Protocols Flashcards
What is the min age for CPAP
Greater than or equal to 3
Indications for Fentanyl
-pain greater than or equal to 5/10
-SBP greater than or equal to 100 w/unimpaired resp.
-GCS normal to baseline
-no known anaphylaxis
Contraindications for ketamine
-GCS less than 14
-suspected/confirmed pregnancy
-suspected ACS
-known/suspected intoxication
-known allergy
When must pain control be confirmed by a physician?
-SBP less than 100
-Significant injury to head, chest, abd
Min age for humoral IO
18
What should you give for a TCA OD
Sodium Bicarb
What should you give for suspected Renal Failure
Calcium/sodium
Joules for defib
A: 200, 300, 360
P: 2J/kg then 4J/kg
What is the dose for narcan in a cardiac arrest
You don’t give narcan in a cardiac arrest
What should you do if asystole converts to an organized rhythm but is less than 40 or ETCO2 less than 20
Continue compressions for 2 mins then reassess
What should you do w/ any VF/VT code prior to termination
Call base
Important things to remember in an hypothermic pt in asystole/PEA
Only 1 round of med admin prior to base hospital contact
Airway considerations for pregnant pt in asystole/PEA
-use ETT 0.5-1mm smaller
-cricoid pressure
-expect more resistance when bagging
-increase resp. To 16-18 per min
When giving push dose what are you titrating to?
Greater than 90 SBP
After giving push dose what is important info to give to the hospital?
-Use of push dose
-Final concentration given
-Total amount of push dose given
What SBP are you maintaining when giving nitro?
Greater then 110 SBP
What should you do if the 12 lead says meets ST elevation criteria or acute MI suspected?
Put pads on pt and expedite transport
What should you do if hypotension is present in ACS but NS doesn’t work or signs of CHF are present?
Call base for push dose
What should you ask for prior to nitro administration?
If the pt has taken any sexual enhancers in the past 48 hours
What conditions must be met for you to consider an alternate airway device or maintain a BLS airway?
-ETT is contraindicated
-difficult airway/delayed airway is anticipated
Joules for Cardioversion(adult and peds)
A: 200, 360
P: 0.5j/kg then 2 J/kg
Minimum age for Zofran
Greater than or equal to 4y/o
What should you give for a calcium channel blocker overdose?
Calcium chloride then glucagon
When should you not administer activated charcoal
Ingestion of caustic materials(toilet bowl cleaner, draino, battery acid), corosive, or petroleum distillate substances(jet fuel, gasoline)
In nerve agent poisoning what’s the difference in treatment between the hot/warm zones and the cold zone
In the hot/warm zones you will administer atropine IM, in the cold zones you’ll obtain vascular access
In the shortness of breath protocol when giving nitro what systolic blood pressure are you trying to maintain?
Greater than 110
What is the criteria for a BLS transport of a seizure patient
Patient has known seizure disorder, are no longer seizing, are in their normal postictal State, and require no ALS interventions
What do you do for hypovolemic shock
1L NS bolus, may repeat x1
Push dose epi
What do you do for hemorrhagic shock when systolic blood pressure is less than or equal to 90
TXA for traumatic injury
Push dose epi
What do you do for septic shock
1L bolus may repeat x1
Push dose epi
What 3 treatments should you do for pediatric in anaphylactic shock
Epi 1:1,000
Push dose epi
NS
What is the criteria for a stroke alert?
Positive Cincinnati
Time last known well less than six hours
Blood glucose greater than 60
Is the patient a stroke alert if they have stroke symptoms but time last known well is greater than six hours or unknown?
No
For documentation of a stroke what should you include
Activation of the stroke care lab
Documentation of the blood glucose level
Cincinnati assessment
Time last known well
Name/contact number of personal time last known well information
What should you do for a patient with a traumatic injury but they are hypotensive with a systolic of less than or equal to 90
1L bolus to maintain 90 SBP
TXA
What should a documentation of a traumatic injury include
Detail description of an injury(presence if swelling, angulation/rotation, neurovascular compromise, estimated blood loss.
