Test Flashcards
baseline vitals and mental status 29 YOF fainted one time.
BLS?
YES may be transferred to BLS
TFR change out expired medications at the end of month with month/year expirations
True or False
TRUE
All refusals of “Inter facility” transport, must be discussed with?
on line medical control or medical director
At least _ people before trying to physically restrain someone
5
Carbon monoxide should normally be under _%
3%
Duoneb-contraindications?
Albuterol-Ipratropium is contraindicated in patients with a history of hypersensitivity to any of its components, or to atropine and its derivatives
treatment for Acute bronchospasm wheezing or history of asthma
Albuterol/Ipratropium 2.5mg/0.5mg via nebulizer o Repeat x 2 if wheezing persists • Methylprednisolone 125mg IV if wheezing persists after first nebulizer treatment • If not improving, Magnesium Sulfate 2G IV in 100mL NS over 10-15 minutes o Contraindicated if history of renal failure o Do not use if CHF suspected • If severe respiratory distress and wheezing persists after above: o Epinephrine 1:1,000 0.3mg IM (prior permission from online medical physician if patient >55 years old or known to be on beta blockers) • After treatment of bronchospasm, and return to an asymptomatic state, some patients will refuse transport to the hospital. The following items should be accounted for and included in the assessment and documentation: o The presentation is consistent with a mild exacerbation of asthma o No severe dyspnea at onset o Not initially hypoxic (oxygen saturation < 90%) o No pain, fever, or hemoptysis o Significant improvement after a single nebulizer treatment, with a complete resolution of symptoms o Vital signs within normal limits after treatment given (BP, pulse, respiratory rate, end tidal carbon dioxide, and oxygen saturation)
Acute pulmonary edema (history of CHF, pedal edema, elevated SBP)
- Nitroglycerine 0.4mg SL every 5 minutes o Contraindicated if SBP < 90 o Contraindicated if use of a phosphodiesterase-5 (PDE5) inhibitor use within last 24hrs (Viagra or Levitra); 48hrs for Cialis • For bronchospasm associated with acute pulmonary edema o Albuterol/Ipratropium 2.5mg/0.5mg via nebulizer Repeat x 2 if wheezing persists
- For hypotension (SBP < 90) o Dopamine infusion at 5-20mcg/kg/min titrated to maintain SBP > 90
Drowning/near drowning
• Refer to Spinal Immobilization Protocol if indicated • Consider CPAP for patients with significant dyspnea or hypoxia • Protect from heat loss • Patients may develop delayed onset respiratory symptoms • Refer to Cardiac Arrest Protocol if appropriate
Foreign body obstruction suspected
• Perform obstructed airways procedures per BLS standards o Attempt suction and removal with Magill forceps using direct visualization o Observe for signs of impending respiratory failure o For conscious, non-pregnant adult, administer Heimlich maneuver and assess for response. o For pregnant adult, administer chest thrusts and assess for response. o If unconscious or unresponsive: Give a series of 30 chest compressions, then inspect for object in mouth prior to attempting breaths If unsuccessful after one series of compressions and ventilations, attempt to directly view object with laryngoscope and remove with Magill forceps
Respiratory Failure
• If suspicion of trauma, refer to Spinal Immobilization Protocol as appropriate • Suction all debris, secretions from airway • Supplemental 100% oxygen, then BVM ventilate if indicated • Monitor EtCO2 (capnography) and pulse oximetry continuously • The decision of how to manage the airway should be made by the officer in charge. • Bag valve mask is an acceptable method of airway management if patient oxygen saturations can be maintained and there is no difficulty maintaining seal or issues with chest wall compliance. o Use nasal or oral airway if needed o Perform jaw thrust/chin lift if needed while maintaining cervical spine protection if concern for trauma. • If BVM is not deemed appropriate for continued management of the patient airway, proceed with placement of endotracheal tube or supraglottic airway. • It is acceptable to place a supraglottic airway without prior attempt at endotracheal intubation, especially if a difficult airway is anticipated, or the patient has other immediate needs beyond airway maintenance (e.g., in order to prioritize high quality CPR in a cardiac arrest patient) • If patient requires medication for placement of advanced airway: o Administer sedative medication (one of the following): Ketamine 2mg/kg IV
