Adult Protocols Flashcards
(559 cards)
1
Q
In adult respiratory emergencies what things should be considered that focus on the respiratory system?
A
Assessment of chest wall movement, including rate and depth Symmetrical chest rise and fall Assessment of accessory muscle use Auscultation of bilateral lung sounds Pulse oximetry EtCo2
2
Q
If signs of hypoxia and respiratory distress are present what must be immediately initiated?
A
Airway and ventilatory management
3
Q
Signs and symptoms of respiratory distress?(8)
A
Altered mental Tachypnea Cyanosis Accessory muscle use Nasal flaring Pursed lips Abnormal lung sounds Tachycardia
4
Q
What respiratory rate, oxygen saturation and EtCo2 should alert paramedic that immediate airway and ventilatory management including placement of advanced airway?
A
Oxygen saturation below 94%
Respiratory rate below 10 or above 36 a minute
EtCo2 outside range of 35-45
5
Q
What should be determined in chronic respiratory disease patient with respiratory distress?
A
If it is chronic or acute
6
Q
Questions pertaining to what is adult respiratory emergencies prove to be invaluable?
A
Chief complaint and accompanying symptoms
7
Q
In adult respiratory emergencies what should be combined with lung sounds?
A
Patient HX
8
Q
5 causes of upper airway obstruction?
A
Tongue Foreign body Swelling due to angio-neurotic edema Allergic reaction/anaphylaxis Trauma
9
Q
In a responsive patient if air exchange is inadequate and there is reasonable suspicion of foreign body obstruction you should?
A
Apply abdominal thrusts until they become unresponsive or object is removed
10
Q
What should yo do if a patient with a suspected foreign body airway obstruction becomes unresponsive?
A
Chest compressions
11
Q
If unable to relieve a FBAO with abdominal thrusts or chest compressions you should?
A
Visualize it with a laryngoscope and extract the foreign body with magill forceps
12
Q
What should you use if a airway obstruction is due to trauma and or edema or if uncontrollable bleeding causes life threatening ventilatory impairment?
A
Advanced airway
13
Q
What procedure should you perform if you are unable to insert an advanced airway or adequately ventilate with BVM?
A
Cricothryroidotomy
14
Q
What should you do with a patient with a partial airway obstruction?
A
Encourage patient to cough
Do not interfere
15
Q
A patient should be considered to have asthma if they present with?
A
Dyspnea
Wheezing
16
Q
What position should the asthma/bronchospasm patient be placed in?
A
Fowlers
17
Q
What drugs can be administered for asthma/Bronchospasms?
A
Albuterol Atrovent Epi 1:1000 Epi 1:10,000 Mag Sulfate
18
Q
What is the dose of albuterol in the adult asthma patient?
A
2.5mg mixed with 2.5mg NS
Administered with nebulizer
19
Q
How many times can you repeated albuterol int he adult asthma patient?
A
Twice
20
Q
What is the dose of Atrovent in the adult asthma patient?
A
0.5mg
Mixed with the 1st dose of albuterol only
21
Q
In the asthma/bronchospasm patient after giving albuterol and atrovent what may you give if the patient is still having severe respiratory distress?
A
Epi 1:000
22
Q
What is the dose and route of Epi 1:1000 in adult asthma/bronchospasm patient?
A
0.3mg IM
23
Q
When can you give a adult patient with asthma/bronchospasm mag sulfate?
A
When they are in severe Respiratory distress
24
Q
What is the dose and route of mag sulfate in adult severe respiratory distress?
A
2g
IV mixed in a 50 ML of D5W
Given over 5-10 minutes
10 gtts
25
When would you give a second dose of Epi 1:1000 in the severe adult respiratory distress patient?
When there is no response from albuterol, atrovent, 1st dose of epi, or mag sulfate
26
When should you consider Epi 1:10,000 in the adult patient with severe respiratory distress?
When the patient is hypotensive with a delay in cap refill
| Consider as the 2nd or 3rd dose of Epi 1:1000
27
What is the recommended location to administer epi 1:1000 to the adult patient with severe respiratory distress?
Lateral Thigh
28
Can you administer CPAP for asthma/bronchospasm patient?
Yes
| 2.5 - 5 PEEP
29
Can you administer a 3rd dose of Epi if no response from previous treatment in adult patient with severe respiratory distress?
Yes
It is a level 2 order
Also consider Epi 1:10,000
30
Can you administer Epi or Bronchodilators to a adult patient with severe respiratory distress and a HR above 140?
Yes
| It is a level 2 order
31
Who should you be cautious in administering Epi to in adult patient?
Pt's over the age of 40
| History of hypertension or heart disease
32
What is dose and route of Epi 1:10,000 in adult patients in severe respiratory distress with hypotension and delay in cap refill?
0.5mg
Slow IV
Over 3-4 minutes
33
In the COPD patient if at anytime during transport if the patients respiratory status deteriorates what should you consider?
Advanced airway
34
What drug should you administer if a COPD patients respiratory status deteriorates and how should you administer it?
Albuterol
| ET tube nebulized
35
What treatments can be used for the COPD patient?
Albuterol
Atrovent
CPAP
36
What level of PEEP should be used in COPD patients?
2.5-5
37
What should be considered for a adult patient with dyspnea and rales and or wheezing without a HX of asthma?
Pulmonary Edema(CHF)
38
What are possible causes of CHF?
Supra ventricular tachycardia
Myocardial infarction
Cardiogenic shock
39
In a patient with pulmonary edema and a BP less than 90 what protocol should be used?
Cardiogenic shock protocol
40
What treatments can be used for pulmonary edema patient?
Nitroglycerin
CPAP
Albuterol
Atrovent
41
When would you not give nitro in the CHF patient?
BP below 120
If patient has taken Viagra in last 24 hours
If patient has taken Levitra or Cialis in past 48 hours
42
When would you give a patient with pulmonary edema 0.8mg(2 sprays) of nitro?
When there BP is over 160
43
How much nitro do you give the adult CHF patient with a BP above 120 and below 160?
0.4mg(1 spray)
44
How often do you repeat SL nitro in the CHF patient?
Every 3-5 minutes as needed
45
What PEEP to you attempt to achieve when administering CPAP in the adult CHF patient?
10 PEEP
46
If a adult CHF patient will not tolerate 10 PEEP with CPAP what should you lower it to?
5-7.5
47
When should you not administered CPAP to the CHF patient?
When the systolic BP is below 90
48
Can you administer bronchodilators to the CHF patient?
Yes but it is a level 2 order
| You may give albuterol and atrovent
49
When should you consider with holding nitro in the CHF patient?
When they have clinical signs of hypovolemia
50
What are some clinical signs of hypovolemia?
Poor skin turgor
Decreased cap refill
Elevated temp
51
Can you administer nitro to a CHF patient without having IV established?
Yes but with caution
52
What are some signs and symptoms of pneumonia?
```
Fever
Productive cough
Possible pleuritic chest pain
Hx of being bedridden
Known immunocompromise
Diabetes
Elderly
Lung sounds indicative of consolidation(rales or rhonchi with egophony over area of concolidation)
```
53
Once a IV has been astablish in a patient with suspected pneumonia what should be administered?
250-500 CC NS
| If lung sounds are clear
54
What type of drug should be avoided in pneumonia patient?
Diuretics
55
What are level 1 drugs in the suspected pneumonia patient?
Albuterol
| Atrovent
56
What are you 7 H's?
```
Hypovolemia
Hypoxia
Hyperkalemia
Hydrogen ion acidosis
Hypothermia
Hypoglycemia
Hypocalcemia
```
57
What are your 6 T's?
```
Tablets
Tamponade cardiac
Tamponade pneumothorax
Thrombosis coronary
Thrombosis pulmonary
Trauma
```
58
How do you threat hypovolemia?
Fluid challenge 500 NS
59
How do you treat hydrogen ion acidosis?
Airway management, ventilate
| Consider sodium bicarbonate
60
How do you treat hyperkalemia?
Consider calcium chloride 1g
| Consider sodium bicarbonate 1mEq/kg
61
How do you treat hypoglycemia?
