SOG 430 Flashcards
1
Q
No ALS procedures are authorized in other jurisdiction, unless
A
as stated herein or under situations in which such procedures are necessary to prevent imminent death or serious harm to the Pt.
2
Q
Personnel discovering an abandoned neonate shall:
A
1) asses neonate per neonate/pediatric resuscitation protocols
2) Notify law enforcement agency
3) Transport neonate to nearest appropriate receiving facility.
3
Q
A Pt is considered to give informed consent when any of the following occur:
A
- Pt gives verbal permission to treat
- Pt gives written permission to treat
- Pt does not object as you begin assessment
4
Q
The documented refusal is only valid with an appropriate witness signature: in order of preference
A
Spouses Relatives Law Enforcement Friends Other JFRD
5
Q
Cooperation with law enforcement.
Who has the final authority and accountability when the pt is under their arrest.
A
Law enforcement
6
Q
When not to remove taser probes.
are implanted in sensitive areas.
A
Face Throat Eye Groin Breast Hands Feet
7
Q
Pt who have been tased should be transported to the hospital under the following circumstances:
A
- History of delirium, mania or irrational bizarre behavior before being tased
- Persistent abnormal vital signs
- Amphetamine or hallucinogenic drug use
- Cardiac hx
- AMS or aggressive
- Hypothermia
- Abnormal CP, SCB, nausea or headaches
- Probes in sensitive area
- In doubt on how to remove probe
8
Q
Physical restraints are permitted for Pt who are at immediate risk for harming themselves or others because of impaired judgment due to any combination of the following:
A
- Drugs/alcohol
- Psychiatric illness
- Head injury
- Metabolic, CNS infection, hypoglycemic
- Dementia
9
Q
Dealing with restrained Pt shall be placed in what position?
A
- Supine
- Fowler’s
- Semi Fowler’s
10
Q
When restraints are in use.
Circulation to the extremities shall be elevated at least every?
A
10 min
11
Q
Excited delirium Pt that were combative Pt who became suddenly ______ should raise a red flag.
A
quiet
12
Q
Excited delirium can mimic several medical conditions including:
A
- Hypoxia
- Hypoglycemia
- Stroke
- Intracranial bleeding
13
Q
Signature instructions for non-transport
the officer in charge to sign the Pt are
report under ______. The following report
types:
A
“Responsibility Puts”
- DOA
- Law enforcement
- Pronouncement of death
- Transfer to another EMS agency
14
Q
Every ______ months completed refusals will be forwarded to the QIC at HQ.
A
6 months
15
Q
When transport is refused in suspicion of abuse the following needs to be done:
A
- Request law enforcement at scene
- Stay with Pt until law enforcement arrival
- Notify the Rescue Chief
16
Q
Reporting abuse following procedure are:
A
- Report to ER Doc
- Call 1-800-962-2873 name and ID# or contact person
- Rescue Chief
- Email Division Chief Rescue within 24 hours via email
17
Q
Unquestionable death criteria, meets the following DOS:
A
- Unresponsive
- Apheic
- Pulseless
- In addition to above must meet at least one:
- Inactive
- Body decay
- Rigor mortis
- Open cranium with exposed brain matter
- Decapitated or severed trunk
- Multi system trauma Pt - asy stroke.
18
Q
Blunt chest trauma death criteria, following is met for DOS:
A
- Unresponsive
- Apneic
- Pulseless
- No heart sounds or cardic activity asystole confirmed in two leads or wide complex ventricular rhythm of 30 or less without pulse.
19
Q
The following situations will require transport of the Pt to the hospital by rescue:
A
- Life threatening emergencies
- Chest or abdominal pain in adult Pt
- Dyspnea
- Pregnancy
- AMS
- All near drowning
- Pt with alerts
- Ped 15 years or younger symptomatic
- Elderly 65 years or older
- Pt who received ALS treatment
- Conditions exacerbated improper handling/transport
20
Q
The following situations will not require transport of the Pt to the hospital by rescue: however they must be documented:
A
- No emergency exits
- Injuries superficial or minor nature
- Require transport to mental health resource or detox facility
- Private provider or private vehicle
- Pt refuse transport
- DOS
- Hospice Pt - Pt disposition
21
Q
Family, friends or other passengers will not be routinely transported unless required for the continuation of Pt care:
A
- Ped Pt requiring a parent or guardian
- Geriatric Pt requiring a guardian or care giver
- Pt with language barriers requiring a translator
- Pt with speech disabilities requiring some one proficient in sign language
22
Q
Pt will not be transported to stand alone ER:
A
- Any alerts
- Pt with abdominal or pelvic cavity pain/discomfort
- Pt who are under arrest or “Acts”
23
Q
Arrival at receiving facility:
Medical staff assess Pt within ______ of arrival if not notify ______
A
15 min
notify charge nurse, nurse manager, Rescue Chief
24
Q
Rescue with transfer Pt to hospital stretcher in ______, or notify ______.
A
30 min
FRCC
25
Trauma scorecard methodology. Any one of the following conditions considered a trauma alert Pt.
- Airway - assistance beyond giving O2
- Circulation - lack radial pulse with heart rate greater than 120 beats BP systolic less than 90
- BMR - 4 or less - paralysis
- Cutaneous - 2nd or 3rd degree to 15% body amputation proximal wrist or ankle penetrating injury - head, neck, torso.
- Long bone fracture - two or more
26
Trauma scorecard methodology. Any two considered a trauma alert.
- Airway - respiratory rate 30 or greater
- Circulation - Pt sustained heart rate 120 or greater
- BMR - 5
- Cutaneous - major degloving injury or major flap avulsion greater 5 inch GSW to extremities
- Long bone fracture - from a MVA or fall 10' or greater
- Age - 55 or greater
- MOI - ejected, steering wheel deformity
- 12 or less on GCS
27
Pediatric trauma, characteristics of a person 15 years of age or less. Trauma alert Pt criteria are identified any one are:
Airway - intubated, jaw thrust, suction, assist ventilatory efforts
Circulation - Faint or non-palpable carotid or femoral pulse or BP systolic is less than 50
-Consciousnesses - AMS, inability to follow command paralysis.
