EMS Protocol Flashcards
1
Q
Treatment protocols are orders that guide actions that an emergency medical service provider (EMS) is expected to take, and should be followed unless____.
A
the protocol requires such contact with a Medical Control physician. It is imperative that providers establish contact with Medical Control for confirmation of medical care and further medical direction in situations that are not covered in treatment protocols.
2
Q
Our commitment is to ___ the citizens, public and private sector employees, and visitors of the Nation’s Capital.
A
provide the best possible care and service to
3
Q
Providers must contact ___ to administer other prescribed rescue medications not specifically mentioned in the District of Columbia Fire and EMS Medical Protocols or formulary.
A
Medical Control
4
Q
The EMC Bear symbolizes ____.
A
when Pediatric Care is warranted, and Medical Control is required.
5
Q
_____ is a vital component of pre-hospital care.
A
Medical communications
6
Q
Medical communications with Medical Control or a receiving facility should be conducted for every ____ patient.
A
Priority 1
For seriously injured or critically ill patients notification to the receiving facility is required.
7
Q
When communicating with Medical Control or a receiving facility, a verbal reportshould include these essential elements:
A
➢ Identify unit, level of provider and name
➢ Destination hospital and ETA
➢ Patient’s age, sex
➢ Mental status
➢ Patient’s chief complaint
➢ Brief pertinent history of the present illness
➢ Baseline vital signs to include EKG, glucose, or other pertinent assessments
➢ Pertinent findings of the physical exam
➢ Past medical history, current meds and allergies
➢ Treatment rendered in the field
➢ Patient response to emergency care given
➢ Orders requested, repeat granted orders back to physician
➢ If Medical Control is obtained, document the physician’s name
8
Q
When transmitting patient information, DO NOT include___.
A
personal or sensitive information
(e.g. name, social security number, address, race, etc.).
9
Q
Once a patient has received medications administered by any level of DCFEMS provider, the patient is categorically considered an ____ patient
A
ALS level
10
Q
No patient will be turned over to BLS care once ALS interventions (Medications,Airway) have been initiated. An exception to this rule can be made in____.
A
mass casualty or disaster scenario.
11
Q
Transfer of care can take place if :
A
- pt has patent airway , maintained w/o assistance or adjuncts
-is hemodynamically stable, vitals stable & commensurate with pt condition
-pt is at their base line mental status and not impaired from medications or drug ingestion
-no MOI warrants a trauma alert or activation
-no cardiac, respiratory, or neurological complaints warrant ALS intervention exist
-the ALS provider gives the BLS provider a full pt report to include. Vital signs and physical assessment
-the EMT who will be in attendance is comfortable with pt conditions and will assume care .
12
Q
Upon arriving at a receiving facility, EMS providers will not _____.
A
Initiate new medical care once they cross the threshold of that facility.
(Examples include: new IV bags , start O2, Immobilization & restraint application)
13
Q
Hospitals will designated personnel to assess
patients brought by EMS transport unit with the goal of transferring care and releasing the unit within___ of the pt arrival to the ED.
A
10 minutes
14
Q
In the event that transfer of care is delayed for longer than ___, EMS provider will contact the ___, who will in turn contact the authorized hospital point of contact and attempt to resolve the delay in pt transfer until release.
A
20 minutes; contact ELO
15
Q
____consent — when a competent patient or guardian is informed of the potential benefits and risks of a process or procedure, alternatives to that procedure, and the possible consequences related to each.
A
Informed consent
16
Q
_____Consent — written or verbal request to be evaluated and treated.
A
Expressed consent
17
Q
____Consent — when a patient is unable to express consent because of altered mental status or severe distress.
A
Implied consent
18
Q
Conduct Three Assessments: Providers should attempt to assess the following three major areas prior to permitting a patient to refuse care and/or transportation:
A
1– Legal Capacity to Refuse Care
2– Mental Capacity to Refuse Care
3– Medical or situational capacity
19
Q
The ______ should be summoned to the scene to assist with patients that you believe may be mentally incompetent and refusing services.
A
Metropolitan Police Department
20
Q
If the patient does not speak English as a primary language and requests language translation services, the ____ will be used for formal translation services.
