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Protocols Flashcards

1
Q

Keep SPO2 above what %

A

92%

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2
Q

What dose of chewable ASA is given for cardiac chest pain

A

160mg (81x2= 162, close enough)

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3
Q

When do you initiate transport in cardiac chest pain

A

After giving ASA and started oxygen if sats are below 92%

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4
Q

When do you insert a saline lock in cardiac chest pain

A

After initiating transport

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5
Q

In cardiac chest pain what do you give if the BP is under 90 systolic after placing an IV lock

A

IV Normal Saline 250mL bolus

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6
Q

In cardiac chest pain what do you give if the BP is over 90 systolic after placing an IV lock

A

Nitroglycerin spray 0.4mg SL

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7
Q

What is the dose, route, max dose, and time between doses for nitroglycerin spray

A

0.4mg SL q5min (max 3 doses)

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8
Q

What can a QL3 do after 3 doses of nitroglycerin spray w/ a BP over 90 systolic in cardiac chest pain

A

Monitor and contact SMA

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9
Q

What can a QL5 do after 3 doses of nitroglycerin spray w/ a BP over 90 systolic in cardiac chest pain

A

Morphine 2.5mg IV slow push, dimenhydrinate 25-50mg PO/IM/IV, and contact SMA

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10
Q

What is the dose, route, max dose, and time between doses for morphine in cardiac chest pain (QL5)

A

2.5mg IV slow push q5min (max 15mg, 6 doses)

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11
Q

What is the dose, route, max dose, and time between doses for dimenhydrinate in cardiac chest pain (QL5)

A

25-50mg PO/IM/IV, one dose.

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12
Q

What’s the dose of ASA to be chewed if the ASA isn’t chewable in cardiac chest pain

Should know

A

325mg

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13
Q

How many doses of ASA do you give in cardiac chest pain

A

1 dose only

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14
Q

What is the dose, route, rate, max dose, and time between doses for normal saline in cardiac chest pain

A

250mL IV bolus q10min (4 doses)

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15
Q

What pulse is usually felt when above 90 mmHg systolic

A

Radial pulse

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16
Q

How do you calculate the doses of nitroglycerin spray if the patient self administered doses before you arrived

A

Self administered doses don’t count, continue as if they didn’t take any nitroglycerin.

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17
Q

If you can feel a radial pulse but can’t get a BP, can you give nitroglycerin spray

A

No

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18
Q

Between doses of Normal Saline IV bolus what are you checking other than BP

A

Pulmonary edema

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19
Q

What are the indications for cardiac arrest

A

No carotid pulse, decreased LOC, and not breathing

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20
Q

In cardiac arrest what takes priority, AED or compressions (if AED is present)

A

AED, but try to do both at the same time until analyzing. Unless due to asphyxiation or hypothermia ( core temp under 30°C) where oxygenation and CPR takes priority

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21
Q

If using a AED, what is the first thing you do when opening the AED and why

A

Turn it on, it will often have command promps that can’t be skipped and sometimes doesn’t turn on

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22
Q

In cardiac arrest, when can you discontinue resusitation

A

After 3 consecutive no shock advised, core temp is greater than 30°C, no pulse after 30 min of continual CPR, or if the SMA directs you to discontinue.

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23
Q

What age uses pediatric AED pads, and what do you do if pediatric pads aren’t present for this age group

A

Ages 1-8, use adult pads if ped pads aren’t present

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24
Q

What are the indications of post cardiac arrest

A

Someone that was in cardiac arrest that now has a carotid pulse

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25
Q

How long after a post arrest should you constantly monitor a patient’s pulse and why

A

10 min because of high likelihood of another cardiac arrest

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26
Q

How often do you take baseline vitals for a post cardiac arrest patient

A

q 5 min

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27
Q

When should you initiate transport for post cardiac arrest if you aren’t in transit yet

A

ASAP after a set of vitals

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28
Q

What is considered breathing spontaneously

A

Over 12 resps per min

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29
Q

In post cardiac arrest what should you consider if the patient doesn’t have spontaneous breathing

A

Advanced airway

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30
Q

What BP in post cardiac arrest do you give NS IV

A

Under 90 mmHg systolic

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31
Q

What is the dose, route, max dose, and time between doses for normal saline during post cardiac arrest

A

500mL IV bolus, only one dose

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32
Q

After verifying BP is over 90 mmHg systolic or you have already given normal saline IV, what can you do in post cardiac arrest

A

Consider urinary catheterization and contact SMA

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33
Q

What is a normal urine output during urinary catheterization during post cardiac arrest

A

0.5mL/kg/hr

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34
Q

Under what geographic setting can vital signs absent protocol be used

A

Operational

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35
Q

What are patients with no pulse, no respirations, and no other signs of life after being injured in a blast or penetrating trauma ON THE BATTLEFIELD considered and treated

A

Killed in action and resusitation is not attempted

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36
Q

What is performed in the vital signs absent protocol that isn’t performed on a cardiac arrest protocol

A

Bilat needle decompression if trauma to truncal/torsal region, and 1L IV/IO bolus of normal saline or ringers

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37
Q

What can only be performed operationally when using respiratory protocols

A

Cricothyroidotomy

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38
Q

What is the criteria for a supraglottic airway in a airway obstruction or impeding obstruction

A

GCS of 8 or under and/or no gag reflex

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39
Q

What can you do if a supraglottic airway in a airway obstruction or impeding obstruction patient isn’t effective

A

Cricothyroidotomy if operational or transport and contact SMA

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40
Q

What can you do if basic airway management isn’t effective in a airway obstruction or impeding obstruction patient that has a GCS over 8 and gag reflex

A

Cricothyroidotomy w/ transtracheal block (time permitting) if operational or transport and contact SMA

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41
Q

Indications for asthma/COPD SOB protocal

A

SOB with hx of COPD, asthma, or wheezing

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42
Q

What two things do you instantly when arriving to a conscious SOB patient

A

Position of comfort (semi-fowlers) and SPO2

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43
Q

S/S of severe SOB compared to mild/moderate

A

Altered LOC, cyanosis, can’t finish sentences, use accessory muscles, SPO2 under 90%

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44
Q

What is the dose, route, max dose, and time between doses for sulbutamol for mild/moderate SOB

A

4-8 puffs MDI q20min (3 doses) or 5mg neb q20min (3 doses)

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45
Q

After giving oxygen to someone with severe SOB what do you give

A

Salbutamol (Ventolin)

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46
Q

When in severe SOB should you initiate transport if you haven’t already

A

After first dose of sulbutamol (Ventolin)

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47
Q

With severe SOB what can a QL3 do after initiating transport and treating with sulbutamol (Ventolin)

A

Place an IV lock and contact SMA

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48
Q

What can a QL5 give for severe SOB that a QL3 can’t

A

Ipratropium bromide, epinephrine, and dexamethasone

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49
Q

What is the dose, route, max dose, and time between doses for sulbutamol for severe SOB

A

Salbutamol nebulized continuous or 2 puffs MDI q1min

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50
Q

What is the dose, route, max dose, and time between doses for ipratropium bromide for severe SOB

A

0.5mg nebulized q10min (max 3 doses) or 8 puffs MDI q10min (max 3 doses)

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51
Q

What is the dose, concentration, route, max dose, and time between doses for epinephrine for severe SOB

A

Epinephrine (1:1000) 0.3mg IM (max 1 dose)

