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Medic > Protocols > Flashcards

Protocols Flashcards

1
Q

What is the min age for CPAP

A

Greater than or equal to 3

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2
Q

Indications for Fentanyl

A

-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

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3
Q

Contraindications for ketamine

A

-GCS less than 14
-suspected/confirmed pregnancy
-suspected ACS
-known/suspected intoxication
-known allergy

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4
Q

When must pain control be confirmed by a physician?

A

-SBP less than 100
-Significant injury to head, chest, abd

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5
Q

Min age for humoral IO

A

18

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6
Q

What should you give for a TCA OD

A

Sodium Bicarb

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7
Q

What should you give for suspected Renal Failure

A

Calcium/sodium

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8
Q

Joules for defib

A

A: 200, 300, 360
P: 2J/kg then 4J/kg

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9
Q

What is the dose for narcan in a cardiac arrest

A

You don’t give narcan in a cardiac arrest

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10
Q

What should you do if asystole converts to an organized rhythm but is less than 40 or ETCO2 less than 20

A

Continue compressions for 2 mins then reassess

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11
Q

What should you do w/ any VF/VT code prior to termination

A

Call base

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12
Q

Important things to remember in an hypothermic pt in asystole/PEA

A

Only 1 round of med admin prior to base hospital contact

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13
Q

Airway considerations for pregnant pt in asystole/PEA

A

-use ETT 0.5-1mm smaller
-cricoid pressure
-expect more resistance when bagging
-increase resp. To 16-18 per min

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14
Q

When giving push dose what are you titrating to?

A

Greater than 90 SBP

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15
Q

After giving push dose what is important info to give to the hospital?

A

-Use of push dose
-Final concentration given
-Total amount of push dose given

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16
Q

What SBP are you maintaining when giving nitro?

A

Greater then 110 SBP

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17
Q

What should you do if the 12 lead says meets ST elevation criteria or acute MI suspected?

A

Put pads on pt and expedite transport

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18
Q

What should you do if hypotension is present in ACS but NS doesn’t work or signs of CHF are present?

A

Call base for push dose

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19
Q

What should you ask for prior to nitro administration?

A

If the pt has taken any sexual enhancers in the past 48 hours

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20
Q

What conditions must be met for you to consider an alternate airway device or maintain a BLS airway?

A

-ETT is contraindicated
-difficult airway/delayed airway is anticipated

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21
Q

Joules for Cardioversion(adult and peds)

A

A: 200, 360
P: 0.5j/kg then 2 J/kg

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22
Q

Minimum age for Zofran

A

Greater than or equal to 4y/o

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23
Q

What should you give for a calcium channel blocker overdose?

A

Calcium chloride then glucagon

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24
Q

When should you not administer activated charcoal

A

Ingestion of caustic materials(toilet bowl cleaner, draino, battery acid), corosive, or petroleum distillate substances(jet fuel, gasoline)

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25
Q

In nerve agent poisoning what’s the difference in treatment between the hot/warm zones and the cold zone

A

In the hot/warm zones you will administer atropine IM, in the cold zones you’ll obtain vascular access

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26
Q

In the shortness of breath protocol when giving nitro what systolic blood pressure are you trying to maintain?

A

Greater than 110

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27
Q

What is the criteria for a BLS transport of a seizure patient

A

Patient has known seizure disorder, are no longer seizing, are in their normal postictal State, and require no ALS interventions

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28
Q

What do you do for hypovolemic shock

A

1L NS bolus, may repeat x1
Push dose epi

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29
Q

What do you do for hemorrhagic shock when systolic blood pressure is less than or equal to 90

A

TXA for traumatic injury
Push dose epi

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30
Q

What do you do for septic shock

A

1L bolus may repeat x1
Push dose epi

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31
Q

What 3 treatments should you do for pediatric in anaphylactic shock

A

Epi 1:1,000
Push dose epi
NS

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32
Q

What is the criteria for a stroke alert?

A

Positive Cincinnati
Time last known well less than six hours
Blood glucose greater than 60

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33
Q

Is the patient a stroke alert if they have stroke symptoms but time last known well is greater than six hours or unknown?

