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SNHD EMT Basic Protocols > Operations > Flashcards

Operations Flashcards

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1
Q

Stroke Destinations

A

Centennial Hills
Desert Springs
Mountain View
Southern Hills
Spring Valley
St. Rose San Martin
St. Rose Siena
Sumerlin Medical Center
Sunrise
UMC
Valley

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2
Q

Pediatric Destinations

A

St. Rose Siena
Summerlin
Sunrise
UMC

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3
Q

L&D Destinations

A

Centennial Hills
Henderson
Mesa View
Mike O’Callaghan Federal
Mountain View
Southern Hills
Spring Valley
St. Rose San Martin
St. Rose Siena
Summerlin Medical Center
Sunrise
UMC
Valley

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4
Q

When should you establish telemetry contact?

A
  • All time-sensitive or life-threatening condition transports
  • Medical emergency in which EMS judgment suggests consultation with a telemetry physician is necessary
  • All trauma pts going to trauma center
  • Telemetry contact required per protocol
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5
Q

TFTC telemetry reports should include

A

ETA
Pt Age
Gender
MOI
Ambulatory at scene
Suspected injuries
Vital signs
Airway statis
Neurological status
Incident identifier if multiple pts involved

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6
Q

What should be included in telemetry for suspected Contact Isolation?

A
  • General type of agent involved (insect, chemical, biological, radiation, nuclear, explosive)
  • Type of agent if known
  • General type w/ patient symptoms (Unkown chemical substance causing respiratory distress w/ secretions)
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7
Q

What are the minimum requirements for non-traumatic or Contact Isolation telemetry?

A

“Information Only Telemetry”
Attendant/vehicle identification
Nature of call
Patient information - age, sex, number
Patient condition - stable, full arrest
Hx - cc, pertinent sxs, time of onset, pmh
Objective findings - general status, level of responsiveness, vital signs, pertinent localized findings, working impression of pt’s problem
Treatment- in progress, request for drugs or procedures
ETA - include circumstances that may cause delay

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8
Q

For patients meeting “Code White” or “Code STEMI” criteria…

A

A preliminary telemetry report should be made to notify the receiving facility of the type of activation, and ETA. “Information Only” telemetry should follow once transport is initiated.

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9
Q

Supportive Care

A

Suction
Administer oxygen
Position for comfort
Splint
Control bleeding
Pain medication (ALS only)
Emotional support
Contact hospice, home health agency, attending physician or hospital

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10
Q

What is a valid DNR?

A

Form, wallet card, or medallion issued by SNHD. NV Division of Public and Bhavioral Health, or an identification issued by another state

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11
Q

What is a DNR Order?

A

Written directive issued by a physician licensed in this state that life-resuscitating treatment is not to be administered to a qualified patient.

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12
Q

What is a POLST?

A

A physician that records the wishes of the patient and directs a healthcare provider regarding the provision of life-resuscitating treatment and life-sustaining treatment.

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13
Q

The DNR/POLST ORder or Idenfitication can be determined invalid if

A

at any time the patient indicates that they wish to receive life-resuscitating treatment.

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14
Q

What is considered Life-Resuscitating Treatment?

A

CPR and its components including:
Chest compressions
Defribrillation
Cardioversion
Assisted ventilation
Airway intubation
Administration of cardiotonic drugs

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15
Q

Protocol if you are unwilling or unable to comply with DNR?

A

Must take reasonable measures to transfer pt to another provider or facility in which the DNR/POLST will be followed.

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16
Q

A patient is:

A

Anyone with a complaint or mechanism suggestive of potential illness or injury
Obvious evidence of illness or injury
Individual or informed 2nd/3rd part caller requests evaluation for potential illness or injury

17
Q

PCRs shall include no less than:

A

Patient’s name, address, age, and sex
Date and location of call
Time of dispatch, arrival at scene, departure from scene, and arrival at hospital
MOI - cc
Medications sed by pt and allergies
PMG, including current medication and allergies
SXS identified during assessment and changes
Care and tx given at a scene and during transport
Pt destination
Name of attendants
If care is provided as authorized by protocol
File attachments
Trauma score, TFTC status, and injury mitigation devices in cases of trauma
At least one full set of vital signs

18
Q

What file attachments should be included in PCR?

A
  1. Assessing and/or monitoring cardiac rhythm
  2. Obtaining a 12-lead EKG
  3. Providing electrical therapy, cardioversion, defibrillation, and/or pacing
  4. Monitoring ETCo2 levels and/or waveform of an intubated pt
19
Q

What is included in a full set of vital signs?

A

BP
HR
RR
Temp as indicated
Oxygen saturation
Reassessment after interventions
Any complications or other relevant information

20
Q

Definition of Hostile Mass Casualty Incident

A

Persons under assault require the immediate need for teams to enter the warm zone to provide initial tx and triage.

21
Q

Patients who appear to have expired will not be resuscitated or transported by EMS if:

A

Any of the obvious signs of death are present OR all 5 presumptive signs of death and at least one conclusive sign of death

22
Q

What is required to perform before contacting medical control for a traumatic injury suspected to be incompatible with life?

A

Perform 2 minutes of CPR

23
Q

Obvious signs of death

A

A. body decomposition
b. decapitation
C. transection of thorax (hemicorpectomy)
d. incineration
e. other traumatic injuries suspected to be incompatible with life, medical control must be contacted for medical direction.

