Medical Protocols Flashcards
The first step in medical termination of resuscitation is determining ______.
A. Patient normothermic
B. EtCO2
C. Pulseless
A. Patient normothermic
Hypothermic patients should be resuscitated, under most circumstances.
A patient who is pulseless, apneic, and has what two signs present should not be resuscitated?
- rigor mortis
- decomposition
In the adult, what medical findings may prevent initiation of resuscitation?
- down time over 15 minutes “and”
- no bystander CPR “and”
- initial rhythm asystole
If an adult remains in a persistent asystole/agonal rhythm without reversible causes for greater than ____ minutes, resuscitation may be ceased.
A. 10
B. 20
C. 30
D. 40
B. 20
If a child remains in a persistent asystole/agonal rhythm without reversible causes for greater than ____ minutes, resuscitation may be ceased.
A. 10
B. 20
C. 30
D. 40
C. 30
What are “agonal rhythms?”
Rhythms that do not produce adequate perfusion and lead to death:
- asystole
- pVT
- VF
- PEA
In the adult/peds medical arrest, failure to obtain ROSC or maintain ROSC for more than ____ minutes may prompt cease resuscitation.
A. 5
B. 10
C. 15
D. 20
A. 5
In the adult/peds medical arrest, if EtCO2 remains above ____ with CPR, resuscitation should be continued.
30 mmHg
consult onscene critical care paramedic or medical command regarding transport or potential cease resuscitation
In the adult/peds medical arrest, if EtCO2 remains between ____ with CPR, resuscitation should be continued while Medical Control is contacted.
10-30 mmHg
In the adult/peds medical arrest, if EtCO2 remains below ____ with CPR, resuscitation should be discontinued.
10 mmHg
Describe the MOA of Aspirin
Inhibition of Thromboxane A2 (and subsequent decreased platelet aggregation) through upstream cyclooxygenase (COX-2 PATHWAY).
Cautions in ASA admininstration
- asthma
- chronic liver disease
Should STILL be administered if STEMI is present.
Absolute contraindications for ASA
- Hypersensitivity to ASA/NSAIDS/Salicilates
- pregnancy
What are the WSCEMSS indications for NTG?
- decompensated HF with pulmonary edema
- Cardiac chest pain in ACS
What medication may decrease the vasodilatory effect of NTG and why?
Ergot (genus Claviceps - 1* a rye fungus);
1st type of Ergot poisoning - “St. Anthony’s Fire” - the serotonergic effect of ergot poisoning on monks in 1095 A.D.; dizziness, hallucinations, paralysis, etc.
2nd type: distal vasoconstriction 2/2 to ergot alkyoids
Most ED drugs, when used within ____ hours, preclude the use of NTG. What is the exception?
48 hours; Viagra/Revation (sildenafil) 24hrs
What is the N/S dividing line in Wichita?
Douglas Avenue
What is the E/W dividing line in Wichita?
Main street
List the mile markers West of Main
1000 W - Seneca 2400 W - Meridian 3900 W - West 5500 W - Hoover 7100 W - Ridge 8700 W - Tyler 10300 W - Maize 119th 135th - Clearwater 151 W - Bentley 167 W - Colwich 183 W 199 W - Goddard 215 W 231 W 247 W - Andale 263 W - Viola 279 W - Mt. Hope 295 W - Garden Plain 311 W 327 W 343 W 375 W - Cheney 391 W 407 W - County Line (Kingman)
Mile Markers East of Main
200 E - Broadway 1600 E - Hydraulic 3100 - Hillside 4700 - Oliver 6300 - Woodlawn 7900 - Rock 9500 - Webb 11100 - Greenwich 127 E 143 E 159 E - Butler County Line
Mile markers N of Douglas
400 N - Central 13 N 21 N 29 N 37 N 45 N 53 N 61 N 69 N 77 N 85 N - Valley Center 93 N 101 N 109 N 117 N 125 N - Harvey Co. Line
Mile markers south of Douglas
400 S - Maple 1500 S - Harry 2300 S - Pawnee 31 S 39 S - MacArthur 47 S 55 S 63 S - Patriot in Derby 71 S - Meadowlark in Derby, Grand in Haysville 79 S 87 S 95 S 103 S 111 S 119 S - County Line
Funky areas:
East of Main
200 E - Broadway
1600 E - Hydraulic
Funky areas:
West of Main
1000 W - Seneca
2400 W - Meridian
Funky areas:
North of Douglas
400 N - Central
Funky areas:
South of Douglas
400 S - Maple
1500 S - Harry
Clearwater
Bentley
Colwich
135
151
167
Goddard
199th
Andale
Viola
Mt. Hope
Garden Plain/Section Line
247
263
279
295
375
Cheney
Odd addresses
S/W
Even
N/E
VC-ST address
14800 W Saint Teresa
21st & 151st
Wesley West address
8714 W. 13th St. N
21st & Tyler
List the physical findings that make a code yellow trauma.
- Chest wall instability, deformity, or significant focal bony
tenderness - Significant abdominal pain, tenderness, or bruising (i.e. seatbelt
sign) related to acute traumatic event - Two or more proximal long-bone fractures
- Amputation proximal to wrist or ankle
- Pelvic fracture
- Open or depressed skull fracture
- Paralysis or new neuro defici
Code yellow mechanism criteria.
