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Standard Operating Guidelines > SOG 430 > Flashcards

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.

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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.

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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
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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
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5
Q

Cooperation with law enforcement.

Who has the final authority and accountability when the pt is under their arrest.

A

Law enforcement

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6
Q

When not to remove taser probes.

are implanted in sensitive areas.

A 
Face
Throat
Eye
Groin
Breast
Hands
Feet
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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
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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
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9
Q

Dealing with restrained Pt shall be placed in what position?

A
  • Supine
  • Fowler’s
  • Semi Fowler’s
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10
Q

When restraints are in use.

Circulation to the extremities shall be elevated at least every?

A

10 min

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11
Q

Excited delirium Pt that were combative Pt who became suddenly ______ should raise a red flag.

A

quiet

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12
Q

Excited delirium can mimic several medical conditions including:

A
  • Hypoxia
  • Hypoglycemia
  • Stroke
  • Intracranial bleeding
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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
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14
Q

Every ______ months completed refusals will be forwarded to the QIC at HQ.

A

6 months

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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
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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
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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.
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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.
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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
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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
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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
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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”
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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

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24
Q

Rescue with transfer Pt to hospital stretcher in ______, or notify ______.

A

30 min

FRCC

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25
Q

Trauma scorecard methodology. Any one of the following conditions considered a trauma alert Pt.

A
  • 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
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26
Q

Trauma scorecard methodology. Any two considered a trauma alert.

A
  • 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
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27
Q

Pediatric trauma, characteristics of a person 15 years of age or less. Trauma alert Pt criteria are identified any one are:

A

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

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28
Q

Pediatric trauma, characteristics of a person 15 years of age or less. Trauma alert Pt criteria are identified any two are:

A
  • 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)
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29
Q

EMT assessment/treatment

medical Pt assessment:

A
  • 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
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30
Q

EMT assessment/treatment

Trauma Pt assessment:

A
  • 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
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31
Q

Adult GCS

A 
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
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32
Q

The goal of Pt care in trauma arrest Pt is:

A

“Load and go”

Limit scene time to 10 min unless extrication is required.

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33
Q

Trauma arrest Pt assessment history:

A
  • 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
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34
Q

Trauma arrest

Pt signs and symptoms

A
  • Skin:
  • Cyanosis
  • Pallor
  • Mottling
  • Number of Wounds
  • Cool Clammy
  • Subcutaneous emphysema
  • Respiratory
  • Abnormal breath sounds
  • Apnea
  • Tracheal shift
  • Abnormal Chest Wall Movements
  • Paradoxical
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35
Q

Trauma Arrest
EMT Treatment

Multi-System Trauma EMT Treatment

A
  • 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
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36
Q

Shock/Trauma

EMT Treatment:

A
  • 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
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37
Q

Head Trauma

History Assessment:

A
  • 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
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38
Q

Head Trauma

Signs and Symptoms:

A
  • 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
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39
Q

Head Trauma

EMT Treatment:

A
  • EMT assessment treatment protocol
  • Airway protocol
  • 100% O2
  • Spinal immobilization protocol
  • Control bleeds
  • Treat co-existing injuries
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40
Q

Chest Trauma

EMT Treatment

A

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

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41
Q

Abdominal Trauma

EMT Treatment:

A

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

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42
Q

Traumatic Injury of Pregnant PT

EMT Treatment:

A

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
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43
Q

Extremity Injuries

EMT Treatment:

A

-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

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44
Q

Extremity Injuries
EMT Treatment:
Consider Specific Treatment;

A
  • 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
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45
Q

Crush Syndrome Assessment

Pathophysiology:

A
  • 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
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46
Q

Crush Syndrome Assessment

Morbidity and Mortality:

A
  • 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)
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47
Q

Crush Syndrome
Clinical Manifestations
Prior to Release from Entrapment:

A
  • 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
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48
Q

Crush Syndrome
Clinical Manifestations
After Release from Entrapment

A
  • 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
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49
Q

Acute Compartment Syndrome
Signs and Symptoms
Five P’s Associated:

A
  • Pain
  • Parasthesis: pins and needles
  • Pressure
  • Passive stretching
  • Pulselessness
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50
Q

Acute Compartment Syndrome

EMT Treatment:

A
  • 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
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51
Q

Burns
Severity Classifications
Major Burn:

A
  • 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
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52
Q

Burns
Severity Classifications
Moderate Burn:

A
  • Partial thickness 15-25% BSA in adults, 10-20% BSA in children
  • Full thickness 2-5% BSA
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53
Q

Burns
Severity Classifications
Minor Burns:

A
  • Partial thickness less than 15% BSA in adults; less than 10% BSA in children
  • Full thickness less than 2% BSA
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54
Q

Burns

Trauma Alert Criteria:

A
  • 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
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55
Q

Burns

EMT Treatment:

A
  • 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)
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56
Q

Burns
EMT Treatment
Specific Treatment
Superficial Burns:

A
  • 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
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57
Q

Burns
EMT Treatment
Specific Treatment
Partial-Thickness Burns:

A
  • 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
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58
Q

Burns
EMT Treatment
Specific Treatment
Full Thickness Burns:

A
  • Wrap burned area in dry sterile dressing, clothes or sheets
  • Remember do not allow pt to become hypothermic; shivering further complicates shock
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59
Q

Burns
EMT Treatment
Specific Treatment
Electrical Burns

A
  • Remove pt from electrical source if no danger to rescuer
  • Assess and dress entrance and exit wounds
  • Follow electrical injury protocol
  • Spinal immobilization
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60
Q

Burns
EMT Treatment
Specific Treatment
Chemical Burns

A
  • 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
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61
Q

Electrical Injuries

EMT Treatment

A

-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

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62
Q

Eye Emergencies
EMT Treatment
Assess Nature of Opthalmologic Emergency
Direct Trauma

A
  • 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
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63
Q 
Eye Emergencies
EMT Treatment
Assess Nature of Opthalmologic Emergency
Chemical Trauma
Atraumatic
A

-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

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64
Q

Chest Pain/Discomfort
Assessment
History:

A
  • 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
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65
Q

Chest Pain/Discomfort
Assessment
Signs and Symptoms

A

-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
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66
Q

Chest Pain Discomfort

EMT Treatment

A
  • 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
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67
Q

Acute Stroke

EMT Treatment

A
  • 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
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68
Q

CHF/Pulmonary Edema

EMT Treatment

A

-EMT Ass Treatment Protocol
-Airway Protocol
-O2 100%
Place the pt in full Fowler’s position

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69
Q

Hypertensive Urgency

Is What?

A

Systolic BP greater than 220 mm Hg

Diastolic BP greater than 120 mm Hg

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70
Q

Hypertensive Urgency

EMT Treatment

A
  • EMT Ass Treatment Protocol
  • Airway Protocol
  • O2 as indicated
  • Place pt in semi-Fowler’s position
71
Q

Cardiac Arrest

EMT Treatment

A
  • 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
Q

Respiratory Insufficiency

EMT Treatment

A
  • 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
Q

Respiratory Arrest

Assessment History

A

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
Q

Respiratory Arrest
Assessment
Common Causes

A
  • 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
Q 
Respiratory Arrest
EMT Treatment
Foreign Body Airway Obstruction
(FBAO)
Conscious:
A
  • 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
Q

Respiratory Arrest
EMT Treatment
Foreign Body Airway Obstruction
(FBAO)

A
  • Reposition airway
  • Before ventilating and after opening the airway, look for obstruction and remove if visible
  • Begin CPR
  • Suction as indicated
  • 100% O2
77
Q

What must not be used to determine if a pt should receive oxygen therapy?

A

Oxygen saturation levels

78
Q

Airway Protocol History

A
  • 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
Q

Airway Protocol

Calf pain is called

A

-Homan’s Sign

80
Q 
Airway Protocol
EMT Treatment
Oxygen Delivery Devices
Nasal Annula"
Non-Rebreather
A

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
Q 
Airway Protocol
EMT Treatment
Oxygen Delivery Devices
Nebulizer:
Bag Valve Mask Ventilation:
A

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
Q

Airway Protocol
EMT Treatment
Airway Ajuncts
Oral Pharyngeal Airway

A

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
Q

Airway Protocol
EMT Treatment
Airway Adjunts
Nasal Pharyngeal Airway

A

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
Q

Airway Protocol
EMT Treatment
Airway Adjunts
Combi-Tube

A
  • 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
Q

Hyperventilation Syndrome

EMT Treatment

A
  • EMT Ass. Treatment Protocol
  • Airway Protocol
  • O2 100%
  • Do not administer any CO2 rebreathing techniques
86
Q