Fracture - open long bone, multiple fracture
Cutaneous - major degloving or flap avulsion 2nd or 3rd degree burns 10% BSA amputation proximal to the wrist or ankle penetrating injury head, neck, torso
28
Pediatric trauma, characteristics of a person 15 years of age or less. Trauma alert Pt criteria are identified any two are:
- Consciousness - amnesia, loss of consciousness
- Circulation - carotid or femoral pulse is palpable radial or pedal pulse are not BP systolic less than 90
- Fracture - single closed long bone fracture not wrist or ankle
- Size - 11kg or less or length is equivalent to this weight on a pediatric length and weight emergency type (33in)
29
EMT assessment/treatment
| medical Pt assessment:
- Assess for responsiveness
- ABC's - BLS/AED
- O2
- Assess level of consiousness - A.V.P.U. - GCS
- HPI - SAMPLE - OPQRST
- Initial signs: Respirations (rate, quality, rhythm), Pulse (rate, quality, rhythm) skin condition, BP, Pupillary conditions, Sp02, Attack ECG, BGL
- Head to toe - Focus Pt
- Calming and reassuring
30
EMT assessment/treatment
| Trauma Pt assessment:
- Assess for responsiveness
- ABC's - BLS/AED
- O2
- Assess level of consciousness - A.V.P.U. - GCS
- HPI - SAMPLE - OPQRST
- Trauma alert criteria
- Hemorrhage control
- Head to toe - Px
- Vitals: Respirations (rate, quality, rhythm), pulse (rate, quality, rhythm), skin condition, BP, Pupillary condition, Sp02, ECG, BGL, spinal immobilization, splint, calming and reassuring
31
Adult GCS
```
Eye opening:
spontaneous 4
to speech 3
To pain 2
None 1
```
```
Best verbal response:
oriented 5
confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1
```
```
Best motor response:
Obeys 6
localizes 5
withdraws 4
abnormal flexion 3
abnormal extension 2
none 1
```
32
The goal of Pt care in trauma arrest Pt is:
"Load and go"
Limit scene time to 10 min unless extrication is required.
33
Trauma arrest Pt assessment history:
- Mechanism of injury (blunt or penetrating)
- Blunt trauma - amount and direction of force
- Penetrating trauma - weapon, size of object, trajectory, caliber of bullet
- MVA - condition of vehicle, dashboard steering wheel: Speed of impact, seat belt use, deployment airbags, amount of intrusion, Pt trajectory
- Description of scene
- Treatment prior to arrival
- Drug or alcohol use
- medical illness
- Current meds
- Allergies
34
Trauma arrest
| Pt signs and symptoms
- Skin:
- Cyanosis
- Pallor
- Mottling
- Number of Wounds
- Cool Clammy
- Subcutaneous emphysema
- Respiratory
- Abnormal breath sounds
- Apnea
- Tracheal shift
- Abnormal Chest Wall Movements
- Paradoxical
35
Trauma Arrest
EMT Treatment
Multi-System Trauma EMT Treatment
- EMT Assessment Treatment Protocol
- Consider unquestionable and/or blunt chest trauma death criteria
- Declare "trauma red"
- Airway Protocol: Ventilate with 100% O2
- Consider SAM Pelvic splint for pelvic fracture
- Consider PASG as an air splint for pelvic or multiple lower extremity long bone fracture
36
Shock/Trauma
| EMT Treatment:
- EMT Ass Treatment Protocol
- Airway Protocol
- Administer 100% O2
- Maintain body warmth
- Place pt in shock position (Trendelenburg position)
- Determine underlying causes of shock
- Prepare for rapid transport
37
Head Trauma
| History Assessment:
- Time of injury
- Mechanism of injury (blunt or penetrating)
- Estimate of force involved
- Helmet use and type
- LOC (duration and progression)
- Amnesia to events
- Medical illness
- Current Meds
- Allergies
- Drug or alcohol use
38
Head Trauma
| Signs and Symptoms:
- Nausea/vomiting
- Neck pain
- Headache
- Diplopia
- Unsteady gait
- Numbness or tingling of the extremities
- Paralysis of the extremities
- Vital sign; Hypotension or Tachycardia indicative of internal hemorrhage
- Skin; Contusions, abrasions, lacerations
- HEENT: ETOH, CSF, pupillary size
- Neck: Tenderness
- Neurologic LOC, AVPU. GCS, seizures
39
Head Trauma
| EMT Treatment:
- EMT assessment treatment protocol
- Airway protocol
- 100% O2
- Spinal immobilization protocol
- Control bleeds
- Treat co-existing injuries
40
Chest Trauma
| EMT Treatment
Best treatment is rapid transport
-EMT assessment treatment protocol
-100% O2
-Flail chest: Positive pressure ventilation BVM
-Sucking chest wound: Vaseline type gauze occlusive dressing, plastic or aluminum foil taped on three sides:
Tension pneumothorax develops, release occlusive dressing
-Penetrating trauma: Stabilize impaled objects in place, do not remove
41
Abdominal Trauma
| EMT Treatment:
Mechanism of injury is the most important indicator of abdominal trauma
Best treatment is rapid transport:
-EMT Assessment Protocol
-Airway Protocol
-100% O2
-Abdominal Evisceration: Never replace replace abdominal viscera: Sterile dressing moisten w/NS:
Wet dressing, cover with large dressing to keep area warm
42
Traumatic Injury of Pregnant PT
| EMT Treatment:
SS May be delayed due to maternal blood volume
- EMT assessment protocol
- Airway protocol
- 100% O2
- LSB elevated on right side is about 15 degrees or 6 inches displacing uterus to left side of vena cava
- LSB cannot be elevated manually displace uterus to left maintain displacement throughout transport
43
Extremity Injuries
| EMT Treatment:
-EMT assessment treatment protocol
-Airway protocol
-O2 95-100%
-Dressing and Pressure bandage, apply tourniquet
- Splint areas of tenderness or deformity
-Splint dislocation and joint injuries in the position found
-Consider ice packs to reduce swelling
-Reduce dislocations or fractures (open or closed) by axial traction for the following:
Absence of distal pulses: Proper immobilization
-Elevate the extremity when practical
-Monitor distal pulses, sensation and motor function before and after splinting
44
Extremity Injuries
EMT Treatment:
Consider Specific Treatment;
