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Medic Protocols > Medic Protocols > Flashcards

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
Q

What is Fluid challenge amount?

A

20ml/kg, 10ml/kg if less than 1 month old

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26
Q

King airway sizes?

A 
>6ft - 5
5-6ft - 4
4-5ft - 3
41-51in - 2.5
35-45in - 2
Contraindicated in pt. under 35in.
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27
Q

What is the site for a pleural decompression?

A

2nd intercostal space, over 3rd rib, use 10 or 14 guage needle.

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28
Q

What pt. get Atropine in RSI?

A

Pt. under 10 y/o.

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29
Q

What meds are given to Head injury pt. prior to RSI?

A

Lidocaine and Fentanyl

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30
Q

What is the induction agent used in RSI?

A

Etomidate

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31
Q

What are the Paralytics used for RSi?

A

Succ or Roc

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32
Q

What meds are given post intubation?

A

Fentanyl and Versed, Rocuronium to continue paralysis.

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33
Q

How long may you suction for?

A

15 seconds

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34
Q

How long must you pre-oxygenate prior to suctioning?

A

3 min with NRM or 5 breaths with BVM.

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35
Q

What are the components of the primary survey?

A

Airway and c-spine, Breathing, Circulation, Disability, GCS, Exposure/Enviroment

36
Q

What are the elements of the secondary survey?

A

Head to Toe/Chief complaint, Vital signs, Monitor/EKG/CBG, Pn. scale, PQRST

37
Q

What are the physiological requirements for a trauma entry?

A

GCS<=13
BP<90
RR<10>29

37
Q

What are the physiological requirements for a trauma entry?

A

GCS<=13
BP<90
RR<10>29

38
Q

What are the anatomical Trauma entry requirements?

A

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
Q

What is the trauma entry requirement in regards to falls?

A

20 ft for adults, 10 for peds or 2-3 times there height.

40
Q

Procedure for chord prolapse?

A

Insert hand and keep body parts off chord, Knee chest position and transport.

41
Q

Breech or limb presentation procedure?

A

Place in left lateral recumbent position.

42
Q

Shoulder dystocia procedure?

A

Flat on her back and knee to chest.

43
Q

CCR compressions and respirations?

A

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
Q

Where do you place clamps and cut the chord, and suction/

A

4”-6” and suction mouth first.

45
Q

Pediatric arrest stats?

A

CPR 2 person 15:1, single person 30:2

1/3 depth of chest @ 100/min

46
Q

What is symptomatic brady in an adult?

A

BP<90 @ <50HR

47
Q

List the 5 H’s and 5 T’s

A

Hypovolemia Tension Pneumo
Hypoxia Tamponade (Cardiac)
Hydrogen ion (acidosis) Toxins
Hypothermia Thrombosis(Coronary)
Hypo/erkalemia Thrombosis(Pulmonary)

48
Q

What info must be given to the charge nurse at riverbend when handling an exposure report?

A

Employee name, first 6 of social, DOB

49
Q

What are the contraindications for the transport vent, and settings?

A

<20KG, tension pneumo
tidal volume 8-10ml/kg
RR 12 adult
RR 20 child

50
Q

When is Apgar score recorded?

A

1 and 5 minutes score greater than 8 is goal.

51
Q

What things are scored in Apgar scoring?

A 
Appearance
Pulse
Grimace
Activity
Respiration
52
Q

May you remove tourniquet that was applied prior to your arrival?

A

Yes

53
Q

What is procedure for children with seizures?

A

Transport all children with seizures, MD consult is requires for refusal.

54
Q

What are the indications for fluid resuscitation in a trauma?

A

BP<80
GCS<=13
Initial bolus of 250, may repeat once

55
Q

Pt. of what age with syncope should be transported?

A

Over 40

56
Q

What are the high risk auto mechanism of injury items for trauma activation?

A 
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
Q

What speed requires Trauma system entry in vehicle vs. pedestrian?

A

20 mph

58
Q

What pt. constitute co morbid factors in trauma calls?

A 
Adults over 55
Children
Anticoagulant or bleeding disorder
Burns
Pregnant>20 weeks
Medic judgement
59
Q

Who is responsible for communication of trauma activation to hospital?

A

Medic in charge of pt. care

60
Q

What info must be passed on to trauma center?

A 
Unit number and priority of transport
Location of incident
Number of pt
Age and Sex
Trauma entry criteria
Vital signs
ETA
61
Q

CPAP inclusion criteria?

A

Resp. distress with

  1. Retractions or accessory muscle use
  2. Pulmonary edema
  3. Hypoxia SPO2
62
Q

When may an IO be done prior to IV attempt?

A

Cardiac Arrest, Hypovolemia with altered mentation, Extremis

63
Q

What are the IO sites?

A

Proximal tibia, Proximal humerus

64
Q

IM administration sites?

A

Deltoid .5-2ml, Quad .5-5ml, Gluteal .5-5ml

Ped Quad only .5-3ml

65
Q

King airway contraindications?

A

Intact gag reflex, Esophageal disease, Caustic substance, 35 in or less.

66
Q

What assessments must be done for a complete neuro assessment?

A

GCS, Cranial nerve (Eye and facial movement), Cerebral Cincinnatti stroke, Cerebellar (Finger to nose and Heel to shin).

67
Q

Indications for oxygen therapy?

A

Chest pn, Hypoxia, Resp. distress, Trauma, Shock, CO poisoning

68
Q

Cardiac monitor data?

A

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
Q

Lift assist documentation.

A

Epcr required on all lift assists, allows reporting to DHS, Narrative must include staffing situation, hazards that led to fall.

70
Q

Indication for fluid resuscitation in a Trauma?

A

BP

71
Q

Albuterol

A

Resp Distress with bronchospasm and wheezes
Hyperkalemia
2.5mg

72
Q

Atrovent

A

.5mg

73
Q

Fentanyl

A

50-100mcg initial max off 300mcg

74
Q

Morphine

A

.1mg/kg usual dose is 5mg max of 20mg

75
Q

Narcan

A

1mg up to 2mg

76
Q

Zofran

A

4mg up to 8mg

77
Q

Adrenal Insufficiency

A

Addison disease, chronic steroid dependent are causes
Hypoglycemeia, hypotension, hyperkalemia, altered mentation are symptoms.
Treat the hypoglycemia, D50, fluid bolus, solumedrol.

78
Q

Key things with N/V pt.

A

Transport if vomiting more than 6 hrs, extremes of age, immunosuppressed.

79
Q

Facts about Pn assessment?

A

Pn scale used on pt >7

Other 3 are FLACC

80
Q

What are the universal treatment guidelines?

A

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
Q

What do all chemically restrained pt. require?

A

Monitoring of ETCO2

82
Q

Parkland burn formula is used on what pt?

A

> than 20% burn

83
Q

Treatment for small burns vs. moderate burns?

A
84
Q

What is the criteria for cath alert?

A

Chest pn or discomfort with no LBBB, ST elevation in 2 or more anatomically adjacent leads or acute stemi on printout.

85
Q

What info is provided to hospital in cath alert?

A

Name, DOB, weight, ETA
12 lead
2nd IV
Defib pads on Anterior/Posterior

86
Q

What is most common cause of Ped arrest?

A

Hypoxia.

Medic Protocols (1 decks)

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