A
language line
21
Q
Obtain signature of a witness; preferably the witness should be someone who ____.
A
witnessed your explanation of risks and benefits to the patient, & who watched the patient sign the form.
All witnesses should be 18 years old or older if possible.
Witnesses may include law enforcement personnel.
22
Q
In cases where the patient’s status is unclear and the appropriateness of withholding resuscitation efforts is questioned, FEMS personnel should _____.
A
initiate CPR immediately and then contact an EMS Supervisor or Medical Control Physician for further guidance.
23
Q
Criteria for determining a patient should be pronounced PDOA shall include ALL of the
Primary Criteria; they are____.
A
- Pulseless
- Apneic.
- No signs of life (such as spontaneous movement or pupillary response)
24
Q
Criteria for determining a patient should be pronounced PDOA shall include ALL of the
Primary Criteria and AT LEAST ONE of the Secondary Criteria! secondary criteria’s are:
A
Rigor mortis
Dependent lividity
Decomposition or putrefaction
Transection of the torso
Incineration
Massive whole-body crush injury
Obvious displacement of brain matter
Valid MOST Form indicating DNR status,other actionable end-of-life medical order
A valid DC licensed physician on scene, familiar with the patient’s medical
status, orders that resuscitation not be attempted
“Compelling reasons” to withhold resuscitation in cases where efforts would
be inappropriate and or inhumane.
During a mass casualty incident, (MCI) the patient is designated as deceased
(black tag) or expectant (grey tag) in accordance with the MCI Protocol.
25
_____ trauma is NOT considered an injury incompatible with life and should be managed per the Traumatic Cardiac Arrest protocol.
Recent penetrating trauma
26
FEMS personnel may withhold resuscitation from a patient in cardiac arrest under
“compelling reasons” when two criteria are BOTH present:
1–End stage of a terminal condition
(e.g., cancer, heart failure, dementia etc.) AND
2—Written or verbal information from family, caregivers or patient stating that the patient did not want aggressive resuscitation efforts such as CPR or intubation.
** Contact FEMS Medical Director or Medical
Control Physician if the situation is unclear.**
27
Online Medical Control Physicians should NOT be used as the pronouncing physician for PDOA patients. The current DC Fire and EMS Medical Director shall be listed on the EPCR as the pronouncing physician. The time the FEMS provider confirmed that the patient was dead shall be listed as the time of death. Wording in the following format must be entered into the ECPR:
“The patient was pronounced dead on date at time by Dr.
first and last name of DC Fire and EMS Medical Director by standing order.”
28
Rigor mortis
The face and neck begin to stiffen between ___ after death. After _____, affect the arms and chest. By ____ after death, rigor mortis is usually firmly established.
Face & neck —two and five hours
arms & chest—seven to nine hours
usually firmly established—By twelve hours after death
(12 hours or longer; there is degradation of the protein in the muscles, causing the, stiffening of rigor mortis to relax and the body to become limp.)
29
Post-mortem dependent lividity also called livor mortis will begin to occur, unless the victim has suffered a large blood loss, about ___ after death, and peak at about ___.
one to two hours after death, and
peak at about six hours
30
The MOST form is divided into four (4) sections (A-D) simplifying patient preferencesfor
life-sustaining treatments, including:
➢ Cardio-Pulmonary Resuscitation (CPR)
➢ Medical Interventions/Treatment Options
➢ Antibiotics and Medically Assisted Nutrition Any incomplete section of the MOST Form implies ______.
full treatment for that specific section.
31
Online Medical Control Physicians ____ be used as the pronouncing physician for PDOA patients.
should NOT
32
The ______shall be listed on the EPCR as the
pronouncing physician. The time the FEMS provider confirmed that the patient was
dead shall be listed as the time of death.
current DC Fire and EMS Medical Director
33
____ transport may be utilized to reduce transport time for critically injured patients when operational and logistical conditions are favorable.
Air medical
34
Air Medical Transport: the United States Park Police (USPP) Aviation Unit “____” is the primary scene response air medical resource within the District of Columbia.
