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SNHD EMT Basic Protocols > Adult Protocols > Flashcards

Adult Protocols Flashcards

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1
Q

Where should patients be transported if they are outside a 50-mile radius of the protocol designated transport destination?

A

Nearest appropriate facility

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2
Q

Criteria for patients to be placed in the hospital waiting room

A
  1. Nl vital signs
  2. No parenteral medications during transport except for a single dose of analgesia and/or antiemetic
  3. Does not require continuous cardiac monitoring (medic judgment)
  4. Can maintain a sitting position w/o adverse impact on their medical condition
  5. Verbal report to hospital personnel
  6. Not on L2K hold
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3
Q

An exception to hospitals being bypassed if they declare internal disaster

A

Cardiac arrest or adequate ventilation has not been established

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4
Q

Normal vital signs criteria for waiting room

A

HR: 60-100
RR: 10-20
Systolic BP: 100-180
Diastolic BP: 60-110
O2: >94%
A&Ox4

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5
Q

Destinations for sexual assault victims

A

< 13 y/o transported to Sunrise
13 - 18 y/o transport to Sunrise or IMC
18 y/o and older transport to UMC

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6
Q

Life-threatening differentials for traumas

A

Tension pneumo
Flail chest
Pericardial tamponade
Open chest wound
Hemothorax
Intra-abdominal bleeding
Pelvis/femur fx
Spine fx/cord injury
Head injury
Extremity fx
HEENT (airway obstruction)
Hypothermia

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7
Q

Pertinent hx for adult trauma assessments

A

Time and MOI
Damage to the structure of the vehicle
Location in structure or vehilc
Others injured or dead
Speed and details of MVC
Restraints/protective equipment
PMH
Medications

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8
Q

Recommended exam for adult trauma

A

Mental status
Skin
HEENT
Heart
Lung
Abdomen
Extremities
Back
Neuro

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9
Q

How are trauma destinations determined?

A

Trauma Field Triage Criteria Protocol

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10
Q

When should procedures be performed for traumas?

A

Enroute when possible. Do not delay transport for procedures.

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11
Q

Why should you have a high-index of suspicion for geriatric trauma pts?

A

Occult injuries may be present and geriatric pts can compensate quickly

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12
Q

Pertinent medical hx for abd/flank pain and n/v?

A

Age
Medical/surgical hx
Onset
Quality
Severity
Fever
Menstrual hx

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13
Q

Pertinent sxs for abd/flank pain and n/v

A

Pain location
Tenderness
N/V/D
Constipation
Dysuria
Vaginal bleeding/discharge
Pregnancy

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14
Q

Possible differentials for abd/flank pain and n/v

A

Liver (hepatitis)
Gastritis
Gallbladder
MI
Pancreatitis
Kidney stones
AAA
Appendicitis
Bladder/prostate disorder
Pelvic (PID, ectopic pregnancy, ovarian cyst)
Spleen enlargement
Bowel obstruction
Gastroenteritis
Ovarian and testicular tension

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15
Q

Recommended examination for abd/flank and n/v

A

Mental status
Skin
HEENT
Heart
Lung
Abdomen
Back
Extremities
Neuro
Retroperitoneal palpitation for kidney pain

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16
Q

Neuro disorders or signs of hypoperfusion/shock with the presence of abdominal pain may indicate?

A

AAA

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17
Q

Pertinent hx for allergic reaction

A

Onset and location
Insect sting or bite
Food allergy/exposure
Medication allergy/exposure
New clothing, soap, detergent
Hx reactions
PMH
Medication hx

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18
Q

Sxs allergic reaction

A

Itching or hives
Coughing/wheezing or respiratory distress
Throat or chest constriction
Difficulty swallowing
Hypotension/shock
Edema
N/V

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19
Q

Mild allergic reaction

A

Involve skin rashes, itchy sensations, or hives w/o respiratory involvement

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20
Q

Moderate allergic reaction

A

Involve skin disorders and may include respiratory involvement, including wheezing. Tidal volume air exchanged remains good.