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52
Q

What is the dose, route, max dose, and time between doses for dexamethasone for severe SOB

A

Dexamethasone 10mg IV/IM/PO (max 1 dose)

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53
Q

What do you do if mild/moderate SOB starts showing signs of severe SOB

A

Change to the severe SOB protocol

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54
Q

What is the indicator of an adult when using anaphylaxis protocol

A

Greater that 30kg

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55
Q

What is the first treatment given after identifying anaphylaxis

A

Epinephrine

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56
Q

When do you initiate transport if not already done in anaphylaxis

A

After epi and oxygen therapy started

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57
Q

How do you treat a patient with a hypotensive systolic BP while in anaphylaxis

A

Normal saline IV

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58
Q

After checking/treating BP during anaphylaxis, what is the next assessment done for possible treatment and how do you treat it

A

SOB/Wheezing, salbutamol (Ventolin)

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59
Q

After checking/treating SOB/wheezing during anaphylaxis, what is the next treatment

A

Diphenhydramine (benadryl)

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60
Q

What can a QL5 give after giving diphenhydramine during anaphylaxis

A

Dexamethasone

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61
Q

What is the dose, concentration, route, max dose, and time between doses for epinephrine for anaphylaxis in an adult

A

Epinephrine 0.3mg IM q5min (max 3 doses)

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62
Q

What is the dose, route, max dose, and time between doses for normal saline for anaphylaxis in an adult

A

Normal saline 1-2L IV/IO titrated to 90mmHg

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63
Q

What is the dose, route, max dose, and time between doses for salbutamol (Ventolin) for anaphylaxis in an adult

A

Salbutamol 4-8 puffs MDI q20min or 5mg nebulized q20min

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64
Q

What is the dose, route, max dose, and time between doses for diphenhydramine (gravol) for anaphylaxis in an adult

Gravol or benadryl?

A

Diphenhydramine 50mg IM/PO/ (IV QL5) q2hrs (max dose 400mg/daily [8 doses])

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65
Q

What is the dose, route, max dose, and time between doses for dexamethasone for anaphylaxis in an adult

A

Dexamethasone 10mg IV/IM/PO (max 1 dose)

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66
Q

What do you access after every dose of epinephrine

A

Airway obstruction and hypotension

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67
Q

If using an epi-pen, how long do you hold it in the muscle

A

5 sec

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68
Q

During anaphylaxis, how much fluid can fluid shift from the vascular space to the tissue space

A

35%

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69
Q

What weight difference are children separated into when calculating epinephrine dose to a child

A

Under 15kg and between 15-30kg

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70
Q

What is the dose, concentration, route, max dose, and time between doses for epinephrine for anaphylaxis in person between 15-30kg

A

Epinephrine (1:1000) 0.15mg IM q5min (max dose 3)

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71
Q

What is the dose, concentration, route, max dose, and time between doses for epinephrine for anaphylaxis in a child under 15kg

A

Epinephrine (1:1000) 0.01mg/kg IM q5min (max dose 3)

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72
Q

What is the dose, route, max dose, and time between doses for normal saline for anaphylaxis in a person under 30kg

A

Normal saline IV/IO 20mL/kg (2 doses)

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73
Q

What is the dose, route, max dose, and time between doses for salbutamol for anaphylaxis in a person under 30kg

A

Salbutamol 2 puffs MDI q20min or 2.5mg nebulized q20min

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74
Q

What is the dose, route, max dose, and time between doses for diphenhydramine for anaphylaxis in people under 30kg

A

Diphenhydramine 1mg/kg IM/PO/ (IV QL5) q6hrs, no max dose

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75
Q

What is the dose, route, max dose, and time between doses for dexamethasone for anaphylaxis in people under 30kg

A

Dexamethasone 0.6mg/kg IV/IM/PO (max at adult dose) (1 dose only)

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76
Q

If suspected massive external hemorrhage with no obvious source or amputation, what regions do you check in order

A

Inguinal region, legs, neck, axilla, then arms.

Then scalp, nose, and abdomen

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77
Q

What should you do after you have identified a massive bleed

A

Control with direct or indirect pressure (unless contraindicated)

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78
Q

For a wound that doesn’t meet tourniquet approval, how would you treat it after direct/indirect pressure.

A

Packing with hemostatic dressing (if not contraindicated)

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79
Q

What do you do if tourniquet protocal failed to control the bleeding

A

Packing with hemostatic dressing

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80
Q

After packing a massive hemorrhage doesn’t work, what do you attempt next

A

Apply a junction tourniquet (if not contraindicated)

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81
Q

What do you do if a junction tourniquet isn’t effective or can’t be used

A

Maintain pressure with hemostatic dressing

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82
Q

What do you do after you have finished controlling or treating a obvious massive bleed

A

Check for non-obivious massive hemorrhage and then significant external hemorrhage

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83
Q

After you have controlled or treated all obvious, non-obvious, and significant hemorrhages, what do you consider applying

A

Consider pelvic binder

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84
Q

After completing the massive hemorrhage protocol, what do you do next

A

Continue with casualty assessment

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85
Q

What cavities can’t be packed

A

Abdo, thoracic, and cranial

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86
Q

If a hemostatic dressing fails at controlling a bleed, what do you attempt

A

Remove packing and attempt a 2nd application

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87
Q

How long should you maintain pressure on a hemostatic or plain packing

A

Hemostatic- 5min
Plain- 10min

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88
Q

What are the indications for a pelvic binder

A

Penetrating/blunt pelvic trauma, unexplained hypotension in blast/blunt trauma, lower limb part/full amputation, or pelvic pain/tenderness

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89
Q

What is the lethal triad in hemorrhage shock

A

Coagulopathy, acidosis, hypothermia

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90
Q

Indication of hemorrhagic shock in adult, child, infant

A

Adult: systolic BP less than 90mmHg (loss of radial pulse), or pulse greater than 110.

Ages 1-9: systolic BP less than 70 - (2 x age)mmHg

Under 1 year old: systolic BP less than 70mmHg

Or injury predicts hemorrhagic shock in future

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91
Q

What are injuries that you can predict hemorrhage shock in near future that isn’t significant external bleeding

A

Penetration injury to chest/Abdo, severe hypothermia w/ trauma, unstable pelvis, femur fracture, blast injury, blunt truama to Abdo/back/chest.

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92
Q

When expecting hemorrhagic shock what 4 things are attempted before establishing an IV/IO line

A

Control external hemorrhages, airway/respiratory management, hypothermia prevention, and transport intitation

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93
Q

What can a QL5 do that a QL3 can’t when treating hemorrhagic shock

A

TXA protocol

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94
Q

When do you do TXA in hemostatic shock protocol

A

After you have IV/IO access, is an adult, and initiated transport

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95
Q

When do you give fluid replacement IV/IO therapy, and what fluid is used

Hypovolemic protocol?

