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WMFR Field Instruction > Protocols > Flashcards

Protocols Flashcards

1
Q

0070 Who can we not refuse?

A
  • Suicidal
  • Homicidal
  • AMS
  • Unable to care self
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2
Q

0070 What makes a person a patient?

A
  • Under 18 years old
  • Lacks decision making capability
  • Acute illness/injury/intoxication based on appearance
  • Person has a complaint
  • 3rd party caller indicates individual is ill, injured, disabled
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3
Q

8090 What situations to apply a C collar and ask not to move neck? (if none present, no C collar needed)

A
  • Midline CTL spine tenderness on palp
  • Neurologic complaints/deficits (sensory and weakness changes included)
  • Distracting injuries
  • Mentation changes/drugs or EtOH
  • Barrier to evaluate for spinal injury (language or developmental)
  • Provider judgement for spinal injury
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4
Q

8090 When to use backboard (full spinal motion restriction)? And when to not?

A

Any qualifier for C collar PLUS
- neurological deficit

Do not do if

  • Patient ambulatory on arrival
  • Patient can lay comfortably still and comply with instructions
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5
Q

8090 Pediatric considerations for C - spine: can you use a car seat for spinal motion restriction?

A

No

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6
Q

8090 Pediatric considerations for C spine - Apply spinal motion restriction (backboard) if any of the following are also present in a peds patient :

A
  • Patient not moving neck
  • Numbness and weakness
  • Torso or pelvic instability
  • High impact diving injury
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7
Q

8090 Pediatric consideration in C spine - What to apply in peds to better fit on backboard?

A

Padding under shoulders to prevent flexion of neck

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8
Q

8090 If a child can provide reliable history, is spinal motion restriction required?

A

No

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9
Q

8090 If C collar, for whatever reason, cannot be used, what should you do?

A

Use foam, towels, etc to reasonably prevent movement. DOCUMENT.

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10
Q

8090 Over what age are patients at higher risk of spinal injuries, even at ground level fall?

A

65 yoa

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11
Q

8090 Is cervical collar indicated in isolated penetrating neck trauma?

A

No

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12
Q

4080 Specific information to obtain for overdose/poisoning

A
  • Type of ingestion
  • What, when, how much?
  • Bring poison, container, medication, questionable substances to ED
  • Note actions taken by bystanders or patient (induced emesis, antidote, etc)
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13
Q

4080 What is key to overdose management?

A

SUPPORTIVE CARE

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14
Q

4080 Stimulant toxidrome signs, treatment

A
  • Tachycardia, HTN, agitation, sweating, psychosis

- Bezos for severe symptoms

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15
Q

4080 Tricyclic antidepressant signs, treatment

A
  • Wide complex tachycardia, seizure
    Sodium Bicarb when QRS > 100 msec

If intubated, consider hyperventilation to ETCO2 at 25-30mmHg

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16
Q

4080 Organophosphate or nerve agent signs, treatment

A
  • DUMBBELS
  • diarrhea, urination, miosis, bronchorrhea, bronchospasms, emesis, lacrimation, laxation, sweating
  • Atropine
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17
Q

4080 Calcium Channel Blocker, signs and treatment?

A

Bradycardia, hypotension, heart block

  • Fluids, Calcium and vasopressor infusion for hypotension
  • Glucagon
18
Q

4080 Beta Blocker overdose, signs and treatment?

A
  • Bradycardia, heart block, hypotension

- Fluids, vasopressor infusion, glucagon

19
Q

4010 Not Persistent AMS - what to consider?

A
  • Determine character of event.

- Consider SEIZURE (postictal), Syncope, and TIA

20
Q

4010 Persistant AMS, what to consider?

A

BGL, trial of Narcan. Treat hypoglycemia if present.

21
Q

4010 Persistant AMS, not hypoglycemic, not narcotics. What next?

A

Neurologic assessment, LOC and FAST-ED exam.

-Stroke alert if deficits, determine last normal and stroke alert criteria

22
Q

4010 Causes of AMS

A
  • Head trauma, overdose, hypoxia, hypercapnea, heat/cold emergency, sepsis, metabolic
  • Alcohol, drugs, hypoglycemia, stroke
23
Q

4010 Unexplained AMS - what do you add to diagnostics?

A

EKG

24
Q

4140 What is SIRS criteria? How to use in the field?

A
  • Temp < 36C (96.8)
  • Temp > 38C (100.4)
  • HR > 90 (or tachy for age)
  • RR > 20 or mechanical ventilation (or fast for age)

If 2 or more are present, look for hypo-perfusion ANY OF THE FOLLOWING.