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21
Q

Severe allergic reaction

A

Involve skin, respiratory difficulty, and may include hypotension

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22
Q

Recommended exam for allergic reactions

A

Mental status
Skin
Heart
Lung

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23
Q

What is anaphylaxis?

A

Acute and potentially lethal multisystem allergic reaction

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24
Q

Why should you use epinephrine cautiously in the elderly?

A

Potential hx of CAD, tachycardia, and/or hypertension. Administration can exacerbate signs and symptoms.

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25
Pertinent hx for AMS
Known DM, medic alert tag Drugs or drug paraphernalia Report of drug use or toxic ingestion PMH Medications Hx trauma Change in condition Changes in feeding or sleep habits
26
Sxs AMS
Decreased mental status or letahry Changes in baseline mental status Bizarre behavior Hypo/hyperglycemia Irritability
27
Possible differentials for AMS
Head trauma CNS (stroke, tumor, seizure, infection) Cardiac (MI, CHF) Hypothermia Infection Thyroid Shock (septic, metabolic, traumatic) DM Toxicological or ingestion Acidosis/alkalosis Environmental exposure Hypoxia Electrolyte abnormality Psychiatric disorder
28
Recommended exam for AMS
Mental status HEENT Skin Heart Lung Abdomen Back Extremities Neuro
29
Potential medical causes for behavioral emergencies
Hypoxia Intoxication/OD Hypoglycemia/electrolytes Head injury Post-ictal state
30
What is excited delirium syndrome?
Combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent behavior, insensitivity to pain, hyperthermia, and increased strength. Potentially life-threatening
31
Excited delirium syndrome is most common in?
Male subjects w/ hx serious mental illness and/or acute or chronic drug abuse, specifically stimulants
32
What is S.A.F.E.R.?
Stabilize the situation by containing and lowering the stimuli Assess and acknowledge the crisis Facilitate the identification and activation of resources (Chaplin, family, friends, or police) Encourage to use resources and take action in best interest Recovery or referral - leave pt in care of responsible person/professional, or transport to appropriate facility
33
What is a dystonic reaction?
Involuntary muscle movements or spasms typically of the face, neck, and UE. Typically adverse reactions to drugs such as Haloperidol Medic to administer Diphenhydramine 50mg.
34
Pertinent hx for behavioral emergenies
Situational crisis Psychiatric illness/medications Injury to self or threats to others Medical alert stage Substance abuse/OD DM
35
sxs of behavioral emergencies
Anxiety, agitation, confusion Affect change, hallucination Delusional throughs, bizarre behavior Combative, violent Expression of SI/HI
36
Differential for behavioral emergencies
AMS differential Alcohol intoxication Toxin/substance abuse Medication effect or OD Withdrawal sxs Depression Bipolar Schizophrenia Anxiety disorder
37
Recommended exam for behavioral emergencies
Mental status Skin Heart Lung Neuro *Do not irritate pt w/ prolonged exam*
38
sxs of bradicardia
HR <60 bpm w/ hypotension, acute AMS, chest pain, acute CHF, seizures, syncope, or shock Respiratory distress
39
Differential for bradycardia
Acute MI Hypoxia Pacemaker failure Hypothermia Sinus bradycardia Athletic Head injury (elevated ICP) or stroke Spinal cord lesion AV block OD
40
Recommended exam for bradycardia
Mental status HEENT Heart Lung Neuro
41
Procedure for thermal burn exposure
Stop burning process w/ water or saline Remove smoldering clothing and jewelry. Do not remove stuck clothing. Ventilation management Cover burned area w/ dry sterile dressing. No ointment of any kind.
42
Procedure for chemical/electrical burn
Eye involvement? Flush w/ water or NS 10-15 min. Remove jewelry, constricting items, and expose burned areas. Identify entry and exit sites, and apply a sterile dressing.