Mechanism:
- Fall:
- adult > 20 feet
- child > 10 feet or 3 x height of child
- High risk auto crash
- ejection (partial or complete) from automobile
-death in same passenger compartment
- Auto vs. pedestrian or bicyclist thrown, run over, or with > 20mph
impact
- Motorcycle crash > 20 mph
Code yellow mechanism and physical findings require a _____ trauma center.
Level I
Pediatric patients are evaluated primarily with the _____.
A. Mnemonic OPQRST
B. Pediatric Assessment Triangle
C. Monitor, Vitals, and Blood Glucose
B. Pediatric Assessment Triangle (Apperance, Work of Breathing, Circulation to Skin)
Explain the parts of the pediatric assessment triangle
“ABC”
- Appearance
- TICLeS
- muscle Tone
- Irritability
- Consolable
- Look/gaze
- Empty
- Speech/cry
- TICLeS
- work of Breathing
- adventitious breath sounds
- retractions
- nasal flaring
- tripod position
- Circulation
- cool skin
- pale skin
- mottled skin
- cyanosis
- capillary refill
If a pediatric patient’s HR is under ____, go to the cardiac arrest algorithm.
A. 40 BPM
B. 50 BPM
C. 60 BPM
D. 70 BPM
C. 60 BPM
What vital signs must be included in the pediatric assessment?
- Pulse
- RR
- Capillary refill
- Breath sounds
What are the required V/S for an adult assessment?
- BP
- Pulse
- RR
- SpO2
- Pain scale
What other adult assessments may be utilized based upon your clinical impression?
- GCS
- Cap refill
- Temp
- EtCO2
- 12-lead
- Breath sounds
- Neuro assessment
What is the primary divider between a focused physical and head to toe examination in the adult/peds trauma patient?
Presence of a localized injury (focused assessment) versus no localized injury (head to toe).
Initial assessment of the trauma patient (the “primary survey”) is focused on ______.
A. ABCs/correcting major life threats
B. Identifying minor injuries
C. Scene safety
A. ABCs/correcting major life threats
What V/S are required for all peds/adult trauma patients?
- BP
- RR
- HR
- Breath sounds
- Cap refill
- GCS/AVPU
Cardiac or respiratory arrest is a triage ______.
A. Blue B. Red C. Yellow D. Green E. Orange
A. Blue
A patient with an LOC less than verbal or acute GCS under 14 is triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
B. Red
STEMI on 12-Lead ECG is triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
B. Red
Suspected strokes with a last normal time under ___ hours are code red patients.
A. 1 hour
B. 3 hours
C. 5 hours
D. 7 hours
C. 5 hours or less
High risk/complicated OB patients greater than ____ weeks gestation are code red patients.
A. 20 weeks
B. 28 weeks
C. 30 weeks
A. 20 weeks
An acute GCS under ____ requires a level 1 trauma center.
A. 8
B. 10
C. 12
D. 14
D. 14
A systolic BP of under 90 mmHg or signs of shock is a triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
B. red
Respiratory rates under 10 or greater than 29, or requiring respiratory support are triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
B. red
Penetrating injury to head, neck, torso, or extremities proximal to knee/elbow are triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
B. red
Partial thickness burns greater than ___ of total BSA is a code red trauma and requires transport to the trauma center.
A. 10%
B. 20 %
C. 30%
D. 40%
A. 10%
What regions of the body that, when burned, constitute a code red patient?
- face
- hands
- genitals
- perineum
- crossing major joints (think issues with eschars)
A ____ degree burn in any age group is a code red trauma alert.
third
Any electrical burn, including lightning injury, is a triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
B. red
Chemical burns are a triage ____ patient.
A. Blue B. Red C. Yellow D. Green E. Orange
B. red
Inhalation burns/injury are a triage ____ patient.
A. Blue B. Red C. Yellow D. Green E. Orange
B. red
Burns in a patient with any pre-existing conditions that might affect management/mortality are considered a are a triage ____ patient.
A. Blue B. Red C. Yellow D. Green E. Orange
B. red
Any patient with burns and concomitant trauma is considered a _____ triage.
A. Blue B. Red C. Yellow D. Green E. Orange
B. red
Pts who require advanced airway management (like medication, monitoring, non-invasive management) are considered triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
A patient with an LOC of verbal (or baseline LOC change) or an acute GCS of 14-15 is a triage _____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Suspected cardiac chest pain without STEMI on 12-lead is considered triage _____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Suspected stroke greater than 5 hours last seen normal is considered triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
A patient with a potentially toxic ingestion is a triage _____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Obstetric patients with impending delivery or uncomplicated field delivery is a triage _____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Following blunt trauma, a patient over 20 weeks gestation with abdominal and/or back pain following blunt trauma is code _____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Newborn with APGAR over 8 is triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Potential long bone fracture is triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Adult patients with fall greater than ____ feet is code ___ and requires a level I trauma center.
20; yellow
Peds patients with fall greater than ____ feet or ____ times the child’s height is code ___ and requires a level I trauma center.
10; 3; yellow
What high risk auto crash findings cause a patient to be a code yellow and require Level I trauma center?
