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Medical Directives Flashcards

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USMLE® Step 1 flashcards
1
Q

Medical Directives

The CPR compression rate for adults is _______ per minute at a depth of ___ cm

A
  • 100-120 per minute

- 5-6cm

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2
Q

Medical Directives

If shock advised prompt is received, immediately perform a minimum of __ compressions while the AED is charging.

A

15

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3
Q

Medical Directives

Adult pads are worn by ages ranging from:

Pediatric pads are worn by ages ranging from:

A

Adult pads: 8 years and up

Pediatric pads: 1 year old to less than 8

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4
Q

Medical Directives

The AED will deliver one shock at a time, with escalating shocks at increasing energy levels of:

Pediatric shock values are:

A

Adult pads: 120J, 150J, 200J

Pediatric pads: 50J, 70J, 85J

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5
Q

Medical Directives

What are two things that are done at a call for the cardiac arrest of a hypothermic patient

A
  • 45 second pulse check

- one analysis only, one shock only

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6
Q

Medical Directives

What information should you request before surrendering care to a physician on scene that wants to deviate from accepted protocols? (3)

A
  • Are you a Medical Doctor licensed in Ontario?
  • Do you Have I.D.?
  • Are you taking full medical responsibility for the patient?
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7
Q

Medical Directives

What three forms of I.D. are considered acceptable for Physicians?

A
  • Ontario Medical Association
  • Canadian Medical Association
  • College of Physicians and Surgeons Ontario
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8
Q

Medical Directives

Only the _______ ________ can de-certify a fire fighter.

A

Medical Director

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9
Q

Medical Directives

A fire fighter should be considered de-certified if off for ___ ______ or if they have not completed ______ re-cert.

A
  • 6 months

- annual

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10
Q

Medical Directives

If a fire fighter is deactivated _____ in any 12 month period, he/she will remain decertified until they attend a complete ____________ ______.

A
  • twice

- certification course

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11
Q

Medical Directives

If a patient has a history of: asthma, COPD, chronic bronchitis or emphysema, and you notice cyanosis, poor air entry, intercostal indrawing, sternal retractions, inspiratory or expiratory wheezing during a physical exam, administer ___ dose of the patients own ventolin. You may repeat _____ to _____ doses depending on the patients age.

A
  • one

- three to eight

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12
Q

Medical Directives

After administering one dose of the patients own ventolin, you may repeat 3-8 doses depending on the patient’s age.

Adult:
1 puff, 4 breathes; repeat x _____.

Pediatric:
1-2 y/o: 1 puff, 4 breathes; repeat x _____.
2-5 y/o: 1 puff, 4 breathes; repeat x _____.
5-8 y/o: 1 puff, 4 breathes; repeat x _____.

A

Adult:
1 puff, 4 breathes; repeat x 8.

Pediatric:
1-2 y/o: 1 puff, 4 breathes; repeat x 3.
2-5 y/o: 1 puff, 4 breathes; repeat x 4.
5-8 y/o: 1 puff, 4 breathes; repeat x 6.

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13
Q

Medical Directives

How many times do you analyze/shock a trauma patient in cardiac arrest?

A

One analysis, one shock only

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14
Q

Medical Directives

What is the criteria for obvious death? (7)

A
  • decapitation
  • transection
  • decomposition
  • gross charring or incineration
  • open head or torso wound with outpouring contants
  • gross rigor
  • gross lividity
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15
Q

Medical Directives

Fentanyl is a powerful synthetic opiod analgesic (pain drug) that is similar to morphine but is ___ times more potent.

A

50-100

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16
Q

Medical Directives

Carfentanyl has a quantitative potency approximately ___ times that of morphine and ___ times that of fentanyl.

A

10,000

100

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17
Q

Medical Directives

What three things must a fire fighter do to remain certified in defib?

A
  • re-certify annually to standards set by medical director
  • follow protocols
  • must not have two or more major infractions to protocols during any 12 month period
18
Q

Medical Directives

What three things are considered to be major infractions to protocols?

A
  • not shocking when instructed to do so by AED
  • not taking defib in to a patient in cardiac arrest
  • injury to by bystander when shocking patient
19
Q

Medical Directives

The compression to ventilation ratio for pediatric patients (one or more to less than 8) in cardiac arrest is:

A

15:2

20
Q

Medical Directives

The compression to ventilation ratio for infants (less than 1) in cardiac arrest is:

A

15:2 (do not apply AED)

21
Q

Medical Directives

The compression to ventilation ratio for neonates/newborns (0-29 days) in cardiac arrest is:

A

3:1

22
Q

Medical Directives

Neonate (0-29 days) resuscitation protocol is to provide ___ if neonate is ______ or if heart rate is less than ___.

