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SOG 430 > Protocol > Flashcards

Protocol Flashcards

1
Q

Eye Opening

A

Spontaneous 4
To speech 3
To Pain 2
None 1

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2
Q

Best Verbal Response (BVR)

A 
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
none 1
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3
Q

Best Motor Response

A 
Obeys 6
Localizes 5
Withdraws 4
Abnormal Flexion 3
Abnormal extension 2
None 1
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4
Q

A mentally competent patient is considered to give informed consent when any of the following occur:

A

Patient gives verbal permission to treat
Patient gives written permission to treat
Patient does not object as you begin assessment.

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5
Q

If the medical personnel are concerned for the safety of minor and the parent or legal guardian refuses treatment and transport, contact

A

the rescue district/battalion chief and law enforcement for assistance with transport

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6
Q

A patient shall be defined as

A

a person who presents with subjective and/or objective signs and/or symptoms or a complaint which results in evaluation and/or treatment

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7
Q

A patient encounter is dependent on

A

neither treatment nor transport nor cooperation from the patient. If a technician perceives a medical problem that requires evalution a patient encounter has been made and a full patient care report must be completed.

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8
Q

Access to the storage safe can be achieved by

A

breaking the seal, then use the appropriate key or entering the individual paramedic’s PIN number and pressing the pound key.

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9
Q

Completed JFRD Controlled Substance Daily Checklists will remain with the notebook until collected by

A

the District/Battalion Chiefs and forwarded to the Quality Improvement Officer

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10
Q

Discrepancies concerning controlled substances will be

A

Reported to Rescue District/Battalion Chief
Recorded in the company logbook, including circumstances
Documented in the Explanation section of the JFRD Controlled Substance Daily Checklist
Investigated by the Quality Improvement Officer and Rescue District/Battalion chief with a discrepancy report provide to the Division chief of Rescue and the JFRD Medical director

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11
Q

Controlled substances with expiration date listing only the month and year will be

A

considered as expired on the first day of the month listed.

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12
Q

Monthly 23rd,24th, or 25th

A

Chief inspection of controlled substance

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13
Q

Controlled substance inventory

ALS Engine

A

Minimum- Midazolam 5mg

Maximum - Midazolam 10mg

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14
Q

Controlled substance inventory
Rescue Units
Minimum

A

Etomidate/Amidate-60 mg
Fentanyl 200mcg
Ketamine 500mg
Midazolam-15 mg

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15
Q

Controlled substance inventory
Rescue Units
Maximum

A

Etomidate/Amidate- 100mg
Fentanyl- 400mcg
Ketamine - 1500mg
Midazolam- 25mg

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16
Q

Controlled substance inventory will be determined and authorized by

A

Division chief of Rescue and the Medical Director

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17
Q

IV Fluids/Medications
Inventory
Medications with a specific expiration date:
Medications that have an expiration date of a month and a year

A

Expire on that date

expire at the end of that month

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18
Q

The JFRD is responsible for the

A

welfare of the patient and all medical treatment at the scene of an emergency

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19
Q

Law enforcement is responsible for

A

traffic control and general scene management.

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20
Q

Blood draw on patients

In your report, record

A

the date printed on the blood draw kit and the investigating officer’s name.

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21
Q

Restrained patients shall be

A

placed in a supine postion

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22
Q

Frequently assess the patient to ensure that the

A

airway is patent, distal limb circulation is adequate and that restraints can be released quickly should the patient’s condition deteriorate.

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23
Q

The Intention of Quality Improvement will be

A

to train.

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24
Q

When JFRD personnel suspect that abuse or neglect to a child or vulnerable adult has taken place, they shall initiate the following

A

Treat related injuries
Transport all suspected cases
If transport is refused:
Request law enforcement at the scene
Stay with patient until Law enforcement arrival
Notify the Rescue District/Battalion Chief

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25
Q

Resuscitation efforts may be terminated only when all of the following criteria exists

A

Arrest was not witnessed
No shocks provide prior to JFRD arrival
Patient is > 18 years old
Rhythm remains asystole after providing 20 minutes of full ACLS

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26
Q

Acutely hypothermic patients in cardiac arrest shall be

A

treated and transported

Includes submersion victims

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27
Q

If law enforcement denies you access to the scene

A

You must obtain the law enforcement officers name and badge number.