What should you do for a patient with the suspected Pneumothorax
Place pt in seated position if possible
Needle T
What should you do if a pediatric is suspected of having a Pneumothorax
If less than 40kg use 14g iv needle
If greater than 40kg use normal needle T
What are the indications for spinal immobilization
Any patient with an MOI sufficient to result in a spinal injury meeting any one of the following criteria…
Not AxO
Intoxicated
Any painful or distracting injury
C-spine pain
C-spine tenderness/deformity
What is the age requirement for TXA
Greater than or equal to 15 years old
Where are the general burn guidelines in BLS procedures?
Remove clothing/jewelry made of synthetic material
Determine type of burn & stop burn
Maintain body heat
Elevate burned limbs
Pediatric dose of albuterol
If <2 y/o 2.5mg/3mL
If >2 y/o 5mg/6mL
Repeat as needed
What systolic bp are you titrating to for nitro
110
Nitro dose for chest pain & titrate to
0.4 every 5mins(no max)
Titrate to >110
If pt is normally hypotensive, titrate to >90
Normal saline dose for ABD/Flank pain
1L
Reevaluate after each 500mL
When do you treat low blood sugar
<60BGL
Treatment for anaphylaxis without shock
Epi 1:1000
Treatment for anaphylaxis with shock
NS 1L
Treatment for an allergic reaction if wheezing is present
Albuterol
Treatment for an allergic reaction with hives only
Diphenhydramine(Benadryl)
What should you do for a behavioral emergency
Consider vascular access
Determine BGL
Cardiac monitor and spo2
In CAM how long do you have to determine if the rhythm is shockable?
3 seconds
How deep should compressions be in cam?
2-2.5 inches
What should you do post ROSC
5-10min femoral pulse check
Obtain peripheral iv access
1L bolus(unless signs of CHF)
Manual BP
Push dose epi to BP 90 systolic
12 lead
What does rescuer #3 do in CAM
At the head, leads the CPR team
How long should an asystole code be worked vs a VF/VT code?
Asystole/PEA: 20 mins
VF/VT: 30 mins(must contact hospital prior to determination)
When should you obtain a BGL in a cardiac arrest?
After ROSC
Indications for push dose epi
Unstable anaphylaxis
Severe hypotension with signs of shock
Septic shock
Unstable bradycardia
What are the actions of push dose?
Increases cardiac output
Increases heart rate
Increases MAP
What should you document when giving push dose epi
Time/amount given
Pt response after 1 min
What drug neutralizes epi?
Sodium bicarb
What should you do for pain refractory to nitro in ACS
Pain control while maintaining >110 systolic
What should you give for stable ventricular ectopy
Amio
What should you do if in ACS the pt has hypotension, signs of CHF, or no response to a fluid challenge?
Call base for push dose
When should you perform a 12 lead in a ACS PT
Prior to med administration(if possible)
If a stemi pt is stable what should you consider?
Code 2 transport
Hr for bradycardia in an adult/ped
Adult: <45
Pediatric: <60
What should you give for an adult in stable bradycardia?
Atropine
What should you give for a pediatric in stable bradycardia
-Epi 1:10,000
0.01mg/kg
(If symptoms persist after initial treatment)
-Give push dose
-Can call base for atropine
Treatment for unstable Bradycardia in an adult?
TCP
What should be initiated immediately when a 3rd degree block is present?
TCP
When should you pace a 2nd degree block?
If the pt becomes symptomatic
What should you give as an initial fluid challenge for symptomatic bradycardia in an adult?
500mL bolus
May repeat x1 for a total of 1000mL
What should you give secondary to a fluid challenge in symptomatic bradycardia with hypotension?
Push dose epi
If a pt is bradycardic but is suspected to have digitalis toxicity what should you withhold?
Calcium chloride
What treatments should you do for an adult in stable SVT
-valsalva
-adenosine
What is the HR for SVT
Greater than 160 BPM
What are some transport considerations with a pt in SVT?
Consider withholding adenosine until ED physician evaluation if the pt is stable or if the pt has an underlying cause(sepsis, hypovolemia, heart failure)
What is required for the documentation for a pt who was in SVT?
Document all ECG strips during Valsalva, adenosine administration, and/or synchronized cardioversion
What is the typical HR for a pt in a wide-complex tachycardia?
Greater than 150
Treatment for adults/pediatrics in unstable wide-complex tachycardia?
Synchronized cardioversion
What must you call base for under the wide-complex tachycardia protocol?
Giving mag sulfate
In the event of an IFT zofran can be administered hourly to a max of (adults/peds)
32mg
16mg
What are the indications for activated charcoal?