Abdominal/Flank Pain
Assessment
History

A
  • 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
Q

Abdominal/Flank Pain
Assessment
Signs and Symptoms:

A
  • 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
Q

Allergic Reaction/Anaphylaxis
Signs and Symptoms
Mild:

A
  • Itching
  • Rash
  • Redness
  • Localized swelling
  • Urticaria (hives)
  • Anxiety
89
Q

Allergic Reaction/Anaphylaxis
Signs and Symptoms
Moderate:

A
  • Wheezing
  • Cough
  • Abdominal Pain
  • Nausea/vomiting
  • Weakness
  • Tachycardia
  • Lethargy
  • Combativeness
90
Q

Allergic Reaction/Anaphylaxis
Signs and Symptoms
Severe:

A
  • 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
Q

Coma/Altered Consciousness
Assessment
History:

A
  • 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
Q

Coma/Altered Consciousness
Assessment
Common Causes:

A
  • Head trauma
  • Drug Overdose
  • Seizures
  • Stroke
  • Diabetes
  • Other metabolic disorders
  • Sepsis
  • Psychiatric illness
93
Q

Coma/Altered Consciousness
Assessment
Signs and Symptoms
Neck: Stiffness is?

A

Nuchal rigidity

94
Q

Epistaxis Can lead to?

A

Hemorrhagic shock

95
Q

Epistaxis

EMT Treatment

A
  • 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
Q

Headache

EMT Treatment

A
  • 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
Q

The most important goal in the pre-hospital management of shock is?

A

The diagnosis and immediate treatment of the underlying cause.

98
Q

Shock/Medical

EMT Treatment

A
  • 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
Q

Drowning Near-Drowning Submersion Assessment

History

A
  • Length of submersion
  • Fresh or saltwater
  • Warm or cold water
  • Water depth
  • Water contamination
  • Trauma
  • Past medical history
100
Q

Decompression Sickness/Dysbarism
Assessment
Etiology:

A
  • Dysbarism
  • Barotrauma
  • Decompression sickness
    ‘
101
Q

Decompression Sickness/Dysbarism
Assessment
History:

A

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
Q

Hyperthermia Assessment
Signs and Symptoms
Heat Cramps:

A
  • A&OX4
  • Normal vital signs
  • Thirst
  • Muscle cramps
  • Sweating
103
Q

Hyperthermia Assessment
Signs and Symptoms
Heat Exhaustion:

A
  • 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
Q

Hyperthermia Assessment
Signs and Symptoms
Heat Stroke:

A
  • 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
Q

Hyperthermia Assessment
Signs and Symptoms
Fever Related to Medical Conditions:

A
  • 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
Q

Hyperthermia
EMT Treatment
Specific Treatment
Heat Cramps”

A
  • Oral fluids as tolerated

- Sponge w/cool water

107
Q

Hyperthermia
EMT Treatment
Specific Treatment
Heat Exhaustion:

A
  • PT transported in position of comfort
  • Remove clothing as appropriate
  • Sponge w/cool water and fan
108
Q

Hyperthermia
EMT Treatment
Specific Treatment
Heat Stroke

A
  • Semi-fowlers w/head elevated to 30 degrees
  • Rapid cooling (neck, axillary region, groin)
  • Sponge w/cool water and fan
109
Q

Hypothermia:
Shivering occurs between:
Rectal temperature below:

A
  • 89.6 - 98.6 degrees

- 95 degrees is a significant finding

110
Q

Hypothermia
EMT Treatment
Specific Treatment
Generalized Hypothermia

A
  • Maintain supine position
  • Handle pt gently/roughness may result in ventricular arrythmias
  • Rewarming is priority
  • Remove wet, cold clothing
  • Wraps
111
Q

Hypothermia
EMT Treatment
Specific Treatment
Localized Hypothermia

A

(Frostbite)

  • Handle gently, leave uncovered
  • Do not allow to thaw if chance exists for refreezing
  • Maintain core temperature
112
Q

Bites and Stings
EMT Treatment
Specific Treatment
Marine Stings:

A
  • 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
Q

Bites and Stings
EMT Treatment
Specific Treatment
Snake Bites

A
  • if constricting bands in place upon arrival, remove
  • Mark initial edematous area with pen and note time
  • ID snake
114
Q