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28
Q

If patient not assessed by medical staff within 15 minutes of arrival

A

consult with charge nurse or nurse manager for guidance; if there is an issue contact your district/battalion chief

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29
Q

Rescue personnel will transfer patient to the hospital stretcher in a timely and expedient manner. If the transfer is delayed

A

more than 30 minutes notify FRCC.

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30
Q

If, after informing patient of the state guidelines, the patient still insists on transport to another facility, transport will proceed according to patients wishes

A

This must be documented in Emergency Pro in the Trauma section of the Incident Tab.

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31
Q

Emphasis should be placed on early identification of

A

cardiac arrests with continuous well performed compressions, defibrillation and rapid transport

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32
Q

Use of an AutoPulse is contraindicated

A

in trauma patients

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33
Q

Trauma V-fib/Pulseless V-Tach

Administer medications starting with

A

Epinephrine 1 mg (1:10,000)IV/IO
Repeat Epinephrine every 3 to 5 minutes(consistently)
Do not mix with any other drugs

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34
Q

Recurrent VF/VT give

A

Amiodarone 300mg Iv/IO

Repeat Amiodarone once at 150 mg IV/IO

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35
Q

Forr Torsades de Pointes
Polymorphic VT
Refractory VF/VT

A

Give Magnesium Sulfate 2 grams IV/IO

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36
Q

Magnesium Sulfate is to be used as the first antiarrhythmic of choice

A

in Torsades(polymorphic VT)

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37
Q

H’s and T’s and their appropriate treatments

Hypovolemia

A

fluid challenge with 2L max

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38
Q

H’s and T’s and their appropriate treatments

Hypoxia

A

100% O2 with use of BVM and appropriate airway adjunct

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39
Q

H’s and T’s and their appropriate treatments

Hydrogen Ion= acidosis

A 
Sodium Bicarbonate 1mEq/kg IV/IO
Condtraindications
None is Asystole/PEA
Precautions
Do not mix with other drugs and flush line well after injecting
Inactivates Epinephrine when mix
Inactivates Dopamine when mix
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40
Q

H’s and T’s and their appropriate treatments

Hyperthermia/Hypothermia

A

cool or warm as needed

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41
Q

H’s and T’s and their appropriate treatments

Hypoglycemia

A

D50W 25grams IV/IO for a BGL less than 60 mg/dl

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42
Q

H’s and T’s and their appropriate treatments

Toxins/Tablets

A

Narcan 1mg- 2mg IV/IO

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43
Q

Shock Trauma

Orotracheal intubation

A

Administer Ketamine 2mg/kg IV/IO

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44
Q

Administer Midazolam in

A

2-5 mg increments IV/IO to maintain sedation, may repeat once in 10 minutes
Greater than 64 years old, administer in 2 mg increments

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45
Q

Midazolam contraindication

A

Intolerance to benzodiazepines
hypotension
Precaution: May cause hypotension

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46
Q

Head Trauma

Orotracheal intubation

A

Administer Etomidate 0.5 mg/kg IV/IO over 30 seconds
Peak effect: 1 minute, do not try to intubate for one minute
Duration: 3-5 minutes

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47
Q

Etomidate Contraindications

A

Known sensitivity
Cardiac/Trauma arrest
Precaution: Pregnancy

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48
Q

If Etomidate is not successful at completing sedation(ie trismus, combative) and post Etomidate systolic BP is

A

greater than 110mm/Hg, administer Midazolam 2-5 mg

49
Q

In cases of isolated spinal injuries

A

scene time is less critical and care should be taken in performing proper spinal immobilization.

50
Q

High cervical injury may cause

A

apnea

51
Q

Spinal Trauma

Dopamine

A

5-10 mcg/kg/min IV/IO

52
Q

Dopamine contraindications

A

Hypovolemic shock
Tachydysrhythmias
Precautions:
Patient receiving monoamine oxidase inhibitors

53
Q

Chest Trauma patients may

A

deteriorate rapidly. Load and go is a priority

54
Q

Sucking chest wound

A

apply Vaseline-type occlusive dressings to cover the wounds
Cover the occlusive dressing with sterile 4x4
Tape the dressing on three sides

55
Q

Mechanism of injury is the

A

most important indicator of abdominal trauma

56
Q

The best treatment for the patient with severe abdominal trauma is

A

rapid transport

57
Q

Abdominal Evisceration

A

Never replace abdominal viscera
Cover with sterile dressing and moisten with NS( may need to periodically remoisten)
Secure the wet dressing in place if possible.

