Procedures Flashcards
what is a required diagnostic to be used when you intubate a patient?
ETCO2
what are the 2 “relative contraindications” of intubations? IT can lead to worse outcomes…
pediatric pts and head injury pts
If a ET tube becomes dislodged, what does DOPE stand for?
Dislodge
Obstruction
Pneumothorax
Equipment Failure
how many attempts at ET tube can you try before you need to move onto a BLS airway?
2
What are the the 4 contra indications to not nasal intubate a pt?
- Apnea
- Severe Mid-face trauma
- BLOOD THINNERS
- JAUNDICE
how old does a pt need to be for a nasal intubation?
12 yo and up
how soon do you need to notify EMS division about a cricothyrotomy?
24 hours
when should you consider doing a cricothyrotomy?
when there is an away issue and an airway is needed, ALL other means of ventilation have been exhausted.
- CAN NOT INTUBATE CAN NOT VENTILATE
Ex:
- anaphylaxis
- burn
- choking (consider right main stem first)
- major facial trauma
what are the contraindications for a cricothyrotomy?
less than 12 yo
what are the major contraindications of using CPAP?
- BP <90
- pneumothorax
- Lack of airway protective reflexes
- Significant altered level of consciousness (unable to follow verbal commands)
- Trauma
- Resp or cardiac arrest
When is ETCO2 mediatory to use?
Any ET tube placement.
What does low CO2 values represent (<25)?
Low perfusion:
- Sepsis
- PE
- hyperventilation (hyperglycemia, acidosis, or anxiety)
when you see the ETCO2 level dropping during CPR what is one thing you can do to see if you can make it go back up?
Switch the person doing compressions
At what level of CO2 after 20 min of CPR likely represents low CO2 and poor outcome to justifying stopping CPR efforts?
10 mmHg
A sudden spike in CO2 during CPR can indicate what?
ROSC
ALL 3 have to be present to indicate needle thoracotomy for a tension pneumothorax?
- severe respiratory distress
- hypotension and signs of shock
- unilateral absent or decreased breath sounds
When should you consider bilateral needle decompression?
Chest blunt trauma and there is traumatic pulseless arrest
how many joules do you cardio vert an adult?
200J
how many joules do you cardiovert a child?
0.5-1j/kg
does the tachycardia cause the hypotension?
what blood pressure can you give a benzodiazepine to?
most like the hypotension is from the rapid heart rate.
88-90 systolic = benzo
<88 systolic = straight to cardiovert
A-flutter or A-fib, should you cardio vert them right away?
NO, try to fix the cause with O2 and fluids. cardiovert in a-fib you can risk a stroke.
What do you need to do if you have to pace a child under the age of 12yo?
contact base, it is rare that they need pacing.
what are the starting values of pacing?
80 mAmps
80 beats per minute
how much do you increase the mAmps if you have not gotten capture?
10 mAmps every 10-15 secs.
check the femoral pulse once you have electrical capture.
what are the three indications that you can consider IO? When do you need to contact base?
- Cardiac arrest
- Severe hypotension with poor perfusion
- Hypoglycemic (unresponsive) and no IV access
Contact base for any other circumstances
Can you remove IOs in the field?
no
how many attempts can you make an IO attempt in a single site?
1
What are the contraindications for IO placement?
- fracture
- compartment syndrome
- prosthetic
- infection
Can EMTs do humoral head IO placements?
NO
What age can you do a proximal tibia or a distal femur IO?
Age 1-12
what age do you do a manual insertion of IO?
<1 yo
After placing a tourniquet what is one thing you need to do?
mark the skin or the tourniquet with time and date of placement.
What is the number one indication of the use of physical restraints?
if the pt is posing danger to themselves or providers
What are the 4 indications for the use of physical restraints?
- significantly impaired (intoxication, medical illness, injury, psychiatric condition) and lacks decision making capacity.
- pt who exhibits violent, combative, or uncooperative behavior and does not respond to verbal de-escalation
- pt who is suicidal and concern of harming themselves
- mental health hold and concern of elopement
can law enforcement tell Ems to use restraints?
NO, must be under the clinical judgment of the provider
are handcuffs an appropriate restraint tool?
no
What are the major points to document when there was the use of restraints?
- description of the scene and the pt
- efforts to de-escalate the pt
- type of restraint used
- condition of the pt when restraints were placed, and reevaluations of pt
- condition of the pt when transferred to hospital
- any injury of pt or of EMS staff
NEVER use AxO4 for the pt mental status when use of chemical restraints
Where can you NOT remove the probes of a taser?
- eye
- genitals
- close to major neuromuscular structures
go to ER for removal
What drug do you consider for a person who is hypotensive and needs pain management?
Ketamine
