Adult

Question 0

12 Lead - CP w/LBBB looks like

Answer 0

CP w/ LBBB (t wave opposite qrs, wide qrs >=120), rabbit ear in v6

Question 1

Seizure

Answer 1

PHC - cspine, ABC’s - 02, 12 lead, hx,
BG <60 (Not Alert/unstable) no spinal injury = pt on side, IV Dextrose 50%, 25 gms(50ml), no IV=glucagon 1mg IM
Chk BG in 10 min,
Resp dep - Narcan 2mg IV titrated, repeat in 2-3 min,
**Actively seizing - Midazolam(10mg IM) or (5mg slow IV/IO), repeat same dose or med control

*Pregnant (eclampsia) - 2gm mag sulfate in 100-250ml NS IV/IO, doesn’t stop=midazolam(10mg IM) or (5mg slow IV/IO) (lorazepam 4mg IV/IO, diazepam 10mg IV/IO/rectal)

Question 2

AMS

Answer 2

PHC - cspine, ABC’s - 02, 12 lead, hx,
Restraints PRN,
BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM
Check BG in 10 min
Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min

Question 3

ABD trauma

Answer 3

PHC - cspine, ABC’s - 02, 12 lead, hx,
spinal assess,
LOC,
Transport,
Pain mgmt, Eviscerations - sterile moist dressing then foil or plastic wrap then towel or blanket,
Knees bent,
Shock,
IV/IO - 1L wide open

Question 4

Adult trauma

Answer 4

PHC - cspine, ABC’s - 02, 12 lead, hx,
spinal assess,
LOC,
Transport,
Shock,
Tourniquet,
IV/IO - 1L wide open,
Pain mgmt

Question 5

Chest trauma

Answer 5

PHC - cspine, ABC’s - 02, 12 lead, hx,
spinal assess,
LOC
Transport
Control hemorrhage
Hi 02
Sucking wound - 3 sided occlusive (release if worsening sob or tension pneumo)
Tension Pneumo - needle decomp, control bleeding, spinal immob PRN
Shock
IV/IO - 1L wide open
Pain mgmt

Question 6

12 Lead - LBBB caused by AMI, CHF, CAD

Answer 6

New LBBB = STEMI, requires pacemaker, (v1 wide rs w/neg deflection, v6 wide rabbit ear), LBBB - deep negative in v1, Elevation >=5mm in old LBBB = STEMI

Question 7

ABD pain

Answer 7

PHC - cspine, ABC’s - 02, 12 lead, hx,
exam abd,
central/distal pulse,
shock,
trauma protocol,
nothing by mouth,
n/v protocol,
pain management

Question 8

12 Lead - Tombstone T wave

Answer 8

Widow maker

Question 9

12 Lead - Pericarditis

Answer 9

global ST elevation, hurts more leaning forward, hx of infection

Question 10

CVA/Stroke

Answer 10

PHC - cspine, ABC’s - 02, 12 lead, hx

AMS -
BG <60 (Not Alert or unstable) - no spinal injury = patient on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM
Recheck BG in 10 minutes
Resp depression - Naloxone 2mg IV titrated, repeat in 2-3 min

Seizure protocol

Stroke Scale

• facial droop
• arm drift
• abnormal speech

Last seen normal
Transport asap
Notify hospital
IV

Question 11

Burns - Electrical

Answer 11

PHC - cspine, ABC’s - 02, 12 lead, hx
Protect from live wires
Spinal immobilization PRN
Assess/Treat entrance/exit wounds
IV/IO - 1 liter wide open for hypotension or severe burns >15%, repeat PRN, max 2 liters
Pain Management
Intubate PRN

Question 12

Burns - Chemical

Answer 12

PHC - cspine, ABC’s - 02, 12 lead, hx
Protect from contamination
Remove constricting items/clothing
Brush off dry chemicals prior to irrigation
Assess/Treat trauma
dry dressings
IV/IO - 1 liter wide open for hypotension or severe burns >15%
Pain Management
Intubate PRN

Question 13

Burns - Thermal

Answer 13

PHC - cspine, ABC’s - 02, 12 lead, hx
Stop the burn
Assess/Treat trauma
Burn extent/severity (rule of nines)
Remove constricting items
>15% - dry dressings
<15% - wet dressings 
NS 1L wide open, repeat PRN for hypotension or severe burns, max 2 liters
Pain Management
Intubate PRN