“Eagle One”
35
High-Risk “____” Zones: areas within the District where depending on the time of day and traffic congestion, ground ambulance transport may exceed ___and the total prehospital event time for a critically injured patient may approach or even exceed ____.
Red zones
15 minutes
60 minutes
36
High-Risk “Red” Zones, areas in general correspond with the first due response
areas of engine _____.
15, 19, 25, 27, 30, 32, and 33.
37
____: > 15-minute transport at an average transport speed of 15 mph
Pink
38
____: > 15- minute transport at an average transport speed of 30 mph
Red
39
Unit officers can make a “____” request to USPP via OUC with call location information if there is credible prearrival information (e.g., multiple-callers or MPD is on scene) that a critical trauma patient meeting flight criterion exists. Patient assessment and the decision to fly should take less than ___.
pre-flight
60 seconds
40
____shall determine if the patient is a candidate for air medical transport and make a request for this resource to the incident commander.
The highest-level on scene care provider treating the patient.
41
The highest-level on scene care provider and incident commander must consider the
following operational and logistical factors when deciding to use air transportation:
➢ Incident location
➢ Weather conditions
➢ Landing zone location in proximity to the scene
➢ Landing zone hazards
➢ Terrain
➢ Additional resources needed for landing zone
➢ Availability and location of ALS ground transport resources (ALS transport unit or
BLS transport unit plus paramedic from another apparatus)
➢ Patient condition (risk of suffering cardiac arrest while in flight)
➢ Weight of the patient
42
If a DC Fire and EMS member is requested to assist with/continue patient care during air
medical transport, the member shall:
➢ Be an independent ALS Provider
➢ Follow DC Fire and EMS Pre-Hospital Treatment Protocols
➢ Operate within the established scope of practice
➢ Wear a helmet and protective eye wear
➢ Follow all instructions provided by the flight crew (e.g., communications, seat belt
use, unloading, etc.)
➢ Document in the ePCR the care provided during air medical transport
43
Clinical Indications for Utilizing Air Medical Transport:Air medical transport may be considered for the following patients or incidents:
1. Penetrating trauma
2. High Speed MVC with entrapment
3. Mass Casualty Incident
44
Contraindications for use of air medical transport. Patients with the following conditions should not be transported by air medical transport:
➢ Cardiac arrest or high likelihood to arrest during transport
➢ Penetrating trauma to the head
➢ Contaminated with hazardous materials
➢ Violent or erratic behavior
➢ If the transport by ground will be faster than by air
45
Either PDOA or terminated after a resuscitation attempt; DC FEMS transporting deceased persons directly to OCME shall ____.
This shall only occur in the rare circumstances.
Deceased persons shall be preferentially _____.
NOT be a routine or regular practice.
preferentially left on scene in police custody.
46
two special scene factors prevent leaving the deceased on scene in police custody:
Imminent danger exists that requires the patient to be rapidly moved to an ambulance and or removed from the scene for safe assessment, treatment, and disposition.
(shooting w aggressive/hostile bystanders)
OR
The deceased is in such a public place that not removing the body from the scene would cause significant public disruption or distress.
(e.g., motorcycle crash in the
middle of the highway with all lanes of traffic blocked)
47
_____ shall confirm patient meets deceased criteria as outlined above; determine that special scene factors prevent safe assessment and disposition of the patient on scene and or leaving the deceased on scene in police custody. And request an EMS Supervisor be dispatched if one is not already on scene or dispatched.
OIC or ACIC
48
Transport to OCME shall occur ____of red lights and siren.
without the use
49
Transport to OCME shall be documented as Hospital ___ in the electronic Patient Care
Record.
Hospital 30
50
Initial Scene Survey and Size Up; Protect ____ first, then _____,from hazards.
Protect yourself first, then victims,
51
Initial Scene Survey and Size Up; In cases of a lightning strike a reverse triage process should be utilized and patients in___Should be treated first.
Cardiac arrest
52
Patients that are identified to be unresponsive and do not have a witness to attest as to the mechanism of the change in mental status shall be treated as if they have a ____ injury.
cervical spinal
(Appropriate spinal immobilization precautions shall be employed while the assessment and care is being performed.