A

No

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34
Q

For documentation of a stroke what should you include

A

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

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35
Q

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

A

1L bolus to maintain 90 SBP
TXA

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36
Q

What should a documentation of a traumatic injury include

A

Detail description of an injury(presence if swelling, angulation/rotation, neurovascular compromise, estimated blood loss.

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37
Q

What should you do for a patient with the suspected Pneumothorax

A

Place pt in seated position if possible
Needle T

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38
Q

What should you do if a pediatric is suspected of having a Pneumothorax

A

If less than 40kg use 14g iv needle
If greater than 40kg use normal needle T

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39
Q

What are the indications for spinal immobilization

A

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

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40
Q

What is the age requirement for TXA

A

Greater than or equal to 15 years old

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41
Q

Where are the general burn guidelines in BLS procedures?

A

Remove clothing/jewelry made of synthetic material
Determine type of burn & stop burn
Maintain body heat
Elevate burned limbs

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42
Q

Pediatric dose of albuterol

A

If <2 y/o 2.5mg/3mL
If >2 y/o 5mg/6mL
Repeat as needed

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43
Q

What systolic bp are you titrating to for nitro

A

110

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44
Q

Nitro dose for chest pain & titrate to

A

0.4 every 5mins(no max)
Titrate to >110
If pt is normally hypotensive, titrate to >90

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45
Q

Normal saline dose for ABD/Flank pain

A

1L
Reevaluate after each 500mL

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46
Q

When do you treat low blood sugar

A

<60BGL

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47
Q

Treatment for anaphylaxis without shock

A

Epi 1:1000

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48
Q

Treatment for anaphylaxis with shock

A

NS 1L

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49
Q

Treatment for an allergic reaction if wheezing is present

A

Albuterol

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50
Q

Treatment for an allergic reaction with hives only

A

Diphenhydramine(Benadryl)

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51
Q

What should you do for a behavioral emergency

A

Consider vascular access
Determine BGL
Cardiac monitor and spo2

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52
Q

In CAM how long do you have to determine if the rhythm is shockable?

A

3 seconds

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53
Q

How deep should compressions be in cam?

A

2-2.5 inches

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54
Q

What should you do post ROSC

A

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

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55
Q

What does rescuer #3 do in CAM

A

At the head, leads the CPR team

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56
Q

How long should an asystole code be worked vs a VF/VT code?

A

Asystole/PEA: 20 mins
VF/VT: 30 mins(must contact hospital prior to determination)

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57
Q

When should you obtain a BGL in a cardiac arrest?

A

After ROSC

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58
Q

Indications for push dose epi

A

Unstable anaphylaxis
Severe hypotension with signs of shock
Septic shock
Unstable bradycardia

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59
Q

What are the actions of push dose?

A

Increases cardiac output
Increases heart rate
Increases MAP

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60
Q

What should you document when giving push dose epi

A

Time/amount given
Pt response after 1 min

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61
Q

What drug neutralizes epi?

A

Sodium bicarb

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62
Q

What should you do for pain refractory to nitro in ACS

A

Pain control while maintaining >110 systolic

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63
Q

What should you give for stable ventricular ectopy

A

Amio

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64
Q

What should you do if in ACS the pt has hypotension, signs of CHF, or no response to a fluid challenge?

A

Call base for push dose

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65
Q

When should you perform a 12 lead in a ACS PT

A

Prior to med administration(if possible)

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66
Q

If a stemi pt is stable what should you consider?

A

Code 2 transport

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67
Q

Hr for bradycardia in an adult/ped

A

Adult: <45
Pediatric: <60

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68
Q

What should you give for an adult in stable bradycardia?

A

Atropine

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69
Q

What should you give for a pediatric in stable bradycardia

A

-Epi 1:10,000
0.01mg/kg
(If symptoms persist after initial treatment)
-Give push dose
-Can call base for atropine

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70
Q

Treatment for unstable Bradycardia in an adult?