- Ejection
- Death in same compartment
Auto versus pedestrian/bicyclist becomes a code yellow trauma when what conditions are met?
- Thrown
- Run over
- Impact over 20 mph
A motorcycle crash over ____ is a code yellow trauma alert.
20 mph
Chest wall instability/deformity/significant focal bony tenderness is a code ____ patient.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Significant abdominal pain/bruising/tenderness related to an acute trauma is triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
2+ long bone fractures is a triage _____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Amputation proximal to wrist/ankle is a code _____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
A pelvic fracture is a code ____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Open/depressed skull fracture is triage ____.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
Paralysis or new neuro deficit is a triage
A. Blue B. Red C. Yellow D. Green E. Orange
C. yellow
Adults over 55 YO on anticoagulant therapy (do/do not) require a level I trauma center.
do not
What high risk auto crash findings are traumas, but do not require level I transport?
- Intrusion over 12” by occupant
- Intrusion over 18” at any location
Patients who are alert/oriented (or at baseline mental status), with normal V/S for age, and do not require emergency care are triage _____.
A. Blue B. Red C. Yellow D. Green E. Orange
D. Green
Patients who are experiencing suicidal thoughts or psychiatric medication non-compliance are triage _____.
A. Blue B. Red C. Yellow D. Green E. Orange
E. Orange
T/F: elderly patients with AMS/confusion/combativeness are triaged orange.
False. These patients often have underlying problems (dementia, sepsis, etc.) that may result in AMS. (altered mental status)
If medication is required to calm/protect a patient, they are triage _____ at minimum.
A. Blue B. Red C. Yellow D. Green E. Orange
C. Yellow
In the case of suspected ischemic chest pain, what is your first step in treatment?
A. 12-Lead ECG
B. 324 mg ASA PO
C. 0.4 mg NTG SO
D. 50 mcg Fentanyl IV
B. 324 mg ASA PO
Outline the treatment of an STEMI on 12-lead ECG.
- After 324 mg po ASA and 12-lead:
- Call STEMI alert as soon as possible
- Place defibrillator pads (in case of arrest)
-consider Fentanyl IV/IM/IN
In the case of an inferior STEMI (II, III, aVF), what is administered in hypotension?
250-500 cc NS under 90 SBP over 90 SBP consider it
In adult chest pain treatment, use what medication is a contraindication of nitroglycerin?
ED/pulmonary HTN drug use in prior 48 hours
If an adult patient does not have an inferior MI, what may be administered to combat pain prior to narcotics?
0.4 mg SL nitroglycerin
SL NTG may be repeated q___min if SBP is over 90 mmHg.
A. 2
B. 3
C. 4
D. 5
B. 3 minutes
IV/IM Fentanyl for 50-74 kg.
50 mcg
IV/IM Fentanyl for over 75 kg.
75 mcg
IV/IM Fentanyl for geriatric patients
25 mcg
IN Fentanyl for 50-74 kg patients.
100 mcg
IN Fentanyl for over 75 kg patients.
100 mcg
IN Fentanyl for geriatric patients.
50 mcg
If pain is improved with 3+ SL nitroglycerin and SBP is over 90 mmHg, what may be given?
2% NTG ointment - 1” on the anterior chest
What is the defibrillation dose for adult cardiac arrest with shockable arrests (pVT/VF)?
360 J
What is the preferred method of ventilation for adult cardiac arrest?
BLS airway/ I Gel
A patient presents with pulseless electrical activity. Every two minutes _____ should be administered.
1 mg 1:10,000 IV epineprine
What are the shockable rhythms of adult cardiac arrest?
- pulseless ventricular tachycardia (pVT)
- ventricular fibrillation (VF)
What are the drugs and repeat times for pVT and VF?
- 1 mg 1:10,000 IV epinephrine q4 minutes PRN
- 300 mg IV amiodarone x1
- Repeat 150 mg IV amiodarone x1 4 minutes after 300 mg of amiodarone
In the absence of ROSC in the adult cardiac arrest, what should be considered?
A. cease resuscitation protocol
Treatment of hypovolemia suspected in adult cardiac arrest.
1-2L chilled normal saline
Treatment of suspected hypoglycemia in adult cardiac arrest.
25 g IV dextrose
Treatment of suspected narcotic overdose in adult cardiac arrest.
2 mg IV/IM/IN naloxone*
*only if not intubated
Treatment of Torsades de Pointes in adult cardiac arrest.
2 g IV magnesium sulfate
Treatment of suspected tension pneumothorax in adult cardiac arrest.
needle decompression
Treatment of suspected cyanide/smoke inhalation in adult cardiac arrest.
5 g IV hydroxocobalamin
Treatment of suspected TCA overdose in adult cardiac arrest.