- Amputation: Place amputated part in sterile gauze, moisten with NS, place in container, keep cool not freeze
- Dress and splint partial amputations in alignment with extremity, avoid torsion
- Do not clamp vessels
- Apply tourniquet
- Alert hospital for possible reattachment
45
Crush Syndrome Assessment
| Pathophysiology:
- Blood flow is restored, multiple processes begin
- Hypovolemia, hypotension, hypovolemic shock
- Increase in serum potassium makes ventricular fibrillation more likely
- Release of myoglobin, uric acid to kidneys and blood directly and indirectly kidney failure
- Reperfusion injury in all tissues
46
Crush Syndrome Assessment
| Morbidity and Mortality:
- Primary cause of death in crush syndrome: Hypovolemia, dysrhythmia, renal failure
- Other causes of death: Adult respiratory distress syndrome (ARDS), sepsis, electrolyte disturbances, ischemic organ injury (gangrene)
47
Crush Syndrome
Clinical Manifestations
Prior to Release from Entrapment:
- Generally no pain in crushed extremity may sense hyperesthesia or anesthesia
- Degree of pain seems disproportionate for amount of visible tissue damage
- Distal pulses may or may not be present; however they are usually present
48
Crush Syndrome
Clinical Manifestations
After Release from Entrapment
- Agitation is common
- Hyperesthesia or anesthesia, severe pain in the crushed extremity
- Passive movement of the affected limb results in pain
- Muscle function decreases rapidly and leads to limb paralysis due to direct muscular dysfunction
- Aggressively marked swelling of the affected area
- Systemic manifestations of crushed syndrome can be seen in seconds to minutes to hours. Depends on the amount of muscle involved
49
Acute Compartment Syndrome
Signs and Symptoms
Five P's Associated:
- Pain
- Parasthesis: pins and needles
- Pressure
- Passive stretching
- Pulselessness
50
Acute Compartment Syndrome
| EMT Treatment:
- EMT Assessment Treatment Protocol
- Airway Protocol: 100% O2
- Determine the underlying cause of injury
- Splint and immobilize all suspected limb fractures
- Do not elevate or apply cold pack
- Prepare for rapid transport
51
Burns
Severity Classifications
Major Burn:
- Partial thickness greater than 25% BSA in adults; greater than 20% BSA in children
- Full thickness greater than 5% BSA
- All partial or full thickness burns of hands, feet, face, eyes, ears or genitalia
- Inhalation injury
- Electrical burns
- Burns complicated by fractures or other major trauma
- High risk pt : Very young, elderly, pt with chronic medical problems
52
Burns
Severity Classifications
Moderate Burn:
- Partial thickness 15-25% BSA in adults, 10-20% BSA in children
- Full thickness 2-5% BSA
53
Burns
Severity Classifications
Minor Burns:
- Partial thickness less than 15% BSA in adults; less than 10% BSA in children
- Full thickness less than 2% BSA
54
Burns
| Trauma Alert Criteria:
- Adults
- Partial/full thickness (2nd/3rd degree) burns equal to or greater than 15% of the BSA
- Pediatric
- Partial/full thickness (2nd/3rd degree) burns equal to or greater than 10% of the BSA
55
Burns
| EMT Treatment:
- EMT Assessment Treatment Protocol
- Airway Protocol 95 and 100%
- Consider hyperbaric facility for CO poisoning
- Remove all clothing and jewelry
- Assessment type and percent of BSA, use Rule of Nine!
- Burning agent is chemical - irrigate with NS or sterile water for 20 minutes ( do not use water on lime, carbolic acid, sulfuric acid, solid potassium or sodium metals)
56
Burns
EMT Treatment
Specific Treatment
Superficial Burns:
- Immerse in cool sterile water or apply cool sterile compresses to the burn site
- Burned hands or feet may be soaked directly in cool sterile water
- Towel soaked in cool sterile water may be applied to burns of the face or trunk
- Maintain body warmth: Apply a dry sheet or blanket over wet dressing to minimize heat loss
57
Burns
EMT Treatment
Specific Treatment
Partial-Thickness Burns:
- For minor burns, wrap burned area with sterile cloths or sheets cooled in ambient temperature NS or sterile water, or utilize burn gel treatment
- Cool burn area with NS or sterile water in sufficient quantities to relieve heat penetration in lieu of burn gel treatment
- Moderate and major burns - cover with dry sterile dressing
- Leave blisters intact
- Maintain temperature control and body warmth, do not allow PT to become hypothermic; shivering further complicates shock
58
Burns
EMT Treatment
Specific Treatment
Full Thickness Burns:
- Wrap burned area in dry sterile dressing, clothes or sheets
- Remember do not allow pt to become hypothermic; shivering further complicates shock
59
Burns
EMT Treatment
Specific Treatment
Electrical Burns
- Remove pt from electrical source if no danger to rescuer
- Assess and dress entrance and exit wounds
- Follow electrical injury protocol
- Spinal immobilization
60
Burns
EMT Treatment
Specific Treatment
Chemical Burns
- Wear appropriate PPE
- Flush burn area w/NS or sterile water for 20 minutes
- After flushing, cover wound w/dry sterile dressing
- if Pt remains symptomatic after initial care, continue irritation throughout transport
For Eyes
- Irrigate eye with lukewarm NS or sterile water as needed for 20 minutes
- After irrigation, bandage both eyes with dry sterile dressing
61
Electrical Injuries
| EMT Treatment
-On lightening strike scenes where there are multiple pt, reverse triage shall be applied and pt in cardiac arrest shall be worked first
-EMT Assessment Treatment Protocol
-Airway Protocol
-O2 assessment and 95% -100%
-Treat co-existant injuries
Head trauma
Extremity Injury Protocol
Subs Tissue Injury
Burns
62
Eye Emergencies
EMT Treatment
Assess Nature of Opthalmologic Emergency
Direct Trauma
- Direct trauma
- Patch both eyes gently without pressure to the globes.
