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Medic Protocols Flashcards

1
Q

Do responders have a right to pt. blood if there has been exposure?

A

Yes, as a result of the Ryan White act by court order if necessary.

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2
Q

What types of deaths require an investigation?

A
  1. Violent/Unnatural 2. Unattended 3. Unanticipated, within 24 hrs of discharge from MD care. 4.Substance abuse 5. Law enforcement custody 6. Death related to employment 7. Communicable disease
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3
Q

When may resucitation efforts be witheld?

A
  1. DNR 2. Pulseless/Apneic in MCI 3. Cremation, Rigor, Decomposition, or Venous pooling/Dependant lividity are present 4.Decapitation 5. Penetrating head wound, no vitals 6. Pulseless/Apneic drowning with more than 1 hour under water 7. Pulseless/apneic with prolonged down time.
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4
Q

May you withhold resucitation without DNR, but family requests?

A

Yes, if pt. is has obvious terminal disease.

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5
Q

What is the LVAD?

A

It is in pt. with heart failure, pumps blood from left ventricle to Aorta. Pt. with device exhibit no pulse, BP, or SPO2. Do not perform chest compressions on these pt.

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6
Q

What is the criteria for an identified pt?

A

Significant MOI, Traumatic injury, Acute change in medical condition, Behavior problems that place pt. at risk, pt is less than 15 y/o, person is caller, medic judgement.

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7
Q

When do we collect blood specimen?

A

Cyanide poisoning, Blood exposure, 2 green tops for cyanide, 2 tiger tops for blood exposure.

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8
Q

What range do you want to maintain ETCO2 at?

A

35-45mmHg, less than 10mmHG after 20 min allows termination of resuscitation.

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9
Q

How many joules are used in cardioversion?

A

100, 120,150, 200

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10
Q

Indication for CPAP use?

A

CHF, COPD, Resp. Distress, Bariatric pt. with rest. distress.

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11
Q

What are CPAP contraindications?

A

BP less than 90, Peds, Asthma, unresponsive, Inability to maintain a patent airway, Pneumothorax, Vomiting or active GI bleed.

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12
Q

What is CPAP set at?

A

CHF 10 cmH2O COPD 5 cmH2O

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13
Q

When is a Cric. indicated?

A

Foreign body obstruction, Croup or Epiglotitis, Angioedema, Trauma, Caustic injury.

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14
Q

What size scalpel and ET tube are used in Cric?

A

20 scalpel, 6.0 tube, kids under 8 use 14 or 16 guage needle and a 3.0 tube

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15
Q

When is cric maneuver contraindicated?

A

kid less than 22lbs/10kg

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16
Q

Where must pads be placed on a pt. with a pacemaker?

A

At least 1” from the device.

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17
Q

Describe the parts of the heart associated with 12 lead.?

A 
II, III, aVF-lower heart
V1,V2-Septal leads/muscle between ventricles
V2,V3,V4-Anterior heart
V4,V5,V6-Lateral,Pre-cordial
I, aVL-lateral from above
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18
Q

When is an IO indicated?

A

IV not established in 2 attempts or 90 seconds and,

  1. GCS 40
  2. SPO2
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19
Q

How do you measure for gastric decompression?

A

From mouth to earlobe to tip of xiphoid process.

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20
Q

What size tubing do you use for gastric decompression?

A

12-18 Fr. and 30-60 ml syringe

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21
Q

GCS score

A

Eye open- 1-None, 2-Pain, 3-Verbal, 4-Spontaneoous.
Verbal- 1-None, 2-Incomprehensible, 3-Inappropriate, 4-Pain, 5-Oriented.
Motor- 1-None, 2-Extension, 3-Flexion, 4-Withdraws, 5-Localizes, 6-Follows commands

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22
Q

When is post resuscitation hypothermia indicated?

A

ROSC for >5 min, BP>100, >12y/o, Advanced airway in place, no purposeful movement.

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23
Q

When is ROSC hypothermia contraindicated?

A

Pregnant, Pulmonary edema, Head trauma, Internal bleeding, Trauma results in arrest.

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24
Q

What is max depth for ET tube in men, women?