Oral ingestion within 1 hour, estimated transport time is greater than 15 mins, pt is awake with gag intact
For BLS procedures in a “poisoning/OD” what should you do in a suspected opiate OD without respiratory effort?
Begin cpr
Apply AED and follow instructions
In the poisoning/OD protocol what must you call BHO for?
Beta blocker OD, Calcium channel blocker OD, Organophosphate poisoning
In a TCA OD if chest pain is present what should you not administer
Aspirin
When can vascular access be obtained in a patient with nerve agent poisoning
When they are in the cold zone and after complete decontamination
In a hazmat incident who determines when the pt can be safely assessed by EMS personnel
The incident commander
What benzodiazepine is in the CHEMPACK
Diazepam
How much epi is in an adult auto ejector and when should it be used
0.3mg
It should be used for SOB
What are the pediatric doses for auto injector epinephrine
15kg-30kg=0.15mg
Greater than 30kg= 0.3mg
What do you give for an adult and pediatric with wheezing(dose & repeat time)
Albuterol
Adult=5mg/6mL
Ped=<2yr=2.5mg/3mL
Greater than or equal to 2= adult dose
Repeat as needed
What should you give for an adult with suspected pulm edema and what dosage
Nitro
0.4 every min x3 mins
Then 0.4 every 2 mins
No max
What should you give for a pt with SOB who develops hypotension
Push dose epi
What BLS procedures should you do in an adult pt having a seizure
Protect from injury
Administer 02 if sats are less than 94
Determine BGL
What BLS procedures should you do for a pediatric pt having a seizure
Protect from injury
Administer 02 if sats are less than 94
Begin passive cooling
Determine BGL
What conditions must be met in order for you to treat for eclampsia
3rd trimester pregnancy, no known seizure history with signs/symptoms of eclampsia or active seizures
Signs and symptoms of septic shock
Fever(hot to the touch)
Tachycardia
Tachypnea
ALOC
History or physical exam suggestive of infection
BLS procedures for stroke
Assess LOC and Neuro(CSS)
Airway management(sp02 <94)
Determine BGL
ALS treatment for stroke
Vascular access
Early BH contact with “stroke alert”
When should you intubate a pt with a head injury?
If there airway is unable to be controlled using BLS measures
What SBP are you to maintain in a traumatic injury
90
Pediatric needle sizing for Needle T
Less than 40kg=3cm needle
Greater than 40kg=8-8.5cm needle
What should you document in a traumatic injury
Detailed description of injury(swelling, angulation/rotation), laceration, open/closed fracture, neurovascular compromise, estimated blood loss
What are the actions of TXA
Inhibits the conversion of plasminogen to plasmin
Reduces fibrinolysis and clot breakdown
Stabilizes clot formation
Contraindications for TXA
Pts less than 15 yrs
Greater than 3 hrs post injury
Isolated head injury
Neurogenic shock(spinal injury with hypotension)
Isolated extremity hemorrhage w/ controlled bleeding
Active thrombotic event within 24hrs(stroke, MI, PE, DVT)
Anaphylactic reaction
Traumatic arrest with greater than 5 mins of CPR without ROSC
Drowning or hanging victims
What’s the concentration of TXA
100mg/mL
What is the onset and duration of TXA
Onset= 20 mins-2 hours
Duration= 2-8
What adverse effects may be present with TXA
Hypotension with rapid IV infusion, chest tightness, difficulty breathing, facial flushing, blurred vision, nausea, vomiting, and diarrhea
How old do you have to be to receive TXA
Greater than or equal to 15 years old
What are the general burn guidelines for adult/ped
Remove clothes made from synthetic material
Determine type of burn(thermal, electric, radiation, chemical)
Maintain body heat
Elevate burned limbs
What are you going do do (ALS interventions) for a burn
Pain control
If greater than 10% TBSA or hypotension present…1L bolus
Rule of 9s for an adult
Head(front and back)= 9
Arms= 9
Chest=18
Back= 18
Legs= 18 each
Perineum= 1
Rule of 9s for a pediatric
Head= 18(front and back)
Chest= 18
Back= 18
Arms= 9 each
Legs= 13.5 each
Perineum= 1
How should you stop the burning process for a pt with an electrical burn
Turn off power source and safely remove the pt from the hazardous area
How should you stop the burning process for a pt with a radiation burn
Keep area clean and dry with sterile dressings
What BLS procedures should you do for a potential crush injury
Administer 02
Spinal precautions(if indicated)
Maintain body heat
Obtain crush timeframe
What should you do for potential crush syndrome
Vascular access
Release compression
Monitor for dysrhythmias
What treatments can you do for potential crush injury/crush syndrome
1L bolus(caution with cardiac or renal history)
Sodium bicarb mixed in first liter of NS
Albuterol
(Additional treatments)
If dysrhythmias present…calcium chloride and repeat NS bolus
What is classified as a potential crush injury
Continuous crush injury to a body part that is less than or equal to 2 hours
What is classified as crush syndrome
A continuous crush injury to a body part lasting greater than 2 hours
What are the changes in the EKG for a crush injury that you are monitoring for?
