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Royal College: Emergency Medicine > EMS > Flashcards

EMS Flashcards

This deck covers Chapters 190-193 in Rosens, compromising all of EMS.

1
Q

Outline differences in the management of hypothermic arrest

A
  • Pulse checks last 30 seconds
  • Max 3 shocks until temp >30 degrees
  • No IV medications until temp >30
  • Some say epi x3 max
  • Actively rewarm
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2
Q

What are the medical TOR guidelines for BLS vs ALS crew?

A

BLS

  1. Unwitnessed by EMS
  2. No ROSC
  3. No shock delivered

ALS

  1. Unwitnessed by EMS
  2. No ROSC
  3. No shock delivered
  4. Unwitnessed by bystander
  5. No bystander CPR
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3
Q

What are 6 characteristics of an ‘ideal’ hemostatic agent?

A
  1. Easy to use
  2. Non-perishable
  3. Flexible
  4. Durable
  5. Cheap
  6. Effective
  7. Adheres to wound only
  8. No tissue damage
  9. No disease risk
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4
Q

List 5 indications for cardiac monitoring post lightning strike

A
  1. Cardiac arrest
  2. ECG changes
  3. Dysrhythmia
  4. Chest pain
  5. CAD
  6. Cardiac RF
  7. LoC
  8. Significant injury
  9. Hypoxia
  10. Conductive injury
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5
Q

List 3 drugs used to assist treatment in internal radioactive contamination

A
  1. Prussian blue
  2. DTPA
  3. Potassium iodide
  4. Penicillamine
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6
Q

Describe 4 levels of PPE

A
  • Level A
  • Maximum resp/skin protection
  • Self-contained breathing system + full suit
  • Level B
  • Maximum resp/moderate skin protection
  • Air purifier, full face mask chemical resistant suit
  • Level C
  • Moderate resp/skin protection
  • Respirator filter + chemical resistant suit
  • Level D
  • Minimal resp/skin protection
  • Routine
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7
Q

List 3 types of anthrax and 2 treatment options

A

Types

  • Inhalational (most lethal - 50%)
  • Cutaneous
  • GI

Treatment

  • Doxycycline
  • Ciprofloxacin
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8
Q

What is the difference between an epidemic and a pandemic?

A
  • Epidemic = incidence higher than expected
  • Pandemic = infectious epidemic across a continent
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9
Q

Define tactical emergency medical support (TEMS)

A

TEMS is the specialty of EMS established to maintain safety, health, and welfare for combat medical units and special operations civilian law enforcement units

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10
Q

List and describe the 3 components of the Medical Priority Dispatch System (MPDS) (Clawson’s System)

A
  1. Chief Complaint Protocol
    * The ‘card’
  2. Determinant Code
    * Type of response
  3. Pre-arrival instructions
    * CPR, deliver baby, recovery position
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11
Q

How do nerve gases work?

A

AChEi

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12
Q

List 9 elements of surge capacity response

A
  • Staff/Stuff/Space
  • Triage/Treat/Transport
  • Defer/Decant/Deflect
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13
Q

What are the 3 goals of Tactical Combat & Casualty Care?

What are the 3 distinct phases that TCCC is divided into?

How is the combat area divided in a TEMS mission?

A

TCCC

  1. Treat the casualty
  2. Prevent additional casualties
  3. Complete the mission

Phases

  1. Care under fire
  2. Tactical field care
  3. Casualty evacuation

Zones

  • Hot zone (imminent threat)
  • Warm zone
  • Cold zone (no threat)
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14
Q

What is the SALT Triage System?

A

SALT

  • Sort - Walk (3rd) vs Wave (2nd) vs Still (1st)
  • Assess - Breathing? Coma? Bleeding? Peripheral pulse?
  • Life-saving Intervention - PTX, Airway, Pressure
  • Treat/Transport
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15
Q

List 6 indications for air transport

A
  1. Distance is too far
  2. Critical condition
  3. Time-sensitive condition
  4. Transport delay with ground EMS
  5. Critical care paramedics needed
  6. Inaccessible to ground EMS
  7. Ground EMS unavailable
  8. Physician requests interfacility transport by air
  9. Scene medical transport needed
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16
Q

List 6 conditions a search and rescue team can be used for

A
  1. Hypothermia
  2. Crush injuries
  3. Inhalation injuries
  4. Haz-mat exposure
  5. Blast injuries
  6. Compartment syndrome
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17
Q

What are the 4 components of the START triage system?

A
  1. Walking
  2. Respiration rate (>30 vs <30)
  3. Radial pulse (yes, cap refill < 2s)
  4. Mental status

30:2: CAN DO

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18
Q

What 3 elements would make you suspect bioterrorism?

A
  1. Many patients at once
  2. Geographic locality
  3. Similar presentations (Respiratory/GI/CNS symptoms)
  4. Dead animals
  5. Increased case mortality
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19
Q

Name of the 6 elements of the AHA Chain of Survival

A
  1. Recognition & Activation
  2. Early high-quality CPR
  3. Early Defib
  4. ACLS
  5. Post-arrest Care
  6. Recovery
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20
Q

How would you prepare your patient for air transport?