Question 14

Allergic reaction/Anaphylaxis

Answer 14

PHC - cspine, ABC’s - 02, 12 lead, hx
Remove source
wheezing - pt’s epi pen
IV/IO - 1 liter wide open

Symptomatic - Benedryl 50 mg IM/IV/IO

Severe reaction (wheezing/hypotension) - epi 1:1000 0.3 mg (0.3ml) or auto injector

Profound reaction (near arrest) - epi 1:10,000 0.3mg (3ml) slow IV/IO

Prednisone (50 mg tablet) or methylprednisolone (125mg) IV

Additional epi -
* Severe (wheezing/hypotension) 1:1000 0.3mg (0.3ml) IM
* Profound (near arrest) 1:10,000 0.3mg (3ml) IV/IO

Question 15

Combitube requirements

Answer 15

> 5’ tall - 41F - Proximal 50-75cc initial, 100cc max, Distal 15cc
4’ tall - 37F - Proximal 50-75cc initial, 85cc max, Distal 12cc
37F preferred <6’ tall
Gastric distention, suction tube opposite ventilating tube to decompress stomach

Question 16

Helmet Removal

Answer 16

Hold c-spine while removing
Football/Hockey can leave in place if patent airway, remove face shield, if well fitting and prearranged w/med control
Leave in place unless airway cannot be controlled or face shield cannot be removed - if prearranged w/med control
If leaving in place use lateral towels, not c-collar to immobilize
Baseball, bicycle, rollerblade helmets - always remove
No prearrangement - remove

Question 17

12 Lead - RBBB caused by MI or lung disorder (PE, corpulmonale) looks like

Answer 17

v1 rabbit ears (1 short, 1 tall), v6 slurred (sloped s)
RBBB - tall positive in v1
Any elevation = STEMI

Question 18

12 Lead - BBB shows in leads

Answer 18

V1 & V6

Question 19

STEMI/NSTEMI

Answer 19

STEMI = ST elevation
NSTEMI = ST depression or t wave inversion

Question 20

Epi pen dose/weight/injection time

Answer 20

0.3mg epi-pen >32kg
0.15 epi jr 10-32kg
10 second injection time

Question 21

Epi pen cautions/location of injection

Answer 21

Caution w/heart disease, high BP, stroke

Anterolateral thigh

Question 22

Epi-Pen weight requirement

Answer 22

No if weight <10kg, call med control

Question 23

Backboarding check this

Answer 23

pms before and after

Question 24

02 dose

Answer 24

Nasal Cannula 2-6 LPM (none to moderate) NRB 8-12 LPM (moderate - severe, cyanide, carbon monoxide, smoke inhalation) Ped blow by - 15 LPM

Question 25

Nebulizer LPM?

Answer 25

6-7 LPM, ask them to breath deep every 5 breaths

Question 26

FBAO - Infant <1 year

Answer 26

No abd thrust due to unprotected liver 5 back blows/5 chest compressions Unconscious = forceps

Question 27

12 lead - Scooped st segment =

Answer 27

Digoxin OD

Question 28

Report acute MI when

Answer 28

ST elevation >= 1mm in 2 contiguous leads

Question 29

12 leads for the following

Answer 29

``` Chest pain or pressure Upper abdominal pain Syncope Shortness of breath (not including asthma or COPD) Pain/discomfort often associated with cardiac ischemia (jaw, neck, shoulder, left arm) Any doubt as to origin of pain Nausea Vomiting Diaphoresis Dizziness Patient expression of “feelings of doom” Any doubts ```

Question 30

Epi pen contraindications

Answer 30

No absolute contraindications in anaphylaxis Caution heart disease, hypertension, stroke Under 10 kg

Question 31

Nausea & Vomiting

Answer 31

PHC - cspine, ABC’s - 02, 12 lead, hx, NS IV/IO - 1L, wide open. Hypotensive max of 2L, Zofran 4mg IV/IM. Post-Med Control - Zofran 4mg IV/IM

Question 32

Drowning/Near Drowning/Submersion

Answer 32