43
Pertinent hx for burns
Type of exposure (heat, gas, chemical) Inhalation injury Time of injury PMH and medications Other trauma LOC Tetanus/immunization status
44
sxs burns
Burns, pain, swelling Dizziness LOC Hypotension/shock Airway compromise/distress Wheezing Singed facial or nasal hair Hoarseness or voice changes
45
Superficial (1st degree) burn
Red and painful
46
Partial thickness (2nd degree) burn
blisters
47
Full thickness (3rd degree)
painless/charred or leathery skin
48
Recommended exam for burns
Mental status HEENT Neck Heart Lungs Abdomen Extremities Back Neuro
49
Why are circumferential burns to extremities dangerous?
Potential vascular compromise is secondary to soft tissue swelling. Elevated extremity.
50
Patients meeting the following criteria shall be transported to the nclosest appropriate burn center
1. Second-degree burns >10% BSA 2. Any third-degree burn 3. Burns involving the face, hands, feet, genitalia, perineum, or major joints 4. Electrical burns, including lightning 5. Chemical burns 6. Circumferential burns 7. Inhalation burns 8. Burn injury w. concomitant trauma
51
Burn percentage of adult
52
Pertinent hx for non-traumatic cardiac arrest
Events leading to arrest Estimated down time PMH Medications Existence of terminal illness
53
Differential for non-traumatic cardiac arrest
Medical vs. trauma VF vs. pulseless VT Asystole PEA Primary cardiac event vs. respiratory or drug OD
54
When should mechanical compression devices be used for cardiac arrest?
If available in order to provide consistent uninterrupted chest compressions and crew safety.
55
H's & T's - Reversible causes of cardiac arrest
Hypovolemia - volume infusion Hypoxia - oxygenation, ventilation, CPR Hydrogen ion (acidosis) - ventilation, CPR Hypokalemia Hyperkalemia - medic drugs Hypothermia - warming Tension pneumo - needle decompression (medic) Tamponade, cardiac - volume infusion Toxins - agent specific antidote Thrombosis, pulmonary - volume infusion Thrombosis, coronary - emergent PCI
56
If witnessed by EMS or CPR in progress and the patient is unresponsive with no pulse:
Begin chest compressions 30:2 until the advanced airway is successfully placed.
57
Pertinent hx for CP and Suspected ACS
Age Medications: Viagra, Levitra, Cialis PMH MI, angina, DM Allergies Recent physical exertion Palliation, provocation Quality Region, radiation, referred Severity Time of onset, duration, repetition
58
sxs CP and Suspected ACS
CP, pressure, ache, vise-like pain, tight Location: substernal, epigastric, arm, jaw, neck , shoulder Radiation of pain Pale, diaphoretic SOB N/V, dizziness Time of onset
59
Differnetial for CP and Suspected ACS
Trauma vs. medical Angina vs. MI Pericarditis PR Asthma, COPD Pneumo Aortic dissection or aneurysm GE reflux or hiatal hernia Esophageal spasm Chest injury or pain Pleural pain Drug OD (cocaine, meth)
60
Recommended exam for CP and Suspected ACS
Mental statues Skin HEENT Heart Lungs Abdomen Back Extremities Neuro
61
Which demographics should you have a high index of suspicion for CP and Suspected ACS?
DM, geriatrics, and females
62
12-Lead EKG is recommended on patients ____ experiencing vague jaw/chest/abd discomfort.
35 + y/o
63
Nitroglycerin is contraindicated in any patient with...
hypotension bradycardia or tachycardia evidence of right ventricular infarction ED medication use within 48 hours
64
What position should patient be placed in with a limb presentation during childbirth?
Left lateral recumbent position
65
Procedure for normal presentation of childbirth
1. Puncture amniotic sac if not already broken 2. Deliver and support the head 3. Suction mouth, then nose. Repeat several times if meconium is present. 4. Deliver upper shoulder, then lower shoulder 5. Deliver the remainder of the baby 6. Clamp and cut the umbilical cord 7. Deliver placenta
66
What is the procedure for cord presentation during childbirth?