If less than 60 consider D50 or glucagon
62
How do you treat hypocalcemia?
Consider calcium chloride 1g
63
How do you treat overdose of tablets?
Consult poison control
64
How do you treat cardiac tamponade?
Fluid challenge
| Dopamine drip
65
How do you treat tension pneumothorax?
Consider chest decompression
66
How do you treat coronary thrombosis?
Consider AMI
| Cardiogenic shock
67
What should you consider in Asystole/PEA patients?
Criteria for death/no resuscitation
68
How should you oxygenate patients in asystole/PEA?
BVM with appropriate airway device
15-25 LPM
8-10 BPM
69
What should be done while monitoring is being attached in asystole/PEA patients?
Compressions at a rate of 100 per minute for 2 minutes
70
What is paramount for patient survival in CPR?
Continuous uninterrupted compressions
71
How do you confirm asystole?
In 2 leads
72
How and when do you confirm advanced airway placement?
EtCo2 monitoring
| Confirm on scene, during transport, and during transfer at hospital
73
Once IV has been established in PEA patient what should you consider giving?
Infusing saline wide open in PEA
74
What class of drug should be given first in asystole/PEA patients?
Vasopressor
75
What 2 vasopressors can be given in asystole/PEA?
Epi 1:10,000
| Vasopressin
76
What is the dose of Epi is asystole/PEA?
1mg 1:10,000
IV/IO
Repeated every 3-5 minutes
77
What is the dose of vasopressin in asystole/PEA?
40 units
| IV/IO
78
When can vasopressin be given in asystole/PEA?
As a replacement for the 1st or 2nd dose of epi
79
In the asystole/PEA patient who is taking calcium channel blockers or has known renal failure you should give?
Calcium Chloride 10%
1g
IV/IO
80
What should be done as soon as a asystole/PEA patient regains spontaneous circulation?
See return of spontaneous circulation and therapeutic hypothermia protocol
81
What is the compression to ventilation ratio in adults with asystole/PEA?
30:2
82
Once a advanced airway is in place in asystole/PEA how often do you provided ventilations?
One every 6 seconds
83
When should you use ET tube as a route for epi or vaso?
As a last resort when IV/IO is unavailable
84
How do you administer epi or vasopressin via ET tube?
Mix Epi 1:1000 2 mg in 8ml of NS or vaso and inject directly into tube
85
Which epi do you use when administering in asystole/PEA via ET tube?
Epi 1:1000
86
During CPR a EtCo2 of less than ___ should prompt you to attempt to improve CPR
10
87
What is the goal during resusicitation when measuring EtCO2?
12-25
88
During CPR what EtCo2 should prompt you to check for ROSC?
35-45
89
If ROSC if achieved what should you do?
Wean down oxygen to maintain a Sp02 equal to or greater than 94%
90
What HR is considered bradycardia?
Less than 50
91
Who gets treated for bradycardia?
Pt with HR less than 50 and who are symptomatic
92
12 potential causes of bradycardia?
```
AMI
Head injury
Atrio ventricular block
Hypoxia
Hypoglycemia
Medications(beta blockers)
Calcium channel blockers
Clonidine
Digitalis
Toxins
Sinus sick syndrome
Spinal cord lesion
```
93
What should you perform if a inferior wall MI is identified?
Perform additional 12 lead to rule out concurrent right ventricular MI
94
What classifies a patient as unstable in bradycardia?
```
Altered mental status
Ischemia chest pain/discomfort
Acute heart failure
Hypotension(less than 90)
Dyspnea
Heart blocks or ischemia/infarction
Other signs of shock that persist despite adequate airway and breathing
```
95
What shall be done while preparing to pace a patient with symptomatic bradycardia?
Administer atropine
96
What is the dose of atropine in bradycardia?
0.5mg IV/IO
97
How often may atropine be repeated in unstable bradycardia?
Every 3-5 minutes
98
What is the max dose of atropine in bradycardia?
3 mg
99
What should you consider doing prior to giving max dose of atropine in bradycardia?
Pacing
100
What other medication can be used for bradycardia if unresponsive to atropine?
IV infusion of primary B-adrenergic agonist(dopamine) with rate accelerating effects
101
What may be the cause of bradycardia with hypotension?
Right ventricular MI
102
How can you treat a patient with hypotension, a inferior wall MI and clear lung sounds?
500 CC NS fluid challenge
103
How many times may you repeat a fluid challenge un a patient with a inferior wall MI and hypotension?
Once
104
What should be avoided in a patient with inferior wall MI?
Nitrates and morphine
105
What may improve a patients hemodynamic status if bradycardia and hypotension exist?
Pacing and IV fluids prior to use of atropine
106
What drug should you give if a bradycardia patient has persistent hypotension/cardiogenic shock?
Dopamine
107
What drugs can be administered prior to pacing if patient is conscious and aware of situation?
Benzodiazepines
Versed
Valium
108
What is the dose and route of valium to be given prior to pacing?
5mg
May be repeated once
Max dose 10
IV, IO, IN
109
What is the dose and route of versed to be given prior to pacing?
2mg increments
IV, IO, IN
Max dose 10mg
110
When do you omit atropine in the bradycardia patient?
2nd degree type 2 AV block
| 3rd degree AV block
111
Can you use atropine in the presence of myocardial ischemia?
Yes but you must use caution
112
How should benzodiazepines be administered?
Slowly, titrated to effect and being aware of associated hypotension
113
What may also be helpful in differential interpretation of narrow complex tachycardia?
Atrial rate
114
What is the sinus tachycardia rate?
100 - 160
115
What is the junctional tachycardia rate?
100 - 180
116
What is the atrial tachycardia rate?
150 - 250
117
What is the atrial flutter rate?
250 - 350
118
What is the atrial fibrillation rate?
Starts at 350
119
What should wide complex tachycardia with a QRS greater than 0.12 initially be considered?
Ventricular in origin unless proven otherwise(documented QRS morphology consistent with preexisting BBB)
120
Patients with SVT may have evidence of what?
Cardiovascular dysfunction
121
How should you treat narrow complex tachycardia patients who present with borderline symptomatic signs and symptoms?
With medications
122
How should patients with narrow complex tachycardia patients who present as unstable be treated?
Cardioverted immediately
123
What 4 signs and symptoms classify a patient as borderline symptomatic(stable)?
Alert and oriented
SBP equal to or greater than 90
Mild chest discomfort
SOB
124
What signs and symptoms classify a patient as being critical(unstable)?
```
Decreased LOC
SBP below 90
Chest pain
SOB
Diaphoresis
Pulmonary edema/CHF
```
125
For all patients with HR greater than 150 and narrow who are borderline symptomatic you should?
Conduct initial assessment
Determine hemodynamic stability
Consider H's and T's
126
For SVT patients who are asymptomatic you should?
Provide supportive care
| Transport immediately
127
What should you attempt first for patients with SVT who are asymptomatic?
Vagal maneuvers
128
In stable patients with SVT that is not resolved with vagal maneuvers you should?
Administer adenosine
129
How should the first dose of adenosine be administered in stable SVT adult patient?
6mg IVP
| Followed by rapid 20mL NS flush
130
If SVT is not resolved by 6mg adenosine you should?
Give a second dose of 12 mg IVP
| Followed by 20 mL flush
131
What medication can be used to treat stable SVT if vagal maneuvers and adenosine do not convert?
Diltiazem(Cardizem)
132
What must you do prior to administering Cardizem in stable SVT patient?
Consult medical direction, it is a level 2 order
133
What is the dose of cardizem as a level 2 order for stable SVT?
0.25 mg/kg IV/IO
| 20mg for the average patient
134
How many minutes should you administer Cardizem over in the stable SVT patient?
2 minutes
135
What should you consider if a borderline symptomatic atrial fibrillation or atrial flutter patient has a BP of 90 to 100?
Other causes of hypotension
| Hypovolemia or sepsis
136
What medication should be administered for the borderline symptomatic atrial fibrillation or atrial flutter?
Diltiazem(cardizem)
137
What is the initial dose of cardizem for the stable atrial fibrillation/atrial flutter patient?