A

QL3: after getting an IV/IO line, normal saline (ped), normal saline or ringers (adult)

QL5: after getting an IV/IO on a ped, normal saline. After TXA protocol on an adult, normal saline or ringers

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96
Q

What is the dose, route, max dose, and time between doses for normal saline for hemorrhagic shock for a pediatric

A

20mg/kg normal saline IV/IO bolus

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97
Q

What is the dose, route, max dose, and time between doses for normal saline/ ringers for hemorrhagic shock adult

A

250mL bolus IV/IO, (max 1L, 4 doses)

unless expected TBI

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98
Q

When an adult is in hemorrhagic shock what can you do after you are in transit and giving IV/IO fluid therapy

A

Hypothermia management, consider a urinary catheter, and contact SMA

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99
Q

What is the dose, route, max dose, and time between doses for TXA for hemorrhagic shock

A

Tranexamic acid 1gram/10mL normal saline IV/IO slow push q1hr (max 2 doses)

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100
Q

Indication for burn management protocol

A

2nd or 3rd degree burns to greater than 20% body surface area

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101
Q

What is the first priority for burn management

A

Stop the burn

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102
Q

After you stop the burn in burn management what is the next step

A

Accessing airway/oxygen therapy

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103
Q

Why is oxygen therapy possibly dangerous with burn management

A

Ignition source (burnt clothes) can ignite the oxygen

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104
Q

What are signs in a burn victim that would make you consider to prepare a surgical airway

A

Soot in mouth, chest burns, neck burns, SOB, hoarse voice, SPO2 low

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105
Q

After you have assessed the airway and gave oxygen therapy to a burn victim, what do you do next

A

Hypothermia prevention and active warming

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106
Q

If a burn management patient has a BP below 90mmHg systolic, what must you consider when treating

A

If the hypotension is primarily caused by a hemorrhage, follow hemorrhagic shock protocol

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107
Q

What is the dose, route, max dose, and time between doses for ringers for burn management

A

500mL ringers IV/IO bolus (max 2 L, 4 doses)

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108
Q

After you have verified the burn management patient isn’t hypotensive, what do you do next

A

Calculate total surface area of the burn and start the rule of ten or parkland formula burn protocols

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109
Q

What protocol should you start after rules of ten or parkland formula burn ptotocol

A

Pain protocol

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110
Q

After pain management for burn patients, what 3 things should you do

A

Transport if you haven’t already, insert urinary Foley catheter, and contact SMA

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111
Q

What kind of dressing do you use on burns

A

Sterile, dry, non-adhesive dressings

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112
Q

What is the target urine output for a burn patient on a Foley catheter by kg and average for an adult

A

0.5mL/kg/hr
Adult: 30-50mL/hr

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113
Q

Before treating for pain what should you assess and consider

A

Assess cause and severity, consider IV lock

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114
Q

What pain management medications do you have to closely monitor airway/breathing/circulation

A

Ketamine, morphine, fentanyl

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115
Q

Pain management is divided into what age groups

A

Child: 4-16 y/o
Adult: greater than 16 y/o

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116
Q

What medications can be used in pain management for a child

A

Advil and tylenol

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117
Q

When can you give ketamine in pain management

A

Adult, severe pain, operationally

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118
Q

When can you give morphine in pain management

A

Adult, severe pain, no significant risk of shock/respiratory distress, operational

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119
Q

When can you give oral transmucosal fentanyl citrate in pain management

A
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120
Q

When can you transition from mild pain protocol to severe pain protocol in an adult

A

Pain is now severe or mild protocol pain management hasn’t completely controlled the pain

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121
Q

What do you do if pain is completely controlled in a mild pain in an adult

A

Transport if not already occurred, contact SMA, continue with previous protocols if referred to pain protocol

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122
Q

What medications are used to treat mild pain and can be used with other mild pain medications

A

Advil or meloxicam
And/or tylenol

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123
Q

What do you give after giving fentanyl, morphine, or ketamine

A

Ondansetron or dimenhydrinate (gravol)

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124
Q

What do you do if you haven’t yet controlled pain and no other pain management available

A

Transport, contact SMA, continue with previous protocol if referred to this protocol

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125
Q

How do you treat severe pain in a patient under 4 years old

A

Contact the SMA

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126
Q

With severe pain, if all medications are not indicated/available, what can be used

A

Mild pain management medications

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127
Q

What treatment can be added for pain management if opioids don’t completely manage the pain

A

Ketamine

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128
Q

How do you treat emergence/recovery reaction to ketamine. Including dose, route, time between doses, and max dose

A

Midazolam 2mg IV/IM/IO q10min (max 4 doses)

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129
Q

What medications shouldn’t be used for mild pain with a hemorrhage

A

Advil

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130
Q

What is the dose, route, max dose, and time between doses for Advil in a child in pain management

A

Advil 10mg/kg PO q8hrs

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131
Q

What is the dose, route, max dose, and time between doses for tylenol in a child in pain management

A

Tylenol 15mg/kg PO q6hrs

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132
Q

What is the dose, route, max dose, and time between doses for ketamine in an adult in pain management

A

Ketamine 25mg IV/IO slow push (1 min) q20min (max 4 doses/2 hrs)

Or

Ketamine 50mg IM/IN q30min (max 2 doses)

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133
Q

What is the dose, route, max dose, and time between doses for oral transmucosal fentanyl in an adult in pain management

A

oral transmucosal fentanyl 800ug transbucal q15min (max 2 doses)

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134
Q

What is the dose, route, max dose, and time between doses for morphine in an adult in pain management

A

Morphine 2.5mg IV/IO slow push (1 min) q5min (max dose 15mg/30min)

Or

Morphine 10mg IM q30min (no max dose)

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135
Q

What is the dose, route, max dose, and time between doses for advil in an adult in pain management

A

Advil 800mg PO q8hrs

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136
Q

What is the dose, route, max dose, and time between doses for meloxicam in an adult in pain management

A

Meloxicam 15mg PO (only one dose)

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137
Q

What is the dose, route, max dose, and time between doses for tylenol in an adult in pain management

A

Tylenol 1g PO q6hrs

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138
Q

What is the dose, route, max dose, and time between doses for ondansetron in adults in pain management

A

Ondansetron 8mg IV/IM/PO q8hrs

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139
Q

What is the dose, route, max dose, and time between doses for dimenhydrinate (gravol) in an adult in pain management

A

dimenhydrinate (gravol) 50mg IV/IM/PO q4hrs

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140
Q

What are the indications for minor TBI protocol

A

Operation, head injury w/ decreased level of concussion or concussion symptoms

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141
Q

Signs of an open globe injury

A

Full thickness Eye laceration, collapsed/severe distorted eye, prolapsed intraocular content, irregular pupil, shallow anterior chamber

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142
Q

How do you treat an open globe injury

A

Rigid eye shield, antibiotic protocol

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143
Q

What can a QL5 give for an open globe injury that a QL3 can’t, and why/when

A

Ondansetron for adults. Used for nausea

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144
Q

What should you look for to remove if a patient has an eye injury

A

Contacts

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145
Q

What do you always do for a foreign body/substance if it doesn’t have an open globe injury

A

Tetracaine eye drops

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146
Q

When do you not allow the patient to eat or drink when they have an eye injury

A

If it’s an open globe injury or if it has a foreign body that can’t be removed

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147
Q

How do you attempt to remove a foreign body/ substance from an eye after freezing

A

Irrigation and removal with moistened cotton tip applicator

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148
Q

If you can’t successfully remove a foreign body from an eye, what do you do

A

Apply a rigid eye shield, contact SMA, transport

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149
Q

What must you do if you have removed a foreign substance/body from a patient’s eye

A

Contact SMA

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150
Q

If there is an eye injury without an open globe injury or foreign body/substance, what do you do after freezing

A

Stain with fluorescein eye drops

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151
Q

What do you do regardless of your findings after fluorescein eye staining

A

Contact the SMA

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152
Q

After successfully treating an eye injury, what do you always do before discharge