Peaked T waves, absent P-waves, widened QRS, bradycardia
What should you consider prior to determination of a traumatic arrest
Bilateral Needle T
What should you do for an insect bite
Flush site
Control bleeding
Apply bandage
What should you do for a pt with a snake bite
Mark the edge of the wound and monitor for 10-15
Remove rings and constrictions
Immobilize the affected part in an elevated position
Avoid excessive activity
What should you do for a bee stings
If present, remove stinger
Apply ice pack
What should you do for a jelly fish sting
Rinse thoroughly with NS
DO NOT
Rinse with fresh water
Rub with wet sand
Apply heat
What should you do for all other marine animal stings
Remove barb if present
Immerse in hot water, if available
Under the bites/stings protocol what can you BLS
All bites other than snake bites
What BLS procedures should you do for a pt having a heat emergency
Place them in a cooling environment
Initiate active cooling measures such as…
Remove clothing
Fan pt
Apply ice packs to arm pits, groin, and back of neck
What should you do if a pt having a heat emergency is altered
Obtain a BGL
What ALS treatment should you do for a pt experiencing a heat emergency
1L bolus to maintain SBP of 110, re-evaluating after each 500mL
May repeat x1
What BLS procedures should you do for a hypothermic pt
Passive rewarding
Minimize movement of extremities
Attempt to maintain supine
Cut off wet clothing and cover pt
What are the acceptable vitals ranges for severe hypothermia(HR/RR)
RR at least 4 breaths per min
HR at least 20 per min
Why should you expedite transport with a pt who has severe hypothermia but is not shivering
Indicates core temp below 90
What BLS procedures can you do for frostbite
Wrap affected extremity in blankets or clothing
DO NOT rub or attempt active rewarming
What ALS procedures should you do for a pt in a “water emergency”
Maintain SBP of greater than 110
What additional things do you want do do in a water emergency
Early BH contact(hyperbaric capable facility)
Review history and report/document…
Use of drugs, trauma, extremes of age
Location of pain
Dive history: depth, time down, bring divers computer with pt
Abnormal Neuro findings
Subcutaneous emphysema
With a pregnant pt what are some things to determine initially
Number of pregnancies(gravida)
Number of deliveries(para)
Number of spontaneous/elective abortions
Due date(how many weeks are they)
Onset/duration/frequency/intensity of contractions
If a rupture of membranes has occurred(including color)
If any expected complications during pregnancy are present
Presence of crowning or any abnormal presenting part
What should you do for a prolapsed cord
Cover cord with wet saline dressing
Place pt in LT lateral
Provide manual pressure on presenting part(to avoid cord compression)
Initiate code 3
What should you do if there is a presenting part while delivering
Elevate hips
Assist delivery while initiating code 3
Assist with breech delivery while supporting the infants body
Covering baby with blanket to maintain heat
What should you do if there is a presenting part while the pt is not delivering
Place mother in LT lateral Trendelenberg
Initiate code 3
What should you do for a delivery with the head crowning
Help guide baby out
Suction only if secretions are causing airway obstruction(mouth then nose)
Dry/stimulate(rub gently, but briskly with a warm towel)
Note time of birth
Cut cord and transport
What should you do for a delivery that has the butt crowning
Have the mother push until the butt and legs are out to the mid calves then assist the feet out
If only 1 leg is presenting reach up and grab the second leg
Grab the torso with a towel or blanket(don’t squeeze the baby’s ABD)
Pull down a loop of cord to continue delivery and rotate baby to the left or right to deliver top shoulder
Raise body to deliver bottom shoulder
Put gloved finger inside mouth and flex chin torwards the chest
Pivot the baby upward(an assistant can provide suprapubic pressure)
Clamp and cut the cord
What should you do if there is a partial delivery and there is no further progress after 1-2 mins
Code 3 transport
What is the A in APGAR
Appearance
0=blue/pale
1=pink w/blue extremeties
2=pink
What does the P in APGAR represent
Pulse
0=absent
1= less than 100
2= greater than 100
What does the G in APGAR represent
Grimace(reflexes)
0=absent
1=grimace
2=cough/cry/sneeze
What does the second A in APGAR stand for
Activity(muscle tone)
0=limp
1=some flexion
2=active
What does the R stand for in APGAR
Respirations
0=absent
1=slow
2=good cry
What should you do if you are arriving to the hospital less than 5 mins after delivery
Use standard neonatal assessment
What BLS procedures will you do for a newly born infant
Provide warmth, dry briskly
Suction(if needed)
Assess the following while drying pt…
full term(39 weeks)?