0.25 mg/kg
20 mg average dose
Over 2 minutes
138
How long after giving the initial dose of Cardizem should you administer a second dose of Cardizem if not resolved?
15 minutes
0.35 mg/kg
25 mg average patient
139
For a patient to be considered critical/unstable symtpomatic narrow complex tachycardia they must have HR above __ and BP below __ along with __________?
HR above 150
BP below 90
Evidence of impending cardiac arrest
140
Signs and symptoms of impending cardiac arrest?
```
Diaphoresis
Shortness of Breath
Decreased LOC
Chest pain
Pulmonary edema
```
141
How much NS should you administer to a unstable SVT patient with clear lung sounds?
500 CC
142
What should be done immediately for unstable SVT patients?
Cardioverted
143
What is the recommended cardioversion joules for unstable narrow SVT or A-flutter?
50 - 100
144
What is the recommended joules for cardioversion of unstable irregular Atrial fibrillation?
120 - 200
145
What medication should not be given to patients with know A-FIB/A-Flutter?
Adenosine
146
Patients with a known HX of wolf parkison white syndrome should not be given what medication?
Cardizem
147
What medication should be considered for patients with wolf parkison white syndrome?
Amiodarone
148
What medication is recommended for treatment of hemodynamically stable VT and prevetion of recurrent VF?
Amiodarone
149
How should patients with asymptomatic PVC's be treated?
Treatment is not recommended
Give supportive care
Oxygen 100% NRB 10-15 LPM
150
If a patient with PVC's becomes symptomatic what should you do?
Contact physician for orders
151
What medication should be given to a stable patient with a wide complex tachycardia and a pulse?
Amiodarone
152
What is the dose of Amiodarone for stable patients with wide complex tachcyardia and a pulse?
150 mg in a 50 ml bag of D5W
Given over 10 minutes
10 gtts
1 drop a second
153
How do you treat a stable patient with torsades de pointes?
Mag sulfate
154
What is the dose of mag sulfate for stable patients with tosades de pointes?
2 g in 50 ml bag of D5W
| Infused over 1-2 minutes
155
If 2 grams of mag sulfate successfully converts torsades de points you should?
Start a mag sulfate maintenance infusion
156
What is a mag sulfate maintenence infusion for conversion of torsades de pointes?
1g in 250 ml bag of D5W
30-60 gtts/min
60 gtts set
157
How do you treat wide complex tachycardia unstable with a pulse that is monomorhic?
Synchronized cardioversion
158
What is the starting and subsequent dose of joules for synchronized cardioversion of unstable wide complex tachycardia with a pulse?
100, 200, 300, 360
159
When should you defibrillate a unstable patient with a wide complex tachycardia with a pulse?
If irregular/unstable
Polymorphic
Tosades
160
What should be administered to a patient who has been cardioverted but was not administered any antiarrthythmic prior to cardioversion?
Amiodarone
| 150mg in 50mL of D5W over 10 minutes
161
What should be checked prior to giving Amiodarone after cardioverting someone?
That there BP is over 100
162
How many times and when can you repeated amiodarone 150 over 10 minutes after cardioverting?
Once
| After 10 minutes
163
What is the initial joules setting for wide complex tachycardia without a pulse?
200
164
What is the second setting of joules for wide complex tachycardia without a pulse?
300
165
What is the 3rd setting of joules for wide complex tachycardia without a pulse?
360
166
What antiarrthymic is used for wide complex tachycardia without a pulse and how much?
Amiodarone
300 1st dose
150 second dose after 3 - 5 minutes
167
When should amiodarone be administered?
During CPR
168
What medication should be given to a patient with wide complex tachycardia that is torsades de pointes without a pulse?
Mag sulfate
2g in 50 mL bag of D5W
Infused over 1-2 minutes
169
When can you stop treatment of a wide complex tachycardia without a pulse?
ROSC
A rhythm change
Termination of efforts
170
In a patient without a pulse and tosades de pointes who was successfully converted with mag sulfate you should?
Start a mag sulfate maintenance infusion of
| 2g in 500 mL NS at 30-60 gtts/min
171
What are your immediate goals of post resuscitation care?
Provide cardio respiratory support to optimize tissue perfusion especially to brain
Institute antiarrthymic therapy to prevent recurrence of the arrest
Attempt to identify precipitating causes of arrest
Rapidly transport to closest facility
172
If a ROSC patient has a BP of less than 90 you should?
Check lung sounds, if clear give
500 NS
May be repeated once
173
If ROSC patients BP remains under 90 after giving fluids you should?
Give dopamine
174
In ROSC patients dopamine should be titrated to maintain a BP greater than or equal to?
90
175
When should you give amiodarone in the ROSC patient?
When it wasnt given prior to converting
176
When would you administer a Amiodarone drip in the ROSC patient?
Frequent runs of VT
Frequent PVC's
Transport time over 30 minutes
177
A amiodarone drip is?
150 mg in 50 mL of D5W
Equals 3:1 concentration
Use a 60 gtts and initiate flow at 1 gtt every 3 seconds
178
In ROSC patient when would you not administer amiodarone?
HR less than 60
2nd degree type 2 block
3rd degree block
Hypotension
179
Why do patients with a ROSC often have a poor neurological outcome?
Cerebral reperfusion therapy
180
What temperature should patients with ROSC be cooled to?
32 - 34 Celsius
| 89.6 - 93.2 F
181
How long should ROSC patients be cooled to 32-34 degrees celsius(89.6-93.2 F)?
12 - 24 hours
182
What must have the initial rhythm have been for ROSC to be cooled using therapeutic hypothermia?
VF
| Pulseless VT
183
For a ROSC patient to recieve theraputic hypothermia the EtCo2 must be atleast?
20
184
For a ROSC to receive therapeutic hypothermia systolic BP must be greater than?
90
| Before or after vasopressor
185
What age must a ROSC patient be to receive Therapeutic hypothermia?
16
186
For a ROSC patient to receive therapeutic hypothermia they must?
```
Non traumatic cardiac arrest
Compressions and defibrillation performed
Advanced airway in place
EtCo2 greater than 20
remain comatose
SBP greater than 90
16 or older
```
187
Therapeutic hypothermia may not be executed in ROSC patient if?
```
Pt is pregnant
Tramatic cardiac arrest
Significant head trauma
Actual or suspected hemorrhage
Initial temp less than 34/93.2
Obvious pulmonary edema
SBP less than 90
```
188
What level of Sp02 should be maintained in Therapeutic hypothermia?
94%
189
In therapeutic hypothermia patient you should attempt to maintain EtCo2 of?
35 to 45
190
What type of assessment should be conducted on therapeutic hypothermia patients?
Neurological assessment
191
When conducting a neurological assessment on therapeutic hypothermia patients you should check?
Pupils(Size, reactivity, equality)
| Motor response to pain
192
What should be removed when conducting therapeutic hypothermia?
Clothing
193
Where should ice packs be placed when conducting therapetuic hypothermia?
Groin
Axillary
Head
194
Why would you want to administer a benzodiazepine in therapeutic hypothermia patients?
To prevent shivering
195
What is the dose of cold saline in therapeutic hypothermia?
30mL/kg
| Max of 2 liters
196
What should you label the saline bag being used for therapeutic hypothermia?
Hypothermia
197
For therapeutic hypothermia patients when would you start a dopamine drip?
When BP drops below 90
198
What would you run dopamine drip at for therapeutic hypothermia patient who's BP drops below 90?
10 mcg/kg/min
199
For a therapeutic hypothermia patient who is being given dopamine because of a BP below 90 what would you attempt to maintain there BP above?
110
200
What should be done if at anytime during therapeutic hypothermia you lose ROSC?
Stop
201
What may preclude initiation of therapeutic hypothermia?
Short transport times
202
What medication can be considered if during therapeutic hypothermia a patient has persistent shivering or is allergic to benzodiazepines?
Morphine
203
If giving morphine to prevent shivering in therapeutic hypothermia what is the dose and how often should you give it?
```
Morphine
2mg increments
IVP
Every 5 mins
Max dose of 6mg
```
204
Cardiogenic shock protocol is used for patients with BP less than?