A

Visual acuity test

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153
Q

What must a patient avoid with a open globe injury or having a foreign body of the eye

A

Avoid increased intraocular pressure (Valsalva, blowing nose, or pressure on the eye)

Eating

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154
Q

What is the dose, route, max dose, and time between doses for ondansetron for an eye injury

A

Ondansetron 8mg IV/IM/PO q8hrs

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155
Q

What is the dose, route, max dose, and time between doses for tetracaine for an eye injury

A

Tetracaine 0.5-1.0% 1-2gtts in eye (only one dose)

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156
Q

What is the dose, route, max dose, and time between doses for fluorescein for an eye injury

A

Fluorescein 1-2gtts in eye (only one dose)

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157
Q

What is an indication of chest trauma

A

Puncture/blast trauma to the torso from the umbilicus up. Or blunt trauma to chest/upper back

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158
Q

Indication of tension pneumothorax

A

Chest trauma w/

Severe/progressive respiratory distress or BP under 90mmHg systolic ( no radial pulse) or SPO2 below 90% or relief after needle decompression during VSA protocol

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159
Q

what is the immediate treatment of a open wound to the trunk region from the umbilicus up.

A

Cover with hand and apply a chest seal

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160
Q

When do you initiate transport during a chest Truama protocol

A

After verifying no open chest wounds or after dressing the open chest wounds

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161
Q

If no indications of a tension pneumothorax what do you do in the chest trauma protocol

A

Continue with casualty assessment before continuing chest truama protocol

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162
Q

What do you do if you have the indications of a tension pneumothorax again and an open chest wound

A

Burp the chest seals

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163
Q

If indications for a tension pneumothorax are present and burping wasn’t effective or there are no open wounds. What is the next treatment

A

Needle decompression performed on the affected side/sides.

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164
Q

What is attempted if needle decompression isn’t effective to an affected side/sides

A

Attempt a second at the other approved need decompression site

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165
Q

If treating a previously effective needle decompression site again, how do you landmark

A

Laterally or posterior of the original site

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166
Q

What is the first thing you do other than initiate BLS to a TBI injury that meets severe criteria

A

Initiate transport

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167
Q

Indication on sever TBI

A

Head injury w/ a GCS of 8 or less

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168
Q

How do you assess brain injury during a severe TBI protocol

A

Pupil size/reactivity
GCS
Gross focal neuro signs/deficits

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169
Q

With severe TBI what are the criteria for a impeding brain herniation

A

Dilated and unreactive pupils, progressive neurologic deterioration, cushings triad, extensor posturing, or asymmetric pupils

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170
Q

What are the symptoms of Cushing triad

A

Increased systolic BP, widening pulse pressure, and bradycardia

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171
Q

If no indication of impeding brain herniation in a severe TBI, what SPO2 range do you want

A

Between 95-99%

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172
Q

What is the systemic BP you want to maintain above with severe TBI. With and without hemorrhage

A

Greater than 110 with no hemorrhage
Greater than 100 with hemorrhage

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173
Q

When maintaining BP in a severe TBI w/ or w/o herniation, what fluid solution is used and what is the dose, route, rate, and max dose

A

Normal saline 250mL IV bolus (max 4 doses)

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174
Q

What is the core temp to maintain with a severe TBI patient

A

35.5-37.2 °C

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175
Q

What will a QL5 give to a severe TBI patient w/ herniation

A

3% hypertonic solution 250mL IV bolus q3hrs (max 2 doses)

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176
Q

What is the preferred head position of a severe TBI patient with herniation

A

Elevated 30° (sniffing position)

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177
Q

What is the ventilation method of a severe TBI patient with herniation

A

Hyperventilate 20 breaths/min or EtCO2 of 30mmHg. Until herniation resolves or 20min.

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178
Q

?Indication of performing a other source of external hemorrhage?

A

Significant hemorrhage that hemodynamic status is believed will become compromised without treatment

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179
Q

When do you apply direct pressure to a scalp bleed

A

No deformity or instability on palpation, meaning damage due to skull fracture is unlikely

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180
Q

How do you treat a scalp bleed with a skull fracture

A

Dressing without direct pressure

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181
Q

Without a skull fracture what can a QL3 do to control a scalp bleed other than direct or pressure

A

Hemostatic dressing/packing

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182
Q

What 2 additional things can a QL5 due to control a scalp bleed without a skull fracture

A

Whip stitch or stapler

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183
Q

What is the first thing you do to control a massive epistaxis or a neck hemorrhage

A

Direct pressure

184
Q

After direct pressure, what can a QL3 due to treat a epistaxis or neck hemorrhage

A

Hemostatic dressing/packing

185
Q

What can a QL5 do to treat a massive epistaxis or a neck hemorrhage

A

Foley catheter with packing

186
Q

When can’t you use a Foley catheter on a massive epistaxis

A

Suspected basal skull fracture

187
Q

How do QL5 and QL3’s treat an Abdo evisceration

A

Rinse with sterile water

Direct pressure on visible bleed location or cover region with hemostatic dressing

Cover exposed bowel with moist sterile dressing and/or a water-impermeable cover

188
Q

After controlling the bleed of all significant hemorrhages what do you do next

A

Continue with casualty assessment

189
Q

What adds extra difficulty when dealing with a massive epistaxis or neck hemorrhage compared to other significant bleeds

A

Have to manage the airway at the same time

190
Q

Indication of narcotic overdose

A

Decreased level of consciousness w/ a respiration rate less than 10/min and a history that suggests narcotic use

Pinpoint pupils increase the likelihood of narcotic overdose

191
Q

What are 2 things to be prepared for when treating a narcotic overdose

A

Seizures and hostile patients

192
Q

What is the therapeutic intent of giving naloxone (narcan)

A

To improve respirations to greater then 10/min, and SpO2 to 92% or greater

193
Q

After getting the indications to start narcotic overdose protocol, what is the first thing you do other than assess

A

Verify systolic BP is 90mmHg or above using BP cuff or if radial pulse is present

194
Q

What do you do if the systolic BP is 90mmHg or higher when first starting your narcotic overdose protocol

A

Attempt to initiate an IV lock

195
Q

If the systolic BP is under 90mmHg or you can’t get IV access when starting your narcotic overdose protocol, what do you do

A

Give naloxone IM, SC, or IN

196
Q

What is the most important support being given to a patient in narcotic overdose before narcan stops the overdose

A

Ventilations

197
Q

After giving the first dose of naloxone to a patient in narcotic overdose w/ a systolic BP under 90mmHg, what do you do

A

Obtain IV or IO access to give IV/IO normal saline

198
Q

After systolic BP is greater than 90mmHg or you have reached the max dose of IV/IO normal saline, after 1 dose of naloxone during a narcotic overdose. What do you do

A

Continue naloxone treatments

199
Q

What is the dose, route, max dose, and time between doses for naloxone in an adult during narcotic overdose

A

Naloxone 0.8mg IM/SC q3min (max 5mg)

Naloxone 0.4mg IV/IO q3min (max 5mg)

Naloxone 5mg q3min (max 20mg)

200
Q

If you reach max dose of naloxone during narcotic overdose protocol and still haven’t increased resperations over 10/min, what do you do

A

Contact the SMA for guidance

201
Q

First thing performed after identifying a seizure after initiating BLS

A

Obtain blood glucose

202
Q

What is considered hypoglycemia

A

Less than 4mmol/L

203
Q

what do you do if a seizure patient is hypoglycemic

A

Start hypoglycemic protocol and remain in the protocol if it resolves the seizure