Etomidate 0.3mg/kg IV o Administer paralytic after sedation if needed to facilitate airway placement: Succinylcholine 1.5mg/kg IV is preferred unless contra-indication exists • Succinylcholine contraindications: o Risk for hyperkalemia (e.g. renal failure patients, crush injury) o Denervation injury (paralysis, burns, muscular dystrophy) o Penetrating eye injury or glaucoma o History of malignant hyperthermia If succinylcholine is contraindicated, administer Rocuronium 1mg/kg • Consider apneic oxygenation by administering high flow nasal cannula, starting prior to drug administration and continuing through intubation attempts if possible. o This can lengthen time to desaturation and allow more time for intubation attempt. • If endotracheal tube placement is attempted, provider attempts should be limited to two attempts for a medical respiratory failure, and one attempt for a trauma respiratory failure. • If endotracheal tube placement is unsuccessful, proceed with placement of a supraglottic airway if possible. • Refer to Failed Airway Protocol if these attempts are unsuccessful. • After airway tube is placed, it is mandatory to confirm proper placement with capnography. o Maintain ventilation at rate such that EtCO2 is 35-45mmgHg if possible o Maintain capnography to ensure that tube has not become dislodged o Failure to obtain initial typical waveform capnography or loss of typical waveform en route should result in immediate removal of the endotracheal tube and maintenance of airway via BVM or supraglottic o Waveform capnography strip should be printed and attached to patient care record as documentation of airway confirmation. Failure to do so can result in disciplinary action. • If drugs were administered for advanced airway placement, or if sedation is required to prevent patient from dislodging airway tube: o Administer Midazolam 2-4mg or Fentanyl 100-250mcg to achieve adequate sedation o Particularly remember the importance of adequate sedation when patient has received a long-acting paralytic such as rocuronium.
Failed Airway
• A failed airway is defined as two failed intubation attempts, or anatomy inconsistent with intubation attempts. o In the event of one failed intubation attempt in a medical patient, the most experienced provider on scene should proceed with second intubation attempt. o No more than two intubation attempts total.
o There should not be more than one intubation attempt in a trauma patient. In this case, the provider should place a supraglottic airway after the first failed intubation attempt. • Continue with BVM if able to maintain seal and oxygen saturations • Place supraglottic airway if possible • Proceed with cricothyroidotomy per Cricothyroidotomy Protocol if above efforts are unsuccessful. • Cricothyroidotomy placement should be confirmed with waveform capnography o As for other advanced airways, capnography waveform strip should be attached to the patient care record.
Smoke Inhalation
Universal Patient Care Protocol • Spinal Care Protocol if appropriate • Measure SpCO and obtain 12-lead EKG for suspected carbon monoxide, cyanide, or combined exposure. • Supplemental oxygen is the mainstay of treatment for carbon monoxide exposure, while cyanokit antidote therapy is required for cyanide exposure. • Mild exposure may be recognized by the presence of soot in the nose, mouth or oropharynx. Moderate exposure may be recognized by the presence of soot in the nose/mouth/oropharynx, along with the presence of altered mental status and/or hypotension. Severe exposure is characterized by the previously mentioned findings, and may progress to respiratory or cardiac arrest. • Cases of mild exposure should be treated with pulse oximetry monitoring and frequent reassessment. • Cases of moderate and severe exposure should have an IV established. Check pulse oximetry using co-oximeter (Rad57). o Treat hypotension with NS 500cc bolus o Administer Cyanokit 5G IV • Treat other presenting symptoms with appropriate protocol and transport to appropriate facility. • Personnel should report to rehab for evaluation after 45 minutes (2 thirty minute or 1 sixty minute cylinder), or earlier if requested by the firefighter or the Incident Commander.