90 with signs and symptoms that are cardiac in origin
205
In cardiogenic shock when would you administer 500 CC NS and how many times may you repeat it?
If lungs sounds are clear
| May be repeated once
206
When would you administer dopamine in cardiogenic shock?
If fluid challenge does not improve BP or if patient is experiencing pulmonary edema
207
What is your mcg/kg/min for dopamine in cardiogenic shock?
5 to 20
208
What is the minimum and maximum BP you want to achieve with a dopamine infusion?
Min 90
| Max 120
209
When would you avoid giving fluids in the cardiogenic shock patient?
Anterior wall MI is suspected
| Unclear lung sounds
210
Anterior wall MI is evidence by?
ST elevations in lead I, AVL, V1- V6
211
Max dose of dopamine?
20 mcg/kg/min
212
Dopamine infusion concentration?
1600 mcg/mL
| 15-60 gtts/min with 60 gtts
213
What amount of oxygen should be administered for chest pain with o2 sat above 94%?
4 LPM via NC
214
What amount of oxygen should be administered to a chest pain patient with oxygen saturation below 94% and respiratory distress?
15 LPM via NRB
215
When should you not administer nitro to the chest pain patient?
BP below 90
| Erectile dysfunction meds taken
216
Aspirin dose for chest pain patients?
162 mg up to 324 mg PO
217
What should be done with a 12 lead ECG as soon as possible when suspecting AMI?
Transmit to hospital
218
What is the max dose of nitro in chest pain patients and how often can it be administered?
1. 2mg is max dose
| 0. 4 can be administered every 3-5 minutes
219
What medication can be given to chest pain patient who is normotensive after giving nitro?
Morphine
2mg increments
Every 3-5 minutes
220
AMI is probable when there is ST elevation of ___ in two or more leads?
1mm
221
A new onset of left BBB on ECG is suggestive of?
AMI
222
Cardiac alert on scene time should be minimized to less than?
10 minutes
223
Hypertensive emergencies are defined as?
Systolic BP greater than 180
Diastolic BP greater than 110
Signs and symptoms of organ failure
224
Neuralgic end organ damage due to uncontrolled BP may include?
Hypertensive encephalopathy
| Cerebral vascular accident
225
Cardiovascular end organ damage from hypertension may include?
Myocardial ischemia/infarction
Acute left ventricular dysfunction
Acute pulmonary edema
Aortic dissection
226
What may be affected by uncontrolled hypertension?
Acute renal failure
| Eclampsia
227
What should you focus on in hypertensive emergency?
Patient presentation
| Not BP itself
228
In chronic hypertension what may cause more harm than good?
rapid reduction in BP
229
Hypertension in thrombotic stroke is a normal response and lowering the BP may?
Extend the area of injury
230
What is the poison control number?
18002221222
231
Pt with altered mental status with unknown etiology and blood glucose above what gets NS?
300
232
What must accompany a blood glucose above 300 in the altered mental status patient with known etiology for a patient to receive NS?
Signs and symptoms of dehydration
233
What is the dose of dextrose for the altered mental status patient of unknown etiology?
Dextrose 50%
25g dextrose in 50 mL
Slow IV
234
How can narcan be administered in altered mental status patient with unknown etiology?
2 mg
IV, IM, IN
ET as last resort
235
Can dextrose 50% be given twice in patient with altered mental status of unknown etiology?
Yes
| As long as blood glucose remains under 60
236
How do you avoid infiltration and resultant tissue necrosis when administering dextrose 50%?
Give it slow with intermittent aspiration of line to confirm patency followed by saline flush
237
How should narcan be administered to patient with altered mental with unknown etiology when hx is unknown or there is a possibility of chronic narcotics?
0.4 mg/min
| Slowly
238
What may be induced when giving narcan to patients with HX of chronic use of narcotics?
Withdrawl or violent behavior
239
The therapeutic goal in administering narcan to a patient with known or possibility of chronic narcotic use is to?
Restore adequate ventilatory support
240
What should yo consider when administering narcan to a patient with known or possibility of chronic narcotic use?
Physical restraints
241
What protocol should the violent and/or impaired patient protocol be used in conjunction with?
Behavioral Emergencies
242
What should be used if a patient poses a threat to self, EMS, or bystanders?
Use restraints
243
If a patient is non violent you should?
Be observant for possibility of violence
| Avoid provoking patient
244
When should particular caution be used in the violent or impaired patient?
When any nonlethal law enforcement devices have been used
245
What should be closely monitored in the violent/impaired patient?
Blood glucose
246
When it is appropriate you may have the police ______ the violent/impaired patient?
Baker Act
247
What act should you refer to if a person has been baker acted by the police?
Impaired/Incapacitated act
248
What non-psychiatric causes must be ruled out in a violent/impaired patient?(5)
```
Drug overdose
CVA
ETOH
Hypoxia
Hypoglycemia
```
249
If a violent/impaired patient is showing signs of bizarre or aggressive behavior, dilated pupils, high body temp, Inchoherent speech, inconsistent breathing patterns, fear and panic, profuse sweating, shivering or nudity you should?
Refer to ExDs protocol
250
Which medications can be used to physical restrain a adult patient?
Valium
Versed
Diphenhydramine
251
Dose of Benadryl for chemically restraining a patient?
50mg IM or IV
252
What must be started once a patient has been sedated because of being violent or impaired?
Cardiac monitoring
| Est IV and give NS wide open
253
What should you check for in the violent/impaired patient?
Temp
| Cool as nessessary
254
How do you cool a patient who is violent or impaired?
Use "cool" normal saline
| Apply ice packs to groin and axillae
255
How should you transport a violent/impaired patient?
Code 3 to the closest appropriate facility
256
Why might you choose IM or IN for route of administration of medication in a violent/impaired patient?
Because IV route might present safety concerns
257
Excited delirium is a state in which a person is?
Psychotic and extremely agitated
258
The excited delirium patient is mentally what?
Unable to focus or process rational thoughts
259
What happeneds to the organs in a ExDs patient?
They are functioning at such a excited rate they will begin to shut down
260
What 3 things essentially bring on ExDs?
Overdose
Drug Withdrawl
Mental subject who is off a medication for a significant amount of time
261
Overdose on what types of medication can cause ExDs?
Stimulant or Hallucinogen
262
What does priority stand for in the ExDs patient?
```
Psychological issues
Recent drug/alcohol use
Incoherent speech
Off clothes and sweating
Resistant to presence/dialogue
Inanimate objects/shiny/glass=violent
Tough, unstoppable, super human strength
Yelling
```
263
What happends in a ExDs patient prior to onset of death?
Instant tranquility
264
What medication should be administered as quickly and safely as possible in the ExDs patient?
Valium
Versed
Diphenhydramine
265
The decision of an ExDs patient to be transported is the sole discretion of who?
The patient based on the information that EMS personnel provide during the physical exam
266
What 3 situations should the seizure protocol be used in?
When seizures are witnessed
When patient has Continuous convulsions
When patient has repeating episodes without regaining consciousness or sufficient respiratory compromise
267
What should be considered in seizure patients?
```
Underlying etiology
Hypoglycemia
Overdose
Head injury
Fever
```
268
When would you administer mag sulfate in a seizure patient?
If the patient is eclamptic female
269
What is the mag sulfate dose for eclamptic female seizure patient?
4g IV in 50 mL of D5W
| Given over 5 to 10 minutes
270
What medication should be given to no eclamptic seizure patients?
Benzodiazepines
271
Can versed be given IM in the seizure patient?
No
IV, IO, IN
IN concentration 10mg/2mL
272
Can valium be given IO in the seizure patient?
No
| IV, IM, IN
273
When should you assume that a female patient who is seizing is having eclampsia?
When she is in her 2rd or 3rd trimester of pregnancy
| Over 20 weeks
274
How long post partum can eclampsia occur?
6 weeks
275
Can more than than 10mg of valium be given in the seizure patient?
Yes but it is a level 2 order
276
When should yo refer to a suspected stroke protocol?