204
Q

During the seizure protocol what do you do if you confirm convulsive status epileptics before having IV/IO access

A

After ruling out hypoglycemia, give midazolam IN than attempt to get a IV/IO line for future doses

205
Q

During the seizure protocol what do you do if you confirm convulsive status epileptics after having IV/IO access

A

If hypoglycemia has been ruled out, give midazolam IV/IO

206
Q

When should you contact the SMA after verifying convulsive status epilepticus

A

As soon as possible as long as it doesn’t delay midazolam doses or transportation

207
Q

Indication of convulsive status epilepticus

A

Continuous convulsive seizures lasting longer than 5min

Or

2 or more seizures within 5 minutes without return of normal mental status in between

208
Q

How do you administer 0.5mL or less IN

A

Every dose in opposite nostrils

209
Q

How do you administer more than 0.5mL IN

A

Half the full dose in each nostril

210
Q

What is the dose, route, max dose, and time between doses for midazolam in an adult during seizure protocol

A

Midazolam 5mg IV/IO/IN than 2.5mg IV/IO/IN q5min until seizure stops

211
Q

What is the dose, route, max dose, and time between doses for midazolam in an pediatric patient (under 50kg) during seizure protocol

A

Midazolam 0.1mg/kg IV/IO/IN than 0.1mg/kg (max 2.5mg) IV/IO/IN q5min until seizure stops or total dose of 0.6mg/kg

IV/IO is slow push over 1-2 min

212
Q

Antibiotic protocol indications

A

Open wounds with surface contamination with delay of transit beyond 2hrs, open globe injury, suspected bowel injury, burn injury with visible infection

213
Q

Before giving antibiotics what should you consider

A

Initiating a IV/IO

214
Q

When can you give moxifloxacin during antibiotic protocol/ who can?

A

If they can take oral medication and an adult

QL3 and QL5

215
Q

When can you give clindamycin during antibiotic protocol and who can?

A

Child/adult, IO/IV access, and allergic to penicillin

QL5

216
Q

When can you give cefoxitin during antibiotic protocol/ who can?

A

Child/adult, IV/IO access, no penicillin allergy

QL5

217
Q

When can you give cefoxitin during antibiotic protocol/ who can?

A

Child/adult, IV/IO access, no penicillin allergy

QL5

218
Q

Ideally when is the latest you should administer antibiotics for a open globe injury

219
Q

What is the dose, route, max dose, and time between doses for moxifloxacin in adults

A

400mg moxifloxacin PO q24hrs

220
Q

What is the dose, route, max dose, and time between doses for clindamycin in adults

A

600mg clindamycin IV/IO/IM q8hrs

221
Q

What is the dose, route, max dose, and time between doses for clindamycin in children

A

10mg/kg clindamycin IV/IO/IM q8h

222
Q

What is the dose, route, max dose, and time between doses for cefoxitin in adults

A

2g cefoxitin IV/IO/IM q8hrs (no max dose)

223
Q

What is the dose, route, max dose, and time between doses for cefoxitin in children

A

30mg/kg cefoxitin IV/IO/IM slow push(not IM) q8hrs

224
Q

What is the youngest age you can treat using antibiotic protocol

225
Q

What is the indication to use hostile/violent patient protocol

A

On operation w/ uncontrollable adult threatening to harm themself/others or a threat to safety

226
Q

What should you consider before using hostile/violent patient protocol

A

Caused by a medical condition

227
Q

Can you combine haloperidol and midazolam in one syringe

228
Q

What is a side effect reaction to haloperidol and how do you treat it with dose, route, and time between doses

A

Muscle spasms treated with diphenhydramine 50mg IV/IM q6hrs

229
Q

What do you attempt before chemically restraining a patient

A

Verbal de-escalation

230
Q

What are the medications used when chemically restraining a patient

A

Haloperidol and midazolam

231
Q

What is the dose, route, max dose, and time between doses for haloperidol and midazolam in a violant adults

A

Haloperidol 5mg IM/IV/IO q10min (max 2 doses)

Midazolam 2mg IM/IV/IO q10min (max 2 doses)

232
Q

Youngest age that you can use hypoglycemic protocol

233
Q

Indication of hypoglycemic protocol

A

Decreased level of consciousness and signs/symptoms suggesting hypothermia

234
Q

What is the first thing you do other than initiate BLS in hypoglycemic protocol

A

Check blood glucose

235
Q

What is an acceptable blood glucose level in a hypoglycemic protocol

A

Greater than or equal to 4.0 mmol/L

236
Q

What do you do if a patient is hypoglycemic and has a patent airway

A

Oral glucose

237
Q

When do you initiate transport for a patient in hypoglycemic protocol

A

After attempting to initiate an IV or if the patient isn’t hypoglycemic when first testing blood glucose

238
Q

If the patient is hypoglycemic and you get an IV, what do you treat with

239
Q

If the patient is hypoglycemic and you can’t get an IV, what do you treat with

240
Q

When do you give oral glucose after glucagon

A

If the airway is patent

241
Q

After giving glucagon to a hypoglycemic patient what should be attempted

A

Initiate IV line

242
Q

If the patient doesn’t recover or deteriorates after giving glucagon what do you attempt if you don’t have an IV line

A

Intimate an IO

243
Q

After getting an IV or IO line after giving glucagon, what should you check

A

Blood glucose

244
Q

What do you do if blood glucose increases above 4mmol/L after treating hypoglycemia

A

Discontinue D10W, rechecking blood glucose q30min, and contact SMA

245
Q

What do you do if the patient initially isn’t hypoglycemic while running a hypoglycemic protocol other than initiate transport

A

Consider other causes / unconscious NYD protocol. Contact the SMA

246
Q

What is the dose, route, max dose, and time between doses for D10W in a hypoglycemic adults

A

D10W 100ml IV/IO bolus q10min (2 doses)

247
Q

What is the dose, route, max dose, and time between doses for D10W in a hypoglycemic pediatric

A

D10W 2ml/kg IV/IO bolus q15min (2 doses)

248
Q

What do you do if the patient is still hypoglycemic after giving 2 doses of D10W for adults and peds

A

Adult: reduce D10W to 100ml/hr
Peds: change to saline lock

And

Contact SMA

249
Q

What is the dose, route, max dose, and time between doses for glucagon in a hypoglycemic adult

A

Glucagon 1mg IM/SC (one dose only)

250
Q

What is the dose, route, max dose, and time between doses for glucagon in a hypoglycemic adult

A

Glucagon 0.5mg IM/SC (one dose only)

251
Q

After getting an IV or IO line after giving glucagon, what should you give if they are still hypoglycemic

252
Q

Indications for unconscious NYD protocol

A

Unconscious adult with an unknown cause

253
Q

What the first step thing you do in unconscious NYD protocol other than initiate BLS

A

Initiate transport

254
Q

What 3 things do you check/do during an unconscious NYD protocol for treatment, and what order

A

Check blood glucose, give naloxone, check for hypovolemia

255
Q

If no treatment works in unconscious NYD protocol what should you do

A

Contact SMA

256
Q

If naloxone improves respiratory distress or level of consciousness what does that mean

A

It’s probably a narcotic overdose and narcotic overdose protocol should be used

257
Q

What is the dose, route, max dose, and time between doses for naloxone in unconscious NYD protocol