Toxic Ingestion/Exposure

EMT Treatment

A
  • 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
Q

Carbon Monoxide
Signs and Symptoms
Skin:
What is cherry red skin:

116
Q

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:

A

24 - 72 hours after inhalation

117
Q

Carbon monoxide confined space burns to face may cause airway edema that does not become severe until after the:

A

First hour

118
Q

Cyanide
Signs and Symptoms
Mild Toxicity

A
  • Anxiety
  • Confusion
  • Unsteady gait
  • Tachypnea
119
Q

Cyanide
Signs and Symptoms
Moderate Toxicity

A
  • Cardiac arrhythmia
  • Dyspnea
  • Depressed LOC
120
Q

Cyanide
Signs and Symptoms
Severe Toxicity

A
  • Loss of muscular coordination
  • Convulsions
  • Reflex bradycardia
  • Respiratory depression and coma
121
Q

Cyanide
EMT Treatment
Decontamination:

A
  • Remove pt’s clothing and jewelry
  • Remove liquid product by blotting
  • Wash pt w/mild soap and copious amounts of water
122
Q

Gravida means what?

A

Number of pregnancies.

123
Q

Para means what?

A

Number of live births.

124
Q

Vaginal Bleeding
EMT Treatment
Specific Treatment
1st, 2nd 3rd Trimester

A

1st or 2nd Trimester
- pt assume position of comfort
3 Trimester
- Place pt in recovery position (left side)

125
Q

Pre-Eclampsia occurs in about ______ of the pregnant population and develops after _________ weeks of pregnancy.

126
Q

Diminished or infrequent urination is called:

127
Q

Hypertensive state of pregnancy.

Mild pre-eclampsia is:

A
  • 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
Q

Hypertensive State of Pregnancy

Severe Pre-Eclampsia is:

A
  • 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
Q

Hypertensive State of Pregnancy

Eclampsia is:

A
  • 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
Q

Imminent Delivery
Signs and Symptoms
First Stage of Labor:

A
  • Onset of contractions and dilation of the cervix
  • Frequency and duration of uterine contractions
  • Hemorrhage - estimated blood loss
131
Q

Imminent Delivery
Signs and Symptoms
Second Stage of Labor:

A
  • 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
Q

Imminent Delivery
Signs and Symptoms
Third Stage of Labor:

A
  • Expulsion of the placenta
  • Evaluate and manage infant
  • Hemorrhage? Estimated blood loss?
  • Placenta must be brought to the hospital for evaluation
133
Q

Imminent Delivery
EMT Treatment
Delivery and DO:

A
  • 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
Q

Complications of Delivery
EMT Treatment
Nuchal Cord

A
  • 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
Q

Complications of Delivery
EMT Treatment
Breech Delivery

A
  • 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
Q

Complications of Delivery
EMT Treatment
Limb or Brow Presentation

A
  • Place the mother in the knee-chest position
137
Q

Complications of Delivery
EMT Treatment
Prolapsed Cord

A
  • 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
Q

Complications of Delivery:
EMT Treatment
Multiple Births or
Premature Birth:

A
  • Maintain the neonate’s warmth
  • O2 as indicated
  • Change gloves prior to the next delivery
  • Closely monitor the cut umbilical cord for bleeding
139
Q

Newborn Stabilization
Resuscitation
What is APGAR Score?

A 
Appearance
Pulse
Grimace/Irritability
Activity/Muscle Tone
Respirations
140
Q

APGAR Score:

A

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
Q

The average term infant weighs approximately

142
Q

Assess utilizing APGAR scoring criteria and record every ______ post delivery.

A

1 minute and 5 minutes

143
Q

Position the infant in the _________ position with the neck _________ position, roll _____ inch blanket under shoulders

A
  • Supine position
  • neutral position
  • 1” blanket
144
Q

Newborn stabilization, resuscitation, suction ________ first, then the ________ with a bulb syringe or mechanical suction with a negative pressure.

A
  • Oral cavity
  • Then the nostrils
  • Negative pressure less than 100 cm H2O
145
Q

Newborn stabilization/Resuscitation

Specific Treatment for Acrocyanosis is:

A

Administer flow by O2: Maintain saturation between 95 and 100%

146
Q

Newborn Stabilization/Resuscitation

Specific Treatment for Persistent Central Cyanosis, APGAR HR less than 100, do what?