53
Assess mental status is AVPU:
A- alert
V- verbal stimulus
P- painful stimulus
U- unresponsive
54
If the patient is unresponsive and presents with apnea or agonal respirations immediately assess for the presence of a pulse. If a pulse is absent, initiate CPR and proceed with resuscitation. If the patient is **very cold due to hypothermia, assess the pulse for** ___ before determining that a pulse is absent.
45 seconds
55
Utilize an Impedance Threshold Device (ResQPOD™) for patients ____ years of age or older in a non-traumatic cardiac arrest (If available). Remove the device immediately in the event of a Return of Spontaneous Circulation (ROSC).
eight (8)
56
If the patient’s respiratory rate is unusually rapid or slow for their age, the
quality of respiration is insufficient, or if the patient is not breathing, ventilate
with a bag-valve-mask (BVM) every ___second or___times a minute.
6 seconds or 10 times a minute.
57
Any patient that has been intubated with a King Airway or Endotracheal Tube shall have a ____ applied.
'cervical collar’
(full spinal immobilization is not required)
58
Central/truncal pulses are___.
Central/truncal pulses (radial, brachial, femoral, carotid) strong, weak or absent.
59
Check perfusion by evaluating____
skin color, temperature, and moisture.
60
Perform a rapid full body scan and identify injuries. Treat life threatening conditions as they are recognized. Inspect and palpate each of the major body systems for the following:
(DCAP BTLS.IC)
➢ D -- Deformities
➢ C -- Contusions
➢ A -- Abrasions
➢ P -- Penetrations/punctures
➢ B -- Burns
➢ T -- Tenderness
➢ L -- Lacerations
➢ S -- Swelling/edema
➢ I -- Instability
➢ C -- Crepitus
61
Investigate the chief complaint and history of the present illness or event. You should use the mnemonic, “OPQRST-I” to evaluate any kind of pain.
O- Onset – When did the pain/discomfort begin?
P-Provocation/Palliative – What worsens or lessens the pain/discomfort?
Q- Quality – What does the pain/discomfort feel like?
R- Region/Radiation/Referral – Where is the pain/discomfort? Does it move
anywhere?
S- Severity – How severe is the pain/discomfort?
T- Timing – How long/often has this been occurring?
I- Interventions – Any intervention performed prior to EMS arrival and any
effect they may have had?
62
Inquire about pertinent past medical history. You may use the acronym, “SAMPLE”.
S-Signs/Symptoms
A- Allergies
M- Medication
P- Past medical history
L- Last oral intake
E- Events leading up to illness or injury
63
Vital signs should be monitored at a minimum of every ____ for all critical patients and every _____ for all other patients.
every 5 minutes for all critical patients and every 15 minutes for all other patients.
64
**Major trauma and burn** patients less than ____of age should be transported to
Children’s National Medical Center (H02).
15 years
65
**Major trauma and burn** patients ____ (adult sized) should be transported to a trauma or burn facility capable of handling adult patients.
15 years of age or greater
66
**Medical or minor** trauma patients less than ____ of age should be transported to a medical facility capable of handling pediatric patients.
18 years
67
Patients with isolated eye trauma should be transported to _____If significant trauma is associated the patient should be transported to the closest major trauma facility.
Howard University Hospital.
68
Adult sexual assault patients who have sustained major single or multiple system trauma should be transported to the closest trauma facility. Adult sexual assault patients with no trauma or minor trauma will be transported to____.
Washington Hospital Center (H13).
69
Patients with left ventricular assist devices (LVAD) should be transported to an LVAD
referral facility. Currently the only facility in the District of Columbia is _____.
Washington Hospital Center (H13)
70
If **cervical spine trauma** is indicated, cervical spine stabilization will be maintained
and the modified ____ will be used to open the airway.
jaw thrust
71
If cervical spine injury is **not** indicated, either the _____ method may be utilized to open the airway.
head tilt-chin lift method or modified jaw thrust
72
Suctioning Time Limits for Adult__.
15 seconds
73
Suctioning Time Limits child___.
10 seconds
74
Suctioning Time Limits infant___.