A

Naloxone 0.4mg IV/IO
Naloxone 0.8mg IM/SC
Naloxone 4mg IN

One dose unless taking narcotic overdose protocol

258
Q

Indication of hypothermia

A

Core temp less than 35°C or signs/symptoms of hypothermia

259
Q

What core temp is mild hypothermia

260
Q

What core temp is moderate hypothermia

261
Q

What core temp is severe hypothermia

A

Less than 28°C

262
Q

Signs/symptoms of mild hypothermia

A

Shivering, vasoconstriction extremities, apathy, slurred speech, ataxia, and impaired judgement

263
Q

Signs/symptoms of moderate hypothermia

A

Altered level of consciousness, decreased pulse, decreased respirations, diluted pupils, NO SHIVERING

264
Q

Signs/symptoms of severe hypothermia

A

Coma, apnea, asystole, nonreactive pupils

265
Q

During hypothermia protocol, what is the first thing you do other than initiating BLS

A

Check blood glucose for hypoglycemia

266
Q

If a hypoglycemia is present in a hypothermia patient what do you do

A

Do the hypoglycemia protocol before returning to hypothermia protocol

267
Q

What do you consider for treatment plan after verifying no hypoglycemia in a hypothermia protocol

A

Consider saline lock

268
Q

What are the 3 ways to treat hypothermia to rewarm, in order

A

Remove cold/wet clothes and insulate/shield from the environment. Passive rewarming. Finally active rewarming.

269
Q

After rewarming patient with hypothermia, what 2 things should you do

A

Contact SMA, bladder catheterization.

270
Q

What are secondary conditions caused by hypothermia

A

Dehydrated, undernutrition, fatigue, arrhythmias

271
Q

Indications of hyperthermia

A

Core temp greater than 40°C or signs/symptoms of hyperthermia

272
Q

What differentiates between heat exhaustion and heat stroke

A

Depressed central nervous system

273
Q

After removing the clothes and start cooling a patient in heat exhaustion what should you do next

A

Encourage PO rehydration and transport

274
Q

After initiating BLS for heat stroke what is the important next step

A

Remove from heat/ immediate evac

275
Q

After removing clothes and start cooling for a heat stroke patient what is left for treatment

A

1L normal saline IV/IO bolus

Contact SMA, consider urinary catheterization

276
Q

Signs of heat cramps

A

Involuntary muscle spasms often in calves, arms, abdomen, and back due to heat

277
Q

Signs/symptoms of heat exhaustion

A

Nausea, heat cramps, h/a, fatigue, light headed, pale/cool/clammy, HEAVY SWEATING

278
Q

Signs/symptoms of heat stroke

A

NO SWEATING, core temp over 40°C, confusion, irrational behavior, tachycardia early, bradycardia late, hypotension, rapid/shallow breathing, hot skin, loss of consciousness, seizure, coma

279
Q

Who can use the dive related emergency protocol

280
Q

What is the indication of dive related emergency protocol

A

A diver with signs/symptoms of arterial gas embolism or decompression sickness

281
Q

What is the recommended position of a dive related condition

A

Supine if conscious
Recovery if unconscious

282
Q

Who is the SMA to contact with regard to a dive related emergency condition

A

Dive medicine consultant

283
Q

Immediate treatment for dive related emergency conditions before contacting SMA

A

100% oxygen therapy
1L normal saline bolus IV/IO (2 doses)

284
Q

What should be asked to the SMA with regards to transportation of a diver

A

Transport to closest medial treatment facility or recompression facility

285
Q

Indication of arterial gas embolism

A

Within 5-10 minutes of surfacing:
Loss of consciousness, neurological deficits, chest pain, SOB.

286
Q

Indication of decompression sickness

A

Severe symptoms in 1-3hrs:
Neurological deficits, vertigo, SOB, chest pain

most symptoms within 24hrs of decompression:
Joint pain, paresthesia, skin rash/swelling

287
Q

If transporting a dive related emergency condition by air, what should you recommend to the air crew

A

To fly as low as safely possible

288
Q

In what environment can you use the nerve agent exposure protocol

A

Operationally

289
Q

What does CRESS acrynom stand for

A

Consciousness (unconscious/seizure)
Respiration (increased or decreased)
Eyes (pinpoint)
Secretions (increased)
Skin (sweaty)
Other (vomiting, incontinence, bradycardia)

290
Q

Severity of nerve agent exposure

A

Mild: pinpoint pupils, minor sections

Moderate: non-ambulatory, excessive secretion, confusion

Severe: cyanosis, unconscious, convulsions, respiratory distress, significant bradycardia

291
Q

What are the 3 B’s of nerve agent toxicity

A

Bronchospasm, bradycardia, bronchorrhea

292
Q

If you have identified signs/symptoms of nerve agent exposure, what should you do before decontamination drills

A

Mild symptoms: straight to decontamination drills.

Mod/severe symptoms: obidoxime/atropine auto-injector and diazepam auto-injector

293
Q

How often do you reassess a patient until evacuation to a decontamination center

294
Q

After decontamination drills how do you treat seizures and time between doses

A

Diazepam auto-injector q5min until seizure stop

295
Q

How to treat nerve agent toxicity after decontamination drills w/ time between doses

A

Continue with obidoxime/atropine auto-injector q15min (max 3 doses)

After max dose: atropine auto-injector q5min

296
Q

Contraindications of acetaminophen (tylenol), prehospital

A

Hypersensitivity, known G6PD deficiency, liver failure.

297
Q

Adverse effects of acetaminophen (tylenol), prehospital

298
Q

Contraindications of acetylsalicylic acid (ASA/aspirin), prehospital

A

Hypersensitivity to NSAIDs, bleeding disorder, active gastrointestinal bleeding

299
Q

Caution of acetylsalicylic acid (ASA/aspirin), prehospital

A

History of asthma or nasal polyps

300
Q

Adverse effect of acetylsalicylic acid (ASA/aspirin), prehospital

A

Gastrointestinal complaints, nausea, heartburn

301
Q

Cautions of atropine, prehospital

A

Can cause anticholinergic toxicology (acute glaucoma w/ blindness, agitation, delirium, confusion, drowsiness, tachycardia).

302
Q

Adverse effects of atropine

A

Tachycardia, h/a, restlessness, insomnia, dizziness, dry/hot skin, photophobia, urticaria, dry mouth, impaired GI mobility, blurred vision, mydriasis

303
Q

Cefoxitin containdications

A

Hypersensitivity to drug or cephalosporin antibiotics

304
Q

Cefoxitin caution

A

Allergy to penicillin

305
Q

Cefoxitin adverse reaction

A

Diarrhea, h/a, rash, urticaria/pruritus, allergic reaction

306
Q

Clindamycin contraindications

A

Hypersensitivity, liver impairment, under 1 month old

307
Q

Clindamycin cautions

A

Ulcerative colitis or crohns

308
Q

Clindamycin adverse reactions

A

Hypotension, nausea/vomiting, diarrhea/Abdo pain, urticaria/rashes, thrombophlebitis

309
Q

Dexamethasone contraindications

A

Hypersensitivity, Anaphylaxis to other corticosteroids, systemic fungal infection

310
Q

dexamethasone cautions

A

Emotionally unstable/psychotic tendencies (exacerbate conditions), diverticulitis, peptic ulcer, congestive heart failure, hypertension, immunocompromised

311
Q

Dexamethasone adverse effects

A

Salt/water retention, potassium loss, hypertension, Anaphylaxis, hyperglycemia

312
Q

Where should you not inject dexamethasone IM

313
Q

D10W caution

A

Suspected head injury (contact SMA)

314
Q

Contraindications for dimenhydrinate (gravol)

A

Glaucoma, chronic lung disease, difficulty urinating due to prostatic hypertrophy.