```
AMS
Slurred speech
Loss of function of any body part
Hemiplegia
Loss of vision
Weakness of facial muscles
Loss of sensation
Drooling
```
277
What should be ruled out in suspected stroke patients?
Hypoglycemia
Drug overdose
Hypoxia
278
Differential diagnosis for a patient with HX of stroke/TIA and impaired understanding of speech?
TIA
279
DD for paitent with previous neurological deficit with aphasia/dysarthria and weakness/hemiparesis is?
Seizure
| Hypoglycemia
280
DD of patient with hypertension and facial drop?
Drug ingestion
281
DD of patient with hx of heart disease and poor coordination/balance?
Tumor
282
DD of patient with hx of diabetes and loss of peripheral vision?
Trauma
283
DD of patient with HX of anticoagulant medications with syncope, dizziness/vertigo?
Stroke
284
To meet stroke alert criteria time of onset of symptoms must be less than or equal to?
4.5 hours
285
To meet stroke alert criteria there must be abnormal findings on what?
Cincinnati stroke scale
or
Expanded neurological examination
286
What must deficits not be due to to meet stroke alert criteria?
Head trauma
Stroke mimic
Blood glucose less than 60
287
How should a stroke alert patient be positioned?
Supine
| Head elevated 30 degree unless patient cannot tolerate it
288
How much o2 should be given to the stroke alert patient with Sp02 above 94%?
None
289
How much oxygen should be given to stroke alert patient with Sp02 below 94%?
2 LPM NC
290
Whens should you administer high flow 02 and assist ventilations in a stroke alert patient?
If Sp02 cannot be maintained at 94% with NC at 2 LPM
or
Patient is in respiratory distress
291
What should be determined and documented in stroke alert patients?
Time of onset of symptoms
| Defined as last time the patient was seen without symptoms
292
What should a neurological exam in a stroke alert patient consist of?
Level of consciousness
GCS
Cincinnati prehospital stroke scale
293
What should be continually done during transport of the stroke alert patient?
Reassess of the patient and there sysmptoms
294
What should you be considering when a patients chief complaint is syncopal episode?
```
Med side effect
Glucose imbalance
Inner ear disorder
CVA
TIA
MI
```
295
What information should be obtained from patient or bystanders in adult toxicologic disorders?
```
Which drug, poison or other substances was patient exposed to
Route of exposure
When and how much
Duration of symptoms
Depressed or suicidal
Exposure accidental
Nature of accident
Duration of exposure
```
296
What 2 things should be transported with adult toxicologic patients?
Pill bottles
| Suicide notes
297
When treating a patient with a snake bite how often should you make the level of swelling with a pen?
Every 15 minutes
298
How should yo position the snake bit patient?
Supine
299
How should the snake bit victims extremity be kept?
At a neutral level
300
What should be done with all jewelry from a snake bite patient?
Remove and secure
301
How should you treat a snake bite patient?
Splint affected area
Keep patient quiet
Wash area with copious amounts of water
302
Should yo attempt to identify a snake in a snake bite victim?
Yes, if safe to do so
303
How do you treat dog, cat and wild animal bites?
Would care, BLS
| Clean wound with soap and water
304
When would you not use hydrogen peroxide on animal bite patients?
When wounds are deep or fat is exposed
305
What should yo advise dispatch to do in animal bite cases?
Contact animal control and police dept for identification and quarantine of animal
306
How should yo attempt to remove a stinger from a insect sting patient?
Scrapping patients skin with edge of flat surface
307
Why should you not attempt to remove a stinger by pulling it from a insect sting patient?
This may release more venom
308
How should you clean a insect sting patients wound?
Soap and water
309
How can you attempt to relieve pain of a marine animal envenomation?
Immerse punctures in non scalding hot water to tolerance
310
What temperature of water should be used to help relief pain from a marine animal envenomation?
110 - 113
311
How long should you attempt to immerse a marine animal envenomation in 110 -113 degree water?
30 to 90 minutes
312
What should be done with any visible pieces of the spine or sheath of a marine animal?
Remove
Gently wash with soap and water
Irrigate with water(avoid scrubbing)
313
For marine animal stings you should?
Rinse with sea water
Do not use fresh water, ice, do not rub skin
Apply acetic acid 5% vinegar until pain is relieved
314
What can be used to treat marine animal stings if vinegar is unavailable?
Paste of baking soda or unseasoned meat tenderizer
315
What should be sued to remove large tentacle fragments in marine animal stings?
Forceps
316
What can you apply to skin a marine animal sting to be shaved off with flat edge of credit card?
Shaving cream
| or Paste of baking soda
317
Signs and symptoms of CNS depressant overdose?
```
AMS
Resp depression
Hypotension
Pulmonary edema
Bradycardia
Coma
Constricted pupils(opioids only)
```
318
When would you administer sodium bicarbonate in CNS depressant overdose?
When the QRS of an ECG is wide(greater than 0.10)
| 1mEq/kg IV
319
When should you administer narcan in the CNS depressant overdose?
When respiratory is depressed
320
When should narcan be repeated in CNS depressant to maintain its effects?
Every 20 - 30 minutes
321
Signs and symptoms of CNS stimulant overdose?
```
Dilated pupils
Agitation
Paranoia
Bizarre behavior
PVC
Tachycardia
Hypertension
Seizures
```
322
What should be done for the CNS stimulant overdose patient who is hot to the touch?
Aggressively cool patient
323
What drugs are contraindicated in cocaine overdose?
Beta blockers
324
Signs and symptoms of digitalis toxicity?
Bradycardia
AV block with rapid ventricular response
SVT
Ventricular ectopy
325
Other ECG changes that may be associated with digitalis toxicity include?
Wide PR interval greater than 0.20
Short QT interval(rate dependent)
Spoon shaped ST segment
Peaked T waves
326
Contact with what type of tree can cause digitalis type toxicity?
Oleander tree
327
What medication should be avoided in digitalis toxicity patients with tachydyhythmias?
Calcium Chloride
328
How should you treat unstable tachycardia in the digitalis toxicity patient?
Synchronized cardioversion
329
How should you synchronize cardiovert a patient with digitalis toxicity?
With 5 - 20 joules
330
When would you administer sodium bicarbonate in the digitalis toxicity patient with unstable bradycarida?
When the QRS is wide(greater than 0.10)
331
What are some signs and symptoms of hallucinogen overdose?
```
Poor perception of time and distance
Paranoia
Anxiety
Panic
Unpredictable behavior
Emotional instability
Possible flashbacks
Dilated pupils
Rambling speech
```
332
What should you attempt to do to the hallucinogen overdose patient?
Talk them down
333
Signs and symptoms of tricyclic antidepressant overdose?
```
CNS depression
Tachycardia
Dilated pupils
Respiratory depression
Slurred speech
Twitching and jerking
Seizures
ST segment and T waves changes
Wide QRS complex
R waves in lead AVR
S waves in lead AVL and lead 1
Shock
```
334
What questions should be asked to the pregnant patient?
```
Number of previous pregnancies including miscarriages
Number of previous liver births
Due date
Hx of complications
Duration and frequency of contractions
Evidence of blood or spotting
Did water break
Have urge to push
Feel like have to move bowels
```
335
What does gravida mean?
Number of previous pregnancies including miscarriages
336
What does Para mean?
Number of previous live births
337
When asking if a pregnant patient if her water broke what other questions should accompany this?
When
What color
Odor
338
How are duration of contractions measured?
Timed from when the contraction starts to when it ends
339
How are frequency of contractions measured?
From the beginning of one to the beginning of the next
340
When should an external visual examination for crowning be performed in the pregnant patient?
If the patient complains of uterine contractions to determine if delivery is imminent
341
How should a mother with a prolapsed cord be positioned?
Knee to chest position
| or Supine with pillows under buttocks
342
How should the cord be cared for prolapsed cord delivery?
Wrapped in warm sterile soaked dressing
| Do not attempt to push cord back
343
What should be checked for in prolapsed cord?
Pulse with a gloved hand
344
If there is no pulse in a prolapsed cord what should you do?