A

TCP

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71
Q

What should be initiated immediately when a 3rd degree block is present?

A

TCP

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72
Q

When should you pace a 2nd degree block?

A

If the pt becomes symptomatic

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73
Q

What should you give as an initial fluid challenge for symptomatic bradycardia in an adult?

A

500mL bolus
May repeat x1 for a total of 1000mL

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74
Q

What should you give secondary to a fluid challenge in symptomatic bradycardia with hypotension?

A

Push dose epi

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75
Q

If a pt is bradycardic but is suspected to have digitalis toxicity what should you withhold?

A

Calcium chloride

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76
Q

What treatments should you do for an adult in stable SVT

A

-valsalva
-adenosine

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77
Q

What is the HR for SVT

A

Greater than 160 BPM

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78
Q

What are some transport considerations with a pt in SVT?

A

Consider withholding adenosine until ED physician evaluation if the pt is stable or if the pt has an underlying cause(sepsis, hypovolemia, heart failure)

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79
Q

What is required for the documentation for a pt who was in SVT?

A

Document all ECG strips during Valsalva, adenosine administration, and/or synchronized cardioversion

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80
Q

What is the typical HR for a pt in a wide-complex tachycardia?

A

Greater than 150

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81
Q

Treatment for adults/pediatrics in unstable wide-complex tachycardia?

A

Synchronized cardioversion

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82
Q

What must you call base for under the wide-complex tachycardia protocol?

A

Giving mag sulfate

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83
Q

In the event of an IFT zofran can be administered hourly to a max of (adults/peds)

A

32mg
16mg

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84
Q

What are the indications for activated charcoal?

A

Oral ingestion within 1 hour, estimated transport time is greater than 15 mins, pt is awake with gag intact

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85
Q

For BLS procedures in a “poisoning/OD” what should you do in a suspected opiate OD without respiratory effort?

A

Begin cpr
Apply AED and follow instructions

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86
Q

In the poisoning/OD protocol what must you call BHO for?

A

Beta blocker OD, Calcium channel blocker OD, Organophosphate poisoning

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87
Q

In a TCA OD if chest pain is present what should you not administer

A

Aspirin

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88
Q

When can vascular access be obtained in a patient with nerve agent poisoning

A

When they are in the cold zone and after complete decontamination

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89
Q

In a hazmat incident who determines when the pt can be safely assessed by EMS personnel

A

The incident commander

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90
Q

What benzodiazepine is in the CHEMPACK

A

Diazepam

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91
Q

How much epi is in an adult auto ejector and when should it be used

A

0.3mg
It should be used for SOB

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92
Q

What are the pediatric doses for auto injector epinephrine

A

15kg-30kg=0.15mg
Greater than 30kg= 0.3mg

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93
Q

What do you give for an adult and pediatric with wheezing(dose & repeat time)

A

Albuterol
Adult=5mg/6mL
Ped=<2yr=2.5mg/3mL
Greater than or equal to 2= adult dose
Repeat as needed

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94
Q

What should you give for an adult with suspected pulm edema and what dosage

A

Nitro
0.4 every min x3 mins
Then 0.4 every 2 mins
No max

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95
Q

What should you give for a pt with SOB who develops hypotension

A

Push dose epi

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96
Q

What BLS procedures should you do in an adult pt having a seizure

A

Protect from injury
Administer 02 if sats are less than 94
Determine BGL

97
Q

What BLS procedures should you do for a pediatric pt having a seizure

A

Protect from injury
Administer 02 if sats are less than 94
Begin passive cooling
Determine BGL

98
Q

What conditions must be met in order for you to treat for eclampsia

A

3rd trimester pregnancy, no known seizure history with signs/symptoms of eclampsia or active seizures

99
Q

Signs and symptoms of septic shock

A

Fever(hot to the touch)
Tachycardia
Tachypnea
ALOC
History or physical exam suggestive of infection

100
Q

BLS procedures for stroke

A

Assess LOC and Neuro(CSS)
Airway management(sp02 <94)
Determine BGL

101
Q

ALS treatment for stroke

A

Vascular access
Early BH contact with “stroke alert”

102
Q

When should you intubate a pt with a head injury?

