SNHD Protocols Flashcards
The goal of the manual is to ____________ prehospital patient care
Standardize
What is the combination of optimal preshospital carea
careful patient assessment
essential pre hospital care
appropriate medical consultation
What does the teddy bear icon mean
Pediatric treatment consideration for patient less than 12
what age determines the destination protocol
18 years old
What triage system is used in a MCI
START
Where must a patient be transported in ventilation cannot be established
the nearest emergency department
The FAO MED CON number is 702-382-9007
true or false
true
A sexual assault victim under the age of 13 must be transported to?
Sunrise Hospital
A sexual assault victim age 13 to 18 is transported to
UMC or Sunrise
A sexual assault victim over the age of 18 is transported to
UMC
Sexual assault victims outside a 50 mile radius is transported to?
the nearest appropriate facility
If a stable patient has no specific hospital choice, transport to?
The closest facility
Patients outside a 50 mile radius are transported to?
The nearest appropriate facility
A l2k patient can be placed in a waiting room?
False
What is the normal pulse rate for someone to be placed in the waiting room
60-100
What is the normal respiratory rate for someone to be placed in the waiting room
10-20
What is the normal systolic blood pressure for someone to be placed in the waiting room
100-180 mm/hg
What is the normal diastolic blood pressure for someone to be placed in the waiting room
60-110
The room air pulse ox must be above what, to be placed in the waiting room
94%
What medications may a patient receive to be placed in the waiting room
A single dose of analgesia or anti-emetic
How many sides of an occlusive dressing be secured
three
what angle should the head be placed at in a suspected traumatic brain injury
30 degrees
If a patient has a GCS less than 8 the EMT should
ventilate to SPo2 greater than 94%
If a trauma patient does not have a palpable pulse, the AEMT should
Establish an IV and administer 1 liter of Normal Saline
Ideally, procedures should be performed
while en route to the hospital
A what is suitable to ventilate a patient if an airway and SPo2 can be maintained greater than 90%
BVM
A Geriatric patient should be evaluated with a high index of suspicion; occult injuries may be present and geriatric patients can de-compensate quickly. True or false
True
What age should a patient with abdominal of flank pain receive a 12 lead EKG
35 years old
What volume of NS may a patient with abdominal or flank pain receive
Initial bolus: 500ml
May repeat up to 2000ml
What is the standard adult dose of Zofran
4.0mg IV, IO, IM or ODT
The standard adult doe of droperidol is
1.25mg IM, IV, IO
Droperidol is also known as
Inapsine
What other organs should be palpated in a patient with abdominal pain
Retroperitoneal space
What is the first drug of choice in a patient having an allergic reaction with no airway involvement or breathing difficulty
Diphenhydramine, 50 mg, IM, IV, IO or PO
If in an allergic reaction the patient is having trouble breathing, what should the AEMT or Paramedic administer
0.5mg epinephrine 1:1,000
What is the max adult dose of epi 1:1000 in an adult allergic reaction patient
1.5mg
How often can 1:1000 epi be administered in an allergic reaction
every 15 minutes
In an allergic reaction, following epinephrine what should you consider administering
Albuterol, 2.5mg in 3ml, repeated as needed
What dose of dopamine can be given to an adult patient in an allergic reaction
5-20mcg/ kg/ min
When giving dopamine to a patient in an allergic reaction, the SBP should be titrated to
90 mmhg or better
The concentration of push dose epi is
1:100,000
How many MCGs of push dose epi is in 1ml
10mcg/ ml
In an allergic reaction following albuterol, what should the next drug administered be
Diphenhydramine, 50mg
What should be considered for hypotension that is refractory to administration of Epinephrine
Dopamine 5mcg-20mcg/kg/min
What is the BGL limit for a patient with altered mental status
60mg/dl
What is the concentration and dose of Dextrose
D10, 25grams
IV/IO 250ml
How many times and when can D10 be repeated
once, in 5 minutes
Normal saline shall be administered in an altered mental status patient in what dose
500ml, may repeat up to 2000ml
a patient with respiratory depression and unresponsive should be considered to have
narcotic overdose
What is the dose of Naloxone?
0.4-2.0mg IN, IM, IV, IO
What is the max dose of Narcan
10mg
Prior to advanced airway procedures, what two drugs should be considered?
