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
A patient in shock should have their SBP maintained at
90 Systolic
Push dose epi dosing in a shock patient is
5-10mcg every 2-5 minutes to maintain SBP >90
0.5ml to 1.0ml of a 1:100,000 solution
Shock often presents with normal vital signs, with tachycardia being the only difference
true
For patients with known adrenal insufficiency, use the patients own soul-cortef (hydrocortisone)
true
Make early decisions on intubation with smoke inhalation patients
true
How much NS do you use to reconstitute Hydroxcobalamin
200ml
Do not shake the vial of hydroxocobalamin
True
Hydroxocobalamin needs to be inverted or rocked for 60 seconds prior to administration
True
Infusion of Hydroxocobalamin is done over 15 minutes
True
A RACE Scale of 5 means a LVO stroke and needs to be transported to a NIR facility
True
What hospitals are NIR Centers
4, 6, 9, 15, 19, 72
What is performed first in a narrow complex tachcardia
Vagal Maneuvers
What is the dosing of adenosine in a stable narrow complex tachycardia
6mg. If unsuccessful repeat one time at 12mg (18mg max)
What is the dosing of Amiodarone in a stable monomorphic Vtach
150mg in 50 ml over 10 minutes
In stable monomorphic Vtach, if amiodarone is unsuccessful, what do you do next
Call for orders, consider sedation with 0.15 mg/ kg of etomidate and cardiovert
A patient with stable Torsades de Pointes receives what?
Mag Sulfate, 2.0grams in 50cc over 10 minutes
In stable torsades, if Mag is unsuccessful what do you do next
Call for orders, etomidate 0.15mg/ kg and defibrillate
Stable rhythms may become unstable quickly
True
In unstable narrow tachycardia, if an IV is established, how much Adenosine do you administer
12mg
In unstable narrow tachycardia, adenosine is ineffective. What are your next steps
Consider sedation, cardiovert. Repeat need for additional cardioversion and sedation
In unstable torsades, what is your first step
Consider sedation and defibrillate
In unstable torsades, your initial defibrillation attempt is unsuccessful. What is your next step
Mag Sulfate, 2gram over 10 minutes in 50ml
Following admin of mag in unstable torsades, you see no change. What do you do next
reassess need for sedation and defibrillate
In unstable Vtach, what is your first step
Consider sedation and cardiovert
In unstable Vtach, your first attempt at cardio version was unsuccessful. What is your next step
Amiodarone, 150mg in 50cc over 10 minutes
in unstable Vtach, Amiodarone was unsuccesful. What do you do next
Reassess for sedation and repeat cardioversion or defibrillate if not resolved
Target temp fluid is administered at what rate?
250ml/ hr up to 1 liter
What is the target ETCO2 range in hypothermic ROSC care
40mm Hg
What is the Induction dose for Etomidate
0.3mg/ kg
What is the IV sedation dose of Ketamine
2.0mg/ kg
What is the IM sedation dose of Ketamine
4.0mg/ kg
What is the initial dose of midazolam to maintain sedation
0.1mg/ kg
What is the sedation repeat maintenance dose of midazolam
0.05mg/ kg repeated every 5 minutes
What is the maintenance dose of diazepam for sedation
5mg
what is the repeat maintenance dose of diazepam for sedation
5mg after 5 minutes with physician order
Pediatric medical patients receive what dose of NS
20ml/ kg. May repeat 2 times. Max 20ml/kg
What is the pediatric dosing for Zofran
0.15mg/ kg max dose 4mg
Zofran ODT is rounded to the nearest 1/2 pill
True
If a pediatric patient is suspected of DKA, do not exceed 20ml/kg of NS
True
What is the pediatric dosing for benadryl over the age of 12
1.0mg/ kg max dose 50mg
What is the pediatric dosing for 1:1000 epi for anaphylaxis
IM 0.01mg/ kg, max dose 0.3mg, may repeat every 5 minutes up to 0.9 mg
What is the pediatric dosing of D10
5mg/ kg
What is the pediatric dosing of glucagon for a patient weighing less than 20 kg
0.5mg IM
What is the pediatric dosing of glucagon for a patient weighing over than 20 kg
1.0mg IM
If a pediatric patients blood glucose is greater than 250, what is the dose of NS