A

If there airway is unable to be controlled using BLS measures

103
Q

What SBP are you to maintain in a traumatic injury

A

90

104
Q

Pediatric needle sizing for Needle T

A

Less than 40kg=3cm needle
Greater than 40kg=8-8.5cm needle

105
Q

What should you document in a traumatic injury

A

Detailed description of injury(swelling, angulation/rotation), laceration, open/closed fracture, neurovascular compromise, estimated blood loss

106
Q

What are the actions of TXA

A

Inhibits the conversion of plasminogen to plasmin
Reduces fibrinolysis and clot breakdown
Stabilizes clot formation

107
Q

Contraindications for TXA

A

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

108
Q

What’s the concentration of TXA

A

100mg/mL

109
Q

What is the onset and duration of TXA

A

Onset= 20 mins-2 hours
Duration= 2-8

110
Q

What adverse effects may be present with TXA

A

Hypotension with rapid IV infusion, chest tightness, difficulty breathing, facial flushing, blurred vision, nausea, vomiting, and diarrhea

111
Q

How old do you have to be to receive TXA

A

Greater than or equal to 15 years old

112
Q

What are the general burn guidelines for adult/ped

A

Remove clothes made from synthetic material
Determine type of burn(thermal, electric, radiation, chemical)
Maintain body heat
Elevate burned limbs

113
Q

What are you going do do (ALS interventions) for a burn

A

Pain control
If greater than 10% TBSA or hypotension present…1L bolus

114
Q

Rule of 9s for an adult

A

Head(front and back)= 9
Arms= 9
Chest=18
Back= 18
Legs= 18 each
Perineum= 1

115
Q

Rule of 9s for a pediatric

A

Head= 18(front and back)
Chest= 18
Back= 18
Arms= 9 each
Legs= 13.5 each
Perineum= 1

116
Q

How should you stop the burning process for a pt with an electrical burn

A

Turn off power source and safely remove the pt from the hazardous area

117
Q

How should you stop the burning process for a pt with a radiation burn

A

Keep area clean and dry with sterile dressings

118
Q

What BLS procedures should you do for a potential crush injury

A

Administer 02
Spinal precautions(if indicated)
Maintain body heat
Obtain crush timeframe

119
Q

What should you do for potential crush syndrome

A

Vascular access
Release compression
Monitor for dysrhythmias

120
Q

What treatments can you do for potential crush injury/crush syndrome

A

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

121
Q

What is classified as a potential crush injury

A

Continuous crush injury to a body part that is less than or equal to 2 hours

122
Q

What is classified as crush syndrome

A

A continuous crush injury to a body part lasting greater than 2 hours

123
Q

What are the changes in the EKG for a crush injury that you are monitoring for?

A

Peaked T waves, absent P-waves, widened QRS, bradycardia

124
Q

What should you consider prior to determination of a traumatic arrest

A

Bilateral Needle T

125
Q

What should you do for an insect bite

A

Flush site
Control bleeding
Apply bandage

126
Q

What should you do for a pt with a snake bite

A

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

127
Q

What should you do for a bee stings

A

If present, remove stinger
Apply ice pack

128
Q

What should you do for a jelly fish sting

A

Rinse thoroughly with NS

DO NOT
Rinse with fresh water
Rub with wet sand
Apply heat

129
Q

What should you do for all other marine animal stings

A

Remove barb if present
Immerse in hot water, if available

130
Q

Under the bites/stings protocol what can you BLS

A

All bites other than snake bites

131
Q

What BLS procedures should you do for a pt having a heat emergency

A

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

132
Q

What should you do if a pt having a heat emergency is altered

A

Obtain a BGL

133
Q

What ALS treatment should you do for a pt experiencing a heat emergency

A

1L bolus to maintain SBP of 110, re-evaluating after each 500mL
May repeat x1

134
Q

What BLS procedures should you do for a hypothermic pt

A

Passive rewarding
Minimize movement of extremities
Attempt to maintain supine
Cut off wet clothing and cover pt