5 seconds
75
Use of the nasopharyngeal airway is contraindicated in patients with:
➢ Head trauma with epistaxis
➢ Potential basilar skull fracture
➢ History of fractured nasal bone
➢ Significant head or facial trauma or bleeding
76
Ventilation Rate adult___.
1 breath every 6 – 8 seconds
77
Ventilation Rate child ___.
1 breath every 3-5 seconds
78
Ventilation Rate infant___.
1 breath every 3 – 5 seconds
79
Ventilations should be delivered over ___ in sufficient volume to produce visible chest rise.
1-2 seconds
80
Nebulized medications shall be driven by a flow rate of ____(lpm) or as prescribed by the manufacturer’s recommendations.
10 liters per minute
81
Patients exhibiting signs of moderate to severe respiratory distress due to pulmonary edema or near drowning should be placed on the ____.
Continuous Positive Air Pressure (CPAP)
system.
82
After assessment of a patient, the ALS or BLS provider must assign a treatment priority:
Priority 1: Unstable Patients
Priority 2: Potentially Unstable Patients
Priority 3: Stable Patients
83
Which hospital will serve as Medical Control for patients being transported?
Each hospital will serve as its own Medical Control for patients being transported to them.
Children’s National Medical Center (H02) will be the designated Medical Control for ALL Pediatric patients.
84
A crashing patient is_____.
A crashing patient is one who upon EMS arrival presents in extremis and or is at risk of rapidly deteriorating into cardiac arrest (i.e., peri-arrest).
This deterioration into cardiac arrest often occurs while attempting to move, package, or load the patient into a transport unit
85
unless logistically impossible, every effort shall be made to ensure that crashing patients are cared for by ____ on scene and throughout transport to an emergency department.
two paramedics
86
A full set of vital signs include 6 findings:
➢ Blood pressure
➢ Heart Rate
➢ Respiratory Rate
➢ Pulse Oximetry
➢ Temperature
➢ Blood Glucose.
87
For pediatric patients greater than or equal to ___, the adult medication/resuscitation guidelines should be followed. If the patient meets the criteria for being dead on arrival (PDOA), resuscitative efforts shall not be attempted, and notification of law enforcement shall be made.
14 years old
88
Pulse should only be checked for a maximum of ____, if no definite pulse is felt, **assume the patient is in cardiac arrest and start cpr.**
10 seconds
89
Once pulselessness is established, chest compressions should be initiated ____.
immediately
90
Chest compressions should be ____ in adults, or greater than ____ chest diameter in pediatrics).
2.0 - 2.4 inches
1/3
91
chest compressions should be ____ compressions per minute
100-120
92
All interruptions in CPR shall be as short as possible and no greater than ___.
10 seconds
93
Switch chest compressors every _____
(or after _____) to prevent a decrease in the quality of compressions.
2 minutes
(5 cycles of compressions and
ventilations at a ratio of 30:2)
94
Ventilate SLOWLY with each breath delivered over ____.
1 second
95
Without an advanced airway in place, BVM ventilations shall be performed as follows: **Adult**
30:2 compression to ventilation ratio
96
Without an advanced airway in place, BVM ventilations shall be performed as follows: **pediatric**
15:2 compression to ventilation
ratio when > 1 rescuer
30:2 compression to ventilation
ratio when only 1 rescuer
97
Once an **advanced airway is in place**, continuous chest compressions shall be provided, and ventilations shall occur at the following rate: **adult**
10 breaths/minute
(1 breath every 6 seconds)
98
Once an **advanced airway is in place**, continuous chest compressions shall be provided, and ventilations shall occur at the following rate: **pediatric**
20-30 breaths/minute
(1 breath every 2-3 seconds)
99
All patients in a refractory shockable rhythm (___ or more defibrillations) shall be transported immediately to an emergency ECMO capable facility.
3
100
If ROSC has not been achieved after ___ minutes of resuscitation in a medical cardiac arrest, consider termination of resuscitative efforts as detailed in the Termination of Resuscitation Medical Cardiac Arrest Protocol.
30
101
All EMT’s and Paramedics are expected to act in accordance with the departments
core values:BASICS
Bravery, Accountability, Safety, Integrity, Compassion, Service.