- Maintain pt in supine position to reduce leakage of fluids from the eye
- If blood is noted in anterior chamber (hyphema), elevate head of the pt below 40 degrees. If on LSB, elevate LSB 40 degrees
- Dim lights to pt comfort
63
```
Eye Emergencies
EMT Treatment
Assess Nature of Opthalmologic Emergency
Chemical Trauma
Atraumatic
```
-Chemical trauma
-Irrigate affected eye w/lukewarm NS or sterile water for 20 minutes
-Apply dry sterile dressings to both eyes
-Dim lights for pt comfort
Remove contact lenses when applicable
Atraumatic
-Patch both eyes gently without pressure to the globes
-Dim lights for pt comfort
-Transport diagnosed central retinal artery occlusion
-100% O2
Place pt in shock position
64
Chest Pain/Discomfort
Assessment
History:
- Chest pain
- Onset and duration
- Location and radiation
- Quality (pleuritic, heavy, crushing)
- Pain/discomfort rating 0-10
- Activity at the onset and relieving factors
- Medical illness
- Smoking
- Recent cardiac-related surgery
- Current meds
- Allergies
65
Chest Pain/Discomfort
Assessment
Signs and Symptoms
-Diaphoresis
-Shortness of breath
-Cough and sputum production
-Nausea/vomiting
-Fever
-Chills
-Vital signs - vary
-Skin
Diaphoresis
Cyanosis
Peripheral edema
-Respiratory
Rales
Rhonchi
Wheezing
Chest wall tenderness
```
-Cardiac
Neck vein distention
pain/discomfort
clutching of chest
irregular pulse
numbness/tingling
differerence in BP between the two arms
```
66
Chest Pain Discomfort
| EMT Treatment
- EMT Assessment Treatment Protocol
- Airway Protocol
- SP O2 less then 95%, O2 at 2-4 LPM via nasal cannula; to maintain SP O2 at 95% or greater
- If room air SP O2 is 95% or greater, do not administer O2
67
Acute Stroke
| EMT Treatment
- EMT Ass Treatment Protocol
- Airway Protocol
- SPO2 less than 95%, O2 at 2-4 LPM via nasal cannula to maintain SPO2 at 95% or greater
- If room SPO2 is 95% do nothing
- Head elevated to 30 degrees if tolerated
- Obtain BP on both arms
- Complete stroke checklist
- Do not administer any oral meds
68
CHF/Pulmonary Edema
| EMT Treatment
-EMT Ass Treatment Protocol
-Airway Protocol
-O2 100%
Place the pt in full Fowler's position
69
Hypertensive Urgency
| Is What?
Systolic BP greater than 220 mm Hg
| Diastolic BP greater than 120 mm Hg
70
Hypertensive Urgency
| EMT Treatment
- EMT Ass Treatment Protocol
- Airway Protocol
- O2 as indicated
- Place pt in semi-Fowler's position
71
Cardiac Arrest
| EMT Treatment
- EMT Ass Treatment Protocol
- Consider unquestionable death criteria
- Declare cardiac Red
- Airway Protocol
- 100% O2
- BLS Healthcare Provider Algorithm
- AHA
CPR
- minimizing interruptions CPR
- -unwitnessed arrest, 2 minutes of CPR
- Ass by AED
- Witnesses arrest - defib
- BVM 100% O2
72
Respiratory Insufficiency
| EMT Treatment
- In pt with severe respiratory compromise, treatment should be aggressive in order to prevent respiratory arrest
- Pt anxiety is one of the first signs of hypoxia
- Obtundation occurs with severe hypoxiation
- EMT Ass Treatment Protocol
- Airway Protocol
- O2 maintain between 95-100%
73
Respiratory Arrest
| Assessment History
Aggressive airway procedures supplemental ventilation should be performed to prevent arrest
- History
- Onset - acute or gradual
- Duration
- Exacerbating or alleviating factors
- Oral Exposure/Foreign bodies
- Trauma
- Environmental Exposure
- Smoking
- Medical illness
- Current meds
- Allergies
- Home O2
- Drug or alcohol use
74
Respiratory Arrest
Assessment
Common Causes
- Asthma
- Acute upper airway obstruction
- Acute bronchitis pneumonia
- Drowning and asphyxiation
- Epiglottis
- Overdose and poisoning
- Acute myocardial infarction (AMI)
- CHF
- Chest trauma
- Pulmonary edema
- Diabetic ketoacidosis
- Environmental exposure
75
```
Respiratory Arrest
EMT Treatment
Foreign Body Airway Obstruction
(FBAO)
Conscious:
```
- Mild obstruction w/good air exchange
- Encourage pt own spontaneous coughing and breathing efforts
- Severe Obstruction
- Abdominal thrusts (Heimlich maneuver)
- If pt is pregnant or obese, perform chest thrusts instead of abdominal thrusts
76
Respiratory Arrest
EMT Treatment
Foreign Body Airway Obstruction
(FBAO)
- Reposition airway
- Before ventilating and after opening the airway, look for obstruction and remove if visible
- Begin CPR
- Suction as indicated
- 100% O2
77
What must not be used to determine if a pt should receive oxygen therapy?