10ml/kg, one time
What is the pediatric dosing of Narcan
0.1mg/ kg. Max single dose 2.0mg. Total dosing 10mg
Narcan is not recommended in newborns
True
In a behavioral emergency, if chemical restraints are considered, you must call for orders
True
If a pediatric heart rate is less than 60, perform CPR
True
The pediatric dose of 1:10,000 epinephrine for bradycardia CPR is
0.01 mg/ kg
Epi 1:1,000 dosing via ETT in pediatric bradycardia CPR
0.1mg/ kg, max dose 1.0mg, repeat 3-5 minutes
Atropine for Pediatric bradycardia is
0.02mg/kg with a minimum dose of 0.1mg. Max dose 0.5mg. May repeat once in 5 minutes
Call for orders for Pediatric Transcutaneous Pacing
True
Hypoxemia is a common cause of Bradycardia
True
Pediatric burn patients go to the UMC Peds ER for evaluation by the burn center
True
Pediatric defibrillation starts at
2 joules/ kg
Repeat doses of pediatric defibrillation is
4 joules/ kg
When is repeat Amiodarone considered in Pediatric Cardiac arrest
after the 5th shock
What is the pediatric dose of amiodarone
5mg/ kg
When is Amiodarone considered in Pediatric Cardiac arrest
after the 3rd shock
Adult paddles may be used on patients >15 kg
True
What is the max age the SBP formula can be used (2x age) +70
10 years old
In a pediatric drowning patient, traditional CPR of 15:2 should be used
True
In neonatal resuscitation deep suctioning is no longer recommeded
True
3:1 CPR is the standard for neonatal resuscitation
True
In a Neonate, a BGL <40 is hypoglycemic
True
If a neonate heart rate is between 60 and 100, oxygenate and ventilate
true
The neonatal dose of bicarb in a TCA or ASA overdose is
1mEq/kg of 4.2%
In a pediatric calcium channel blocker OD, what is the dose of Calcium Chloride
20mg/ kg
If a pediatric patient overdoses on Beta Blockers, what is the dose of Glucagon?
0.5mg IV/ IM
May repeat once in 3-5 minutes
The pediatric dose for Atropine in organophosphate poisoning is
0.02mg/kg
may repeat every 15 minutes
The minimum age for Ipratropium is is 2 years old
true
Ipratropium and duoneb can only be given once
true
Albuterol may be repeated until improvement
true
If suspected croup and sats are < 94% call for orders form racemic epi of 3-5mg in a svn
true
In a pediatric seizure, what is the dose of midazolam
0.1mg/ kg, max dose 5mg
May repeat once if recurrent
In a pediatric seizure, what is the dose of diazepam
.01mg/ kg, max dose 5mg. May repeat once if recurrent
If the pediatric patient is in shock, what is the dose of D10 if the BGL is less than 60 (40 for neonate)
1mg/ kg
What is the first step in treating a pediatric patient, with stable narrow tachycardia
Vagal Maneuvers
Does a Paramedic need to call for orders to perform vagal maneuvers?
No
If vagal maneuvers were unsuccessful in the pediatric narrow tachycardic patient, what is your next steps
Call for orders
Adenosine 0.1mg/kg IV
If needed, repeat at 0.2mg/ kg
Do not exceed adult dosing
A stable pediatric patient with Monomorphic Vtach is treated how?
Call for orders
Amiodarone, 5mg/kg in 50cc over 20 minutes
if unsuccessful, call for orders and cardiovert 0.5 to 1 joule/ kg. May use 2j/kg if unsuccessful
What is the sedation dose for Etomoidate in the pediatric patient with stable, refractory Vtach
0.15 mg/ kg
What is the treatment for Tordades in a stable, pediatric patient
Call for orders
Mag sulfate, 25mg/ kg in 50cc over 10 minutes
When should you sedate a patient
Prior to cardioversion if time allows
If a pediatric patient is unstable with narrow tachycardia, what is the first step
Call for orders,
Adenosine, 0.2mg/ kg IVP
If Adenosine is unsuccessful in the unstable pediatric patient with narrow tachycardia, what is your next step
Call for orders
Synchronize cardiovert at 0.5 to 1 joule per kilogram.
May use to joules if unsuccessful.
Consider Etomidate for sedation
If a pediatric patient is in Torsades and is unstable, what is your first step
Consider sedation. Defibrillate at 2 joules/ kg, increasing to 4 joules/ kg if unsuccessful.