1. Position the patient in Trendelenburg and slightly on the left side 2. Wrap the cord and keep it moist 3. Insert gloved hand to life baby off cord; obtain and document cord pulse
67
What is the procedure for breech presentation during childbirth?
Support the body of the baby during the delivery of the head
68
Pertinent hx for chilbirth/labor
Due date Time contractions started/duration/frequency Rupture of membranes (meconium) Time and amount of any vaginal bleeding Sensation of fetal movement Pre-natal care PMH and delivery hx Medications Gravida/Para status High-risk pregnancy
69
sxs childbirth/labor
Spasmodic pain Vaginal discharge or bleeding Crowning or urge to push Meconium
70
Differential for childbirth/labor
Abnormal presentation (breech, limb) Prolapsed cord Placenta previa Abruptio placenta
71
Recommended exam of the mother
Mental status Heart Lungs Abdomen Neuro
72
What is a normal APGAR score?
7-10
73
What APGAR score requires resuscitative measures?
4-7
74
When is the APGAR score measured?
One and five minutes after birth
75
APGAR acronym
Activity/Muscle Tone Pulse Grimace/Reflex Irritability Appearance/Skin Color Respiration
76
Activity/Muscle Tone APGAR Scoring
Absent = 0 Arms/legs flexed = 1 Active movement = 2
77
Pulse APGAR SCoring
Absent = 0 Below 100 = 1 Above 100 = 2
78
Grimace/Reflex Irritability APGAR Scoring
No response = 0 Grimace = 1 Sneeze, cough, pulls = 2
79
Appearance/Skin Color APGAR Scoring
Blue-Grey, pale all over = 0 Normal, except extremities = 1 Normal = 2
80
Respiration APGAR Scoring
Absent = 0 Slow, irregular = 1 Good, crying = 2
81
What is the procedure for localized cold injury?
Remove from environment Measure temperature if available Remove wet clothing Dry/warm pt Passive warming measures Monitor and reassess General wound care DO NOT rub skin to warm DO NOT allow refreezing
82
What is the procedure for a systemic hypothermia patient without respiratory disress?
Remove from environment Measure temperature if available Remove wet clothing Dry/warm pt Passive warming measures Awake w/without AMS Active warming measures Adult Trauma Assessment Shock protocol Monitor and reassess Continue general patient care and transport
83
Pertinent hx for cold-related illness
Age PMH and medications Drug or alcohol use Infections/sepsis time of exposure/wetness/wind chill
84
Differential for cold-related illness
Sepsis Environmental exposure Hypoglycemia Stroke Head injury Spinal cord injury
85
Recommended exam for cold-related illness
Mental status Heart Lung Abdomen Extremities Neuro
86
What does active warming include?
Hot packs on armpits and groin. Do not place directly to skin.
87
What is considered mild hypothermia?
90-95 degrees F 33-35 degrees C
88
What is considered moderate hypothermia?
82-90 degrees F 28-32 degrees C
89
What is considered severe hypothermia?
<82 degrees F <28 degrees C
90
What should you do if foam is present in the airway of a growing victim?
Do not suction! Bag through it initially.
91
What is the procedure for a patient that does not have a protected airway and is not ventilation adequately after a drowning?
General Adult Assessment Ventilation management Consider C-collar Oxygen 15 L SpO2
92
What is the procedure for a patient that is protecting their airway and has adequate ventilation after a drowning?
General Adult Assessment Consider C-collar Oxygen 15 L NRB SpO2
93
For drowning victims in cardiac arrest, the emphasis should be on?
Good oxygenation/ventilation, 30:2 compression, no continuous compressions
94
Pertinent hx for drowning
Submersion in fluid, regardless of depth Possibility of trauma Duration of immersion Temperature of water or possibility of hypothermia Degree of water contamination
95
sxs of drowning
Unresponsive Mental status changes Decreased or absent vital signs Vomiting Coughing, wheezing, rales, stridor, rhonchi Apnea Frothy/foamy sputum
96
Differential for drowning
Trauma Pre-existing medical conditions Barotrauma Decompression illness Post-immersion syndrome