102
___ is the single-most important intervention for a patient in cardiac arrest
CPR;
CPR is the single-most important intervention for a patient in cardiac arrest. High quality, uninterrupted chest compressions are the most critical component of CPR and should be provided as soon as possible.
103
___% of victims of out of hospital cardiac arrest (OHCA) have agonal breathing on
presentation. Agonal breathing is a common reason to misdiagnose a patient as not being in cardiac arrest.
40-60
104
The five components of high-quality CPR are:
1) Ensuring chest compressions of adequate rate
2) Ensuring chest compression of adequate depth
3) Allowing full chest recoil between compressions
4) Minimizing interruptions in chest compressions
5) Avoiding excessive ventilation.
105
Initiation of chest compressions in patients who are unconscious but not in cardiac arrest is associated with low rates of significant adverse events. This contrasts with the significant risk of withholding CPR when a patient is in cardiac arrest. When in doubt, ____.
start chest compressions.
106
_____ pad placement is preferred for defibrillation as preliminary evidence suggests this configuration is superior to anterior/lateral pad placement in shock resistant cardiac arrests. In addition, the initial pad placement at the start of a cardiac arrest allows for easier deployment of double sequential defibrillation if indicated under the refractory VF/pVT protocol.
Anterior/Posterior
107
Utilize _____ for pediatric medication dosing. Recommend consulting and preparing
the Handtevy application enroute to the incident.
Handtevy
108
When using an AED on infants and children ____old, use of reduced energy pediatric specific pads is recommended. If a manual defibrillator nor an AED equipped with reduced energy pediatric specific pads is available, an AED without the reduced energy pads may be used.
< 8 years
109
Epinephrine is administered every ___minutes.
3-5 minutes
110
Post-_____care is a critical component of the chain of survival.
Post-cardiac arrest
111
Resuscitation efforts in presumed medical cardiac arrests shall occur for at least ___ minutes of ALS care
30
112
ALS care starts when ____.
the monitor/defibrillator is both turned on and attached to the patient in cardiac arrest.
113
The _____must authorize termination before resuscitation efforts are stopped.
Medical Control Physician
114
_____ remove any personal property (e.g., jewelry) or medical devices from the body. This includes any devices from procedures you have performed. (e.g., endotracheal tube, IV/IO)
Do not remove
115
If termination of resuscitation is NOT granted: Obtain any additional patient care orders from the medical control physician. Unless medical control recommends immediate transport, remain on scene to continue high quality CPR and ALS care for an additional ____.
10 minutes.
116
If medical control refuses termination a second time, ____.
transport patient to an appropriate receiving facility while continuing resuscitation efforts.
117
For cardiac arrest pt, Immediate Transport Criteria: initiate immediate transport to nearest trauma center(expedite scene time and provide all treatment enroute) for the following patients:
➢ Traumatic cardiac arrest **witnessed by FEMS** personnel
➢ Traumatic cardiac arrest in a female patient with **known pregnancy > 20 weeks**
gestational age or fundal height at or above the level of the belly button
118
If the infant is ventilating adequately, administer free flow (blow-by) 100% oxygen at a minimum of ____lpm close to the face.
6 liters per minute
119
APGAR score should be determined____.
Determine the 1-minute APGAR score.
Repeat at the 5 minute interval.
120
What is APGAR?
A-Activity (Muscle Tone)
P-Pulse (Heart Rate)
G-Grimace (Response Stimulation
or Reflex Irritability)
A- Appearance (Skin Color)
R-Respiration (Breathing)
121
Remember that conditioned athletes may have resting heart rates of ____.
40-60 BPM
122
Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than __%.
94
123
Withhold Nitroglycerin and consult Medical Control if:
➢ The patient meets **pediatric** criteria.
➢ The patient has a systolic blood pressure **≤110 mmHg or HR<60.**
➢ The patient has taken **erectile dysfunction medications** within the past 24 hours
(i.e. Viagra, Cialis, or Levitra)
124
Washington Metropolitan VAD Centers:
➢George Washington University Hospital H8
➢ MeStar Washington hospital center H13
➢ Inova Fairfax Hospital H29
125
The two most common causes of VAD pump failure are
disconnection of the powersource &
failure of the driveline.
