Needle thoracostomy, TOR, additional treatment is needed

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12
Q

What is primary, secondary, and tertiary transport

A

Primary transport: transition an unstable and undifferentiated patient from the scene to a higher level of care
Secondary transport: interfacility transport between Eds with a partially diagnosed and stabilized patient
Tertiary transport: interfacility transport of one inpatient that is stable

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13
Q

Describe the criteria for a field TOR

A

Unwitnessed cardiac arrest with no ROSC
- PCP: not witnessed by EMS, no shock, no ROSC
- ACP: not witnessed by EMS, no shock, no ROSC, not witnessed by bystander, no bystander CPR
Valid DNR
Obvious incompatibility with life: rigor mortis, decapitated, transected, frozen, decomposing
Continuing CPR would put the providers at an unsafe level of death or disability

see photo

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14
Q

List 3 situations where a TOR should NOT be called

A

Non-cardiac ethology: hypothermia, toxicologic, electrocution, suspected PE, airway obstruction
Penetrating trauma with signs of life
Unexpected: paediatric or young adult

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15
Q

When can an EMS crew bypass to a trauma centre

A

Direct to trauma centre if below and <30 mins to trauma centre
- Physiologic: GCS <15 in context of trauma, SBP <90, RR<10 or >30
- Anatomic: skull #, penetrating trauma, flail chest, pelvic #, 2+long bones fractures, crushed/de-gloved or pulseless extremity, amputation
- Mechanism: Fall >6m or x2 height of child, high risk MVC (ejection, death in vehicle), car vs. Pedestrian, motorcycle >30 kph
- Population: extremes of age, anti-coagulant, pregnant, burn with trauma

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16
Q

Describe the PARAMEDIC 2 trial

A

Perkins GD, et al. “A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest”.NEJM. 2018. 379:711-721.
Population: EMS services in the UK with OHCA
Intervention: Epi 1 mg q3-5mins
Control: Placebo
Outcomes: Primary outcome: survival to 30 days 3.2% vs. 2.4%. Secondary outcomes: favourable neurologic outcomes 2.2% vs. 1.9%

Bottom line: EPI as part of OHCA will improve survival but is associated with worsening neurologic outcomes

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17
Q

List 5 elements of the AHA chain of survival in cardiac arrest

A
  1. Early Recognition
    2- Early CPR
    3- Early Defibrillation
    4- Advanced Life support
    5- Post arrest cardiac care
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18
Q

*Reasons why air transport is better than ground transport (5)

A
  1. Faster & more direct (esp vs. ground system)
  2. More access to remote areas
  3. don’t have to deal with traffic (vs ground)
  4. don’t have to deal with other ground obstacles (road closure etc)
  5. Large operating distance (150-200 miles vs. ground systems)
  6. Landing zones smaller vs. fixed wing (though disadvantage vs. ground system) - don’t need an airport
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19
Q

*Why is fixed wing better than rotor wing (4)

A

1- increased range
2- faster (fixed > heli > ground)
3- larger (more pts, crew & equipment)
4- less cabin noise & turbulence (easier pt management)
5- pressurized cabin (so less pt Mx issues - ie less impacted by gas laws, pressurized to 8000ft)
6- cheaper than rotor
7- smaller maintenance time:flight time ratio

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20
Q

*5 interventions/physiologic strategies to prep a patient for air transport

A

• Chest tube (PTX)
• Oxygen
• Intubation
• IV access, good, at least 2
• IVF (prevent dehydration)
• NG tube to decompress stomach or any hollow viscus (will expand with dec pressure)
• Sedation (should be trialed pre-flight)
• Antiemetics

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21
Q

*True or False- does HEMS improve mortality in trauma?

A

Yes

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22
Q

*List 4 advantages of rotor wing over fixed wing.