A
  • Chest tube for PTX
  • Fill Foley/ETT with water
  • NG to decompress the stomach
  • Intubate if CNS/Resp symptoms may deteriorate
  • Usual critical care equipment/monitors
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21
Q

How do you manage a patient with internal contamination with radioactive material?

A
  • Isolation
  • Blocking agent = KI
  • Collect all bodily fluids
  • Chelating agent = DTPA
  • Radioactivity monitoring
  • Supportive care
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22
Q

What are the 4 steps in the field trauma triage guidelines?

A
  1. Vitals
  2. Anatomy
  3. Mechanism
  4. Special circumstances
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23
Q

Describe the differences between single and multi-tiered EMS systems

A

Single

  • Everyone trained the same

Multi-tiered

  • Different training levels result in different response based on call
24
Q

List 5 clinical signs of Botulism infection

A

3 P’s

  • Ptosis
  • Paresis
  • Paralysis

6 D’s

  • Diplopia
  • Dysmetria
  • Dysarthria
  • Dysphagia
  • Descending paralysis
  • Death
25
Q

Name 2 classes and 5 types of dangerous radiation

A

Classes

  • Ionizing
  • Non-ionizing

Types

  1. X-ray
  2. Gamma-ray
  3. Alpha particle
  4. Beta
  5. UV
26
Q

What are 2 bad prognostic signs in Acute Radiation Syndrome?

A
  1. Vomit within 1st hour
  2. 48h lymphocyte count <500
27
Q

List 6 elements of the Haddon Matrix for injury prevention

A
  • Pre-event
  • Event
  • Post-event
  • Host (Patient)
  • Agent (Vehicle)
  • Vector (Environment)
28
Q

List 5 human cavities/spaces affected by air medical transport

A
  1. Middle ear
  2. Sinuses
  3. Teeth
  4. GI (hollow viscous)
  5. Thoracic (pleural space)
  6. Mediastinum
29
Q

Name 3 roles for a physician on scene at a mass casualty incident

A
  1. Destination triage
  2. Online medical control of EMS
  3. RED - Advanced level care
  4. GREEN - Treat & Release
  5. Field amputation
  6. Pronounce death
30
Q

List 3 ways radiation affects your body

A
  1. Irradiation
  2. Internal contamination
  3. External contamination
31
Q

What 3 body systems are most affected by radiation?

A
  1. CNS
    * Seizure, Tremor
  2. GI
    * N/V/D
  3. Hematologic
    * Cell lines down
32
Q

Define the four objectives of urban search & rescue (USR). What are 4 components? What is the golden day?

A

Urban Search & Rescue

Science of responding to, locating, reaching, medically treating, and extricating people in collapsed structures

Objectives

  1. Locating
  2. Reaching
  3. Treating
  4. Extracting

Components

  1. Search team
  2. Rescue team
  3. Medical team
  4. Technical team

Golden Day

  • Extraction within 24h or mortality rate increases greatly
33
Q

List the 4 phases of disaster response

A
  1. Mitigation
    * Reduce impact before
  2. Preparedness
    * Training drills
  3. Response
    * Assess and coordinate resources
  4. Recovery
    * Debrief and back to normal
34
Q

Describe ONLINE and OFFLINE medical control

A

Online

  • Direct consultation with MD
  • Can use nearby hospital or ‘base hospital’
  • ie. patch phone

​Offline

  • Medical directives
  • QA
  • EMS CME
  • Prospective/Retrospective care review
35
Q

In regards to disaster response, name 6 essential societal functions

A
  1. Public Health
  2. Sanitation/Hygiene
  3. Shelter
  4. Engineering
  5. Transportation
  6. Search & Rescue
  7. Economy
  8. Medical
  9. Food
  10. Energy
36
Q

What are the components of the Incident Command System?

A

COMICAL FLOP

  • COMMunications
  • IC (Incident Commander)
  • Liaison
  • Finance
  • Logistics
  • Operations
  • Planning
37
Q

Draw the START triage algorithm

A
  1. Assess ambulation
    * If walking = GREEN
  2. Assess airway
    * If no RR = Position airway
    * BLACK if No change
    * RED if Breathing
  3. Assess respiratory rate
    * RED if >30/min
  4. Assess perfusion (cap refill or radial pulse
    * RED if Delayed/Absent
  5. Assess mental status
    * RED if Altered
    * YELLOW if Follows commands
38
Q

List 4 types of chemical warfare agents and given an example of each.

A
  1. Nerve agents
    * Sarin/Soman/VX
  2. Asphyxiants
    * CO/Cyanide/H2S
  3. Irritants
    * Cl, Ammonia, Sulfur dioxide
  4. Vesicants
    * Mustard, Phosgene
39
Q

What is the JUMP-START Triage system?