If heart rate is less than __ despite adequate oxygenation and ventilation, continue to provide PPV and administer chest compressions at :.

A
  • PPV, apneic, HR < 100

- HR < 60, 3:1

23
Q

Medical Directives

What are three signs and symptoms that can be used to identify and opiod overdose?

A
  • pinpoint pupils
  • unconsciousness
  • respiratory depression
24
Q

Medical Directives

Do not administer Epi to an anaphyactic patient if their blood pressure is greater than ___mm Hg

A

No Epi if blood pressure is more than 140mm Hg

25
Q

Medical Directives

Only administer Epi if a physical examination shows any two of the following: (5)

A
  • wheezing
  • stridor
  • generalized urticaria (hives)
  • generalized edema (swelling)
  • systolic BP < 90mm Hg
26
Q

Medical Directives

Only administer Epi if the patient has their own prescription.

If their weight is greater than or equal to 30kg, ___mg.

If their weight is less than 30kg, ___mg.

A
  • 0.30mg

- 0.15mg

27
Q

Medical Directives

After one epinephrine dose, repeat the dose ____ if clinical condition does not improve or deteriorates ___ minutes after the initial does.

A
  • once

- ten

28
Q

Medical Directives

If the patient has self administered Epi prior to FF assessment, the FF may repeat administration if the patients clinical condition warrants. The total number of doses is ___ including any self administered.

A
  • two
29
Q

Medical Directives

Only administer one dose of NTG if the patient has a history of three or more of the following five things with no contra-indications:

and…

A physical exam reveals: (3)

A
  • chest pain
  • ischemic heart disease (angina MI)
  • nitroglycerin use
  • last NTG > 5 minutes ago and not more than 3 NTG
  • feels like usual cardiac pain
  • alert and responsive
  • BP > 100mm Hg
  • pulse > 60 bpm
30
Q

Medical Directives

After administering one dose of a patients own NTG, you may repeat every ____ minutes to a max of _____ doses, if BP is greater than ___mm Hg.

If systolic BP drops by greater than or equal to __, stop protocol.

A
  • five minutes
  • three doses
  • 100mm Hg
  • 1/3
31
Q

Medical Directives

What are the 6 contraindications to NTG?

A
  • known hypersensitivity to nitrates
  • hypotension (systolic BP < 100mm Hg)
  • heart rate < 60bpm
  • 3 or more doses of NTG already administered
  • chest pain over 30 minutes
  • use of ED med in last 48 hours
32
Q

Medical Directives

Only administer ASA if the patient has a history of three or more of the following 4 things with no contraindications:

Give __ x __ mg of the patient’s own chewable ASA tablets.

A
  • crushing chest pain
  • acute onset chest pain
  • shortness of breath
  • sweating
  • two x 80mg
33
Q

Medical Directives

If a patient has chest pain for > 30 minutes and has used their prescribed NTG, consider ___ if prescribed.

Contraindications to ASA are: (5)

A
  • ASA

Contraindications to ASA are:

  • Allergy to ASA or NSAID
  • Hx of ulcers or GI bleed
  • CVA or TIA in last 24 hours
  • Asthma with no prior use of ASA
  • Tx with blood thinners
34
Q

Medical Directives

There are 2 types of PPE, what are they?

A

Standard - N95, nitrile gloves, protective eyewear, gowns or bunker gear
Enhanced - hoods, shields, gowns, leg/food coverings

35
Q

Medical Directives

Return of pulse - after detection of a pulse what should you do?

A
  • Turn defib off
  • Leave pads on
  • Reassess for loss of pulse every 45-60 sec with a 10 sec pulse check
  • If no pulse, turn AED on again and follow prompts
36
Q

Medical Directives

With an airway obstruction after performing 30 chest compressions what should you do prior to giving 2 ventilations?

A

Visualize patients airway

37
Q

Medical Directives

T/F Under no circumstances will FF’s operate any AED other than the Fire Service AED.

A

True - except to turn off

38
Q

Medical Directives

What should be done with the pads if the patient has a permanent pacemaker or automatic implantable defib (AID)

A

Avoid putting the AED pads over or near

39
Q

Medical Directives

Epi will not exceed _ doses total?

A

2

*Patient must have prior history of anaphylaxis and/or prior use of Epi to administer

40
Q

Medical Directives

Is a photocopy of a DNR acceptable?

A

Yes

41
Q

Medical Directives

How many defibrillators incidents can our defibs memory card store?

A

4

Medical Directives (1 decks)

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