Glucose and Narcan
What is given to an altered patient with no IV access
Glucagon, 1.0mg IM
A 12 lead EKG should be considered in a patient with a BGL over 60mg/ dl with altered mental status
True
What are the 5 causes of a behavioral emergency
Head Injury Hypoglycemia Hypoxia Intoxication or Overdose Post-Ictal
What is the dose of Ketamine for an Excited Delirium Patient
2.0mg/ kg IV/IO
or
2-4mg/ kg IM
According to the Parkland formula, what is the weight based dose of NS
4mg/ Kg
What is the initial dose of Midazolam in a behavioral emergency
0.1mg/kg IN, IM, IV, IO
What is the repeat dose of Midazolam in a behavioral emergency
0.05mg/ kg every 5 minutes
What is the initial dose of Diazepam in a behavioral emergency
5.0mg iv/ io
What is the repeat dose of Diazepam in a behavioral emergency
5mg every 5 minutes
What is the initial dose of Droperidol in a behavioral emergency
1.25mg iv/ io/ im followed by a saline flush
When can a second dose of Droperidol be repeated
every 5 minutes
What is the dose of Diphenhydramine in a dystonic reaction
50mg im/iv/io
What should you perform if a patient is bradycardia and showing signs of a STEMI
Transcutaneous Pacing
What is the dose of Atropine in a bradycardia patient
0.5mg ivp or io
may repeat q 3-5 minutes
what is the max dose of atropine in a bradycardia patient
3.0 mg
What is the next step if bradycardia is refractory following atropine
Transcutaneous pacing
When trying to pace and you get a failure to capture, what is your next step
Consider Dopamine 5-10mcg per kg per minute. Max dose 20 mcg/ kg titrate to 90mm/hg
For a bradycardia patient who you suspect overdosed on beta blockers
Glucagon: 1mg IV
What would you administer to a bradycardia patient who you suspect overdosed on calcium channel blockers
Calcium Chloride: 1 gram IV or IO
In a bradycardia patent, delay pacing until an IV is established
True or False
False
What is a common cause of bradycardia
Hypoxemia
What do you use to cover a burn patient
Dry sterile dressings
How long do you flush an eye burn
10-15 minutes
What do you do if hypoxia is the cause of cardiac arrest?
Early Ventilation
If Cardiac is witnessed by EMS or CPR is in progress and the patients unresponsive with no pulse, what do you perform
Continuous Compression CPR and defibrillate
If arrest is unwitnessed or no CPR is in progress, what do you perform
2 minutes of CCC CPR
If at anytime ROSC occurs, go too?
The Target Temperature Management and Post Resuscitation protocol
Amiodarone is given after which shocks?
3 and 5th shocks
In cardiac arrest, epinephrine delivered via ETT tube is delivered at what dose?
2-2.5 times the IV dose
NTG may be administered how many times?
3
NTG is contraindicated in what conditions
Hypotension bradycardia tachycardia >100bpm in the absence of heart failure use of ED meds in the past 48 hours evidence of right ventricle infarction
What groups of patients have atypical pain in ACS
Females
Diabetics
Geriatrics
How fast should a 12 lead be performed in a chest pain call
5 minutes
How often do you reassess a patient with ACS
after every intervention
In childbirth you should suction the _______ first and the ________ second
Mouth then nose
How do you transport a patient with a limb presentation
Left lateral recumbent
How do you deliver a breech patient
Support the body of the baby during the delivery of the head
How do you treat a prolapsed cord
Position patient in the trendelenberg, slightly to the left. wrap the cord and keep it moist. insert gloved hand to lift baby off of cord and document cord pulse
When is APGAR recorded
At 1 minute and 5 minutes
What is a normal APGAR score
7-10
What APGAR score requires resuscitation
4-7
What is vital in a drowning patient
Adequate ventilation
An adequate breathing patient who was in a drowning incident should receive what concentration of oxygen
high flow at 15lpm
You should suction foam from an airway. True or false
false
Use traditional cpr of 30:2 in a drowning.
True
What is often associated with a submersion incident
Hypothermia
Patients should be transported due to potential to worsen over the next few hours
True
It is difficult to quantify the amount of blood loss from a nose bleed
True
What is the core body temp in heat stroke
> 104
At what temperature does sweating disappear
> 104
A patient may shiver as they are cooled
True
Active cooling includes what measures
cold packs not directly on skin, fanning or air conditioning
Cold saline is not to be administered IV unless directed by medical control
True
Elevated temperature is not associated with heat cramps
True
What conditions indicate Suspected Hyperkalemia
Bradycardia, Peaked T Waves, Widened QRS, Cardiac Arrest
What is the dose of calcium chloride in a suspected hyperkalemic patient
1.0 gram slow IV push
What is the dose of Sodium Bicarbonate for a suspected Hyperkalemic Patient
1.0 mEq/ Kg slow IV push
What EKG changes findings are consistent with Hyperkalemia
Bradycardia w/ widening QRS complexes
What is a contraindication to administration of Calcium Chloride
Pt taking Digitalis
What is the dose of mag sulfate in a seizing pregnant patient
4.0mg in 50ml of ns over 20 minutes
If seizure is refractory to mag, what is the dose of midazolam
0.1mg/ kg IV/ IM/ IO, IN
What is the repeat dose of midazolam and how often
0.05mg every 5 minutes
What is the dose of diazepam for a seizing pregnant patient who is refractory to Mag
5mg IV
How many repeat dose of Diazepam be administered
1 dose of 5mg in 5 minutes. Additional doses require physician order
What is the dose of Mag in a pre eclamptic patient
2gm in 50 ml over 10 minutes
In the setting of pregnancy hypertension is defined as _____ systolic or____ diastolic or a relative increase of ____ systolic and ____ diastolic from the patient’s normal pre- pregnancy BP.