58
Q

Extremity Trauma

Adult and pediatric Fentanyl

A

1 mcg/kg (Maximum single dose 100 mcg) Slow IVP only
May repeat once in 10 minutes
Total max dose 200 mcg

59
Q

Fentanly Contraindications

A

Hypotension (systolic blood pressure less than 90 mmhg)
Respiratory depression
Precaution:
Rapid administration may cause chest wall rigidity

60
Q

Crush injury

Adult

A

20 ml/kg Normal Saline; max 2L
include 50 mEq of Sodium Bicarbonate with initial normal saline liter prior to removing the compressive force
monitor for evidence of fluid overload

61
Q

Crush injury

Pediatric

A

20 ml/kg Normal Saline max 2L
Include 1 mEq/kg of Sodium Bicarbonate (Max dose 50mEq) with initial Normal Saline liter Prior to removing the compressive force

62
Q

Crush Injury

Life threatening dysrhythmias

A

peaked T waves or widening QRS complex
Calcium Chloride 5mg/kg (max dose 500 mg) over 2 minutes
Precaution: possible crystallization when mixed with Sodium Bicarbonate

63
Q

Only law enforcement officers are permitted to

A

remove probes

64
Q

Chemical burns

A

irrigate with NS for 20 minutes

65
Q

Chemical burns involving Lime, Carbolic Acid, Sulfuric Acid, Solid Potassium or Sodium metals

A

Do not flush wounds with water, normal saline, sterile water, etc
Contact receiving physician for treatment

66
Q

Superficial burns

A

Apply burn gel dressing if needed

67
Q

Partial Thickness burns

A

apply dry, sterile dressings

leave blisters intact

68
Q

Full-Thickness burns

A 
apply dry, sterile dressing
Adult and pediatric pain management
Fentanyl 1-2 mcg/kg (Maximum single dose 200 mcg) slow iv/io only
may repeat once in 10 minutes
Total max dose 400 mcg
69
Q

On lightning strike scenes where there are multiple patients

A

reverse triage shall be applied and patients in cardiac arrest shall be worked first

70
Q

Eye trauma

Direct trauma

A

Patch both eyes gently without pressure to the globes
Maintain patient in supine position to reduce leakage of fluids from the eye
If blood is noted in anterior chamber, place the patient in semi-fowlers
Stabilize any impaled object and cover affected eye dim lights for patient comfort

71
Q

Eye trauma

Chemical/Irritant Exposure (ie pepper spray, tear gas)

A

irrigate affected eye with normal saline during transport
Apply dry sterile dressings to both eyes
Dim lights for patient
Tetracaine 2 drops to each eye before and after irrigation
may be repeated every 10 minutes

72
Q

Tetracaine contraindications

A

known hypersensitivity to tetracaine or other ophthalmic anesthetics
Open ocular trauma

73
Q

Eye trauma

Atraumatic

A

Patch both eyes gently without pressure to the globes

Dim lights for patient comfort

74
Q

Patients presenting with chest pain should receive

A

Aspirin unless contraindicated or previously taken within 2 hours
Aspirin 324 mg PO, chewed

75
Q

Aspirin Contraindications

A 
Allergies to salicylates
Active GI bleeding
Precautions:
History of GI bleeding (consider Aspirin 162 mg po)
Use of anticoagulants
Pregnancy
76
Q

Normotensive (SBP > 110 mmHg) and evidence of Acute Coronary Syndrome

A

NTG 0.4 mg SL every 5 minutes until pain is resolved or systolic BP drops below 110 mmHG

77
Q

NTG Contraindications

A

Systolic BP less than 110 mmhg

Hypovolemia

78
Q

Pain management for STEMI patients only

A

Fentanyl 1 mcg/kg Slow IVP only ( Maximum single dose 100 mcg)