A
  • Lower flying altitude
  • Can fly to remote locations inaccessible by other means
  • Can land at scene (don’t have to deal with other ground transport)
  • Can land at or near hospital
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23
Q

*Define Boyle’s Law

A

“The volume of a unit of gas is inversely proportional to the pressure on it” [at constant temperature]
ie. P1V1 = P2V2

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24
Q

List 5 safety considerations in approaching a helicopter

A

See photo

25
Q

List 5 contraindications to air medical transport

A

Absolute contraindications to flight
- Imminent obstetrical delivery
- Unlikely to survive
- Cardiac arrest in progress
- Unsafe weather conditions
- Ground transport faster than air transport

Relative contraindications
- Severe hypoxia
- Trapped gas that cannot be vented ex. bowel obstruction, pneumothorax
- 12-24 hours after SCUBA diving or decompression illness
- Active labour
- Psychosis, violent, or dangerous patient
- DNR

26
Q

List 2 reasons why a rotor wing may be preferred to a fixed wing

A

Flexibility to land anywhere
Can fly lower to the ground; less impact on flight physiology

27
Q

Describe Boyle’s law and list one clinical implication in flight physiology

A

P1V1=P2V2
Pressure is inversely related to volume; as pressure decreases volume increases
Issue for trapped gases as these will expand at altitude ex. Bowel obstruction, pneumothorax, air embolisms, ETT balloons, air casts

28
Q

Describe Charles’s law and list one clinical implication in flight physiology

A

V1T2=V2T1
As volume decreases temperature also decreases
Temperatures fall with altitude; patients travelling via air may be hypothermic on arrival.

29
Q

Describe Dalton’s law and list one clinical implication in flight physiology

A

PT = P1 + P2 + P3…
Total pressure of a gas mix is equal to the sum of the partial pressures. Partial pressure of oxygen is lower at high altitudes even if FiO2 remains the same
You cannot transport someone who is already at 100% Fio2 at sea. At risk populations include COPD, low HgB, V/Q mismatch

30
Q

Describe Henry’s law and list one clinical implication in flight physiology

A

Mass of gas absorbed in a liquid is directly proportional to the partial pressure of the gas above the liquidi.e. hyperbarics
Sudden decompression of an aircraft at high altitude may cause decompression sickness

31
Q

*Define the START triage categories

A

Black (deceased) : Apneic (after head tilt)
Red (immediate): RR>30, Cap refill >2s or no radial pulse, Unable to follow commands
Yellow (delayed): None of the others
Green (Minor): Can walk away

32
Q

*3 categories in SAVE triage

A

The SAVE triage system is designed to identify patients who are most likely to benefit from care available under austere field conditions in a resource-poor environment.
Categories:
(1) those who will die regardless of care,
(2) those who will survive without care, and
(3) those who will benefit from austere field interventions

33
Q

*Define convergence (disaster)

A

If hospitals remain accessible, patients tend to seek care at the closest one, a phenomenon known as convergence. Hospitals close to the disaster scene are overwhelmed, whereas hospitals located only a few miles away may receive few if any patients.

34
Q

*What problems result from convergence (disaster)?

A
  • Communications breakdown
  • Staffing limitation
  • Limited resources/supplies
35
Q

*How do goals of triage in disasters differ from normal ED triage?

A

“to do the most good for the most people.” In other words, there is a shift from focus on individual patients to focus on the entire affected population.

36
Q

*Describe SALT (disaster triage)

A

sort, assess, lifesaving interventions, and treatment or transport

37
Q

*What are 4 components of incident command?

A

incident command, operations, planning, logistics, and finance

I FLOP

38
Q

What are the 5 functional elements in the organizational structure of the Incident Command System?