100 mEq IV sodium bicarbonate
Outline the position of the 12-lead electrodes
V1 - right 4th ICS
V2 - left 4th ICS
V3 - 1/2 between V2 and V4
V4 - left 5th ICS, mid-clavicular line
V5 - Horizontal to V4, anterior axillary line
V6 - Horizontal to V5 - mid-axillary line
Describe position 1 of the BLS triangle
Location: Patient right
Assess unresponsiveness/pulselessness
Initiates: compressions
Switches off with position 2 in counting in 20s
Switches off with position 2 in off-cycle 20:1 BVM ventilations
Describe position 2 of the BLS triangle
Location: Patient left
Initiates: Metronome; NRB mask; defib pads
Operates: AED/LP
Switches off with position 1 in counting in 20s
Switches off with position 1 in off-cycle 20:1 BVM ventilations
Describe position 3 of the BLS triangle
Location: Patient head
Initiates: Airway management
Applies BVM/OPA at 660 compressions
Monitors end-tidal and assesses airway compliance.
Describe the role of Code Commander in resuscitation.
- Owns the clinical care.
- Interprets and responds to ECG findings.
- Ensures accurate documentation (coordinates with BLS Team Leader)
- Owns advanced airway interventions
- Responsible for coordinating with medical command about cease resuscitation.
Describe the role of the PM position in resuscitation.
- Assists code commander
- ## Initiates IV/IO access
Describe the role of the PM position in resuscitation.
- Assists code commander
- Initiates IV/IO access
- Assess airway intervetions/ETCO2 monitoring
What type of airway is preferred in the pediatric cardiac arrest?
A. BLS airway
B. ALS airway - SGA
C. ALS airway - ETT
A. BLS airway
Evaluation of the patient’s cardiac rhythm is done every ___ minutes.
A. 2
B. 3
C. 4
D. 5
A. 2
Defibrillation of the pediatric arrest is done at _____.
A. 1 J/kg
B. 2 J/kg
C. 4 J/kg
C. 4 J/kg
Is this ALWAYS? There’s no 2J/kg first, then 4 J/kg next?
1:10,000 IV epinephrine is administered q ____ minutes in the peds arrest.
A. 2
B. 3
C. 4
D. 5
C. 4
What are the Hs of pediatric cardiac arrest and how are they treated?
Hypoglycemia - dextrose IV
What are the Ts of pediatric cardiac arrest and how are they treated?
Toxins
- smoke inhalation - hydroxocobalamin
- TCA od - sodium bicarbonate
Torsades
- Magnesium sulfate
Tension pneumo - needle decompression
What is the mnemonic for common causes of altered mental status?
A - alcohol E - epilepsy, electrolytes I - insulin O - overdose U - uremia (kidney failure) T - temp, trauma I - infection P - poisoning (CO) S - shock ETCO2
What is one of the first assessments performed in AMS patients?
A. 12-lead ECG
B. BGL
C. ETCO2
B. BGL
Based on a blood glucose under 50 mg/dL in an adult patient, what medication may be administered if an IV is obtained?
A. 25g D50 Dextrose
B. 0.1 mg/kg Glucagon
C. 1 mg Glucagon
A. 25g D50 Dextrose IV
Dextrose 25g is administered to ALL patients regardless of age/weight in adult patients
Based on a blood glucose under 50 mg/dL in an adult patient, what medication may be administered if an IV is not obtained?
A. 25g D50 Dextrose IM
B. 0.1 mg/kg Glucagon IM
C. 2 mg Glucagon IM
C. 2 mg Glucagon IM
Is administered to ALL patients regardless of age/weight in adult patients
BGL is re-evaluated after ____ when dextrose or glucagon is administered.
5-10 minutes
If a patient has a glucose over 300 mg/dL, what should be evaluated?
Signs/symptoms of dehydration.
If a patient with AMS and has S/S of dehydration, what should be administered?
NS IV bolus
- 250-500 mL NS(20mL/kg)
If a suspected narcotic overdose is present (pinpoint pupils, respiratory depression), what should be administered?
0.4 mg IV/IM/IN Naloxone to achieve adequate respirations.
A positive Cincinnati Pre-Hospital Stroke Scale over ____ hours PTA of EMS requires supportive care and transport to the hospital of patient’s choice.
A. 6
B. 12
C. 18
D. 24
D. 24
If a patient was last seen normal less than ____ or woke up with stroke-like symptoms, the patient should undergo the RACES assessment.
A. 6
B. 12
C. 18
D. 24
A. 6
If after utilizing the RACES score, and a patient scores between 0-4, to where should they be transported?
A. Any hospital of patient’s choice
B. St. Francis/Wesley Main
C. St. Francis only
B. St. Francis/Wesley Main
If after utilizing the RACES score, and a patient scores between 5-9, to where should they be transported?
A. Any hospital of patient’s choice
B. St. Francis/Wesley Main
C. St. Francis only
C. St. Francis only
What is an LVO Stroke alert?
“Large vessel occlusion.”
The first step in assessing a seizure patient is determining ______.
A. ABCs
B. BGL
C. 12-lead ECG
A. ABCs
After assessing a seizure patient’s ABCs, what is evaluated next?
A. BGL
B. 12-lead ECG
C. Pregnancy
A. BGL
The minimum BGL of a seizure patient should be ____.
50 mg/dL
If a patient is experiencing an active seizure, or recurrent seizures without a lucid interval, what is evaluated next?
Whether or not the patient is in third trimester of pregnancy with signs of eclampsia.
IM/IN Midazolam for adult seizure geriatric patient.
5 mg
IM/IN Midazolam for adult seizure patient weight over 75 kg.