315
Q

Dimenhydrinate (gravol) cautions

A

Contact SMA before use with alcohol or sedatives due to increased sedation

316
Q

Dimenhydrinate (gravol) adverse reactions

A

Drowsiness, dizziness, dry mouth, nausea, excitement in children

317
Q

When pushing Dimenhydrinate (gravol) IV/IO, what rate/concentration is used

A

Slow push over 2min w/ 15mL of normal saline/25mg gravol

318
Q

How do you treat nausea for a child, or an adult outside a protocol?

A

Contact the SMA for approval, ask for dosage for child

319
Q

Diphenhydramine (benadryl) contraindications

A

Hypersensitivity, acute asthma, neonate

320
Q

Diphenhydramine (benadryl) cautions

A

Angle-closure glaucoma, urinary obstruction, symptomatic prostatic hypertrophy, stenosing peptic ulcer, elderly, children (paradoxical excitation)

321
Q

What is the dose change for diphenhydramine (benadryl) for a patient older than 60

A

1/2 the Norma dose

322
Q

Diphenhydramine (benadryl) contraindications adverse affects

A

Hypotension, tachycardia, palpitations

Drowsiness, dizziness, coordination. Difficulty

h/a, nervousness, paradoxical excitement, euphoria, confusion, insomnia

N/V/D, dry mouth, urinary frequency/retention/difficulty, tremors, paresthesia, blurred vision

323
Q

Epinephrine contraindications

A

No contraindications for anaphylaxis

324
Q

Epinephrine adverse effects

A

Tachycardia, arrhythmias, angina, flush skin, anxiety, tremors, h/a, dizziness, nausea/vomiting, dry mouth, urinary retention/obstruction, weakness/trembling, wheezing/dyspnea, diaphoresis

325
Q

Epinephrine cautions

A

Elderly, diabetes mellitus, cardiac arrhythmias, thyroid disease

326
Q

What do you do after injected epinephrine IM

A

Massage the site

327
Q

Fentanyl lozenge containdications

A

Respiratory depression, current episode of severe asthma/COPD, head injury, hypersensitivity to opioids, possible gastrointestinal obstruction, suspected they will have Abdo surgery

328
Q

Fentanyl lozenge cautions

A

Lung disease, SOB, pregnancy/nursing

329
Q

Fentanyl lozenge adverse reactions

A

Nausea, constipation, somnolence, h/a, CNS depression

330
Q

Instructions to patients when using Fentanyl lozenges

A

Place in cheek and close mouth, don’t suck, don’t chew

331
Q

What is done differently with Fentanyl lozenge second dose

A

Put in other cheek

332
Q

Fluorescein contraindications

A

Ruptured global injury

333
Q

Fluorescein adverse reactions

A

Irritation/stinging to the eye, blurred vision,

334
Q

Dose of glucose gel used in hypoglycemia

A

Upto 1 tube

335
Q

Glucagon contraindications

A

Hypersensitivity, pheochromocytoma

336
Q

Glucagon cautions

A

Acute or chronic alcohol ingestion

337
Q

Glucagon adverse reaction

A

Nausea and vomiting

338
Q

Haloperidol contraindications

A

Severe CNS depression, hypersensitivity, spastic disorders (Parkinson’s)

339
Q

Haloperidol cautions

A

Risk of orthostatic hypotension, seizure disorder, severe hepatic/renal impairment

340
Q

Ibuprofen (advil) contraindications

A

Hypersensitivity to NSAIDs, GI ulcers, bleeding, inflammatory bowel disease, severe liver/kidney illness, hyperkalemia, systemic lupus erythematous, pregnant

341
Q

Ibuprofen (advil) cautions

A

High blood pressure

342
Q

Ibuprofen (advil) adverse effects

A

Nausea, diarrhea, epigastric pain,heart burn, Abdo cramps/pain, bloating, dizziness, h/a, nervousness, rash, pruritus, anemia, decreased appetite, edema, fluid retention

343
Q

Ipratropium bromide (atrovent) contraindications

A

Hypersensitivity to atropinics/aerosol components

344
Q

Ipratropium bromide (atrovent) caution

A

Bronchospasm (slower effect than others)

345
Q

Ipratropium bromide (atrovent) adverse reactions

A

Aerial arrhythmias, tachycardia, dry mouth, cough

346
Q

Ketamine contraindications

A

Hypersensitivity

347
Q

Ketamine cautions

A

Psychosis, cardiovascular disease, increased ocular pressure

348
Q

Ketamine adverse effects

A

Catalepsy, diplopia, nystagmus, tachycardia, increased blood pressure

349
Q

Ringers lactate contraindications

A

28 days old or younger

350
Q

Ringers lactate caution

A

Blood transfusion, TBI’s (make brain swelling worse)

351
Q

Meloxicam contraindications

A

Hypersensitivity, asthma, NSAIDs (causes urticaria), post coronary bypass graft

352
Q

Meloxicam cautions

A

Risk of heart attack or stroke, alcohol (risk of GI bleeding), pregnancy, breast-feeding

353
Q

Meloxicam adverse reactions

A

Cardiovascular thrombotic events, GI bleeds, ulcerations/perforations, hepatotoxicity, heart failure/edema, renal toxicity/hyperkalemia, Anaphylaxis, serious skin reaction, hematology toxicity

354
Q

Midazolam contraindications

A

Hypersensitivity to benzodiazepines

355
Q

Midazolam cautions

A

Hypotension, taking opioids, pediatric patients, hemodynamic instability, elderly, liver disease

356
Q

Morphine contraindications

A

Hypersensitivity, severe respiratory distress/hypotension, head injury, decreased LOC

357
Q

Morphine caution

A

Pregnancy, elderly, intoxicated, respiratory conditions

358
Q

Moxifloxacin contraindications

A

Hypersensitivity to quinoline antibacterial agents

359
Q

Moxifloxacin cautions

A

NSAIDs, epileptic risk

360
Q

Naloxone contraindications

A

Hypersensitivity

361
Q

What do you do after injecting narcan SC

A

Massage the site

362
Q

Nitroglycerin spray contraindications

A

Severe hypotension, hypersensitivity, vasodilator medications: Viagra/Levitra 24hrs, Cialis 48hrs