``` PHC - cspine, ABC’s - 02, 12 lead, hx, Temp? **Pulse absent - submersion >1 hr = Dead on Scene, Normothermic - CPR, Hypothermic - Hypothermic CPR,  **Pulse present - Hypothermic/Frostbite Protocol/warm/dry, Consider CPAP/BiPAP, Med Control if no transport  ```

Question 33

Excited Delirium definition

Answer 33

extreme agitation, confusion and hallucinations, erratic behavior, profuse diaphoresis, elevated vital signs, hyperthermia, unexplained strength and endurance, and behaviors that include clothing shedding, shouting out, and extreme thrashing when restrained. It is often found in correlation with alcohol and illicit drug use, and in those patients with preexisting mental illness. The most immediate threat to patients experiencing this syndrome is sudden apnea and cardiac arrest, usually after thrashing against physical restraint.  Be vigilant if a combative patient suddenly becomes quiet. Excited delirium can mimic several medical conditions, including hypoxia, hypoglycemia, stroke, or intracranial bleeding. Blood glucose should be measured, when possible 

Question 34

Excited Delirium

Answer 34

Defined as an imminent physical threat to personnel and/or themselves Restraints Midazolam 10 mg IM or 5 mg IN Transport. Request Law Enforcement to accompany to hospital.  Monitor vitals, cardiac closely Treat other medical problems (hypoglycemia, vomiting, etc.) as indicated.

Question 35

EXERTIONAL HEAT STROKE

Answer 35

PHC - cspine, ABC’s - 02, 12 lead, hx,  Restraints PRN, BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM Check BG in 10 min Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min ``` Cool body (torso) ASAP via ice or cool-water immersion/dousing. A Cool then transport 2nd NS IV/IO - 1L wide open, repeat PRN Seizure protocol ECG (lead cables can go in the water)    ```

Question 36

HEAT STROKE:

Answer 36

PHC - cspine, ABC’s - 02, 12 lead, hx,  Restraints PRN, BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM Check BG in 10 min Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min   Cool pt, remove clothing, semi fowlers, head elevated NS IV/IO - 1L, wide open, repeat PRN

Question 37

Heat Cramps

Answer 37

PHC - cspine, ABC’s - 02, 12 lead, hx,  Restraints PRN, BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM Check BG in 10 min Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min Cool pt/oral liquids.

Question 38

HEAT EXHAUSTION

Answer 38

PHC - cspine, ABC’s - 02, 12 lead, hx,  Restraints PRN, BG <60 (Not Alert or unstable) - no spinal injury = pt on side, IV Dextrose 50%, 25 grams (50ml), no IV - glucagon 1mg IM Check BG in 10 min Resp dep - Naloxone 2mg IV titrated, repeat in 2-3 min   Cool pt, remove clothing, NS IV/IO - 1L, wide open. Oral fluid if no nausea (sports/rehydration drinks). If AMS, abd pain or nausea, nothing by mouth. 

Question 39

Hypothermia

Answer 39

PHC - cspine, ABC’s - 02, 12 lead, hx, Hypothermic CPR Warm, dry,  temp >86F (30C shivering/conscious) Heat packs to groin, axillae, neck Warmed 02, Alert=warm, oral fluid **<86F (30C) = transport asap, warm NS IV/IO 1L, wide open

Question 40

Frostbite

Answer 40

PHC - cspine, ABC’s - 02, 12 lead, hx,  Warm, dry, thaw if no chance of refreezing, elevate, dry sterile dressings prevent pressure, trauma, friction, Pain Mgmt 