Oxygen saturation levels
78
Airway Protocol History
- Onset cause and results
- Duration
- Exacerbating or alleviating factors
- Oral exposure/foreign bodies
- Trauma
- Environmental Exposure
- Smoking
- Medical illness
- Current medications
- Allergies
- Home O2
- Drug or alcohol use
79
Airway Protocol
| Calf pain is called
-Homan's Sign
80
```
Airway Protocol
EMT Treatment
Oxygen Delivery Devices
Nasal Annula"
Non-Rebreather
```
NC - considered low flow
- set flow meter to 2-6 LPM
NRB - considered high flow
- set flow meter to at least 10 LPM
- adjust liter flow to maintain O2
in the reservoir bag
81
```
Airway Protocol
EMT Treatment
Oxygen Delivery Devices
Nebulizer:
Bag Valve Mask Ventilation:
```
Neb - set flow at least 6 LPM (typically 8 LPM)
- Adjust liter flow to maintain mist
BVM - Use E-C technique
- or at 15 LPM
- Consider two rescuer technique
- Squeeze bag until chest rises
82
Airway Protocol
EMT Treatment
Airway Ajuncts
Oral Pharyngeal Airway
OPA - Unconscious/unresponsive pt
- Do not use in pt with gag reflex
- Measure from corner mouth to tip of ear lobe
- Insert with tip toward roof of the mouth
- Do not push the tongue into back of the throat
- Once halfway into the mouth, rotate 180 degrees
- Advance until flange resets upon the lips
83
Airway Protocol
EMT Treatment
Airway Adjunts
Nasal Pharyngeal Airway
NBA - Semi-conscious, unconscious and unresponsive
- Measure tip of nose to angle of jaw
- Lob w/KY Jelly
- Insert nostril bevel side toward the nasal septum of the nose
Extreme caution w/neonates and small infants due to risk of nasal obstruction
84
Airway Protocol
EMT Treatment
Airway Adjunts
Combi-Tube
- Indications
- Cardiac, respiratory, or traumatic arrest
- Contraindications
- Height less than 5 feet tall or greater than 7 feet
- Age less than 16 years old
- Esophageal disease
- Ingested caustic substance
- FBAO
- Responsive or has gag reflex
- Use w/KY Jelly
- Hand neutral position, tongue jaw lift
- Bleck line between teeth/gum line
- Inflate cuff #1 with 100 ml air
- Inflate cuff #2 with 15 ml air ventilate blue tube
85
Hyperventilation Syndrome
| EMT Treatment
- EMT Ass. Treatment Protocol
- Airway Protocol
- O2 100%
- Do not administer any CO2 rebreathing techniques
86
Abdominal/Flank Pain
Assessment
History
- Onset and duration
- Location and radiation
- Quality - crampy, sharp, intermittent
- Menstrual history
- Suspected pregnancy - ectopic
- Previous trauma
- Current medications
- Medical illness
- Allergies
- Surgery
- Abnormal ingestion
87
Abdominal/Flank Pain
Assessment
Signs and Symptoms:
- Nausea
- Vomiting - bloody, coffee ground
- Constipation
- Melena - bloody, tarry stools
- Urinary problems
- Vaginal discharge - abnormal bleeding
- Fever
- Diarrhea
- Skin - Disphoresis, pallor
- GI - Abdominal tenderness
- Guarding
- Distention
- Pulsatile mass
- Emesis
88
Allergic Reaction/Anaphylaxis
Signs and Symptoms
Mild:
- Itching
- Rash
- Redness
- Localized swelling
- Urticaria (hives)
- Anxiety
89
Allergic Reaction/Anaphylaxis
Signs and Symptoms
Moderate:
- Wheezing
- Cough
- Abdominal Pain
- Nausea/vomiting
- Weakness
- Tachycardia
- Lethargy
- Combativeness
90
Allergic Reaction/Anaphylaxis
Signs and Symptoms
Severe:
- Pale and cool skin
- Hypoperfusion (caused by vasodilation)
- Inadequate respirations (tidal volume and or rate)
- Hoarseness
- Stridor
- Tongue and/or upper airway (uvola) edema
- Upper airway noise
- Unresponsive
91
Coma/Altered Consciousness
Assessment
History:
- Onset (acute vs. gradual)
- Duration
- History of trauma
- Description of scene
- Unusual odor in residence or at scene
- Recent carotidal trauma or crisis
- Drug or alcohol ingestion
- Toxic exposure
- Exertion or heat exposure
- Psychiatric disorders
- Medical illness
- Current medicaitons
- Allergies
92
Coma/Altered Consciousness
Assessment
Common Causes:
- Head trauma
- Drug Overdose
- Seizures
- Stroke
- Diabetes
- Other metabolic disorders
- Sepsis
- Psychiatric illness
93
Coma/Altered Consciousness
Assessment
Signs and Symptoms
Neck: Stiffness is?
Nuchal rigidity
94
Epistaxis Can lead to?
Hemorrhagic shock
95
Epistaxis
| EMT Treatment
- EMT Ass Treatment Protocol
- Airway Protocol
- O2 be maintained 95-100%
- Do not use nasal cannula
- Place pt sitting position head leaning forward
- Suction airway is required
- If associated with a head injury and CSF drainage, do not attempt to control bleeding
- Control hemorrhage by pinching nostrils and packing gauze between the upper lip and gum.
- Do not allow pt to sniff or blow nose
96
Headache
| EMT Treatment
- EMT Ass Treatment Protocol
- Airway Protocol
- Maintain aspiration prophylaxis of pt w/a decreased level of consciousness by placing the pt in the recovery position
- O2 between 95 and 100%
- Closely monitor blood pressure
97
The most important goal in the pre-hospital management of shock is?
The diagnosis and immediate treatment of the underlying cause.