97
What QI Metrics must be completed for drownings?
SNHD Submersion Incident Report Form
98
Recommended exam for drowning
Trauma survey Head Neck Chest Abdomen Back Extremities Skin Neuro
99
Why should all drowning victims be transported for evaluation?
Potential for worsening sxs over the next several hours
100
What is the procedure for epistaxis?
Compress nose with direct pressure Tilt head forward Position of comfort If bleeding is controlled, perform general adult assessment. If bleeding is not controlled, have patient blow nose and suction active bleeding. Then administer2 sprays of Oxymetazoline or Phenylephrine in each nostril. Follow with direct pressure.
101
Pertinent hx for epistaxis
Age PMH Medications (HTN, anticoagulants, ASA, NSAID) Previous episodes of epistaxis Trauma Duration of bleeding Quantitiy of bleeding
102
Differential for epistaxis
Trauma Infection Allergic rhinitis Lesions HTN
103
What are some common anticoagulants?
Warfarin (Coumadin) Heparin Enoxaparin (Lovenox) Dabigatran (Pradaxa) Rivaroxaban (Xarelto) Other OTC headache powder relief
104
What are some common anti-platelet agents?
ASA Clopidogrel (Plavix) Aspirin/dipyridamole (Aggrenox) Ticlopidine (Ticlid)
105
sxs of heat cramps
Normal to elevated body temperature, weakness, muscle cramping. Usually secondary to dehydration.
106
sxs of heat exhaustion
Elevated body temperature Cool, moist skin Weakness Anxious Tachypnea Dizziness AMS Headache Muscle cramping N/V Vital signs: tachycardia, hypotension, elevated temp Usually secondary to dehydration and salt depletion
107
sxs of heat stroke
High body temperature <104 F Hot, dry skin (absences of sweating) Hypotension AMS/coma Tachycardia
108
What is the procedure for heat cramps?
General Adult Assessment Remove from environment Measure temperature if available Remove tight clothing Passive cooling measures PO fluids as tolerated Monitor and reassess Continue general patient care and transport
109
What is the procedure for heat exhaustion?
General Adult Assessment Remove from environment Measure temperature if available Remove tight clothing Active cooling measures If poor perfusion is present, proceed to the appropriate shock or trauma protocol If poor perfusion is not present, continue to monitor and reassess. continue general patient care and transport
110
What is the procedure for heat stroke?
General Adult Assessment Remove from environment Measure temperature if available Remove tight clothing Airway as indicated AMS as indicated Active cooling measures If poor perfusion is present, proceed to the appropriate shock or trauma protocol If poor perfusion is not present, continue to monitor and reassess. continue general patient care and transport
111
Pertinent hx for heat-related illness
Age Exposure to increase temperature and/or humidity PMH/ medications Time and duration of exposure Poor PO intake, extreme exertion Fatigue and/or muscle cramping
112
Differential for heat-related illness
Fever Dehydration Medications Hyperthyroidism DTs Heat cramps, heat exhaustion, heat stroke CNS lesions or tumors
113
Recommended exam for heat-related illness
Mental status Skin Heart Lung Abdomen Extremities Neuro
114
What drugs can cause an elevated body temperature?
Cocaine Amphetamines Salicylates
115
What are considered active cooling techniques?
Cold packs Ice Fanning Air conditioning
116
Pertinent medical hx for obstetrical emergency
Medical hx HTN medications Prenatal care Prior pregnancies/births Previous pregnancy complications
117
sxs of obstetrical emergency
Vaginal bleeding Abdominal pain Seizures HTN Severe HA Visual changes Edema of hands or face
118
Differential for obstetrical emergency
Pre-eclampsia/eclampsia Placenta previa Placenta abruptio Spontaneous abortion
119
Recommended exam for obstetrical emergency
Mental status Heart Lung Abdomen Neuro
120
What medical condition can cause severe headaches, vision changes, or RUQ pain in a pregnant patient?