10 mg
T/F: The adult, non-pregnant patient with recurrent seizure may receive magnesium sulfate.
True
Signs/symptoms of eclampsia
SBP over 140 mmHg or DBP over 90 mmHg
AND 1+ of the following:
- Proteinuria
- Renal impairment (proteinuria, high creatinine)
- Liver disease (epigastric pain, liver tenderness, elevated AST/ALT)
- Neuro problems (seizure, visual disturbance, clonus)
- Hematologic changes (thrombocytopenia - , hemolysis, DIC)
- Fetal grown restriction
Severe if SBP over 160 or DBP over 110, or if sever organ dysfunction
Medical control may be contacted for orders if a patient experiences another seizure following ____ dose(s) of benzodiazepines.
2
Hyperthermia is considered a temperature over ______.
104*F
What is considered “mild” hypothermia?
90-95F/32-35C
What is considered “moderate“ hypothermia?
86-90F/30-32C
What is considered “severe“ hypothermia?
Under 86F/30C
What are the possible causes of non-environmental factor induced hyperthermia?
- Antipsychotics
- Tranquilizers
- Cyclic antidepressants
- Amphetamies
- MAOIs
- Anti-Ch drugs
- Illicit drugs
What are the S/S of mild hypothermia?
- amnesia
- poor judgement
- hyperventilation
- bradycardia
- shivering
What are the S/S of moderate hypothermia?
- Loss of coordination
- Decreasing RR/depth
- No shivering
- bradycardia
What are the S/S of severe hypothermia?
- Decreased LOC
- Slow respirations/apnea
- A-fib
- decreased BP
- decreased HR
- Ventricular irritability
What are the “progressive techniques” of patient cooling in hyperthermia?
- removed from hot environment
- remove clothing
- mist/sponge with water
- ice packs in axillae and/or groin
In the case of traumatic drowning with cardiac arrest, the Trauma Cease Resuscitation Protocol (T-3) should be implemented if submersion is over ______.
A. 30 minutes
B. 60 minutes
C. 90 minutes
C. 90 minutes
What warming techniques are used in hypothermic patients?
- remove from cold environment
- remove wet clothing
- cover with dry sheets/towels/warm blankets
- give warm IV fluids
How does cardiac arrest in the hypothermic patient vary?
Mild hypothermia: no change
Moderate hypothermia: Double time between medications; defibrillated as usual
Severe hypothermia: Epinephrine ONLY with doubled time between administration; single defibrillation for pVT/VF
Ingestion of a stimulant requires management under what protocol?
Behavioral emergencies (M-10)
______ must be administered in a dedicated IV line, mixed with no other drugs.
A. Glucagon
B. Hydroxocobalamin
C. Ondansetron
D. Atropine
B. Hydroxocobalamin
Which medications require orders from a physician for administration in the case of suspected poisoning?
- Atropine
- Calcium chloride
- Zofran/glucagon
- Hydroxocobalamin
For symptomatic organophosphate poisonings, what must be given?
A, Atropine
B. Calcium chloride
C. Zofran/glucagon
D. Hydroxocobalamin
A, Atropine
For hypotension associated with beta-blocker/calcium-channel blocker OD:
A, Atropine
B. Calcium chloride
C. Zofran/glucagon
D. Hydroxocobalamin
C. Zofran/glucagon
For magnesium toxicity/calcium-channel blocker overdose:
A, Atropine
B. Calcium chloride
C. Zofran/glucagon
D. Hydroxocobalamin
B. Calcium chloride
For suspected cyanide poisoning, what must be given?
A, Atropine
B. Calcium chloride
C. Zofran/glucagon
D. Hydroxocobalamin
D. Hydroxocobalamin
In the case of suspected dystonic reactions from anti-psychotics, what may be given to adult, non-geriatric patients?
50 mg diphenhydramine IV/IM
Known TCA ingestion with wide-complex rhythms are given ______.
Sodium bicarbonate
TCA overdoses with wide-complex rhythms in patients between 50-74kg are given ______.
50 mEq sodium Bicarbonate IV
TCA overdoses with wide-complex rhythms in patients over 75 kg are given ______.
75 mEq sodium Bicarbonate IV
Atropine is administered for organophosphate overdoses. By what mechanism does it affect S/S?
A. By freeing glucose from glycogen.
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
D. Overcoming calcium channel blockade/increases force of contraction.
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
By what mechanism does glucagon treat calcium channel overdose?
A. By freeing glucose from glycogen.
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
D. Overcoming calcium channel blockade/increases force of contraction.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
By what mechanism does glucagon treat beta-blocker overdose?
A. By freeing glucose from glycogen.
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
D. Overcoming calcium channel blockade/increases force of contraction.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
By what mechanism does glucagon treat insulin overdose?
A. By freeing glucose from glycogen via enzymatic activity (activation of PKA creates a step-wise series of reactions to cleave liver glycogen)
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
D. Overcoming calcium channel blockade/increases force of contraction.
A. By freeing glucose from glycogen via enzymatic activity (activation of PKA creates a step-wise series of reactions to cleave liver glycogen)
The first step in management of the syncope/ditziness patient is:
A. Assessment of ABCs
B. BGL
C. 12-Lead ECG
A. Assessment of ABCs
If a syncope/dizziness patient presents with a blood glucose under ____ mg/dL, proceed to the AMS protocol.