98
Shock/Medical
| EMT Treatment
- EMT Ass Treatment Protocol
- Airway Protocol
- O2 100%
- Maintain body warmth
- Place pt in shock position
- Determine underlying causes of shock
- Anticipate rapid transport
99
Drowning Near-Drowning Submersion Assessment
| History
- Length of submersion
- Fresh or saltwater
- Warm or cold water
- Water depth
- Water contamination
- Trauma
- Past medical history
100
Decompression Sickness/Dysbarism
Assessment
Etiology:
- Dysbarism
- Barotrauma
- Decompression sickness
'
101
Decompression Sickness/Dysbarism
Assessment
History:
Scuba Diving
- Air tank failure
- Rapid ascent
- Prolonged/repetitive dive profile
Altitude
- Depressurization or inadequate pressurization while flying at high altitude
- High altitude exposure after scuba diving
102
Hyperthermia Assessment
Signs and Symptoms
Heat Cramps:
- A&OX4
- Normal vital signs
- Thirst
- Muscle cramps
- Sweating
103
Hyperthermia Assessment
Signs and Symptoms
Heat Exhaustion:
- A&OX4
- Normal or slightly elevated temperature
- Pallor or flushing
- Muscle cramps
- Cool clammy skin
- Weakness
- Chills
- Nausea/vomiting
- Rapid heart rate
- Dizziness
- Headache
104
Hyperthermia Assessment
Signs and Symptoms
Heat Stroke:
- Altered consciousness
- Behavioral changes
- Delirium
- Psychosis
- Coma
- Seizures
- Headache
- Visual disturbances
- Extremely high temperature greater than 104 degrees F
- Moist or dry skin
- Rapid or stray pulse/weak and thready
- Nausea/vomiting
- Pallor or flushing
- Increase respiratory rate
105
Hyperthermia Assessment
Signs and Symptoms
Fever Related to Medical Conditions:
- Altered consciousness
- Behavioral changes
- Delirium
- Psychosis
- Coma
- Seizures
- Rapid breathing
- Rapid heart rate
- Stiff neck
- Abdominal breath sounds
- Hot dry skin
- S/S of dehydration
106
Hyperthermia
EMT Treatment
Specific Treatment
Heat Cramps"
- Oral fluids as tolerated
| - Sponge w/cool water
107
Hyperthermia
EMT Treatment
Specific Treatment
Heat Exhaustion:
- PT transported in position of comfort
- Remove clothing as appropriate
- Sponge w/cool water and fan
108
Hyperthermia
EMT Treatment
Specific Treatment
Heat Stroke
- Semi-fowlers w/head elevated to 30 degrees
- Rapid cooling (neck, axillary region, groin)
- Sponge w/cool water and fan
109
Hypothermia:
Shivering occurs between:
Rectal temperature below:
- 89.6 - 98.6 degrees
| - 95 degrees is a significant finding
110
Hypothermia
EMT Treatment
Specific Treatment
Generalized Hypothermia
- Maintain supine position
- Handle pt gently/roughness may result in ventricular arrythmias
- Rewarming is priority
- Remove wet, cold clothing
- Wraps
111
Hypothermia
EMT Treatment
Specific Treatment
Localized Hypothermia
(Frostbite)
- Handle gently, leave uncovered
- Do not allow to thaw if chance exists for refreezing
- Maintain core temperature
112
Bites and Stings
EMT Treatment
Specific Treatment
Marine Stings:
- Remove any clinging tentacles by saltwater rinse
- Avoid rinsing w/fresh water
- Irrigate affected eye w/NS or sterile water
- Apply ice pack wrapped in gauze to affected area
113
Bites and Stings
EMT Treatment
Specific Treatment
Snake Bites
- if constricting bands in place upon arrival, remove
- Mark initial edematous area with pen and note time
- ID snake
114
Toxic Ingestion/Exposure
| EMT Treatment
- EMT Ass Treatment Protocol
- Airway Protocol
- O2 maintenance between 95-100%
- Pulse co-oximeter
- Contact Poison Control 1-800-222-1222
- Request Hazmat for air monitoring and expertise
- Organophosphate exposure
- PPE, mask gloves, eye
- Toxicity by inhalation or topical exposure
- remove clothing
- Irrigate w/NS or may use soap and water. Contain runoff
115
Carbon Monoxide
Signs and Symptoms
Skin:
What is cherry red skin:
Cynanosis
116
Carbon monoxide signs and symptoms of fatal burns to respiratory tracts may occur w/no evidence. Non-carcinogenic pulmonary edema may develop as late as:
24 - 72 hours after inhalation
117
Carbon monoxide confined space burns to face may cause airway edema that does not become severe until after the:
First hour
118
Cyanide
Signs and Symptoms
Mild Toxicity
- Anxiety
- Confusion
- Unsteady gait
- Tachypnea
119
Cyanide
Signs and Symptoms
Moderate Toxicity
- Cardiac arrhythmia
- Dyspnea
- Depressed LOC
120
Cyanide
Signs and Symptoms
Severe Toxicity
- Loss of muscular coordination
- Convulsions
- Reflex bradycardia
- Respiratory depression and coma
121
Cyanide
EMT Treatment
Decontamination:
- Remove pt's clothing and jewelry
- Remove liquid product by blotting
- Wash pt w/mild soap and copious amounts of water
122
Gravida means what?
Number of pregnancies.
123
Para means what?
Number of live births.
124
Vaginal Bleeding
EMT Treatment
Specific Treatment
1st, 2nd 3rd Trimester
1st or 2nd Trimester
- pt assume position of comfort
3 Trimester
- Place pt in recovery position (left side)
125
Pre-Eclampsia occurs in about ______ of the pregnant population and develops after _________ weeks of pregnancy.