APGAR
Place skin to skin with mother
Cover both with dry linen
Continue to reassess
What should you do if there’s any deficits to the APGAR of a newly born infant
Stimulate briefly(less than 15 seconds)
Flick soles of feet
Briskly rub infants back
What BLS procedures should you do for a neonate
Assess ABCs
What should you do if a neonate has Apneic or gasping respirations
PPV with room air @40-60 BPM for 30seconds
Continue ppv reassessing every 30 secs until the infant has a HR of greater than 100
When assessing a neonates circulation what should you do if there HR is between 60 and 100
PPV with BVM @room air at 40-60 BPM for 30 seconds
Continue PPV reassessing every 30 seconds until HR maintains above 100
When assessing a neonate what should you do if their HR is less than 60
CPR @3:1 ratio for 30 seconds
90/min compressions
30/min ventilations
Reassess every 30 seconds until HR is greater than 60 BPM
If no improvement after 90secs of room air, add 02 until HR is greater than 100
When should you establish an IO on a neonate
Only in the presence of CPR
If they weigh greater than 3kg
What treatment will you do for asystole and/or persistent bradycardia less than 60BPM(ped dose)
Epi 1:10,000
0.01mg/kg every 3-5mins
When should you withhold resuscitation efforts of a neonate
If they are less than 23 weeks or 9in long
However sensitivity to the desires of the parents may be considered
What should you do if a premature baby is born but you are unsure if it is greater than 23 weeks old(gestational age unknown)
Begin resuscitation
What BLS procedures should you do for vaginal bleeding/spontaneous abortion
Place pad/dressing over vaginal opening(NOT IN)
Save and transport all tissue or fetal remains passed
What BLS procedures should you do for pre-eclampsia/eclampsia
Minimize stimulation(lights, noise)
Left lateral
What ALS interventions can you do for Pre-eclampsia
Vascular access
IV/IO TKO or saline lock
Maintain SBP above 90 by giving fluids, re-evaluating after every 500mL
Max 1L
What ALS interventions can you do for 3rd trimester pregnancy, no known seizure Hx, with S&S of eclampsia/active seizures
Mag sulfate
Midazolam
Under the OB/GYN protocol what should your Hx/report/documentation include?
Last menstrual period/possibility of pregnancy
Duration of bleeding, estimated blood loss, passage of the products of conception
If pregnant: gestational age of fetus, gravida/para, and anticipated problems(placenta previa, pre-eclampsia, lack of prenatal care, use of drugs
Presence of contractions, cramps, or discomfort
For pre-eclampsia/eclampsia: ALOC, seizures, or HTN
Normal RR, HR, and SBP for a newborn
RR= 30-60
HR= 85-205
SBP=60-84
Normal RR, HR, and SBP for an Infant
RR=30-60
HR=80-140
SBP=70-105
Normal RR, HR for toddler and preschooler
RR=22-40
HR=80-120
Normal RR/HR for a school age child(6-12)
RR=18-30
HR=70-110
How long should the RR of an infant be counted for
Full 60 seconds
In a decompensating child what vital sign will be the last to change
The BP
What does bradycardia represent in a child
Hypoxia…pt is extremely critical
A person has decision making capability if they are able to…
-Understand the need for treatment, implications of receiving/not receiving care and ALT forms of care available
-Relate the above info to their personal values and then make/covey a decision
What is a Patient defined as?