Pre-eclampsia
121
What is hypertension defined as in a pregnancy?
Systolic >140 Diastolic >90 OR increase of 30 systolic and 20 diastolic from pt's nl pre-pregnancy BP
122
When does postpartum eclampsia present?
48 hours after childbirth
123
Pertinent hx for OD/poisoning
Ingestion or suspected ingestion Substance ingested, route, quantity Time of ingestion Reason (suicidal, accidental, criminal) Available medications in home PMH, medications
124
sxs OD/poisoning
Mental status change Hypotension.hypertension Decreased RR Tachycardia, dysrhythmias Seizures SLUDGE Malaise, weakness GI sxs Dizziness Syncope Chest pain
125
Differential for OD/poisoning
TCA OD Acetaminophen OD ASA Depressants Stimulants Anticholinergic Cardiac medications Solvents, alcohols, cleaning agents, insecticides
126
Recommended exam for OD/poisoning
Mental status Skin HEENT Heart Lung Abdomen Extremities Neuro
127
sxs of acetaminophen OD
Initially normal or N/V Tachypnea AMS Renal dysfunction, liver failure, and or/cerebral edema
128
sxs of depressant OD
Decreased HR, BP, tempearture, and RR
129
sxs of anticholinergic OD
Increased HR and temperautre Dilated pupils AMS changes
130
sxs of solvent OD
N/V cough AMS
131
sxs stimulant OD
Increase HR, BP, temperature, dilate pupils, seizures, and possible violence
132
What is the ideal scene time for a patient having a stroke?
Less than 10 minutes
133
What are the possible causes of hypovolemic shock?
Hemorrhage Trauma GI bleeding Ruptured AA Pregnancy related bleeding
134
How far should the head be elevated for a suspected traumatic brain injury?
30 degrees
135
What are the possible causes of obstructive shock?
Pericardial tamponade PE Tension pneumo
136
When is cervical stabilization not performed?
Penetrating trauma to the head and/or neck without evidence of spinal injury Injuries where placement of collar might compromise assessment, airway management, ventilation and/or hemorrhage control Patients in cardiac arrest
137
What should happen to orogastric or nasogastric tubes during transfer?
Left in place Closed off Set to suction
138
A DNR or POLST order shall be validated by confirming the patient's:
Name Age Condition of identification form
139
How long should eyes be flushed if they are exposed to chemicals?
10-15 minutes
140
What protocols must be followed in the specific sequence noted?
General Assessment
141
All trauma calls that meet the Trauma Field Triage Criteria and occur within any other area of Clark County are to be transported to UMC. T/F
True
142
What are possible causes of Cardiogenic Shock?
Heart failure MI Cardiomyopathy Myocardial contusion Toxins
143
What triage methodologies can be used when patients exceed available resources?
SMART STARTS
144
Patients must have suspected hyperkalemia OR EKG findings consistent with hyperkalemia BEFORE initiating treatment. T/F
True
145
Patients with a possible spinal injury found in MVC should not be asked if they can exit the motor vehicle on their own. T/F
False
146
Tape, head straps, wedges, and head and/or neck support devices are not recommended during spinal immobilization. T/F
True
147
Patients are not to be transported on backboards (unless movement off the backboard would delay immediate transport of patients w/ life-threatening injuries or acute spinal injuries). T/F
True
148
What is considered a hypertensive patient in the setting of Pulmonary Edema/CHF?
Diastolic BP > 100 mmHg
149
Hospitals that have declared internal disaster should be bypassed, except for patients presenting with what condition(s)?
Cardiac arrest Inability to ventilate
150
What are the approved Hypothermia Centers?
Centennial Hills Desert Springs Henderson Hospital Mountain View Hospital St. Rose Siena Southern Hills Spring Valley Summerlin Sunrise UMC Valley
151
What are the possible causes of Disruptive Shock
Sepsis Anaphylaxis Neurogenic Toxins

SNHD EMT Basic Protocols (7 decks)

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