A

23cm, 21cm

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25
What is Fluid challenge amount?
20ml/kg, 10ml/kg if less than 1 month old
26
King airway sizes?
``` >6ft - 5 5-6ft - 4 4-5ft - 3 41-51in - 2.5 35-45in - 2 Contraindicated in pt. under 35in. ```
27
What is the site for a pleural decompression?
2nd intercostal space, over 3rd rib, use 10 or 14 guage needle.
28
What pt. get Atropine in RSI?
Pt. under 10 y/o.
29
What meds are given to Head injury pt. prior to RSI?
Lidocaine and Fentanyl
30
What is the induction agent used in RSI?
Etomidate
31
What are the Paralytics used for RSi?
Succ or Roc
32
What meds are given post intubation?
Fentanyl and Versed, Rocuronium to continue paralysis.
33
How long may you suction for?
15 seconds
34
How long must you pre-oxygenate prior to suctioning?
3 min with NRM or 5 breaths with BVM.
35
What are the components of the primary survey?
Airway and c-spine, Breathing, Circulation, Disability, GCS, Exposure/Enviroment
36
What are the elements of the secondary survey?
Head to Toe/Chief complaint, Vital signs, Monitor/EKG/CBG, Pn. scale, PQRST
37
What are the physiological requirements for a trauma entry?
GCS<=13 BP<90 RR<10>29
37
What are the physiological requirements for a trauma entry?
GCS<=13 BP<90 RR<10>29
38
What are the anatomical Trauma entry requirements?
Tension Pneumo, Flail chest, Penetrating injury, Amputation proximal to wrist or ankle, Two long bone fx, pelvic fx, crush injury, degloving, skull fx, sensory or motor deficit
39
What is the trauma entry requirement in regards to falls?
20 ft for adults, 10 for peds or 2-3 times there height.
40
Procedure for chord prolapse?
Insert hand and keep body parts off chord, Knee chest position and transport.
41
Breech or limb presentation procedure?
Place in left lateral recumbent position.
42
Shoulder dystocia procedure?
Flat on her back and knee to chest.
43
CCR compressions and respirations?
Compress chest 2 in/5cm @ 100-120 per min Passive ventilation for 6 min then advanced airway and BVM 6-8 bpm 1st rhythm check @ 2 min
44
Where do you place clamps and cut the chord, and suction/
4"-6" and suction mouth first.
45
Pediatric arrest stats?
CPR 2 person 15:1, single person 30:2 | 1/3 depth of chest @ 100/min
46
What is symptomatic brady in an adult?
BP<90 @ <50HR
47
List the 5 H's and 5 T's
Hypovolemia Tension Pneumo Hypoxia Tamponade (Cardiac) Hydrogen ion (acidosis) Toxins Hypothermia Thrombosis(Coronary) Hypo/erkalemia Thrombosis(Pulmonary)
48
What info must be given to the charge nurse at riverbend when handling an exposure report?
Employee name, first 6 of social, DOB
49
What are the contraindications for the transport vent, and settings?
<20KG, tension pneumo tidal volume 8-10ml/kg RR 12 adult RR 20 child
50
When is Apgar score recorded?
1 and 5 minutes score greater than 8 is goal.
51
What things are scored in Apgar scoring?
``` Appearance Pulse Grimace Activity Respiration ```
52
May you remove tourniquet that was applied prior to your arrival?
Yes
53
What is procedure for children with seizures?
Transport all children with seizures, MD consult is requires for refusal.
54
What are the indications for fluid resuscitation in a trauma?
BP<80 GCS<=13 Initial bolus of 250, may repeat once
55
Pt. of what age with syncope should be transported?
Over 40
56
What are the high risk auto mechanism of injury items for trauma activation?
``` Intrusion>12" into passenger compartment or 18" anywhere on vehicle Ejection Death in same passenger compartment Telemetry of vehicle consistent with high risk injury ```
57
What speed requires Trauma system entry in vehicle vs. pedestrian?
20 mph
58
What pt. constitute co morbid factors in trauma calls?
``` Adults over 55 Children Anticoagulant or bleeding disorder Burns Pregnant>20 weeks Medic judgement ```
59
Who is responsible for communication of trauma activation to hospital?
Medic in charge of pt. care
60
What info must be passed on to trauma center?
``` Unit number and priority of transport Location of incident Number of pt Age and Sex Trauma entry criteria Vital signs ETA ```
61
CPAP inclusion criteria?
Resp. distress with 1. Retractions or accessory muscle use 2. Pulmonary edema 3. Hypoxia SPO2
62
When may an IO be done prior to IV attempt?
Cardiac Arrest, Hypovolemia with altered mentation, Extremis
63
What are the IO sites?
Proximal tibia, Proximal humerus
64
IM administration sites?
Deltoid .5-2ml, Quad .5-5ml, Gluteal .5-5ml | Ped Quad only .5-3ml
65
King airway contraindications?
Intact gag reflex, Esophageal disease, Caustic substance, 35 in or less.
66
What assessments must be done for a complete neuro assessment?
GCS, Cranial nerve (Eye and facial movement), Cerebral Cincinnatti stroke, Cerebellar (Finger to nose and Heel to shin).
67
Indications for oxygen therapy?
Chest pn, Hypoxia, Resp. distress, Trauma, Shock, CO poisoning
68
Cardiac monitor data?
Red folder in Capt. office and medic unit. Must switch data card and fill out short form. Include CCR form and strips or code summary
69
Lift assist documentation.
Epcr required on all lift assists, allows reporting to DHS, Narrative must include staffing situation, hazards that led to fall.
70
Indication for fluid resuscitation in a Trauma?
BP
71
Albuterol
Resp Distress with bronchospasm and wheezes Hyperkalemia 2.5mg
72
Atrovent
.5mg
73
Fentanyl
50-100mcg initial max off 300mcg
74
Morphine
.1mg/kg usual dose is 5mg max of 20mg
75
Narcan
1mg up to 2mg
76
Zofran
4mg up to 8mg
77
Adrenal Insufficiency
Addison disease, chronic steroid dependent are causes Hypoglycemeia, hypotension, hyperkalemia, altered mentation are symptoms. Treat the hypoglycemia, D50, fluid bolus, solumedrol.
78
Key things with N/V pt.
Transport if vomiting more than 6 hrs, extremes of age, immunosuppressed.
79
Facts about Pn assessment?
Pn scale used on pt >7 | Other 3 are FLACC
80
What are the universal treatment guidelines?
These are done for every pt! 1. Scene safety 2. Trauma scene assessment 3. Physical exam 4. History assessment 5. Follow appropriate treatment protocol
81
What do all chemically restrained pt. require?
Monitoring of ETCO2
82
Parkland burn formula is used on what pt?
> than 20% burn
83
Treatment for small burns vs. moderate burns?
84
What is the criteria for cath alert?
Chest pn or discomfort with no LBBB, ST elevation in 2 or more anatomically adjacent leads or acute stemi on printout.
85
What info is provided to hospital in cath alert?
Name, DOB, weight, ETA 12 lead 2nd IV Defib pads on Anterior/Posterior
86
What is most common cause of Ped arrest?
Hypoxia.

Medic Protocols (1 decks)

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