Question 41

APGAR

Answer 41

``` A – appearance (color) P – pulse (heart rate) G – grimace (reflex irritability to slap on sole of foot) A – activity (muscle tone) R – respiration (respiratory effort) ``` Appearance – skin color, 0-Bluish/pale, 1-Pink/ruddy; hands/feet blue, 2-Pink/ruddy; entire body Pulse – HR, 0-Absent, 1-Below 100, 2-100 Grimace – reflex irritability to foot slap 0-No response 1-Crying; some motion 2-Crying; vigorous Activity – muscle tone, 0-Limp 1-Some flexion of extremities, 2-Active; good motion in extremities Respiratory effort 0-Absent 1-Slow/Irregular 2-Normal; crying

Question 42

Arm or limb presentation – Life threatening condition.

Answer 42

Transportation ASAP Delivery should not be attempted outside the hospital. Mom position of comfort or with hips elevated on pillow. Maintain airway, give 02

Question 43

Obstetrical Emergencies

Answer 43

PHC - cspine, ABC’s - 02, 12 lead, hx previous births, previous complications duration of gestation (weeks), whether single or multiples expected vital signs, assess contractions wait for delivery if Multiple pregnancy, strong regular contractions, every 2 minutes or less; ruptured membrane, bloody show, need to push or bear down, crowning IV  **Normal Delivery 02/Suction ready for newborn, Monitor for hypotension=position so weight of uterus is to pt’s left side, Drape, Slow deep breaths through her mouth, Prevent an explosive delivery, suction mouth/nose Cord around neck - slide over head, no tug, or clamp/cut Note time Place head lower than the body, suction mouth/nose making Warm/dry/stimulate (rub back, slap soles) 15L 02 for no breathing 15L 02 if breathing, until pink Cord clamped 8” - 2 clamps 2” apart/cut between Keep cord moist if resuscitating. APGAR @ 1 & 5 mins  APGAR <6 = resuscitate,  Deliver placenta enroute (w/in 20 min) massage uterus Bring placenta to hospital **Meconium in airway Intubate/suction (low pressure), repeat w/new tube

Question 44

Prolapsed Cord – Life Threatening Condition

Answer 44

``` Mom in supine position w/hips on pillow. Maintain airway, give 02,  sterile gloved hand, gently push baby up vagina several inches to release pressure on cord. DO NOT PUSH CORD BACK! Maintain pressure on head.  ```

Question 45

Abnormal Deliveries

Answer 45

Med control Breech position, Buttocks/trunk deliver spontaneously, legs clear, support body w/palm of your hand, allowing head to deliver If head doesn’t deliver immediately, transport rapidly to the hospital with mother’s buttocks elevated on pillows with baby’s airway maintained w/gloved hand in the vagina with your palm towards the baby’s face “V” with your fingers on either side of the baby’s nose and push the vaginal wall away from baby’s face until the head is delivered. 

Question 46

Multiple births

Answer 46

PHC - cspine, ABC’s - 02, 12 lead, hx previous births, previous complications duration of gestation (weeks), whether single or multiples expected vital signs, assess contractions wait for delivery if imminent Multiple pregnancy, strong regular contractions, every 2 minutes or less; ruptured membrane, bloody show, need to push or bear down, crowning IV  Immediate transportation small birth weight/maintain body heat. 1st baby clamp cord, airway, dry, warm  There may be time to transport between births.

Question 47

Pre-eclampsia/Eclampsia signs/treatment

Answer 47

``` BP 160/110 or higher, Marked peripheral edema, Diminished LOC, Seizure (eclampsia), Transport ASAP, Seizure - Mag Sulfate 2 gm in 100 or 250ml NS over 10 minutes IV/IO until stops If seizure does not stop Midazolam IM 10mg or Midazolam 5mg, Lorazepam 4mg, or Diazepam 10mg slow IV/IO push  Diazepam can be given rectal ``` Post Med Control G. If seizure persists, additional Mag Sulfate 2 gms IV/IO, if available. 

Question 48

Psych definitions

Answer 48

**Protective Custody - The temporary custody of an individual by a law enforcement officer with or without the individual's consent for the purpose of protecting that individual's health and safety, or the health and safety of the public and for the purpose of transporting the individual if the individual appears, in the judgment of the law enforcement officer, to be a person requiring treatment. Protective custody is civil in nature and is not to be construed as an arrest. (330.1100c (7), Sec. 100c, Michigan Mental Health Code) **Authority to Restrain - EMS personnel are able to restrain and treat and transport an individual under authority of Sec 20969 of Public Act 368 which states: "This part and the rules promulgated under this part do not authorize medical treatment for or transportation to a hospital of an individual who objects to the treatment or transportation. However, if emergency medical services personnel, exercising professional judgment, determine that the individual's condition makes the individual incapable of competently objecting to treatment or transportation, emergency medical services may provide treatment or transportation despite the individual's objections unless the objection is expressly based on the individual's religious beliefs."