Reposition mother and recheck
If not pulse is restored you should insert a gloved hand into the vagina and lift the fetal head or other presenting part off of the umbilical cord while gently pushing the fetus into the uterus
With the other hand push on the lower abdomen in an upward or cephalic direction
Push fetus back far enough to regain a pulse in the umbilical cord
Transport patient immediately while maintaining fetal position so as to maintain umbilical pulse
345
How should a breech birth be delivered?
Do not pull on newborn
Allow for normal delivery supporting with the palm of your hand and arm allowing head to deliver
346
In a breech birth if the head is not delivered in 3 minutes you should?
Place a gloved hand into the vaginal with your palm towards the face of the newbord
Form a V with your index fingers on either side of the newborns nose
Push the vaginal wall away form the newborns face to create an airspace for the newborn until delivery of the head
Suction may be provided as needed
Transport immediately while maintaining the airspace for the newborn
347
In a delivery with limb presentation how should you position the mother?
Knee to chest position
| or supine with pillows under buttocks
348
What should be done immediately in limb presentation delivery?
Transport immediately
349
When is a delivery of a newborn considered shoulder dystocia?
When the head delivers normally and then retracts back into the perineum because the shoulders are trapped between the symphysis pubis and sacrum(turtle sign)
350
How can you facilitate delivery in shoulder dystocia?
Have mother drop her buttock off end of the bed and flex her thighs upward
Apply firm pressure with an open hand immediately above the symphysis pubis
If delivery does not occur you should transport immediately
351
What is evidence of imminent delivery?
Crowning at the vaginal opening
352
What position should a patient with signs of imminent delivery be placed in?
Comfortable, supine
353
How should you assist expulsion of the newborn from the birth canal in its natural descent?
Gently and carefully
354
Upon complete presentation of a newborns head you should?
Instruct mother to stop pushing
Clear airway by gently suctioning
Inspect newborns neck for umbilical cord
Instruct mother so start pushing once airway has been cleared
355
In what order do you suction a newborns airway?
Mouth then nose
356
If a newborns umbilical cord is wrapped around the neck and you are unable to unwrap it what should you do?
Clamp it twice and cut between clamps
357
Upon complete delivery of newborn where should you keep the newborn and why?
Level with the vagina
| To prevent over or under transfusion of blood from the cord
358
How are umbilical clamps applied?
8 inches from naval
| 2 inches apart
359
Do you ever milk the umbilical cord?
No
360
How should you avoid holding the newborn and why?
By the legs allowing for the head to hang below the body
This may cause cerebral hemorrhage
361
What should you do if meconium is noted in the newborns airway?
See newborn resuscitation protocol
362
How should a newborn be cared for?
Wrapped in a blanket to preserve body heat
363
What is a major area of heat loss in newborns?
Head
364
When should APGAR be performed?
1 and 5 minutes
365
When performing APGAR when number would tell you begin resuscitation?
Less than 7
366
What is normal for a mothers vagina to do after delivery of a baby?
Ooze blood
| Do not pull on umbilical cord
367
If active hemorrhage is noted from a mothers vagina you should perform?
Continuous uterine fundus massage
368
What will breastfeeding for the mother do after delivery of a newborn?
Aid in contraction of the uterus
Help stop bleeding
Facilitate delivery of the placenta
369
Should you wait for delivery of the placenta before transporting?
No necessary
370
After delivery of the newborn you should clean and inspect the vagina for?
Inspect the perineal area for tears and active bleeding
371
What can be given to manage pain in uncomplicated delivery?
Nitronox
| It is a ALS level 2 order
372
Causes of nontraumatic vaginal bleeding?
```
Anterpartum hemmorrhage
Postpartum hemorrhage
Ruptured ectopic pregnancy
Ruptured ovarian cyst
Spontaneous abortion
```
373
What should be place in a plastic bag and brought to hospital after delivery?
All products of delivery
374
When should you administer a fluid challenge of 250-500 of NS in non traumatic vaginal bleeding?
Hypotensive with a BP of less than 100
375
What are 3 signs of toxemia in pregnancy?
Proteinuria(dark colored urine)
Excessive weight gain
Hypertension
376
How may signs of toxemia in pregnancy should a patient have to be classified as pre-eclampsia?
2 of 3
377
What demonstrates need for immediate treatment in the toxemia of pregnancy patient?
Witnessed continuous convulsions
Repeated episodes with regaining conciousness
Sufficient respiratory decompensation
378
Can mag sulfate be repeated in the toxemia of pregnancy patient?
Yes
| 2g mixed in 50 mL of D5W given over 5-10 minutes
379
If a toxemia of pregnancy patient continues to seizure after 2 doses of mag sulfate what should you do?
Administer benzodiazepine
380
What skin signs and symptoms of allergic reaction?
```
Flushing
Itching
hives
Swelling
Cyanosis
```
381
Respiratory signs and symptoms of allergic reaction?
```
Dyspnea
Sneezing
Coughing
Wheezing
Stridor
Laryngeal edema
Laryngealspasm
Bronchospasm
```
382
Cardiovascular signs and symptoms of allergic reaction?
Vasodilation
Increased HR
Decreased HR
383
Gastrointestinal signs and symptoms of allergic reaction?
Nausea
Vomiting
Diarrhea
Abdominal cramping
384
CNS signs and symptoms of allergic reaction?
Dizziness
Headache
Convulsions
Tearing
385
What are the severity level of allergic reactions?
Mild
Moderate
Severe or anaphylaxis
386
Signs and symptoms of a mild allergic reaction?
BP greater than 110
No dyspnea
Stable vitals
Redness and or itching
387
How do you treat mild allergic reaction
Diphenhydramine
388
What is the dose of diphenhydramine IV in mild allergic reactions?
25mg
389
What is the dose of diphenhydramine IM in mild allergic reactions?
50mg
390
Signs and symptoms of moderate allergic reaction?
```
Edema
Hives
Dyspnea
Wheezing
Lump in throat
Difficulty swallowing
Facial swelling
BP greater than 90
```
391
Drugs that may be given in moderate allergic reactions?
Diphenhydramine
Epi 1:1000
Albuterol
Atrovent
392
Dose of diphenhydramine in moderate allergic reactions?
50 mg
| IM or IV
393
Dose and route of Epi in moderate allergic reactions?
0.3
1:1000 IM
May be repeated once
394
How many times may albuterol be repeated in moderate allergic reactions?
Twice
395
What may you administer in no other means of Epi are available?
Epipen
396
If a allergic reactions HR is above 140 you must call orders to administer what?
Bronchodilators
397
What medication do you not give if a moderate allergic reaction patients HR is above 140?
Albuterol
| Atrovent
398
Severe allergic reactions signs and symptoms?
```
Edema
Hives
Severe dyspnea
Wheezing
Unstable vital signs
Systolic BP less than 100
Cyanosis
Laryngeal edema
```
399
What should be considered in severe allergic reaction?
Advanced airway
400
Can Epi 1:10,000 be given in severe allergic reactions?
Yes
| It is a level 2 order
401
What is the dose of Epi 1:10,000 in severe allergic reactions?
0.3 mg
Slow IV
0.1 mg increments over 2 minutes
402
Blood glucose above _____ and below __ is considered a diabetic emergency?
Above 300
| Below 60
403
In the abdominal pain patient you should ask the patient to point to the paint and you should palpate this area?
Last
404
Palpate abdominal pain patient for?
```
Tenderness
Rebound tenderness
Distention
Rigidity
Guarding
Pulsating masses
Flank for CVA tenderness
```
405
All patients of childbearing age with abdominal paint should be considered to be having?
Ectopic pregnancy
406
How much fluid should you administer to the abdominal pain patient who is hypotensive?
500 Ml NS
407
Sickle cell anemia is?
Chronic hemolytic anemia characterized by presence of sickle shaped blood cells
408
Who does sickle cell anemia patients almost always exclusively occur in?
African americans
409
What does sickle cell crisis occur from?
Occlusion of blood vessel by masses of misshaped blood cells
410
What is the principle manifestation of a sickle cell anemia crisis?
Pain in the joints and back
411
Hepatic, pulmonary, or central nervous system pain can occur in what type of anemia crisis?