A pt is any person for whom the EMS system has been activated for, or who EMS providers encounter that meet the following criteria…
-has a known/obvious injury or illness
-has communicated a medical complaint
-requests an EMS providers assessment, treatment, and/or transport
-is determined to NOT have decision making capability
EMS providers have a duty to act and render emergency care/transport when these conditions are met
When medically indicated
When requested to render treatment and/or transportation
When evidence for impaired capacity exists in accordance with SBCEMSA policies
When a person is a minor
What is the difference between a refusal of care and a refusal of service?
Care= BLS assessment was done and the pt required nothing further
Service= subject is declining any and all EMS services
Who may refuse medical care or transportation
18yrs of age or older
Legal representatives by legal custody or durable power of attorney for HEALTH CARE
Parents of minors
An emancipated minor
Should you do Resuscitative efforts on a pt who has a DNR medallion
No
If a pt with a DNR is overdosing on opioids what can you do
Administer narcan sparingly
0.1mg IV every 2-3 mins
When is a DNR inoperative?
If there is no signature from both the pt and the physician
If the pt has a medical condition that is correctable(hypoglycemia, airway obstruction, pain, dyspnea, hemorrhage)
What should you confirm when implementing a POLST
Confirm the pts name is on the form
Confirm that the form is signed by both parties
What treatments are you supposed to do if a POLST says “comfort measures only”
Anything that relieves pain/suffering
Pt positioning
02
Airway suctioning
Relief of airway obstruction(including using magills)
Pain control
What treatments can you do if a pts POLST form says “limited additional interventions”
You may provide comfort measures along with…
Iv fluids
BVM
CPAP
DO NOT INTUBATE
What should you do if a pt has multiple end-of-life documents with different dates
Follow the most recent one
What should you do if there’s a conflict between the written end-of-life orders and the legally recognized decision-maker
Initiate BLS measures while consulting the BH physician
What should you do if the pts power of attorney on scene requests witholding resuscitation
EMS provider shall inform the agent of the consequences of the request
The agent needs to sign a refusal
What do you need to document for the use of a DNR/POLST
Type of order followed
For written orders: you need the name of the physician who signed the DNR
POLST ONLY= what section of the POLST was applicable to the PT
What should you document if a power of attorney requests to withhold resuscitation
Their full name and phone number
What must you attach to the EPCR when a DNR/POLST is used?
Original form
Copy or fax
Photocopy
Under what conditions may a pt be presumed dead
Decapitation
Decomposition
Hemicorporectomy(sliced in half)
Incineration
Valid DNR
What are you assessing for respiratory under the determination of death policy
Open the pts airway
Auscultation of the lungs while observing for chest movement for 30 secs
What respiratory finding are needed for DOD
No spontaneous breathing
No breath sounds upon auscultation
What assessment procedures are you doing under the Cardiac section of the DOD policy
Palpate carotid pulse(brachial artery for infants)
Or auscultate the heart sounds for a minimum for 1 min
Or…
Monitor the pts cardiac rhythm for a minimum of 1 min
Confirm asystole in 2 leads
Obtain a 6 second strip and attach to ePCR
What cardiac findings are needed for determination of death
No pulse
No heart sounds
What assessment procedures are you doing for neurological section of DOD policy
Check pupils response to light
Check response to painful stimuli
What neurological findings are needed for DOD
No pupillary response
No response to painful stimuli
What treatment must you do for a pt less than 18 years old in a traumatic arrest
Resuscitation efforts and transport to the closest receiving hospital
What criteria must me met for you to pronounce a traumatic arrest in a pt older than 18 years old
Time from arrest to the nearest hospital will exceed 20 mins or…
The pt has remained in cardiac arrest after 20 mins of extended extrication
The cardiac rhythm is asystole or wide-complex PEA at 30BPM or slower
Deaths that occur in any place other than the hospital or a SNF must be reported to?