135
Q

What are the acceptable vitals ranges for severe hypothermia(HR/RR)

A

RR at least 4 breaths per min
HR at least 20 per min

136
Q

Why should you expedite transport with a pt who has severe hypothermia but is not shivering

A

Indicates core temp below 90

137
Q

What BLS procedures can you do for frostbite

A

Wrap affected extremity in blankets or clothing
DO NOT rub or attempt active rewarming

138
Q

What ALS procedures should you do for a pt in a “water emergency”

A

Maintain SBP of greater than 110

139
Q

What additional things do you want do do in a water emergency

A

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

140
Q

With a pregnant pt what are some things to determine initially

A

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

141
Q

What should you do for a prolapsed cord

A

Cover cord with wet saline dressing
Place pt in LT lateral
Provide manual pressure on presenting part(to avoid cord compression)
Initiate code 3

142
Q

What should you do if there is a presenting part while delivering

A

Elevate hips
Assist delivery while initiating code 3
Assist with breech delivery while supporting the infants body
Covering baby with blanket to maintain heat

143
Q

What should you do if there is a presenting part while the pt is not delivering

A

Place mother in LT lateral Trendelenberg
Initiate code 3

144
Q

What should you do for a delivery with the head crowning

A

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

145
Q

What should you do for a delivery that has the butt crowning

A

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

146
Q

What should you do if there is a partial delivery and there is no further progress after 1-2 mins

A

Code 3 transport

147
Q

What is the A in APGAR

A

Appearance
0=blue/pale
1=pink w/blue extremeties
2=pink

148
Q

What does the P in APGAR represent

A

Pulse
0=absent
1= less than 100
2= greater than 100

149
Q

What does the G in APGAR represent

A

Grimace(reflexes)
0=absent
1=grimace
2=cough/cry/sneeze

150
Q

What does the second A in APGAR stand for

A

Activity(muscle tone)
0=limp
1=some flexion
2=active

151
Q

What does the R stand for in APGAR

A

Respirations
0=absent
1=slow
2=good cry

152
Q

What should you do if you are arriving to the hospital less than 5 mins after delivery

A

Use standard neonatal assessment

153
Q

What BLS procedures will you do for a newly born infant

A

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

154
Q

What should you do if there’s any deficits to the APGAR of a newly born infant

A

Stimulate briefly(less than 15 seconds)
Flick soles of feet
Briskly rub infants back

155
Q

What BLS procedures should you do for a neonate

A

Assess ABCs

156
Q

What should you do if a neonate has Apneic or gasping respirations

A

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

157
Q

When assessing a neonates circulation what should you do if there HR is between 60 and 100

A

PPV with BVM @room air at 40-60 BPM for 30 seconds
Continue PPV reassessing every 30 seconds until HR maintains above 100

158
Q

When assessing a neonate what should you do if their HR is less than 60

A

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

159
Q

When should you establish an IO on a neonate

A

Only in the presence of CPR
If they weigh greater than 3kg

160
Q

What treatment will you do for asystole and/or persistent bradycardia less than 60BPM(ped dose)

A

Epi 1:10,000
0.01mg/kg every 3-5mins

161
Q

When should you withhold resuscitation efforts of a neonate

A

If they are less than 23 weeks or 9in long
However sensitivity to the desires of the parents may be considered

162
Q

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)

A

Begin resuscitation

163
Q

What BLS procedures should you do for vaginal bleeding/spontaneous abortion

A

Place pad/dressing over vaginal opening(NOT IN)
Save and transport all tissue or fetal remains passed

164
Q

What BLS procedures should you do for pre-eclampsia/eclampsia

A

Minimize stimulation(lights, noise)
Left lateral

165
Q

What ALS interventions can you do for Pre-eclampsia

A

Vascular access
IV/IO TKO or saline lock
Maintain SBP above 90 by giving fluids, re-evaluating after every 500mL
Max 1L

166
Q

What ALS interventions can you do for 3rd trimester pregnancy, no known seizure Hx, with S&S of eclampsia/active seizures

A

Mag sulfate
Midazolam

167
Q

Under the OB/GYN protocol what should your Hx/report/documentation include?