Sickle cell anemia
412
Sickle cell disorder patients have high incidence of what?
Life threatening disorders at a young age
413
How much oxygen should be given to the sickle cell anemia crisis patient?
15 LPM via NRB
414
How much fluid should be given to the sickle cell anemia crisis patient?
500-1000 mL NS
415
What medication should be given to the sickle cell anemia crisis patient to help relief pain?
Morphine
416
What should you initial effort be for the patient in an Enviromental emergency?
Remove patient from the harmful enviroment
417
What causes barotrauma and decompression illness?
Surrounding atmospheric pressure beyond the bodies ability to compensate for excess gas load
418
Barotrauma and decompression illness are mostly commonly associated with the use of what?
Self contained underwater breathing apparatus
419
SCUBA emergencies can occur at what depth?
Any depth
420
When do most serious dive injuries symptoms occur?
After a dive
421
If a patient took a breath from any compressed gas source while greater than how many feet could the patient be a victim of barotrauma?
3 feet
422
Barotrauma may cause several injuries to include?
```
Arterial gas embolism
Pneumothorax
Pneumomedistium
Subcutaneous emphysema
The squeeze
```
423
Decompression illness may also include?
Decompression sickness(bends)
424
How much oxygen should be given to the barotrauma/decompression illness patient?
15 LPM
425
What position should the barotrauma/decompression illness patient be placed in?
Supine
426
What should be completed on all dive accidents?
Dive accident checklist
427
Who may be helpful in answering dive history questions?
Dive buddy
428
Who should secure the dive victims gear?
Legal authority
Police
Marine patrol or coast guard
429
Why should you make sure dive gear is handled in the proper chain of custody?
For testing, analysis and other measure
430
Where should dive accident patients be transported to?
Closest emergency trauma center with a helipad
431
What altitude must dive accident victims stay under during air transport?
1000 feet
432
Who should you contact for dive accidents?
Divers alert network at duke university
| 919 684 4326
433
If available what should be brought to the hospital with dive accident victims?
Dive computer
434
Some factors that predispose and/or cause a patient to develope hypothermia?
```
Geriatric
Pediatric
Poor nutrition
Diabetes
Hypothyroidism
Brain tumors
Head trauma
Sepsis
Alcohol
Certain drugs
Prolonged exposure to water
Prolonged exposure to low temp
```
435
3 categories of hypothermia?
Mild
Moderate
Severe
436
Body temp considered mild hypothermia?
94 - 97
437
Moderate hypothermia body temp?
86 - 94
438
Severe hypothermia body temp?
Less than 86
439
most oral thermometers wont ready temp below?
96
440
What will some tympanic thermometers read temps between?
68 and 108
441
Mild ot moderate hypothermia patients will generally present with?
Shivering
Lethargy
Stiff
Uncoordinated muscles
442
Severe hypothermia patients will typically present with?
Disorientation
Confusion
To the point of stupor or coma
443
What level of hypothermia will shivering usually stop and physical activity will become uncoordinated?
Severe
444
What changes on ECG will sometimes be seen in severe hypothermia?
Osborn wave or J wave
445
What should be removed from all cold related emergency patients?
Wet clothing
446
What should you protect hypothermia patient from?
Heat loss and wind chill
447
What position should the hypothermia patient be placed in?
Horizontal
448
What should you avoid with the hypothermia patient?
Rough movement and excessive activity
449
Where should heat be added to the hypothermia patient?
Head, neck, chest, groin
450
What fluids should be given to the hypothermia patient?
Warm
451
When would you not treat dysrhythmias in the cardiac arrest patient?
Body temp is below 86 degrees
452
How do you treat frostbite?
Bandage with dry sterile dressing
| Transport without rewarming
453
How can hypothermia manifest?
Heat cramps
Heat exhaustion
Heat stroke
454
What drugs can cause increase in body temp?
Drugs like cocaine and ecstasy
455
Signs and symptoms of heat cramps?
```
Muscle cramps of fingers, legs and abdomen
Sweaty
Hot skin
Weakness
Dizziness
Tachycardia
Normal BP
Normal temp
```
456
Signs and symptoms of heat exhaustion?
```
Cold clammy skin
Profuse sweating
Nausea/vomiting
Diarrhea
Tachycardia
Weakness
Dizziness
Transient syncope
Muscle cramps
Headache
Positive orthostatic vitals
Normal or slightly elevated temp
```
457
Signs and symptoms of heat stroke?
```
Hot dry skin
Confusion and disorientation
Rapid bounding pulse followed by slow weak pulse
Hypotension
Low or absent diastolic reading
Rapid and shallow respirations which may later slow
Seizures
Coma
Elevated temp
```
458
What temperature should you cool a heat stroke patient to?
102
459
If a heat stroke patient has a systolic BP less than 90 with IV fluids what should you avoid using?
Vasopressors and anticholinergic drugs
| They may potentiate heat stroke by inhibiting sweating
460
Drowning is the process resulting in primary respiratory impairment from?
Submersion in a liquid medium
461
When possible who should remove a patient who is still in the water upon arrival of EMS?
Dive rescue
462
Why should non fatal drownings be transported to the hospital regardless of how well they seem to have recovered?
Because death or complications due to pulmonary edema or aspiration pneumonia are not uncommon
463
Electrical emergencies can occur from?
Direct contact
An arc
Flash of electricity
Splash from lightening
464
Why should c-spine be protected in the electrical emergency patient?
Movement of electricity current through the body can cause violent muscle contractions that can lead to fractures
465
Thermal energy causes what type of burns?
External and internal
466
In most cases of electrical energy causes what type of burns?
Internal
467
What is common in electrical emergencies besides burns?
Dysrhythmias
468
What should be done in all electrical emergencies before initiating treatment?
Be sure patient is no longer in contact with electrical current
469
What should you try to determine with electrical emergencies?
Amps, Voltage, and duration of contact
470
What is common presentation with lightening strikes?
Asystole
| These patients should be aggressively resuscitated unless injuries are incompatible with life
471
What causes most patients who have had an electronic controlled device used on them?
The events that led up to the device being used on them
472
When responding and evaluating patients who have had electronic control device used on them you should use this seven step approach
Find out what happened before the patient was subdued to give you some information on there mental status
Approach patient with caution
Complete a thorough physical exam
Consider potential for sudden unexpected death syndrome
```
During transport be very conscientious of patients whom exhibit on or more of the following symptoms
ExDs
Persistent abnormal vitals
Hx of physical findings consistent with amphetamine or hallucino
Cardiac Hx
ALOC or aggressive violent behavior
Evidence of hypothermia
Abnormal subjective complaints
```
473
Who should remove probes from taser?
Not EMS
| Transport with them attached, cut wires
474
Probes should be treated as?
Contaminated sharp
475
What care should all patients who a taser is used on receive?
Supportive and ALS level 1
476
What should be determined about the energy used on patients from a taser?
How many 5 seconds cycles of energy the individual was exposed to
477
ALS level 1 for electronic control devices?
Cardiac monitoring
Glucose
Use hyperthermic protocol if exhibiting signs of ExDs
478
What should priority be given to in trauma alert patients?
Airway management
Rapid preparation for transport
Control of gross hemorrhage
479
In a trauma patient who is hypovolemic(BP less than 90) how much fluid should be given?
1 to 2 L
| 20mL/kg
480
What is the max total fluids that should be given in trauma alert patients?
3 liters
481
When should physician consult be used prior to administering large amounts of fluids to a trauma alert patient?
When patient has a transport time of less than 20 minutes
482
How should a female in her second or third semester(greater than 20 weeks) of pregnancy be transported?
Left side
| If on backboard tilt it to side
483
What can happen to a pregnant patient who is not positioned on her side?
Hypotension due to decreased venous return
484
In the head and spine injury patient if patient is not hypotensive(systolic BP greater than 100) you should?
Elevate backboard 30 degrees
485
Signs and symptoms of brain stem herniation?
Pupillary dilation
Asymmetric pupillary reactivity
Motor posturing
486
What should you do to the patient who presents with signs and symptoms of brain stem hernation?