> 140, >90, >30, >20
Severe headache, vision changes or RUQ pain may indicate pre-eclampsia.
True
A eclamptic patient should be transported in what position
Left lateral position
How do you quantify bleeding in a female pregnant patient
Number of pads per hour
Post partum eclampsia/ preeclampsia presents up to how long
48 hours up to 6 weeks
Hydroxocobalamin dose is
5 grams over 15 minutes
In a patient with suspected TCA or ASA OD, what EKG changes will you see
Widened QRS
In a patient with suspected TCA or ASA OD, what is the repeat dose of Sodium Bicarb
1 mEq/ kg in 3-5 minutes
What do you give to a suspected Calcium Channel Blocker OD
Calcium Chloride, 1gm slow IV/ IO
What do you give to a suspected Beta Blocker OD
Glucagon, 1mg IV, IM, IO
How often can Glucagon be given in a suspected Beta Blocker OD
once, in 3-5 minutes
What is the dose of Atropine in a suspected Organophosphate poisoning
2mg every 15 minutes
What is goal of atropine administration in an organophosphate poisoning
decrease secretions and ventilatory resistence
Narcan or Glucose should be administered prior to use of an extraglottic airway or intubation
True
What is the pain management dose of Ketamine
0.2mg/ kg
Ketamine is contraindicated in Chest Pain, Suspected ACS and STEMI Protocol
True
What is the dosing of morphine
0.1mg/ kg, Max dose 10 mg
What is the repeat dose of morphine
0.1mg/ kg, 10 minutes after the first dose
when can you not repeat a morphine dose?
pain is relieved or respiratory depression occurs
What is the dose of Fentanyl
1.0 mcg/ kg, max dose of 100 mcg
What is the repeat dose of fentanyl
100mcg after 10 minutes
What is the dose of Dilaudid
0.01mg/ kg, max dose 1.0mg
What is the repeat dose of dilaudid
0.01mg/ kg after 10 minutes
Weight base dosing provides a standard of dosing calculations, but does not predict a response
True
Repeat dosing of pain medications require nasal canal capnography
True
Droperidol can result in hypotension, prolonged QT and Torsades
True
When treating pulmonary edema or chf, what SBP do you titrate a dopamine response
> 100 mmHg sbp
What is the dosing of Nitroglycerine in a normotensive patient with a SBP >100 mmHg
0.4mg sl
What is the dose of NTG in a pulmonary edema/ CHF patient with a diastolic pressure >100
1.6mg SL
When can high dose NTG be repeated
in 5 minutes if DBP is >100
A dopamine dose of 2-10mcg/ kg increases?
Myocardial Contractility and HR and Blood pressure via Vasoconstriction
A dopamine dose of 10-20mcg/ kg increases?
renal, mesenteric and peripheral blood vessels.
A dopamine dose of 10-20mcg/ kg can cause
poor perfusion and renal failure
Ipratropium or duoneb can be administered how many times?
Once
What is the concentration of Ipratropium?
2.5ml of 0.02%
A patient with non reactive bronchospasm can receive mag at what dose
2 grams in 50ml over 10 minutes
A patient with a history of seizures receives what dose of midazolam
0.1mg/ kg up to 5.0mg
What is the dose of diazepam in a seizure patient
5.0mg
If a seizing patient has a bel <60, how much D10 should they receive
250ml/ 25g
When can D10 be repeated in a seizing patient
in 5 minutes
What is the repeat dose of midazolam in a status epilepticus patient
Repeat 0.05mg/ kg
What is the repeat dose of diazepam in a status epilepticus patient
5.0 mg
Do not delay IM or IN admin of Benzos while starting an IV
True
A patient in non-traumatic, non cariogenic shock can receive how much saline
1000ml
may repeat x1 with no rales on lunge exam
A patient in cardiogenic shock can receive how much saline
500ml
may repeat once if no rales on lung exam