363
Q

How do you assist a patient take their own nitro tablets

A

Under the tongue, sublingual

364
Q

Normal saline containdication

A

Pulmonary edema

365
Q

Ondansetron contraindications

A

Hypersensitivity

366
Q

Ondansetron cautions

A

Long QT syndrome

367
Q

How long should you slow push ondansetron

A

No less than 30sec, preferably 2-5min

368
Q

Oxygen therapy cautions

369
Q

Salbutamol (Ventolin) contraindications

A

Hypersensitivity

370
Q

Salbutamol (Ventolin) cautions

371
Q

Tetracaine protocol concentrations

A

1% or 0.5%

372
Q

Tetracaine contraindications

A

Anaphylaxis to anaesthetics, open globe injury

373
Q

Tetracaine cautions

A

Premature baby, taking sulfonamide medication

374
Q

Tranexamic acid (TXA) contraindications

A

DVTs, pulmonary edema, cerebral thrombosis, hypersensitivity, hematuria

375
Q

Tranexamic acid (TXA) cautions

A

No cautions over 18 years old

376
Q

Xylocaine concentrations/epi use

A

1% or 2% w/ epi

377
Q

Xylocaine contraindications

A

Hypersensitivity to anaesthetics

378
Q

1% concentration of xylocaine is how many mg/ml

379
Q

Max xylocaine dose with and without epi

A

With epi - 7mg/kg or 500mg

Without epi - 4.5mg/kg or 300mg

380
Q

Hypertonic saline is at what concentration

381
Q

Hypertonic solution cautions,

A

Congestive heart failure or severe renal dysfunction

382
Q

Igel Contraindications

A

Gag reflex, trismus, limited mouth opening, trauma/mass/abscess affecting igel insertion, or risk of creating a full stomach (sepsis, morbid obesity, pregnancy, gastro-intestinal surgery)

383
Q

Igel max peak airway pressure of ventilation

384
Q

Max time a Igel can be used in a patient

A

4hrs (call SMA)

385
Q

Size 3,4,5 Igel colours and patient weight associated

A

3 - yellow - 30-60kg
4 - green - 50-90kg
5 - orange - 90+ kg

386
Q

What kind of lubricant can be used with an Igel

A

Water based lubricant

387
Q

How do you confirm igel placement

A

Auscultate epigastric region/lungs, confirm thorax rise evenly, and CO2 detector

388
Q

What do you do if the teeth line on an Igel is above the teeth

A

Reattempt insertion (jaw thrust) and then lower the igel size if same result.

389
Q

Why do pediatric sizes of igels not have teeth line

A

Greater variable of length in that age group

390
Q

What must be available when removing a Igel airwsyy

391
Q

What is encouraged for the patient to do with a rib fracture

A

Deep breaths/coughing

392
Q

What should be avoided with a rib fracture

A

Rib immobilization

393
Q

What can happen within 24hrs of pulmonary contusion

A

Deterioration to possible respiratory failure

394
Q

How do you burp a chest seal

A

Release pressure by pushing down during an exhalation and reseal

395
Q

When do you attempt a needle decompression if burping is ineffective

A

After 2 burping attempts

396
Q

Landmarks for needle decompression

A

2nd intercoastal midclavicular line or 4/5th intercoastal anterior axillary line

397
Q

How do you insert a needle decompression in a intercoastal space

A

Directly above the inferior rib

398
Q

What do you do with a needle after removing it from the cathelon

A

Re-sheath the needle if you have a limited supply of needle decompression cathelon sets

399
Q

What is Beck’s triad

A

Muffled heart sounds, JVD, hypotension

400
Q

Indications of a cardiac tamponade

A

Beck’s triad, paradoxical pulses

401
Q

Describe transtracheal block procedure

A

Inject xylocaine 1% subcutaneous 2mL above/below/directly over the cricothyroid membrane, and 4mL into the trachea (aspirating to verify airway placement)

402
Q

When do you flush an IV lock

A

After insertion, 6hrs of inactivity, before/after medication administration, if blood is in the lock

403
Q

Convert kg to lbs

A

2.2 x kg = lbs

404
Q

How many mg in a gram

405
Q

What to consider when reconstituting a medication

A

Verify the amount of fluid to reconstitute, what fluid is compatible, verify completely reconstituted before administration

406
Q

When verifying drip rate, what steps are taken

A

Calculate 15sec average, than 30sec, than 1min

407
Q

IV rate formula

A

[ Volume infused (mL) x admin set (gtts/ml) ] / total time of infusion

= Gtts/min

408
Q

IO contraindications

A

Fractured bone/infection/excessive tissue/osteoporosis/previous IO IM last 48 hrs at site

409
Q

What must you do after placing an IO to allow flow

A

Flush vigorously

410
Q

How long can you leave in an IO

A

24hrs (contact SMA)

411
Q

What site do you use for IO on peds

A

Proximal tibial

412
Q

When is the only time you connect a syringe directly to an IO port without a lock

A

Used to remove the IO

413
Q

How to size an NPA

A

Nose to earlobe

414
Q

GCS spontaneous eye opening

415
Q

GCS eye opening with verbal stimulus

416
Q

GCS eye opening to pain

417
Q

GCS no eye opening

418
Q

GCS oriented verbal speaking

419
Q

GCS confused verbal speaking

420
Q

GCS inappropriate words

421
Q

GCS incomprehensible speaking

422
Q

GCS no verbal response

423
Q

GCS obey commands

424
Q

GCS localized pain

425
Q

GCS withdraws from pain

426
Q

GCS abnormal flexion

427
Q

GCS abnormal extension

428
Q

No motor response

429
Q

Rule of nine- entire head

430
Q

Rule of nine- chest

431
Q

Rule of nine- abdo

432
Q

Rule of nine- entire arm

433
Q

Rule of nine- entire back

434
Q

Rule of nine- upper leg

435
Q

Rule of nine- lower leg

436
Q

Rule of nine- genital region

437
Q

Rule of nine- child entire head

438
Q

Rule of nine- infant entire head

439
Q

Target urinary output with pediatric burn patients

A

O.5-1.0 mL/kg/hr

440
Q

Calculation for parkland formula for 24hrs

A

3 x kg x (%2/3rd degree burns)

441
Q

Parklands formula amount separated by time

A

1/2 - 1st 8hrs
1/4 - 2nd 8hrs
1/4 - 3rd 8hrs

442
Q

When calculating parkland formula how do you calculate the fluid used to bring the pediatric patient out of hypovolemia

A

Subtract the fluid given from the first 8hr calculation

443
Q

Rules of 10 fluid replacement formula

A

%TBSA x 10 + (100 for every 10kg over 80kg) = ml/hr of IV therapy

444
Q

Blood loss for each class of hemorrhagic shock in adults

A

1 - under 750ml
2 - 750-1500ml
3 - 1500-2000ml
4 - over 2000ml

445
Q

Total time in a d-tank when administering at 15L/min

446
Q

Grades of a pen torch test for shadowing of the anterior chamber. What grade is normal

A

Grade 1: greater than 2/3 shadowed
Grade 2: 1/3-2/3 shadowed
Grade 3: less than 2/3 shadowed
Grade 4: no shadowing (normal)

447
Q

What does MISTAT stand for

A

MOI
Injury/illness
S/S vitals
Treatment
Age
Time of injury

448
Q

When sending a MISTAT how do you identify a patient

A

ZAP number or differentiating reference instead of name.

Local 1, enemy 1, friendly 1, etc

449
Q

What are the lines required to be passed up by the medic on ground when sending a 9-liner

450
Q

What is line 3 of a 9-liner

A

of patients / priority

451
Q

What is line 4 of a 9-liner

A

Special equipment required

452
Q

What is line 5 of a 9-liner

A

of patients of each mobility type

453
Q

What is line 8 of a 9-liner

A

of patients by nationality & professional status

NATO military, embedded interpreter, POW

454
Q

What are the priorities in a 9-liner

A

P1 - hospital in 1hr
P2 - hospital in 4hr
P3 - hospital in 24hr

455
Q

What are the types of patients on line 5 of a 9-liner

A

Stretch, walking, escort, and other(describe)

456
Q

What are the 6 potential sites of a massive hemorrhage

A

External, Abdo cavity, thoracic cavity, retroperitoneal space, pelvic fracture, long bone fracture

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