5%
20th
126
Diminished or infrequent urination is called:
Oliguria
127
Hypertensive state of pregnancy.
| Mild pre-eclampsia is:
- Systolic BP greater than 140
- Diastolic BP greater than 90
- Greater than 30 increased systolic baseline
- Greater than 15 increase in diastolic baseline
- Non-dependent edema - hands - face
- Persistent or recurring headache
- Vision change
- Abdominal pain
- Diminished or infrequent urination
- Weight gain greater than 2 lbs. per week
128
Hypertensive State of Pregnancy
| Severe Pre-Eclampsia is:
- Systolic BP greater than 160
- Diastolic BP greater than 110
- Generalized edema
- Weight gain greater than 6 lbs. per week
- Persistent or recurring headache
- Vision changes
- Abdominal pain
- Diminished or infrequent urination
- Dyspnea
129
Hypertensive State of Pregnancy
| Eclampsia is:
- Onset of seizure activity in the pre-eclampsia pt indicates eclampsia
- Can occur postpartum (up to 6 weeks)
- Poor maternal prognosis
- There is usually no aura preceding the seizure and pt may have multiple episodes
- Pt hyperventilates after tonic/clavic seizure compensate for acidosis
130
Imminent Delivery
Signs and Symptoms
First Stage of Labor:
- Onset of contractions and dilation of the cervix
- Frequency and duration of uterine contractions
- Hemorrhage - estimated blood loss
131
Imminent Delivery
Signs and Symptoms
Second Stage of Labor:
- Fetal head entering the vaginal canal to expulsion of the fetus
- Urge to push
- Presentation of fetal parts
- Hemorrhage - estimated blood loss
- Nuchal cord - wrapped around infant's neck
- Injuries (tears) to external genitalia or vagina
- Evaluate infant on delivery - APGAR score
132
Imminent Delivery
Signs and Symptoms
Third Stage of Labor:
- Expulsion of the placenta
- Evaluate and manage infant
- Hemorrhage? Estimated blood loss?
- Placenta must be brought to the hospital for evaluation
133
Imminent Delivery
EMT Treatment
Delivery and DO:
- Apply gentle perineal pressure to allow a slow, controlled delivery of the head
- Observe for meconium staining; suctioning imperative
- As soon as the head is delivered, suction the oropharynx first before the nostrils
- Newborn stable/resume protocol
- Apply 2 clamps (2-3 inches apart) 7-10 inches from abdomen of the neonate
- Cut between clamps
- Maintain neonate body temperature
134
Complications of Delivery
EMT Treatment
Nuchal Cord
- Feel for the cord around the neck as soon as the head is delivered
- Gently remove the cord from around the neck
- If unable to remove, clamp and cut the cord
135
Complications of Delivery
EMT Treatment
Breech Delivery
- If delivery is not immediate:
- Place mother in knee-chest position
- If delivery is immediate:
- Allow the buttocks or feet to deliver on their own and support the trunk
- Check for the umbilical cord around the neonate's neck and allow the head to deliver
- If the head does not delivery w/3 minutes, use gloved hand to make an airway for the neonate, using the finger to make air space
136
Complications of Delivery
EMT Treatment
Limb or Brow Presentation
- Place the mother in the knee-chest position
137
Complications of Delivery
EMT Treatment
Prolapsed Cord
- Assessment should focus on the presence of purses in the umbilical cord and relief of the pressure obstructing the blood flow within the cord
- Place mother in the knee-chest position or supine with hips elevated
- Relieve pressure from the prolapsed cord. If no pulses are detected in the cord:
- Use gloved hand to gently but firmly push the neonate's head back into the vagina. Avoid pushing on the fontanels
- Stop pushing upon the return of the pulses in the cord
- Do not push the cord back into the vagina, but keep moist w/NS soaked towels
138
Complications of Delivery:
EMT Treatment
Multiple Births or
Premature Birth:
- Maintain the neonate's warmth
- O2 as indicated
- Change gloves prior to the next delivery
- Closely monitor the cut umbilical cord for bleeding
139
Newborn Stabilization
Resuscitation
What is APGAR Score?
```
Appearance
Pulse
Grimace/Irritability
Activity/Muscle Tone
Respirations
```
140
APGAR Score:
Appearance
0 - Blue all over
1 - Acrocyanosis
2- Pink all over
Pulse
0 - Absent
1 - Less than 100
2 - Greater than or equal to 100
Grimace/Irritability
0 - No response or none
1 - Grimace weak cry
2 - Sneeze, cough, vigorous cry
Activity/Muscle Tone
0 - Limp/flaccid
1 - Some motion, flexion of extremities
2 - Active motion
Respirations
0 - Absent
1 - Slow/Irregular
2 - Vigorous cry or normal respirations
141
The average term infant weighs approximately
3 kgs.
142
Assess utilizing APGAR scoring criteria and record every ______ post delivery.
1 minute and 5 minutes
143
Position the infant in the _________ position with the neck _________ position, roll _____ inch blanket under shoulders
- Supine position
- neutral position
- 1" blanket
144
Newborn stabilization, resuscitation, suction ________ first, then the ________ with a bulb syringe or mechanical suction with a negative pressure.
- Oral cavity
- Then the nostrils
- Negative pressure less than 100 cm H2O
145
Newborn stabilization/Resuscitation
| Specific Treatment for Acrocyanosis is:
Administer flow by O2: Maintain saturation between 95 and 100%
146
Newborn Stabilization/Resuscitation
| Specific Treatment for Persistent Central Cyanosis, APGAR HR less than 100, do what?
-Ventilate with 100% O2 at 40-60 breaths/minute (initial ventilation pressures may exceed 30-40 cm H2O, therefore, occlude the pop off valve).
147
Newborn stabilization/Resuscitation
| Specific Treatment for HR less than 60, do what?
- Administer chest compressions at rate of 120 per minute
148
Newborn Stabilization/Resuscitation
| Re-assess every ____________:
30 seconds
149
Newborn Stabilization/Resuscitation
| Determine BGL by ___________:
Heel stick
150
General Definitions for Pediatrics:
```
Neonate
Infant
Child
Adolescent
Adult
```
Neonate - Birth to 1 month
Infant - Greater than 1 month to 1 year of age
Child - Greater than 1 year to 12 years of age
Adolescent - Greater than 12 years to 15 years of age
Adult - Greater than 15 years of age
151
Pediatric Glascow coma score for child:
```
Eye Opening
4 - Spontaneous
3 - To speech
2 - To pain
1 - None
```
```
Best Verbal Response
5- Oriented/appropriate
4 - confused
3 - Inappropriate words
2 - Incomprehensible words or non-specific sounds
1 - None
```
```
Best Motor Response
6 - Obeys commands
5 - Localizes painful stimulus
4 - Withdraws in response to pain
3 - Flexion in response to pain
2 - Extension in response to pain
1 - None
```
152
Pediatric Respiratory Distress
Infant Conscious but Severe Obstruction
Do What?