A

IFLOP
Incident commander
Financial (Payers)
Logistics (Getters)
Operations (Doers)
Planning (Thinkers)

39
Q

Describe the 4 stages of emergency medicine disaster management

A
  1. Mitigation: actions to reduce the impact of identified hazards
  2. Preparedness: training and drills, creating equipment stashes
  3. Response: coordination of resources to address disaster
  4. Recovery: return to normal operations after disaster situation is resolved

MPRR

40
Q

List 6 critical substrates for hospital resources

A

physical plant, personnel, supplies and equipment, communication, transportation, supervisory managerial support

41
Q

Describe the PICE Nomenclature

A

see photo

42
Q

What are 2 interventions in the START assessment

A

opening of an obstructed airway and direct pressure

43
Q

Draw the START triage assessment

A

Remember RMP: respirations, perfusion, mental status. See photo

44
Q

What is JUMPSTART

A

Modification of START that includes 5 rescue breaths for children w apnea, tachypnea, and altered mental status

45
Q

*List 4 “Class A” biological pathogens

A

The CDC lists Category A (high threat) agents:
anthrax [Bacillus anthracis],
botulism [Clostridium botulinum toxin],
plague [Yersinia pestis],
smallpox [variola major],
Tularemia [Francis Ella tularensis],
viral hemorrhagic fevers [filoviruses (eg, Ebola, Marburg)]
arenaviruses [eg, Lassa, Machupo]),

46
Q

*Name 8 factors associated with an explosive blast injury that increase the chance of patient injury

A

• Type of explosion: Conventional vs enhanced
• Amount of explosive material
• Composition of explosive (e.g. presence of fragments such as nails)
• Location of explosion (i.e. confined vs open)
• Distance from explosion
• Associated structural collapse
• Delivery method of explosion
• Presence of chemical toxins in explosive
• Presence of radioactive contamination in explosive
• Other surrounding environmental factors

47
Q

There are 4 types of blast injuries. List them, and give one specific example of each.

A
  • Primary injuries: Caused by shock waves (e.g. tympanic membrane rupture, hollow viscous rupture)
  • Secondary injuries: Caused by fragmentation and other objects propelled by explosion (e.g. penetrating trauma - msot common cause of mortality)
  • Tertiary injuries: Caused by displacement of air by the explosion that can throw victims against solid objects (e.g. fracture)
  • Quaternary injuries: Other miscellaneous injuries (e.g. flash burns, respiratory injuries includes exacerbation of additional injury)
48
Q

*True of false: the presence of tympanic membrane perforation is an appropriate triage tool to determine the presence of severe injury.

A

FALSE

49
Q

List 2 chemical, 2 biologic, and 2 radiologic agents that could be used as weapons of mass destruction

A

see photo [Box 193.1]

50
Q

List 3 syndromes and 3 epidemiology features that suggest a biologic weapon

A

see photo [Box 193.3]

51
Q

For each of the following list pathogen, clinical presentation, required PPE, and management:
- Anthrax

A

Bacillus anthracis (spores).
Inhalational = influenza, hilar adenopathy, hemorrhagic mediastinitis. Cutaneous = non tender necrotic ulcer with black eschar.
Airborne (PAPR) for inhalational, contact for cutaneous. Fluoroquinolones + clinda for 60 days or until 3 doses of vaccine

52
Q

For each of the following list pathogen, clinical presentation, required PPE, and management:
- Plague

A

Yersinia pestis
Pneumonic = Influenza, lobar PNA. Bubonic = lymphadenopathy, buboes
Droplet contact
Fluoroquinolones

53
Q

For each of the following list pathogen, clinical presentation, required PPE, and management:
- Smallpox

A

Variola virus
Influenza with vesicular rash, peripheral -> central
Airborne (PAPR)
Vaccine + VIG

54
Q

List 4 categories of chemical weapons

A

Nerve agents (organophosphates), vesicants (blistering agents ex. Mustard gas), cyanide, chocking agents (ex. Chlorine)

55
Q

What is the clinical presentation of mustard gas

A

Skin blisters that look like second degree burns

56
Q

Describe the 4 levels of PPE

A
57
Q

Reccomendations to prevent hospital transmission

A
58
Q

WMD - reccomendations for PPE

A
59
Q

Steps of ED preparedness for WMD

A

KChan Saves the World (24 decks)

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