A

-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
Q

Newborn stabilization/Resuscitation

Specific Treatment for HR less than 60, do what?

A
  • Administer chest compressions at rate of 120 per minute
148
Q

Newborn Stabilization/Resuscitation

Re-assess every ____________:

A

30 seconds

149
Q

Newborn Stabilization/Resuscitation

Determine BGL by ___________:

A

Heel stick

150
Q

General Definitions for Pediatrics:

Neonate
Infant
Child
Adolescent
Adult
A

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
Q

Pediatric Glascow coma score for child:

A 
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
Q

Pediatric Respiratory Distress
Infant Conscious but Severe Obstruction
Do What?

A
  • 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
Q

Pediatric Respiratory Distress, if suction is indicated, limit to __________.

A

10 seconds

154
Q

Pediatric Respiratory Distress
If ventilation with BVM is indicated, ventilate premature neonate and neonate at _____________ and infants and children to _____________.

A
  • 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
Q

Pediatric Allergic Reactions/Anaphylaxis:

SS mild are:

A
  • Itching
  • Rash
  • Redness
  • Localized swelling
  • Urticaria (hives)
  • Anxiety
156
Q

Pediatric Allergic Reactions/Anaphylaxis:

SS moderate are:

A
  • Wheezing
  • Cough
  • Abdominal pain
  • Nausea/vomiting
  • Weakness
  • Tachycardia
  • Lethargy
  • Combativeness
157
Q

Pediatric Allergic Reactions/Anaphylaxis:

SS severe are:

A
  • 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
Q

Pediatric fever, apply cooling measure if oral or rectal temperature is greater than _______. Do not use _________ as cooling measures.

A

Greater than 105 degrees
Greater than 104 degrees tympanic

Do not use ice or cold water as cooling measures.

159
Q

Auto pulse contraindications:

A
  • Trauma pt
  • Pt less than 18 years of age
  • Unknown or suspected aortic rupture
160
Q

Pediatric Stretcher Restraint Device

Placed on caregiver for pediatric pt with ___________ and head of stretcher should be at ____________.

A

Croup or stridor

45 degree angle

161
Q

SAM Pelvic Splint Indications are ______, and cautions are ______.

A

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
Q

Spinal Immobilization of a pregnant pt, after secure the pt do what next?

A

-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
Q

Violent/combative pt management, agitation is defined as?

A

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
Q

Violent/combative pt management, two of the most common causes of pt agitation are?

A
  • Pain

- Shortness of breath

165
Q

Violent/combative pt management
Sign and symptoms
Mild:

A
  • Hyper-alert
  • Irritable, easily annoyed
  • Mildly upset
  • Short tempered
  • Insomnia
166
Q

Violent/combative pt management
Sign and symptoms
moderate:

A
  • 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
Q

Violent/combative pt management
Sign and symptoms
Severe:

A
  • 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
Q

12 Lead ECG ZOLL E Series

Indications:

A
  • Chest pain
  • Syncone
  • Acute Dyspnea
  • Palpitations
  • Epigastric Pain
  • Unexplained diaphoresis
  • Unexplained hypotention
169
Q

Place the electrodes on the chest, where?

A

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
Q

Pulse co-oximeter Zoll E-series
Indications are:
SpO2 is:
SpCo is:

A

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
Q

Pulse Co-Oximeter Zoll E-series

Monitor Display: SPO2 and SPCO in:

A

Spo2 - Blue color - will display for 20 seconds

SPCO - Red color - will display for 10 seconds

172
Q

Pulse Co-oximeter Zoll E-series,

SPCO Normal values are:

A

Carboxyhemoglobin

  • nonsmoker 0 to 10%
  • smoker 5 to 15%

Oxygen saturation:
93 to 100%

173
Q

Pulse Co-oximeter Zoll E-series,

SpCO abnormal values are:

A

Carboxyhemoglobin:

  • nonsmoker - greater than 10%
  • For any person - greater than 15%

Oxygen saturation:
-Less than 93%

174
Q

Pulse Co-oximeter Zoll
E-series: EMT Treatment
Abnormal carboxyhemoglobin

A
  • 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.

Standard Operating Guidelines (34 decks)

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