- If possible, bare the infant's chest
- Infant in prone position, deliver up to 5 back blows, forcefully, in the middle of the back between the infant's shoulder blades using the heel of your hand.
- Rotate to supine position, head lower than trunk
- Deliver up to 5 quick downward chest thrust
- Repeat sequence until obstruction is cleared or infant becomes unresponsive
153
Pediatric Respiratory Distress, if suction is indicated, limit to __________.
10 seconds
154
Pediatric Respiratory Distress
If ventilation with BVM is indicated, ventilate premature neonate and neonate at _____________ and infants and children to _____________.
- Premature neonate and neonate ventilate at 40-60 per mm.
| - Infants and children, ventilate at 12-20 per mm (once every 3-5 seconds)
155
Pediatric Allergic Reactions/Anaphylaxis:
| SS mild are:
- Itching
- Rash
- Redness
- Localized swelling
- Urticaria (hives)
- Anxiety
156
Pediatric Allergic Reactions/Anaphylaxis:
| SS moderate are:
- Wheezing
- Cough
- Abdominal pain
- Nausea/vomiting
- Weakness
- Tachycardia
- Lethargy
- Combativeness
157
Pediatric Allergic Reactions/Anaphylaxis:
| SS severe are:
- Pale and cool skin
- Hypoperfusion (caused by vasodilation)
- Inadequate respiration (tidal volume and/or rate)
- Hoarseness
- Stridor
- Tongue and/or upper airway (uvula) edema
- Upper airway noise
- Unresponsive
158
Pediatric fever, apply cooling measure if oral or rectal temperature is greater than _______. Do not use _________ as cooling measures.
Greater than 105 degrees
Greater than 104 degrees tympanic
Do not use ice or cold water as cooling measures.
159
Auto pulse contraindications:
- Trauma pt
- Pt less than 18 years of age
- Unknown or suspected aortic rupture
160
Pediatric Stretcher Restraint Device
| Placed on caregiver for pediatric pt with ___________ and head of stretcher should be at ____________.
Croup or stridor
45 degree angle
161
SAM Pelvic Splint Indications are ______, and cautions are ______.
Indication
- Suspected fracture to the greater trochanter or femoral head
- Unstable pelvis
Cautions
- Do not use on pediatric pt
- Do not cut any portion of the splint.
162
Spinal Immobilization of a pregnant pt, after secure the pt do what next?
-Elevate right side of LSB approximately 15 degrees/approximately 6 inches. Displaces the uterus and fetus to the left side and off the vena cava.
163
Violent/combative pt management, agitation is defined as?
Distress or uneasiness of the mind that is caused by fear or danger or a state of apprehensive and psychic tension from a mental disorder.
164
Violent/combative pt management, two of the most common causes of pt agitation are?
- Pain
| - Shortness of breath
165
Violent/combative pt management
Sign and symptoms
Mild:
- Hyper-alert
- Irritable, easily annoyed
- Mildly upset
- Short tempered
- Insomnia
166
Violent/combative pt management
Sign and symptoms
moderate:
- Difficulty concentrations
- Easily distracted
- Restless
- Visibly upset
- Increased irritability
- Express a feeling of worry
- Tearful
- Tachycardia
- Nausea
- Express the desire to harm themselves or others (Baker Act Pt)
167
Violent/combative pt management
Sign and symptoms
Severe:
- Disconnected state: unable to follow simple directions
- Crying uncontrollably
- Greatly agitated
- Physically combative
- Irrational behavior
- Self-soothing behavior
- Expresses feeling of terror
- Hyperventilation
- Dilated pupils
168
12 Lead ECG ZOLL E Series
| Indications:
- Chest pain
- Syncone
- Acute Dyspnea
- Palpitations
- Epigastric Pain
- Unexplained diaphoresis
- Unexplained hypotention
169
Place the electrodes on the chest, where?
V1 - 4th Intercostal space, right para sternal
V2 - 4th Intercostal space, left para sternal
V4 - 5th Intercostal space, mid clavicular
V6 - 6th Intercostal space, mid axcillary
V3 - between V2 and V4
V5 - between V4 and V6
170
Pulse co-oximeter Zoll E-series
Indications are:
SpO2 is:
SpCo is:
Indications:
- SpO2: All pt
- SpCo: Suspected CO poisoning, cyanide exposure, AMS without an obvious cause, Firefighter rehab
SPO2 is - Arterial oxygen saturation
SPCO is - Carboxy hemoglobin saturation
171
Pulse Co-Oximeter Zoll E-series
| Monitor Display: SPO2 and SPCO in:
Spo2 - Blue color - will display for 20 seconds
SPCO - Red color - will display for 10 seconds
172
Pulse Co-oximeter Zoll E-series,
| SPCO Normal values are:
Carboxyhemoglobin
- nonsmoker 0 to 10%
- smoker 5 to 15%
Oxygen saturation:
93 to 100%
173
Pulse Co-oximeter Zoll E-series,
| SpCO abnormal values are:
Carboxyhemoglobin:
- nonsmoker - greater than 10%
- For any person - greater than 15%
Oxygen saturation:
-Less than 93%
174
Pulse Co-oximeter Zoll
E-series: EMT Treatment
Abnormal carboxyhemoglobin
- Abnormal carboxyhemoglobin:
- 10 to 15% - Administer 100% O2
- Greater than 15%
- Administer 100% O2
- Transport to hyperbaric facility
- If SpCo is related to an exposure to carbon monoxide or cyanide.