79
Q

Chest pain

Hypotensive (SBP

A

Administer Normal Saline bolus of 250 ML
Repeat as necessary up to 1L to maintain a systolic BP of 90 mmHg
If patient develops pulmonary edema stop IV fluid administration and administer Dopamine 5-10 mcg/kg/min IV and titrate to effect

80
Q

Dopamine Contraindications

A

Hypovolemic shock
Tachydysrhythmias
Life-threatening arrhythmia

81
Q

If onset of symptoms are 2 hours or less

A

Patient shall be transported to the nearest Comprehensive or Primary Stroke Center unless an exception exists.

82
Q

If onset of symptoms are greater than 2 hours and up to 6 hours or the patient wakes up with stroke symptoms

A

Patient shall be transported to the nearest Comprehensive stroke center

83
Q

Acute Stroke

Hypoglycemia (

A

With vascular access
D50W 12.5 grams IV. Repeat BGL by finger stick in 5 minutes
If no improvement and BGL is below 60, repeat D50W 12.5 grams

84
Q

Hypertension

Place patient in

A

semi-fowlers position

85
Q

Hyperkalemia in dialysis patients who may have missed dialysis

A

Calcium Chloride 5 mg/kg (max dose 500mg) over 2 minutes

86
Q

Post Resuscitation Care

Midazolam Contraindications

A

Systolic BP

87
Q

If rhythm was converted with defibrillation prior to administering initial Amiodarone dose

A

150 mg Amiodarone in 100 cc NS bag over 10 mins

88
Q

Post resuscitation care

Bradycardia with Hypotension BP 9Systolic Bp

A

Administer Atropine 0.5 mg IV/IO every 5 to minutes (Maximum total dose 3mg)

89
Q

V-tach or runs of V-tach (6> consecutive PVCs)

A

150 mg Amiodarone in 100cc NS bag over 10 mins

90
Q

Narrow regular QRS (SVT)

A

Administer Adenosine 6mg rapid IV ( may attempt vagal maneuvers before administration of Adenosine) If adenosine 6 mg unsuccessful, administer adenosine 12 mg rapid IV

91
Q

Adenosine contraindication

A

Third degree heart block

Known WPW syndrome

92
Q

Wide regular or irregular QRS (A flutter & A Fib)

A

Amiodarone 150 mg in 100ml NS run over ten minutes with 60 gtts/ml infusion set.
Contraindications
Hypersensitivity to medication

93
Q

Tachycardia

Unstable patient

A

Symptoms include CP or SOB, hypotension and altered mental status

94
Q

Unstable

Narrow regular QRS (SVT)

A

Synchronized cardioversion at 50J

repeat as needed with escalating doses up to 100J

95
Q

Unstable

Narrow irregular QRS

A

Synchronized cardioversion at 120 J

Repeat as needed with escalating doses up to 200 J

96
Q

Unstable

Wide regular QRS

A

Synchronized cardioversion at 100 J

Repeat as need with escalating doses up 200 J

97
Q

Symptomatic bradycardia is a combination of slow heart rate with symtoms such as

A

altered mental status, ongoing chest discomfort, hypotension or signs of shock

98
Q

Unstable patient with bradycardia

A

Presenting with poor perfusion evidenced by slow heart rate and hypotension
Atropine 1mg IV/IO repeat once in 3 to 5 minutes

99
Q

If bradycardia still refractory

A

Epinephrine Drip at 2-10 mcg/min

1mg (1:1000) Epinephrine mixed in 100cc normal saline

100
Q

Asthma

Mild distress

A

Wheezes only
Albuterol 5 mg and Atrovent 0.5 mg. May repeat as needed. Subsequent nebulizer treatments will contain only Albuterol 5mg

101
Q

Asthma

Moderate Distress

A

Wheezes/decreased breath sounds/accessory muscle use.
Albuterol 5 mg and Atrovent 0.5 mg. May repeat as needed. Subsequent nebulizer treatments will contain only Albuterol 5mg
Magnesium Sulfate 2 grams IV in 100ml of NS, infused over 5 minutes with a 60 ggts/ml set
Solu-medrol 125 mg IV