126
The controller is connected to two rechargeable batteries which can provide anywhere from ____hours of power. The VAD can also receive power from a base unit, typically located at the patient’s home, or via adapters to other power sources such as a grounded electrical outlet or car battery.
8 to 12
127
The most common cause of VAD alarms are ___.
low batteries or battery failures.
128
If the patient presents with respiratory distress with suspected bronchospasm /wheezing,
administer Albuterol:
ADULT____
PEDIATRIC____
Adult- Albuterol 2.5 mg via nebulizer
Pediatric - Albuterol 2.5 mg via nebulizer
129
If the patient continues to exhibit or report respiratory distress with bronchospasm/wheezing after the first dose of Albuterol; administer a ______ only for pre-hospital care.
combination of Albuterol and Ipratropium Bromide (Atrovent) via nebulizer
**one time**
130
For COPD patients experiencing significant respiratory distress, consider _____and start at a pressure of ___ cmH2O with an in-line nebulizer.
Continuous Positive Airway Pressure Device (CPAP) ; 5
Some COPD patients have lung problems that may be worsened by CPAP. If the
patient worsens on CPAP, remove the device immediately.
131
If the patients that present with a loud cough that mimics the “bark of a seal”, respiratory distress, grunting, wheezing or stridor on inspiration, the patient presents with respiratory distress with clinical evidence of “_____”. Administer ____.
“croup”
Administer ,Normal Saline 3 ml via Nebulizer. Repeat 2 additional times as necessary if the patient improves with the initial administration.
132
If a narcotic (opiate) overdose is suspected, administer _____.
Naloxone (Narcan)
133
Narcan an in adult pts at a BLS provider level can administer 2 mg IN only, may repeat ___ at the same dose.
**twice**
134
Never let the BVM simply “___” while connected to an endotracheal tube (ETT) as this may
dislodge the tube.
“drop”
135
_____ventilate with the minimum volume necessary to see chest rise. Excessive____ and over-inflation of the lungs can result in lung injury and increase mortality and morbidity in some patient populations.
Tidal volume
136
______: maintain normal ventilation rates based on patient age. Routine and or accidental hyperventilation should be strictly avoided.
Goal is to maintain an ETCO2 of 35-45 mmHg.
- Adult: 10-12 breaths per minute
- Child: 20 breaths per minute
- Infant: 30 breaths per minute
Ventilation Rate
137
VAD is a _____.
Ventricular Assist Device (VAD)
138
The patient’s travel bag with ____.
back-up controller and spare batteries, should always accompany them. If feasible, bring the patient’s power module, cable, and display module to the hospital as well.
139
If the patient continues to exhibit or report respiratory distress with bronchospasm/wheezing administer a combination of ____&___ via nebulizer ____ time only for pre-hospital care.
Albuterol and Ipratropium Bromide (Atrovent); one time
140
If the patient is in extremis or does not clear after ____doses of nebulized Albuterol treatment ALS care shall be immediately initiated.
the first
141
Abdominal pain is perceived in three ways:
**Visceral**: pain is vague, colicky (intermittent) and poorly localized. It is usually the first type of pain felt. It arises from inside the organs.
**Somatic**: pain is a more specific, localized, and constant pain that arises from outside
the organs due to inflammation of the peritoneum. (e.g., appendicitis = Right lower
quadrant pain or diverticulitis = left lower quadrant pain)
**Referred**: pain associated with a structure distant from the actual source. (e.g.,
epigastric pain from an acute MI or abdominal pain from pneumonia)
142
______ is a state where a patient is not alert and oriented to person, place, time, and situation within the context of their expected developmental level.
Altered mental status
143
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) A is____
A
Alcohol (intox or withdrawal)
Acidosis
Arrhythmias
144
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) E is___.
E
Endocrine
Electrolytes
Encephalopathy
145
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) I is____.
Insulin (too much or too little)
Hypoglycemia
Hyperglycemia
146
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) o is ___.
O
O2 (hypoxia)
Opioid overdose
147
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) u is__.