A. 70
B. 60
C. 50
D. 40
C. 50
When faced with a syncope/dizziness patient with a BGL over 50 mg/dL, what should be evaluated next?
ECG: 4-lead
If there is any arrhythmia besides _____ in the syncope/dizziness patient, a 12-lead ECG is warranted.
Sinus tachycardia
_______ is a tool utilized to determine the cause of dyspnea (asthma/COPD versus CHF).
End-tidal CO2:
- bronchospastic waveform is found found in Asthma/COPD
- normal waveform found in CHF
For bronchospasm, adults are administered _______ and _______ in a nebulized form.
- 6 mg albuterol
- 1 mg ipratropium
Bronchospastic adults may receive what medication after Duo-Neb?
125 mg IV Solmedrol or 60 mg PO Prednisone
- Steroids take a long time to act (appx. 4-6 hours), but act to counteract the inflammatory process associated with allergy/asthma.
In the adult respiratory patient for whom Duo-Neb and steroids are not improving their condition, __________ may be administered.
2 gm Magnesium IV/15 minutes
_______ may be administered to adult dyspnea patients for whom Duo-Neb, steroids, and magnesium has been unsuccessful.
0.3 mg 1:1,000 epinephrine IM
Magnesium for geriatric adult respiratory distress.
1 gm
Magnesium for non-geriatric adult respiratory distress.
2 gm
By what mechanism does CPAP assist in pneumonia?
There may be pulmonary edema 2/2 inflammation and the infectious process. CPAP acts to maintain alveolar opening as it would in CHF/pulmonary edema.
What are the S/S of suspected pulmonary edema?
- rhales
- JVD
- peripheral edema
CPAP may be administered in adult dyspnea patients if the SBP is over _____.
90 mmHg
SL or topical NTG may be given to adult dyspnea patients if you suspect their dyspnea is related to ______.
CHF/pneumonia
For the pediatric respiratory distress, oxygen should be titrated to _____.
A. over 90%
B. Over 92%
C. Over 94%
D. Over 96%
C. Over 94%
For the pediatric respiratory distress, what are the S/S that would indicated possible sepsis?
fever, decreased PO intake, dehydration
For the pediatric respiratory distress, if no inspiratory stridor is present, what is administered first?
A. Methylprednisone IV
B. Albuterol/Ipratropium
C. NS bolus at 20 mL/kg
D. Prednisone PO
B. Albuterol/Ipratropium
In pediatric respiratory distress, what is the dose of albuterol/Ipratropium?
6 mg nebulized albuterol
1 mg ipratropium
What is the mechanism of action of albuterol?
alpha and beta receptor agonist, which acts to:
- Increase heart rate, increase cardiac contractility, increase peripheral vasoconstriction (alpha effects)
- Promote bronchodilation (beta effects)
What is the mechanism of action of ipratropium?
Acts to reduce bronchoconstriction by blocking muscarinic receptors in bronchial smooth muscle.
Ipratropium is a compound produced by mixing isopropyl bromide and _____.
atropine
In peds respiratory distress, what are the mild/moderate S/S that would prompt administration of steroids?
- No retractions
- No extremis (hypotension, AMS, etc.)
- No bronchospastic waveform on capnography
- ETCO2 under 35 mmHg with increased RR
- No hypoxia (SpO2 under 94%)
In peds respiratory distress, assessment of severe bronchospasm includes what findings during physical?
- prior intubation
- prior ICU stay
- Hx of asthma
In severe peds respiratory distress and not with suspected croup, what should be administered quickly?
A. 1:1,000 epinephrine IM
B. 5 mg albuterol
C. 125 mg solumedrol
A. 1:1,000 epinephrine IM
S/S of croup:
- Severe inspiratory and expiratory stridor (seal-like cough)
Initial treatment for croup involves ______.
humidified oxygen
Stridor at rest in the peds respiratory distress patient should be given ______.
nebulized albuterol
What protocol do you go to if patient is not normal thermic in Medical Cease Resuscitation protocol?
Environmental Emergencies (M7)
What two actions must be taken when calling a stemi?
Call EMS stemi alert, place defib pads
Which patients get a 12-lead ECG asap?
Syncope, suspected cardiac chest pain, dysrhythmia or suspected ischemic equivalent
When do you give supplemental oxygen?
if pulse oximetry is <92 on room air, patient with abnormal breathing, or signs of inadequate perfusion
How many times should stable patients be evaluated?
2, every 15 minutes minimum
If initial AIC is not transporting what should be documented?
time of transfer, name of provider assuming care
What 3 types should you pre alert dispatch for?
STEMI, Stroke, Trauma
After significant status changes and/or interventions what should happen?
Vital repeated
What questions to include with all pediatric patients?
immunization history, number of wet diapers/urine output, oral intake?
When do you consider assisting ventilations in a peds patient?
signs of inadequate ventilation, altered mental status, signs of inadequate perfusion
4 items to include in a pre alert to receiving hospital?
Chief complaint, brief assessment vitals if available, treatments, eta
How long should an initial assessment in a trauma take?
<1 minute
Which type of trauma gets supplemental oxygen?