102
Q

Asthma

Severe Distress

A

Wheezes/stridor/decreased breath sounds with little or no air movement/accessory muscle use/tripoding.
Epinephrine 1:1000 0.3-0.5 mg IM( 0.3mg appropriate for >50 years old)
CPAP in conjunction with an in-line Albuterol/Atrovent
Albuterol 5 mg and Atrovent 0.5 mg. May repeat as needed. Subsequent nebulizer treatments will contain only Albuterol 5mg
Magnesium Sulfate 2 grams IV/IO in 100ml of NS, infused over 5 minutes with a 60 ggts/ml set
Solu-medrol 125 mg IV/IO

103
Q

COPD

Severe Distress

A

Wheezes/stridor/decreased breath sounds with little or no air movement/accessory muscle use/tripodingCPAP in conjunction with an in-line Albuterol/Atrovent
Albuterol 5 mg and Atrovent 0.5 mg. May repeat as needed. Subsequent nebulizer treatments will contain only Albuterol 5mg
Magnesium Sulfate 2 grams IV/IO in 100ml of NS, infused over 5 minutes with a 60 ggts/ml set
Solu-medrol 125 mg IV/IO

104
Q

Abdominal/Flank pain

Place patient in

A

position of comfort

105
Q

Alcohol-related illness

Maintain aspiration prophylaxis by

A

placing the patient in the recovery postion

106
Q

For all alcohol syndrome and malnourished patients prior to

A

D50W administration
Thiamine 100 mg IV/IM
Contraindication
Known hypersensitivity

107
Q

Allergic Reaction/Anaphylaxis

Mild reaction

A

(without respiratory compromise)

Benadryl 25 mg slow IV push or IM

108
Q

Allergic Reaction/Anaphylaxis

Moderate reaction

A

(without respiratory compromise)
Benadryl 25 mg slow IV push or IM
Solu-Medrol 125 mg slow IV push or IM

109
Q

Allergic Reaction/Anaphylaxis

Moderate reaction

A

(with respiratory compromise)
Benadryl 25 mg slow iv push or IM
Albuterol 5mg and Atrovent 0.5 mg. Subsequent nebulizer treatments will contain only albuterol 5mg
Solu-Medrol 125 mg slowIV push or IM

110
Q

Allergic Reaction/Anaphylaxis

Severe reaction/anaphylaxis

A

(severe respiratory distress and/or cardiovascular compromise)
Epinephrine 1:1000 0.3-0.5 mg IM (0.3 mg appropriate for >50 years old)
Albuterol 5mg and Atrovent 0.5 mg. Subsequent nebulizer treatments will contain only albuterol 5mg
Benadryl 25 mg slow IV/IO push or IM
Solu-Medrol 125 mg slow IV/IO push or IM

111
Q

Altered Consciousness

If respiratory depression present or unable to protect airway

A

Narcan 0.4 mg IV/IO/IM

If no change in 2 minutes, may repeat Narcan to a total max dose of 1 mg

112
Q

Nose Bleed

Hemorrhage cannot be controlled

A

Neo-Synephrine 2 gtts in affected nostril

113
Q

Neo-Synephrine Contraindications

A

Nose bleed secondary to Hypertension (Bp> 160/110)
Nose bleed secondary to head injury and CSF drainage
Hypersensitivity

114
Q

Gastrointestinal related nausea and vomiting

A

Phenergan 12.5 mg ( 6.25 if greater that 64 years old) IV diluted in 100 ml of NS, infused over several minutes with a 60 gtts/ml set
May repeat dose once after 15 minutes if vomiting persists.
Contraindication
Pediatric patients

115
Q

Signs of poor perfusion include

A 
Cool mottled skin
Diminished pulses
altered mental status
increased capillary refill time ( greater than 3 seconds)
Tachycardia
Systolic BP less than 90 mm/hg
116
Q

Excited delirium can mimic several medical conditions including

A

hypoxia
hypoglycemia
stroke
intracranial bleeding

117
Q

Excited delirium

If medication is required to calm the patient

A

administer Ketamine 4 mg/kg IM

118
Q

The hypothermic heart is

A

irritable; excessive movement may result in ventricular arrythmias

SOG 430 (1 decks)

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