If unstable pediatric torsades is refractory to defibrillation, what is your next step
Call for orders, Mag sulfate, 25mg/ kg in 50ml over 10 minutes
In a pediatric patient with unstable Vtach, what is your first step
Sedate if time allows. Cardiovert at 0.5-1 joule/ kg. May increase to 2 joules if unsuccessful. Or you may defibrillate at 2j/ kg increasing to 4 j/ kg if unsuccessful
If a pediatric patient with unstable Vtach is refractory to initial electrical therapy, what is your next step
Amiodarone, 5mg/ kg in 50ml over 20 minutes
If unstable vtach in a pediatric patient does not convert with electrical or amiodarone, what is your third step
Repeat synchronized cardioversion or defibrillation. Assess for repeat sedation and repeat amiodarone
The most common tachyarrythmia in children is
Sinus Tach
What is the pediatric dose of midazolam for ventilation management
0.1mg/ kg, max single dose is 5mg. Additional dosage requires physician order
What is the Pediatric sedation dose for ketamine
2mg/ kg iv or 4mg/ kg im
What do you use to maintain sedation in a pediatric patient
Diazepam at 0.2mg/ kg. Max dose 5mg. May repeat after 5 minutes with physician order
What is the PR dosage of Diazepam to maintain sedation
0.5mg/ kg via #5 or #8 French feeding tube. Max dose is 20mg.
An intubation attempt is defined as the passing of a laryngoscope blade or ET tube past the teeth or inserted into the nasal passage
True
Gastric tubes should be put in place if time allows
True
AEMT and Paramedics may monitor any crystalloid solutions
True
Attendants are authorized to administer all medications listed in the inventory that is appropriate for their level
True
Hep locks and catheters may be closed off and left in place or an iv drip established
True
OG and NG tubes may be left in place and capped or attached to suction.
True
If in the judgement of the provider, transport time would be detrimental to the critical pediatric patient, the patient should be transported to the closest ER
True
Body decomposition is an obvious sign of death
true
Decapitation is an obvious sign of death
true
Transection of the thorax is an obvious sign of death
true
Incineration is an obvious sign of death
true
Functional separation from the body of the heart, brain or lungs is an obvious sign of death
true
Unresponsiveness, Apnea, Pulselessness, Fixed and dilated pupils and systole in 2 or more leads are presumptive signs of death
true
Conclusive signs of death include dependent lividity and rigor mortis
True
To determine prehospital death any one of the obvious signs of death must be present
True
to determine prehospital death, 5 presumptive signs of death and 1 conclusive sign of death must be present
True
If there is any question to patient viability, resuscitation must be initiated
True
If the body is in public view, use what to cover the body
Clean, sterile burn sheet
To go to an alcohol facility, what must the respiratory rate be between
12-22
What must the GCS be to go to an alcohol facility
> 14
What are the blood pressure ranges to go to an alcohol facility
90-180 systolic
60-100 diastolic
The pulse rate must be between what to go to an alcohol facility
60-120
To transport to an alcohol facility, contact must be made via FAO and approval of the physician or medical staff
True
If a QI issue arises contact the agency representative. If no problem exists, nothing needs to be done
True
If an investigation is requested, an incident report should be requested and forwarded to OEMSTS
True
Step 1 of the trauma field triage criteria measures
Vital Signs and Level of Consciousness
Step 2 of the trauma field and triage criteria measures
Anatomy of the injury
Step 3 measures
Mechanism of Injury
Step 4 measures
Special Patients
A GCS <13 must be transported to a
Level 1 or Level 2 trauma center
A respiratory rate of <10 or >29 must go to a
Level 1 or 2 trauma center
A pediatric patient must be transported to a pediatric center for the treatment of trauma
True
Auto ped/ bicycle greater than _____ must go to a level 1,2 or 3 trauma center
20mph
A fall greater than ______ feet must go to a level 1,2 or 3 trauma center
20
In a pediatric patient, a fall greater than ________feet or ____times the height of the child must go to a trauma center
10 feet or 2 times height
A patient who is greater than 20 weeks gestation gets transported to a trauma center
True
To use CPAP, the patient must be older than 18 years of age, in chf, respiratory distress with bronchospasm and pneumonia who have 2 of the 3 following conditions
Retractions or accessory muscle use, RR>25 or SPO2 <94%
Use of the device is determined by
Manufacture instruction
What are the contraindications for CPAP
Apnea, Vomiting or GI bleed, Major Trauma, AMS
In an unwitnessed arrest bu EMS personnel, 2 minutes of CPR should be performed prior to defibrillation
True
In a witnessed arrest by EMS, defibrillation should be performed immediately
True
Initial and subsequent shocks shall be at the dose established by the device manufacturer or the agencies medical director
True
paddles or electrodes should be placed how far from an implanted defibrillator
1 inch
To perform cardioversion or electric therapy, the patient must be on a cardiac monitor and should have vascular access
True
For sedation for electric therapy, the blood pressure should be ______
> 90 SBP
What is the sedation dose of etomidate
0.15mg/ kg
Dosages of etomidate may NOT be repeated
True
What is the sedation dose of Midazolam
0.1mg/ kg
What is the sedation repeat dose of Midazolam
0.05mg repeated every 5 minutes
What is the sedation dose of Diazepam?