Head trauma
7 additional questions to ask ob patients during events leading up to calling 911
first day of last menstrual period,
estimated weeks gestation(if <15 weeks is there an ultrasound documented intrauterine pregnancy)
gravida/number of pregnancies’ including this one, para/number of deliveries
any known complications with this pregnancy
whether this is a single or multiple pregnancy
time on onset of labor, membranes have ruptured(when), discoloration of amniotic fluid
any vaginal bleeding, trauma that caused the bleeding or pain with the bleeding
What to have with patient at all times in ob call
ob kit
oxygen
towel/sheet
pediatric bvm
What is needed for pre alert on rapid fetal assessment or active labor?
pt age
G# P# A#
assessment including, weeks gestation, time of onset of labor, frequency of contractions, any bleeding, whether membranes ruptured
name of obgyn
treatments
eta
note if pt is code red (gestation <36 week in active labor, known abnormal presentation (breech, etc), known prenatal complications, distressed neonate delivered in field)
Contraindications of Aspirin
Pregnancy
Hypersensitivity to aspirin, salicylates and NSAIDS
Caution if: asthma, chronic liver disease: single dose is still appropriate in STEMI
At what age does a pediatric patient get the full tube of glucose
2 years or older gets full tube 24g of dextrose
What are the contraindications of glucose?
Inability of patient to maintain own airway and prevent aspiration of oral medication
Hyperglycemia
Hypersensitivity to corn or corn products
What are the contraindications for Nitroglycerin?
hypersensitivity to organic nitrates
use of ANY erectile dysfunction drug within 48 hours, except sildenafil(viagra) within 24 hours
use of pulmonary hypertension drug in women such as sildenafil(Revatio)
caution if: inferior wall MI with suspected right ventricular involvement (ST elevation in II, III F)
Nitro Dose
.3-.6 mg every 5 minutes
sublingual tabs are .4 mg
topical is 2%
Dose for albuterol
2.5 mg in 3 ml
initiate treatment with two bullets of nebulized albuterol
Contraindications for albuterol
Hypersensitivity
Caution if: tachyarrhythmia (not sinus tach)
What should be offered to every patient?
Unconditional offer of transport
When requesting a paramedic level evaluation for patient declination of care what should that patient be retriaged as?
Yellow
Triaged Red patient must have what level of evaluation for patient declination of care?
Medical director consult
What should the provider give the patient declining care against medical advise?
info on specific treatments, benefits of treatments, and specific risks of declining treatment and transport
What four things plus a full set of vital signs should a provider obtain to properly inform a patient declining care?
history of present illness/injury, circumstance of 911 activation(patient or 3rd party), past medical history, any history of self-injury or suicidality
What are the components of being competent and have the capacity to understand risks
normal mental status
capacity for decision-making verified
absence of head injury
Components to verify capacity for decision-making
absence of clinical intoxication(alcohol, drugs), normal speech no slurring
normal coordination(gait, fine motor function)
no nystagmus
normal ability to pay attention and respond appropriately to questions/requests
Components of a patient safety net after declination of care
plan to seek care through another ave (PCP)
someone with them to call ems if patient status changes
advising they can call back for care at anytime
syncope or seizure patients should be instructed that they may not drive or operate machinery until cleared by physican
if patient declines to sign, witnesses to this conversation should be documented prefer pd with badge number
Which patients should PD be involved with and not be allowed to decline care?
altered mental status and impaired judgment or active suicidality
If a parent is reached by phone for minor declination of care what should be documented?
time, phone #, name, and relationship, and plan to retrieve the patient
What exam must be completed to asses capacity?
mini-mental status exam
What patient do to adequately reflect understanding of assessment, risks and benefits being communicated to them>
repeat back in their own words and reflect understanding of the assessment
For patients with suspected cardiac chest pain or anginal equivalent what score should be giving to the patient when declining?
TIMI Risk Score, low intermediate or High
In hypoglycemia patients what may be an early sign of concerning problems including infection, or heart attack?
low blood sugar in patients whose insulin dose has not changed may be the only sign
What six elements and division leader agreement are required for hypoglycemic patients to decline care?
patient is insulin-dependent only, no oral agents, or long acting insulins like lantus and humalog
patient has eaten carbohydrates, no hx of vomiting or diarrhea or fever that led to low bgl
Someone with the patient to monitor patients mental status
repeat glucose level of at least 100 for iv dextrose or 70 for oral glucose
returned to baseline mental status and competent
plausible reason for hypoglycemic episode
What are the long acting insulins that require medical director consult for patient to refuse?
Lantus or Humalog
Division leader approval is needed for what patient declination of care situations?
incompetent patient
suicidal or homicidal ideation
declination in police custody
hypoglycemic patient who meets all 6 criteria
Medical Director consult is required for which patient declination of care situations
triaged red
hypoglycemic that does not meet the six criteria
Glucose assessment is indicated in which patients?
AMS, Combativeness, stroke like symptoms
Patients with a glucose reading of high may show signs and symptoms of what?
inadequate perfusion, consider fluid resuscitation procedure
CO level of 0-5% actions
supportive care, no further evaluation
CO 6-15%
02 sat >90% if yes then are they showing S/S of co poisoning or hypoxia are the pregnant?
if yes give 100 02 via non rebreather
actions above 15% co level
100% 02 transport to ed
Smokers may have a CO baseline up to?