Consider placement of advanced airway
| Hyperventilation
487
In the patient presenting with signs and symptoms of brain stem herniation what EtCo2 should you hyperventilate to?
30 to 40
488
What should you avoid giving to the patient with head and spine injuries who is seizing?
glucose containing solutions and medications
489
Who should remove the patients contact lens in eye injuries?
Patient
490
How do you care for a penetrating object to the eye?
Stabilize object and cover entire eye with rigid device
Cover both eyes to minimize eye movement
Avoid direct pressure on either eye or object
491
If patient with eye injures eyeball has been forced out of socket you should?
Cover it with a ridged container
Avoid contact with exposed globe
Apply pressure with sterile dry dressing if bleeding is present
492
How do you treat an eye injury if you suspect exposure to chemicals or foreign body?
Irrigate with normal saline
493
Tetracaine cannot be given to?
Penetrating eye injuries
| Patients with allergies to lidocaine
494
Penetrating injuries to the chest or upper back should be?
Covered immediately with an occlusive dressing
495
How many sides should an occlusive dressing be secured on?
3
496
What should you monitor for in the penetrating chest injury?
Tension pneumothorax
497
How can you attempt to relieve/prevent tension pneumothorax in a penetrating chest injury patient?
Burp the dressing
498
If a penetrating object is large and unwieldy in the chest injury you should?
Attempt to cut it to no less than 6 inches from chest
499
In a tension pneumothorax you should attempt to decompress the chest on which side?
Affected side
500
In a patient with a massive flail chest without severe compromise you should attempt to stabilize it by?
Placing the patients ipsilateral arm in a sling and swathe
501
For traumatic asphyxia you should establish?
2 large bore IV's
502
In traumatic asphyxia if the crushing object is still on the patient you should do what prior to attempt the object off the patient?
Infuse a minimum of 1 L fluid
| Amin sodium bicarb 1 mEq/kg
503
For traumatic asphyxia you should admin what?
Sodium bicarbonate 1 mEq/kg IV
504
Blunt injuries such as pulmonary contusion and cardiac contusion may causes?
Respiratory insufficiency
| Myocardial infarction
505
How do you treat patients with abdominal evisceration?
Cover organs with saline soaked sterile dressing
Cover with occlusive dressing
Do not attempt to place back inside
506
How do you get patients with suspected pelvic fracture onto stretcher?
Use scoop
| Do not roll
507
If pelvic fracture is suspected you should attempt to stabilize patient with a?
Sheet sling
508
Closed angulated fractures should be?
Aligned using proximal and distal traction during splinting
509
When would you not align closed angulated fractures?
If it involves a joint(splint in position found)
510
When should traction splints be used?
Closed femur fractures unless pelvic fracture is suspected
511
Amputations should be dressed with?
Bulky dressings
512
A amputated limb should be?
Placed in a plastic bag and placed on ice for transportation to hospital
513
If bleeding is not controlled with direct pressure in an amputation you should?
Apply a tourniquet
514
What should determine if a traumatic arrest is resuscitated?
Paramedic judgment
| Possibility of organ harvest
515
Avoid use of what medications in cases of suspected hypovolemia in traumatic arrest?
Vasopressors
516
Burn patients are volume?
Depleted
517
Many burn injuries are associated with?
Inhalation injuries
518
Signs and symptoms of inhalation injuries?
Nasal and oropharyngeal burns
Abnormal lung sounds
Respiratory distress
519
In inhalation injuries the paramedic should consider the need for early intubation because?
Swelling to the airway can cause complete obstruction
| Early intubation can help avoid complete airway obstruction that requires Cricothyroidotomy
520
How do you stop the burning process in thermal burns?
Lavage the burned area with tepid water to cool the skin
| Do not attempt to wipe off semi solids
521
How do you stop the burning process in dry chemical burns?
Brush off dry powder
| Lavage with copious amounts of tepid water for 15 minutes
522
Should you remove clothing form burned patient?
Yes from around the burned area
| Do not peel off skin or tissue
523
When should you use dry sterile dressing or water gel to cover burns?
Equal to or greater than 20% 2nd degree burns or 5% 3rd degree burns
524
If there is less than 20% second degree burns or less than 5% of 3rd degree burns you should apply?
Wet sterile dressing to burned area for 15 minutes to aid in pain control
525
Prevent hypothermia in the burn patient by?
Keeping them warm and ensuring all outer layers of dressing are dry
526
Obtaining a Hx of a patient with specials needs includes asking parent or caregiver?
```
Normal vitals
Actual weight
Developmental level of patient
Allergies including latex
Pertinent medications/therapies
```
527
Home mechanical ventilators may be indicated for?
Chronically ill adults with abnormal respiratory drive
Severe chronic lung disease
Severe neuromuscular weakness
528
The need for home mechanical ventilators may either be?
Continuous or intermittent
529
Home mechanical ventilators may either be?
Volume or pressure limited
530
All home mechanical ventilators are equipped with?
Alarm
531
Types of home mechanical ventilator alarms?
```
Lower pressure or apnea
Low power
High pressure
Setting error
Power switchover
```
532
What can a low pressure or apnea alarm be caused by?
Loose of disconnected circuit
| Air leak in the circuit or tracheostomy resulting in inadequate ventilation
533
Low power mechanical ventilator alarm may be caused by?
Depleted power
534
High pressure mechanical ventilator alarm may be caused by?
Plugged or obstructed airway or circuit tubing
| Coughing or bronchospasm
535
A setting air alarm in a home mechanical ventilator may be caused by?
Settings outside the normal capacity
536
When does a power switchover alarm occur in a home mechanical ventilator?
When the unit switches from alternating current to battery power
537
What can you do for a patient on a home mechanical ventilator who is in respiratory distress and the cause cannot be easily determined?
Remove the ventilator and provide assisted ventilations with BVM
538
What are tracheostomies used for?
Long term ventilatory support to bypass an upper airway obstruction
Aid in the removal of secretions
539
Tracheostomies can either be?
Single or double lumen
540
Signs of tracheostomy obstruction?
```
Excess secretions
No chest wall movement
Cyanosis
Assessor muscle use
No chest wall rise with BVM
```
541
Special attachments to a tracheostomy include?
Inject 1 to 3 mL NS into the tube and suction as needd
542
If unable to clear an obstruction from a tracheostomy tube with saline and suctioning you should?
Remove it and replace it with another of the same size of one smaller
543
If unable to insert a new or one is unavailable in tracheostomy you should?
Insert ET tube of a smaller size into stoma and ventilate with BVM
544
How do you ventilate a patient with a stoma?
Over the stoma or over the mouth while covering the stoma
545
What are central venous lines used for?
```
Admin of medications
Delivery of chemotherapy
Nutritional support
Infusion of blood products
Blood draws
```
546
Types of central venous lines?
Broviac/Hickman
Port a cath/Med a port
Percutaneous intravenous catheters
547
Types of central venous line emergencies?
```
Catheter coming out
Bleeding at site
Catheter broken in half
Blood embolus
Thrombus
Air embolus
Internal bleeding
```
548
Can you use SQ ports for IV access?
No, these require special training
549
Signs of blood embolus, thrombus, internal bleeding the central venous line patient include?
Chest pain
Cyanosis
dyspnea
Shock
550
Under sterile conditions can PIC or CVP line be used in emergency conditions?
Yes
551
If a central venous catheter has come completely out you should?
Apply direct pressure to the site
552
If a central venous catheter is broken in half you should?
Clamp the end of the remaining tube
553
If blood embolus, thrombus, or internal bleeding is suspected you should?
Clamp the line
554
If air embolus is suspected in the central venous line patient you should?
Clamp the line and place the patient on his left side
555
What are some potential complications of feeding tubes?
Leaks
Bleeding around the site
Displacement of tube
556
Feeding tubes are used for patients who?
Have the inability to swallow
557
If a feeding tube has come completely out you should?
Cover the site with vaseline gauze and apply direct pressure
558
Types of feeding tubes?
Nasogastric(temp)
| Gastrostomy(G tubes)
559
Types of G tubes?
```
PEG tubes(percutaneous endoscopic)
J tubes(jejunal tubes)
```