A

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

168
Q

Normal RR, HR, and SBP for a newborn

A

RR= 30-60
HR= 85-205
SBP=60-84

169
Q

Normal RR, HR, and SBP for an Infant

A

RR=30-60
HR=80-140
SBP=70-105

170
Q

Normal RR, HR for toddler and preschooler

A

RR=22-40
HR=80-120

171
Q

Normal RR/HR for a school age child(6-12)

A

RR=18-30
HR=70-110

172
Q

How long should the RR of an infant be counted for

A

Full 60 seconds

173
Q

In a decompensating child what vital sign will be the last to change

A

The BP

174
Q

What does bradycardia represent in a child

A

Hypoxia…pt is extremely critical

175
Q

A person has decision making capability if they are able to…

A

-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

176
Q

What is a Patient defined as?

A

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

177
Q

EMS providers have a duty to act and render emergency care/transport when these conditions are met

A

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

178
Q

What is the difference between a refusal of care and a refusal of service?

A

Care= BLS assessment was done and the pt required nothing further
Service= subject is declining any and all EMS services

179
Q

Who may refuse medical care or transportation

A

18yrs of age or older
Legal representatives by legal custody or durable power of attorney for HEALTH CARE
Parents of minors
An emancipated minor

180
Q

Should you do Resuscitative efforts on a pt who has a DNR medallion

A

No

181
Q

If a pt with a DNR is overdosing on opioids what can you do

A

Administer narcan sparingly
0.1mg IV every 2-3 mins

182
Q

When is a DNR inoperative?

A

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)

183
Q

What should you confirm when implementing a POLST

A

Confirm the pts name is on the form
Confirm that the form is signed by both parties

184
Q

What treatments are you supposed to do if a POLST says “comfort measures only”

A

Anything that relieves pain/suffering
Pt positioning
02
Airway suctioning
Relief of airway obstruction(including using magills)
Pain control

185
Q

What treatments can you do if a pts POLST form says “limited additional interventions”

A

You may provide comfort measures along with…
Iv fluids
BVM
CPAP
DO NOT INTUBATE

186
Q

What should you do if a pt has multiple end-of-life documents with different dates

A

Follow the most recent one

187
Q

What should you do if there’s a conflict between the written end-of-life orders and the legally recognized decision-maker

A

Initiate BLS measures while consulting the BH physician

188
Q

What should you do if the pts power of attorney on scene requests witholding resuscitation

A

EMS provider shall inform the agent of the consequences of the request
The agent needs to sign a refusal

189
Q

What do you need to document for the use of a DNR/POLST

A

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

190
Q

What should you document if a power of attorney requests to withhold resuscitation

A

Their full name and phone number

191
Q

What must you attach to the EPCR when a DNR/POLST is used?

A

Original form
Copy or fax
Photocopy

192
Q

Under what conditions may a pt be presumed dead

A

Decapitation
Decomposition
Hemicorporectomy(sliced in half)
Incineration
Valid DNR

193
Q

What are you assessing for respiratory under the determination of death policy

A

Open the pts airway
Auscultation of the lungs while observing for chest movement for 30 secs

194
Q

What respiratory finding are needed for DOD

A

No spontaneous breathing
No breath sounds upon auscultation

195
Q

What assessment procedures are you doing under the Cardiac section of the DOD policy

A

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

196
Q

What cardiac findings are needed for determination of death

A

No pulse
No heart sounds

197
Q

What assessment procedures are you doing for neurological section of DOD policy

A

Check pupils response to light
Check response to painful stimuli

198
Q

What neurological findings are needed for DOD

A

No pupillary response
No response to painful stimuli

199
Q

What treatment must you do for a pt less than 18 years old in a traumatic arrest

A

Resuscitation efforts and transport to the closest receiving hospital

200
Q

What criteria must me met for you to pronounce a traumatic arrest in a pt older than 18 years old

A

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

201
Q

Deaths that occur in any place other than the hospital or a SNF must be reported to?