10
any above 10 must be evaluated they are always abnormal
Which patient should get 02 therapy and transported even when normally wouldnt?
Pregnant women exposed to CO
Looking at etCO2 when is CPAP withheld?
Sharkfin is present
ETCO2 waveform is prolonged what action to take?
CPAP,
How many cycles of no bvm in CCR?
first 3 cycles
What are the steps for cardiac arrest management flowchart (p-30)
Pulseless/apneic w/o incompatible with life signs
hypoxic arrest go to cpr
non hypoxic start ccr delay bvm vent to after first 3 cycles
Cardiac arrest protocol MC4-5), airway management p-10, cardiac arrest management procedure p-30
medical or trauma?
Rosc?
if no Medical Resuscitation protocol (MC-9)
What is CCR designed to do?
sustain the highest possible aortic pressure
In patients with suspected primary cardiac events what method of resuscitation will be used?
CCR
In Cardiac Arrest Management what should be immediately brought to the patients side?
AED or Monitor/ with waveform capnography Metronome Cardiac arrest checklist BLS triangle Standard jump bag Airway management equipment 02 suction
What is the minimum ppe for provider at the airway management position?
gloves, mask, eye protection
AED pad placement
heart electrode lateral to the left nipple midaxillary line
other right upper torso lateral to sternum below clavicle
What position obtains pulse with compressions at 180?
Code commander
How many metronome beeps until resume compressions?
15
At what point does the compressons stop and AED is in analyze mode?
at 220 position 2 presses analyze
Compression ratio should be what?
90% or greater
Any pause over __ seconds diminishes the compression ratio
3 seconds
Non hypoxic medical arrest airway management is done by?
02 at 15lpm via non rebreather with oral airway
3 cycles of 220 compressions
When 3 to 4 providers are onscene what must continually be monitored?
femoral pulse
In patients with repeated rhythm changes resuscitation should continue until?
PT in asystole at least 15 mins or total of at least 30 mins of active resuscitation
If EtC02 persistently < __ with CPR, may consider cease resuscitation by standing order at __ minutes
10, 20
List 10 steps to mini mental status exam
orientation to time 1 point each total 5
orientation to place 1 point each total 5
Repeat 3 words 1 point each total 3
spell “world” backward or count backward by 3 from 20/ 1 point each total 5
remember previous 3 words 1 point each total 3
pt perform a 3 step command 1 point each total 3
name 2 objects you point at 1 point each total 2
read a sentence then perform its actions 1 point
patient write a sentence 1 point
draw to overlapping pentagons then patient does it 1 point
How many points is considered competent in mini mental status exam?
over 21
What are the reversable causes in an arrest situation?
Hypovolemia Hypo/Hyperkalemia Hydrogen Ion (acidosis) Hypoxia Tension pneumothorax Toxins Thrombosis
Patient with critical or serious hemodynamic, physiologic, or mental status changes or a significant expectation that patient will acutely decompensate in the short term
Code Red
Loc less than verbal, or acute gcs < 14
code red
High risk or complicated obstetric patient > 20 weeks gestation
Code red
Newborn with APGAR score < or equal to 7 at 5 minutes
Code red
What Trauma physiologic findings are code red and require Level 1 Trauma center
GCS < 14
SBP < 90 or signs of shock
Respiratory rate < 10 or >29 or need for respiratory support
What Trauma mechanism is code Red and requires level 1 Trauma
Penetrating injury to head, neck, torso, or extremities proximal to knee or elbow
Patient with currently non-critical, though potentially serious hemodynamic, physiologic, or mental status changes with potential for decompensation in the short term
Code yellow
What triage is a patient that is non compliant with psychiatric medication
Code Orange
How long does Rosc need to be present to restart the timer of cease resuscitation?
5 minutes or more will start the new timer.
What is EXTREMIS s/s
Near arrest
unable to speak,
tachypnea
hypotension
What are Anaphylaxis s/s
sudden onset severe flushing rash, hives severe bronchoconstriction laryngospasm anxiety sense of impending doom Loc decrease then unconscious
What are Allergic reaction S/s
gradual onset mild flushing rash, hives mild bronchoconstriction normal mental status
In pediatric medical protocol what are the first two considerations of the protocol?
02 to maintain sat above 94
inspiratory stridor?
What is the first consideration in adult respiratory distress protocol?
Suspected bronchospasm? (asthma, COPD)
In the respiratory distress adult protocol if bronchospasm is not suspected what should be considered and actions to take?
CHF, pneumonia
02 above 94
In neonate resuscitation triangle when to assist ventilation with bvm?
heat rate less than 100
or apneic after 30 seconds
Neonatal resuscitation triangle compression ratio
3:1 with ventilations
120/min
Categories of APGAR scoring
Apperance pulse grimace activity respiration
what gets a 0 on apgar
pale, cyanotic blue absent pulse no grimace response limp absent respiration
What gets a 1 in APGAR
pink body blue limbs less than 100 pulse grimace some flexion slow less than 30 or irregular
What gets a 2 APGAR scoring
Completely pink over 100 pulse cry, cough, sneeze active motion good crying