Law enforcement personnel and the body must be left in their custody
What is the criteria for a step 1 trauma pt
GCS less than or equal to 13
SBP less than 90
RR less than 10, greater than 30, need for ventilatory support, less than 20 breaths per min in an infant younger then 1 year of age
What is the criteria for a step 2 trauma
All penetrating injuries to the head, neck, torso, and extremities proximal to the elbow or knee
Chest wall instability or deformity
Two or more proximal long bone fractures
Crushed, degloved, mangled, or pulseless extremity
Amputation proximal to wrist or ankle
Pelvic fractures
Open/depressed skull fracture
Paralysis
What is the criteria for a step 3 trauma
Falls:
Adults= greater than 20ft(one story=10ft)
Children= greater than 10 for or 2x the height of the child
High risk auto crash:
Intrusion(including roof) greater than 12in occupant site, 18in for any site
Ejection(partial or complete)
Death in the same passenger compartment
Auto vs ped, thrown, run over, or with sig. impact(>20mph)
What is the criteria for a step 4 trauma
Age greater than 65
SBP less than 110(may represent shock after age 65)
Head injury with LOC or physical signs of head trauma AND with bleeding disorders or on anticoagulants
Burns
Time sensitive extremity injury(open fracture, neurovascular compromise)
Pregnancy greater than 20 weeks with known or suspected ABD trauma
Ems provider judgment
Adult trauma pts must meet what steps to fly
1 and 2
What steps must a pediatric trauma meet to fly?
1, 2, and 3
What should you do if the air ambulance is unavailable in north county?
Contact MRMC and they will determine your destination
In south county when will you transport by air ambulance
If the pt meets step 1, 2, if transport exceeds 30 mins and air ambulance will save 15 mins
Contraindications to intubation
Intact gag reflex
Indications for intubation
Cardiac arrest, ONLY if unable to ventilate using BLS procedures
Resp arrest, compromise AND unable to ventilate with BLS procedures
Physicians request
How many attempts do you get to intubate and for how long?
2 for 20 second
How far do you advance the ETT for a pt less than 5ft
2 cm past vocal chords
How far do you insert the ETT for a pt who is 5-6 1/2 ft tall
22cm at the teeth
How far do you insert the ETT for somebody who is over 6 1/2 ft tall
24 cm at the teeth
How far should you load the stylet into the ETT using the 1 person technique
4 inches past the distal end of the ETT
Do you use a stylet for intubating a stoma
No
What are the best ways to confirm intubation
End tidal waveform
Auscultation
What are the indications for a needle T
SBP less than 90(70 for peds less than 40kg)
Signs of hypoperfusion
And absent/decreased lung sounds on affected side
Traumatic arrest
What size needle T does a ped less than 40kg receive
3cm needle
What is the preferred site for and adult needle T
4th intercostal space at the anterior axillary line
What is the alternative needle T sites for adults or preferred pediatric site
2nd intercostal space, mid clavicular line
How many IO attempts do you get
2 attempts at different sites
What is defined as an IO attempt
The IO puncturing the skin with the intent to establish IO access
What are the contraindications for an IO
Fracture
Osteogenesis imperfecta
IO in the bone within the past 48 hours
Previous, significant orthopedic procedures at insertion site (prosthetic limb or joint)
Inability to identify anatomical landmarks
Peds weighing less than 3kg
Infection at the site
What weight is the 15mm pink IO needle indicated for
3-39kg
What weight is the 25mm blue IO needle indicated for
Pts greater than 3kg
What weight is the 45mm yellow IO needle indicated for
Greater than or equal to 40kg
What is the dose for lidocaine
0.5mg/kg(max of 40mg) slow IVP over 60 secs
Indications for a 12 lead
Chest or upper abd discomfort
New onset cardiac dysrhythmias
Unexplained syncope or near syncope
Unexplained acute generalized weakness
Other signs or symptoms suggestive of ACS
How quickly into the call should you obtain a 12 lead
Less than 3 mins
What is the age range for a BRUE
24 months or younger
What height is the size 3.5(red top) LMA for
Women less than 6ft
Men less than 5’6
And any pt that wont fit a size 4.5
What height is the size 4.5(purple) LMA for
Women at least 6ft
Men at least 5’6
How many attempts for an LMA and how long
2 attempts 30 seconds
What are the contraindications for an LMA
Intact gag
Pt weighs less than 45kg(100lbs)
Age less than 15yr
What must you document for every placement for an LMA
All of these are yes or no
Rescue device
Successful placement
Number of attempts
Emesis
Bleeding
Hypoxia
Dislodgement
What should you do for a burn pt if their TBSA is less than 10%
Cool burned area with Saline dressings
What should you do for a burn pt if their TBSA is greater than 10%
Cover with dry sterile dressings + burn sheet