A

Law enforcement personnel and the body must be left in their custody

202
Q

What is the criteria for a step 1 trauma pt

A

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

203
Q

What is the criteria for a step 2 trauma

A

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

204
Q

What is the criteria for a step 3 trauma

A

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)

205
Q

What is the criteria for a step 4 trauma

A

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

206
Q

Adult trauma pts must meet what steps to fly

A

1 and 2

207
Q

What steps must a pediatric trauma meet to fly?

A

1, 2, and 3

208
Q

What should you do if the air ambulance is unavailable in north county?

A

Contact MRMC and they will determine your destination

209
Q

In south county when will you transport by air ambulance

A

If the pt meets step 1, 2, if transport exceeds 30 mins and air ambulance will save 15 mins

210
Q

Contraindications to intubation

A

Intact gag reflex

211
Q

Indications for intubation

A

Cardiac arrest, ONLY if unable to ventilate using BLS procedures
Resp arrest, compromise AND unable to ventilate with BLS procedures
Physicians request

212
Q

How many attempts do you get to intubate and for how long?

A

2 for 20 second

213
Q

How far do you advance the ETT for a pt less than 5ft

A

2 cm past vocal chords

214
Q

How far do you insert the ETT for a pt who is 5-6 1/2 ft tall

A

22cm at the teeth

215
Q

How far do you insert the ETT for somebody who is over 6 1/2 ft tall

A

24 cm at the teeth

216
Q

How far should you load the stylet into the ETT using the 1 person technique

A

4 inches past the distal end of the ETT

217
Q

Do you use a stylet for intubating a stoma

A

No

218
Q

What are the best ways to confirm intubation

A

End tidal waveform
Auscultation

219
Q

What are the indications for a needle T

A

SBP less than 90(70 for peds less than 40kg)
Signs of hypoperfusion
And absent/decreased lung sounds on affected side
Traumatic arrest

220
Q

What size needle T does a ped less than 40kg receive

A

3cm needle

221
Q

What is the preferred site for and adult needle T

A

4th intercostal space at the anterior axillary line

222
Q

What is the alternative needle T sites for adults or preferred pediatric site

A

2nd intercostal space, mid clavicular line

223
Q

How many IO attempts do you get

A

2 attempts at different sites

224
Q

What is defined as an IO attempt

A

The IO puncturing the skin with the intent to establish IO access

225
Q

What are the contraindications for an IO

A

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

226
Q

What weight is the 15mm pink IO needle indicated for

A

3-39kg

227
Q

What weight is the 25mm blue IO needle indicated for

A

Pts greater than 3kg

228
Q

What weight is the 45mm yellow IO needle indicated for

A

Greater than or equal to 40kg

229
Q

What is the dose for lidocaine

A

0.5mg/kg(max of 40mg) slow IVP over 60 secs

230
Q

Indications for a 12 lead

A

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

231
Q

How quickly into the call should you obtain a 12 lead

A

Less than 3 mins

232
Q

What is the age range for a BRUE

A

24 months or younger

233
Q

What height is the size 3.5(red top) LMA for

A

Women less than 6ft
Men less than 5’6
And any pt that wont fit a size 4.5

234
Q

What height is the size 4.5(purple) LMA for

A

Women at least 6ft
Men at least 5’6

235
Q

How many attempts for an LMA and how long

A

2 attempts 30 seconds

236
Q

What are the contraindications for an LMA

A

Intact gag
Pt weighs less than 45kg(100lbs)
Age less than 15yr

237
Q

What must you document for every placement for an LMA

A

All of these are yes or no
Rescue device
Successful placement
Number of attempts
Emesis
Bleeding
Hypoxia
Dislodgement

238
Q

What should you do for a burn pt if their TBSA is less than 10%

A

Cool burned area with Saline dressings

239
Q

What should you do for a burn pt if their TBSA is greater than 10%

A

Cover with dry sterile dressings + burn sheet

Medic (3 decks)

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