A

Very similar to START - Pediatric

  • All children get 5 rescue breaths before BLACK
  • Peds specific resp rates
  • Mental status uses AVPU
40
Q

List 4 advantages and 4 disadvantages of fixed vs rotary-wing transportation

A

Fixed

  • Pros
  • Longer distance
  • Pressurized
  • More space
  • More equipment
  • Quieter
  • Cons
  • Airport
  • Requires ground crew
  • No scene landing
  • Slower
  • Can’t get remote

Rotary

  • Pros
  • Faster
  • Scene landing
  • Remote locations
  • No need for ground transport
  • Cons
  • Loud
  • Not pressurized
  • Shorter distances
  • Less space
  • Less equipment
  • Weather restrictions
41
Q

List 5 infectious agents needing airborne precautions

A
  1. Measles
  2. Monkeypox
  3. TB
  4. Smallpox
  5. Varicella
  6. COVID-19
42
Q

Describe the Potential Injury Creating Event (PICE) system

A
  • A - Potential for additional casualties
  • Static vs Dynamic
  • B - State of local resources
  • Disruptive vs Paralyzed
  • C - Geographic involvement
  • Local vs Regional vs National vs International
43
Q

Name 3 critical substrates for normal hospital operations

A
  1. Physical plant
  2. Personnel
  3. Supplies/Equipment
  4. Communications
  5. Transportation
  6. Managerial system
44
Q

List the goals/tasks during each phase of TCCC

A

Care Under Fire (Hot)

  • Hemorrhage control
  • Returning fire
  • Self-aid/buddy aid

Tactical Field Care (Warm)

  • TEMS provider
  • Hemorrhage/tourniquet control
  • Basic airway (eg. NP)
  • Needle decompression
  • IO access

Casualty Evacuation (Cold)

  • ALS
  • TEMS provider
  • Evacuation (Ambulance/helicopter)
45
Q

List 6 factors affecting injury/illness rate at mass gatherings

A
  1. Planned
  2. Duration
  3. Attendance
  4. Demographics
  5. Weather
  6. Purpose
  7. Alcohol/Drugs
  8. VIP presence
  9. Crowd mobility
  10. Access/Egress routes
  11. Availability of food/water/shelter
  12. Availability of medical resources
46
Q

List the 4 stages of a blast injury

A
  • Primary
  • Blast
  • Secondary
  • Flying objects hit you
  • Tertiary
  • Landing
  • Quaternary
  • All other injuries
    * Toxic inhalation, radiation, burn, etc.
47
Q

Discuss the effects of mustard gas on the body

A
  1. Blistering agent (vesicant)
  2. Bone marrow suppression
  3. Leukopenia

Treatment

  • Supportive
  • Burn care
  • Tetanus
  • Prophylactic antibiotics
48
Q

What are the three zones in a chemical spill? Where do people get decontaminated?

A

Hot Zone

  • Site of spill

Warm Zone

  • Site of decontamination

Cold Zone

  • Safe
49
Q

List 4 reasons why children are more prone to biochemical terrorist attacks.

A
  1. Faster RR
  2. Closer to ground
  3. Thinner skin
  4. CNS still in development
  5. BMI and smaller fluid reserve (same amount of agent causes greater concentration in child)
50
Q

What is a medical threat assessment (MTA) that a TEMS unit must consider?

A

Assessment of the potential medical threats that may confront the team during the mission. The plan mitigates and responds to the threats.

51
Q

List 6 contraindications to air travel

52
Q

Explain the 5 steps to put on PPE and 6 steps take off PPE

A

Put On

  1. Hand hygiene
  2. Gown
  3. Mask
  4. Eyewear
  5. Gloves

Take Off

  1. Gloves
  2. Gown
  3. Hand hygiene
  4. Eyes
  5. Mask
  6. Hand hygiene
53
Q

List 3 type of plague and 2 treatment options

A

Types

  • Pneumonic
  • Bubonic
  • Septecemic

Treatment

  • Doxycycline x10d
  • Ciprofloxacin x10d
54
Q

What 3 factors affect your radiation exposure risk?

A
  1. Time
  2. Distance
  3. Shielding
55
Q

Name 3 causes of preventable death in Tactical Combat Casualty Care (TCCC) and recommendations to fix

A

Massive hemorrhage

  • Tourniquet

Tension pneumothorax

  • Decompress

Airway

  • SGA/Intubate/Cric
56
Q

List 6 biologic agents that could be weaponized

A
  1. Anthrax
  2. Plague
  3. Smallpox
  4. Ebola
  5. Tularemia
  6. Botulism
57
Q

List 3 differences between smallpox and chickenpox in terms of clinical presentation

A

Smallpox

  1. Starts on face/arms
  2. Moves to trunk/legs
  3. All lesions same age
  4. On palms/soles

Chickenpox

  1. Starts on trunk
  2. Spreads to face/extremities
  3. Different aged lesions
  4. Not on palms/soles

Royal College: Emergency Medicine (25 decks)

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