5mg
What is the repeat dose of Diazepam for sedation
5mg after 5 minutes with Physician order
Analgesia dose of Dilaudid
0.01mg per kg, up to 1.0mg
To pace, set the rate at
60 bpm
increase amperage in pacing by
20 milliamps until capture
If pacing and cannot obtain capture
Continue pacing and perform CPR
Pediatric pacing is by MD order only
True
ET induction dose of Etomidate is
0.3mg/ kg
Etomidate is used on patients greater than 12 years old
True
To induce a pediatric patient under the age of 12, use
Midazolam, 0.1 mg/ kg, titrated to effect Max dose 5.0mg
What is the induction dose of Ketamine
2.0mg IV or 4.0mg IM.
Ketamine is approved for use on all ages of patients
True
Midazolam must be administered over what time frame
3-5 minutes
After intubating a patient, the initial dose if midazolam to maintain sedation is?
0.1mg/ kg
To maintain sedation of a patient, what is the dosing of
Ketamine
2mg/ kg IV or 4mg/ kg IM. Contact medical control for repeat doses
Phenylephrine and Oxymetazoline are used to prep the nostrils for nasal intubations along with 2% lidocaine for lubrication
True
To use the first response criteria, a patient must be between 18 and 65 years old
true
under the first response criteria, the patient must have a phone and willingness to call 911
true
In tourniquet use, record the application time so it is clearly visible
True
IM and SQ injections should be 20g or smaller
True
IM injections are at 90 degrees to the skin
True
SQ injections are at a 45 degree angle
True
Intranasal medications are
Fentanyl, Ketamine, Midazolam, Narcan
During IN administration, half the dose is delivered in each nostril
True
Needle Crich is performed when there is total airway obstruction to any BLS or ALS procedure or inability to ventilate at any level of care
True
A tracheal transection is contraindicated in a needle crich
true
Acute laryngeal disease is contraindicated in a needle crich
true
use a 14 gauge over the needle Cath attached to a 10cc syringe or commercial device for a needle crich
True
If a trach tube cannot be easily replaced, withdraw the tube and oxygenate with positive pressure
true
An et tube of similar outer diameter can be used in lieu of a trach tube
true
If a trach tube cannot be easily replaced, a suction cath may be used as a guide
True
To perform vagal maneuvers, the patient must have vascular access and must be on a monitor
True
Vagal maneuvers are performed on a patent with SVT and with adequate perfusion
True
The diving reflex is performed by facial immersion in ice water unless ischemic heart disease is present
True
Carotid massage may be performed only on a patient under the age of 40
True
The most effective vagal maneuver in children is the application of ice to the face
True
IV access in not mandatory for vagal maneuvers in children
True
AEMT may perform IO on an adult only
True
IO is contraindicated in a fractured bone or distal to
True
IO is contraindicated in prosthetic limb or joint, or use IO use in the previous 48 hours
True
IO is contraindicated if there is an infection at the site of insertion
True
H73 is not an approved hypothermic center
True
H18 is not an approved stroke center
True
Albuterol is what class of drug
Sympathomimetic
What is the action of Amiodarone
Suppresses ventricular ectopy, Increases ventricular fibrillation threshold.
Amiodarone is contraindicated in
Cardiogenic shock, high grade av block, bradycardia with ventricular escape beats and marked sinus bradycardia
What is the action of atropine
Cholinergic blocking agent, increases rate of SA node discharge, increases conduction through the AV node
What are the contraindications of hydroxocobalamin
none
What is the class of ipratropium
Anticholinergic
What are the contraindications of ipratropium
Hypersensitivity
What are the contraindication of a duoneb
hypersensitivity to either of the base medications
What are the contraindications to Ketamine
Known hypersensitivity, systolic bp greeter than 190mm, acute CVA, head trauma
What is the action of Nitroglycerine
Dilates systemic arteries and veins; reduces both preload and after load
What is the action of Zofran
Antiemetic
A respiratory rate less than 10 or greater than 29 go to what kind of trauma center
Level 1 or 2
What is involved the mechanism of injury step 3 classification
Falls, High Risk Auto Crash involving ejection, rollover with unrestrained occupants and death in the same compartment
What is the heart rate for a patient to go to the waiting room?