  • Hypotension for age.
  • AMS
  • Delayed cap refill AND mottling
  • Systolic BP < 90 mmHg
  • MAP < 65 mmHg
  • Sustained EtCO2 < 25
25
Q

4140 If SIRS criteria + hypoperfusion present, whats the treatment?

A
  • IV fluid at 30mL/kg, monitor lung sounds for pulmonary edema AND hemodynamics
  • 2 large bore IV’s
  • Transport to closest facility
  • NOTIFY HOSPITAL of sepsis

**Consider epi drip for ongoing hypertension, poor perfuston, or pulmonary edema present (no fluid)

26
Q

4140 Sepsis considerations for pediatrics

A
  • Use push/pull with 60mL syringe for less than 40kg
  • Compensated shock? Think aggressive fluid treatment, up to 60mL/kg
  • Normalize vital signs within an hour is goal.
  • Hypotension is LATE sign in peds!
27
Q

4140 Common infection sites with severe sepsis

A
  • Respiratory
  • Bacteremia
  • Genitourinary (especially females)
  • Abdominal
  • Device related
  • Soft tissue/wound
  • CNS
  • Endocarditis
28
Q

6010 Patient is agitated but cooperative, what do you do?

A
  • Address patient concerns, verbally deescalate (RASS +1 or +2)
  • Assume medical cause of agitation
  • If escalation to RASS +3 or +4, consider restraints, benzo, droperidol.
29
Q

6010 Patient is agitated and disruptive/dangerous. What to do if they’re agitated, and a danger to self/providers?

A
  • Consider cause of agitation, treat accordingly if possible. If unknown, can justify using either benzo or droperidol.
  • Restrain
  • Get capno and SpO2 on ASAP (safely)
  • Cardiac monitor.
  • Repeat dose of sedative after 5 min if still RAS +3 or +4.
  • Still agitated? CALL FOR MORE
  • Complete post sedation protocol
30
Q

6010 EXTREME agitation posing serious and probable bodily harm to self/others

A

Hyperactive delirium
-10 mg Droperidol or 10 mg Versed
(refer to protocol 6011)

31
Q

6010 What key things to document for agitated combative patients?

A
  • Specifics on actions or behaviors that put us or the patient at risk.
  • RASS scale
32
Q

1130 Indications for restraints:

A
  • Significant impairment and lacks decision making capacity for care
  • Violent, combative, unccoperative behavior without response to verbal judo.
  • Suicidal, at risk of dangerous behavior to self or us.
  • M1 with elopement concern
33
Q

3040 Treatment for sinus tachycardia?

A
  • Search for and treat underlying condition, i.e. dehydration, fever, hypoxia, hypovolemia, pain
  • Consider medical shock
34
Q

3040 If patient is stable and in a tachyarrhythmia that is not sinus tach, what do you do next?

A
  • Determine if the rhythm is NARROW or WIDE.
35
Q

3040 Tachyarrythmia, stable, narrow QRS, regular. What to do?

A
  • Start with vagal maneuver.
  • Give Adenosine 12 mg RAPIDLY, with additional 12 mg if needed.
    - Convert? Repeat 12 lead, monitor.
    - Doesn’t convert? Contact base for consult. Monitor.
  • If at ANY POINT becomes unstable, CONVERT.
36
Q

3040 Tacchyarrythmia, stable, WIDE and REGULAR. What to do?

A
  • V Tach or SVT with an aberrancy.
    • Call in for amiodarone, 150 mg over 10 min in a bolus.
  • Regular and polymorphic?
    • Torsades de Pointes, consider MAGNESIUM 2 gm IV/IO.
37
Q

3040 Tachyarrythmia, stable, narrow QRS, irregular. What to do? What rhythm is likely?

A
  • Likely A-fib, A-flutter, MAT.

- NO ADENOSINE. Monitor, cardiovert if they become unstable.

38
Q

3040 Tachyarrythmia, stable, narrow QRS, regular. What to consider with a pediatric patient?

A
  • Children with stable AVNRT generally remain so and do not need interventions, just monitoring and transport.
39
Q

3040 Tacchyarrythmia, stable, WIDE and IRREGULAR. What to do?

A
  • Do not give ADENOSINE. Monitor for stability and transport. Cardiovert if needed.
40
Q

3050 Bradyarrythmias with a pulse. What to do if adequate signs of perfusion present?

A
  • Monitor and transport.
41
Q

3050 Bradyarrythmias with a pulse, poor perfusion present (AMS, CP, Shock, Hypotension). What to do?

A
  • Epinephrine infusion. 1 mg 1:1,000 in 1000mL bag. Titrate to effect (BP raises).
  • Consider Atropine 0.5 mg, max dose of 3 mg.
42
Q

3050

A

WMFR Field Instruction (2 decks)

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