Succinylcholine contraindications
Known hypersensitivity to the drug. • Penetrating eye injuries, history of glaucoma and malignant hyperthermia (consider using Rocuronium.)
Allergic Reaction
If patient has a previously prescribed epinephrine auto-injector, and shows signs of anaphylaxis, it is appropriate to assist the patient in self-administration of the auto-injector. • For mild reaction (itching, hives), administer Diphenhydramine 1mg/kg IV (maximum 50mg). o May be administered IM if no IV access available. • For moderate reaction (dyspnea, wheezing, chest tightness): o Albuterol/Ipratropium 2.5mg/0.5mg via nebulizer Repeat x 2 if wheezing persists o Diphenhydramine 1mg/kg IV (maximum 50mg IV) May be administered IM if no IV access available o Methylprednisolone 125mg IV • For severe reaction (BP < 90, stridor, severe respiratory distress): o Epinephrine 1:1,000 0.3mg IM for rapidly progressive worsening of symptoms Repeat epinephrine if signs of severe reaction or shock persist after initial dose o Albuterol/Ipratropium 2.5mg/0.5mg via nebulizer Repeat x 2 if wheezing persists o Diphenhydramine 1mg/kg IV (maximum 50mg IV) May be administered IM if no IV access available o Methylprednisolone 125mg IV • For cardiac arrest (or if cardiopulmonary arrest appears imminent): o Epinephrine 1:10,000 1mg IV (instead of 1:1,000 IM) o For cardiac arrest, refer to appropriate protocol based on the presenting rhythm o In the setting of cardiac arrest, the following items should be performed in the postresuscitative phase, if time allows: Albuterol/Ipratropium 2.5mg/0.5mg via nebulizer • Repeat x 2 if wheezing persists Diphenhydramine 1mg/kg IV (maximum 50mg IV) • May be administered IM if no IV access available Methylprednisolone 125mg IV
Epinephrine for cardiac arrest
1:10,000 1mg IV
If blood glucose elevated (>200) with signs of dehydration or DKA
administer 500cc bolus
Naloxone for altered mental status
0.5mg IV/IM/IO/IN, repeat in 0.5 increments every 3 minutes to max dose of 8mg
Behavioral/agitated delirium
midazolam 5-10mg IV, preferred for patient with suspected history of recent substance abuse, generally has a faster onset than haloperidol
Altered Mental Status
Universal Patient Care Protocol • If hypoglycemic (BGL < 60): o Dextrose 50% 25G slow IV o If patient is alert enough to self-administer oral agent, give glucose paste or oral glucose containing agent (e.g. orange juice) o If hypoglycemia persists, repeat blood glucose check with a different glucometer, and repeat treatment as above if BGL < 60 after 10 minutes • If blood glucose elevated (>200) with signs of dehydration or DKA: o Administer NS 500cc bolus • If opioid overdose suspected (significantly altered mental status or respiratory depression): o Naloxone 0.5mg IV/IM/IO/IN Repeat as needed in 0.5mg increments, titrated to mental status and respiratory drive (monitor respiratory status with continuous capnography) o If respiratory depression persists, repeat every 3 minutes to a maximum of 8mg. • If stroke suspected, see CVA Protocol. • If sepsis suspected (advanced age, high risk for infection, febrile), see Sepsis Protocol. • If head injury suspected, see Trauma/Head Injury Protocol. • If cardiac arrhythmia present, see appropriate cardiac arrhythmia protocol. • Consider restraints if necessary for patient/personnel protection, per the Patient Restraint Protocol.
Bradycardia with a pulse
administer atropine 0.5mg IV and repeat every 3-5 min up to 3mg. If atropine unsuccessful, transcutaneous pacing, or epinephrine 2-10 mcg/min IV. 500mL bolus NS if hypovolemia.
Initial shock for Vfib or pulseless V tac
200J