24
Q

Presumptive signs of death

A
  1. unresponsiveness
  2. apnea
  3. pulselessness
  4. fixed, dilated pupils
  5. non-traumatic arrests, asystole in two leads, or “No Shock Advised: prompt from AED
25
Q

Conclusive signs of death

A
  1. dependent lividity
  2. rigor mortis
26
Q

Once is has been determined that the patient has expired and resuscitation will not be attempted:

A

a. immediately notify the appropriate authority
b. DO NOT leave body unattended. Excused by a responsible person if present (Coroner’s investigator, police, security, or family member)
c. DO NOT remove any property from the body or the scene for any purpose (including equipment used)
d. NEVER transports/move a body without permission from the Coroner’s office except for assessment or its protextion

27
Q

If the deceased body is in public view and cannot be isolated, screened, or blocked from view, creating an unsafe situation with citizens/family, what should you do?

A

Cover the body with a clean, sterile burn sheet from the ambulance

28
Q

A person who is suspected to be intoxicated and has no other emergent need shoulder be transport to approved alcohol and drug abuse facility IF the patient meets ALL the following criteria:

A

a. Pt is able to stand w/ minimal assistance of one or two people
b. vital signs as follows:
1. BP: 90-180/60-100
2. HR: 60-120
3. BG: 60-250
5. GCS >= 14
6. SPO2 >94% or 90% if smoker
7. No acute medical complications
8. No signs of trauma
9. No suspected head injury
10. Approval of physician or medical staff upon assessment prior to transport to an alternative facility

29
Q

Step 1 of Trauma Field Triage Criteria

A

Measure vital signs and level of consciousness. If the patient’s
a. GCS is 13 or less;
b. Systolic BP <90 mm Hg; or
c. RR <10 or > 29 bpm or needs ventilatory support

The adult pt MUST be transported to a Level 1 or Level 2 center for trauma treatment. PEDs MUST be transported to the pediatric center

30
Q

Step 2 of Trauma Field Triage Criteria

A

Assess the anatomy of injury. If the patient has:
a. penetrating injuries to head, neck, torso, or extremities proximal to elbow or knee
b. chest wall instability or deformity (flail chest)
c. two or more proximal long-bone fractures
d. crushed, degloved, mangled, or pulseless extremity
e. amputation proximal of wrist or ankle
f. pelvis fx
g. open or depressed skull fx
h. paralysis

the adult pt MUST be transported to Level 1 or 2 trauma center

31
Q

Step 3 of Trauma Field Triage Criteria

A

Assess MOI and evidence of high-energy impact which may include:
a. falls
1. adults: > 20 feet (one story = 10 feet)
2. peds: > 10 feet or two times their height
b. high-risk auto crash
1. motor vehicle traveling at least 40 mph immediately before collision
2. intrusion, including roof: > 12” occupant site, > 18” any site
3. partial or complete ejection
4. rollover w/ unrestrained occupants
5. death is same passenger compartment
c. motorcycle crashes > 20 mph
d. auto vs ped/bicyclist thrown, run over, or significant impact > 20 mph

The pt MUST be transported to Level 1, 2, or 3 trauma center

32
Q

Step 4 of Trauma Field Triage Criteria

A

Assess special patients

a. older adults
1. risk of injury/death increases after 55 y/o
2. SBP < 110 mm Hg could represent shock after age 65
3. low impact mechanisms might result in severe injury
b. children shoulder be traige preferentially to a trauma center
c. anticoagulants and bleeding disorders: pt w. head injury at high risk of rapid deterioration
d. burns
1. w/o other trauma mechanisms: transport following burns protocol
1. w/ trauma mechanisms: follow catchment guidelines for trauma. Pt w/ St. Rose Siena catchment - Sunrise. Mike O’Callaghan catchment - UMC.
e. pregnancy > 20 weeks
f. EMS provider judgment

The pt MUST be transport to LEvel 1, 2, or 3 trauma center

33
Q

Are EMS personnel obligated to continue resuscitation efforts started by other persons at the scene?

A

No, only if the pt meets the criteria of the Prehospital Death Determination protocol

34
Q

Resuscitation has started in the field. How would you terminate resuscitation for medical arrest?

A

Telemetry physician orders from the closest hospital when the following conditions are met: pt remains in persistent asystole or agonal rhythm after 20 minutes of including:

  1. CPR
  2. Effective ventilation w/ 100% oxygenation
  3. Administration of ACLS medications
  4. Confirm no organized rhythm or PEA <40 or “No Shock Advised”
35
Q

Resuscitation has started in the field. How would you terminate resuscitation for trauma arrest?

A

Contact trauma center based on catchment for telemetry physician order when the following conditions are met:
1. Open airway with BLS support measures
2. Provide CPR and effective ventilations w/ 100% oxygenation for 2 minutes
3. B/l needle thoracentesis performed if tension pneumo suspected
4. Confirm no organized rhythm, or PEA <40, or “No Shock Advised”

36
Q

When resuscitation has been terminated in the field, all medical interventions:

A

shall be left in place

37
Q

When can a body be left unattended?

A

Body can be turned over to a responsible person (i.e. Coroner’s investigator, police, security, or family member) present on scene

SNHD EMT Basic Protocols (7 decks)

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