60-100
What is the respiratory rate for the waiting room criteria
10-20
What is the systolic BP range for a patient to go to the waiting room
100-180
What is the diastolic BP range for a patient to go to the waiting room
60-110
What is the first drug used in suspected hyperkalemia
Albuterol, 2.5mg in 3ml
What 4 conditions indicate suspected hyperkalemia
Bradycardia, Peaked T waves, Widened QRS complex or cardiac arrest
What 2 medications and doses can be given to patients with suspected hyperkalemia
Calcium Chloride, 1.0gram slow IVP/ IO and
Sodium Bicarbonate, 1.0 mEq/kg slow IVP/ IO
What does the history of a suspected hyperkalemic patient include
history of renal failure
History of dialysis
History of crush injury or trauma
Patients must have suspected hyperkalemia or EKG findings consistent with hyperkalemia before initiating treatement
True
Findings consistent with hyperkalemia include bradycardia with widening QRS complexes
True
What is the maximum single dose of morphine in a pediatric patient
0.1mg/ kg, 10mg max single dose
What is the max single pediatric dose of fentanyl
1.0mcg/ kg, max dose is 100mcg.
In pediatric pain management, medical control must be contacted for additional doses of morphine and fentanyl
True
Obtain pain severity, scale of 1-10, in a pediatric patient before and after dosing
True
Weight bases dosing may provide a standard means of dosing calculation but it does not predict a response
True
A combination of benzodiazepines and opiates result in deeper anesthesia with significant risk of respiratory compromise
True
Burn patients may require more aggressive dosing
True
Neuro disorders or signs of hypo perfusion in the presence of abdominal may indicate what?
An aneurysm
Contact medical control for refractory anaphylaxis
True
Alcohol is not commonly a cause of total unresponsiveness to pain
True
If administering Atropine, a patient should be placed on pacer pads
True
How much fluid should you give to a burn patient with hypo perfusion or more that 10% bsa
500ml. May give up to 2000ml if no improvement
An adult patient with >20% bsa meets burn center criteria
True
A pediatric patient less than 10 or adult older than 50 with 10% bsa meets burn center criteria
True
Epinephrine is administered after what shock
Second shock
If a patient is in a non shockable rhythm, when can epinephrine be administered
after iv established and after the first rhythm check
Droperidol can result on hypotension, QT prolongation and Torsades de Pointes
True
A wide complex Monomorphic VT that is suspected to be SVT receives what treatment
6mg adenosine
Morphine is not recommended in children with abdominal pain
True
Epinephrine 1:10,000 in a pediatric allergic reaction is dosed at
0.01mg/kg IV or IO
Anaphylaxis refractory to repeat doses of IM Epinephrine may require IV Epinephrine dosed at 1:10,000
True
Midazolam is NOT recommended for children in a behavioral emergency
True
The pediatric behavioral emergency protocol is specific to children under the age of 12
True
A pediatric burn patient showing signs of hypo perfusion or >10% bsa can receive how much fluid
20/ml/ kg. May repeat up to 60ml/kg total if no improvement
In Pediatric Cardiac Arrest, the Epi 1:10,000 dose IV/ IO is
0.01mg/ kg
In Pediatric Cardiac Arrest, the EPI 1:1,000 ETT dose is
0.1mg/ kg every 3-5 minutes
Patients with a TCA ovrdose will present with
Decreased mental status, dysrhythmias, seizures, hypotension, coma and death
A pediatric patient with a BGL over 250 receives how much normal saline
10ml/kg, may repeat 2 times
A pediatric patient weighing less than 20kg will receive what dose of glucagon
0.5mg IM
Tachycardia in a child is defined at?
> 180bpm
Tachycardia in an infant is defined as?
> 220bpm
Vagal maneuvers may be performed on a patient experiencing SVT attic adequate perfusion
True
What is the repeat dose of Midazolam to maintain sedation in an intubated patient
0.05mg per kg every 5 minutes