U
Uremia
148
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) T is
T
Trauma (blood loss)
Intracranial Pressure
Temperature (low or high)
149
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) the second I is ____
I
Infection (sepsis)
Ischemia (heart attack)
150
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) p is__.
P
Poisoning
Psychiatric
151
Treatable Causes of Altered Mental Status
(AEIOU-TIPS) s is__.
S
Seizure
Stroke
Shock
152
The postictal state after a seizure does not typically last longer than ____ minutes.
Consider non-convulsive status epilepticus (persistent brain seizure without extremity
movement) in patients with prolonged altered mental status after a seizure.
20-30
153
In assessing a patient with an altered level of consciousness, a thorough history, when
able to be obtained, is the most important step in identifying the cause. The history
should include:
➢ History from bystanders
➢ Age of the patient
➢ Environment where patient was found
➢ Recent complaints (e.g., headache, chest pain vomiting, fever)
➢ Pill bottles/medications (e.g., opioids, diabetes, or seizure medication, etc.)
➢ Medical alert tags and accessory medical devices
➢ Evaluate for potential dehydration as a cause of altered mental status in the
pediatric and geriatric population. Assess for reduced oral intake, vomiting,
diarrhea, etc
154
when the body has a hypersensitivity reaction to a foreign protein or allergen (e.g., food, medicine, pollen, insect sting or any ingested, inhaled, or injected substance). Symptoms involve only one organ system and are typically mild to moderate in severity and may include any of the following: hives, skin itching, scratchy throat, watery or itchy eyes, sneezing, dry cough; this is known as as____.
Allergic Reaction
155
a severe, immediate, systemic hypersensitivity reaction that can lead to cardiopulmonary collapse, shock, or arrest. Is known as___.
Anaphylaxis
156
Anaphylaxis is diagnosed when any one
of the following three presentations occur:
**1**Acute onset of hives, itching, flushing, swollen lips-tongue-uvula and at least one
of the following:
• Respiratory distress
• Hypotension
**2**Two or more of the following occur rapidly (within minutes to hours) after
exposure to a known or likely allergen:
• Skin-Mucosal reaction (e.g., hives, swollen lips-tongue-uvula)
• Respiratory distress (shortness of breath, stridor, wheezing, hypoxia)
• Hypotension or associated symptoms (e.g., syncope)
• Persistent GI symptoms (e.g., crampy abdominal pain, nausea/vomiting)
**3** Hypotension within minutes to hours after exposure to a known allergen for that
patient.
157
____ is the first-line treatment for anaphylaxis and should be administered as soon as possible.
Epinephrine
158
Adult Epinephrine 1 mg/ml
BLS or ALS: ___ mg IM via adult auto-
injector in the anterolateral thigh
0.3 mg IM
159
Pediatric Epinephrine 1 mg/ml
Age ≤ 9 yo
BLS or ALS: ____ mg IM via pediatric auto-
injector in the anterolateral thigh.
0.15 mg
160
Pediatric Age > 9 yo
BLS or ALS: __ mg IM via adult auto-
injector in the anterolateral thigh
0.3 mg
161
If signs of anaphylaxis persist following the first dose of epinephrine, additional IM epinephrine can be repeated by all providers every ____ min as needed
5-15 minutes
162
Anaphylaxis symptoms usually begin within ___ minutes after exposure to the offending agent. Symptom onset from food allergies can be more prolonged, up to a few hours.
5-20
163
To administer Auto injectors after firmly into the thigh until it “clicks” hold in place for __full seconds.
3
164
Cincinnati Pre-hospital Stroke Screen
(FAST Exam) includes:
**Facial droop** or weakness on either side.
-Ask patient to smile and show their teeth.
**Arm** and/or Leg weakness.
-Ask patient to extend arms, palms up, with eyes closed. Watch to see if one
arm drifts down. If only one arm drifts, the test is positive. If both arms drift
down, the results are unclear.
**Speech** is slurred or impaired.
-Ask patient to say, “You can’t teach an old dog new tricks.”
**Time**: Determine the “last known well” time and transport immediately to a stroke
center
165
___ is the 5th leading cause of death in the United States and a leading cause of long-
term disability.
Stroke
166
____refers to the time-dependent treatment effect of reperfusion therapies
-(tPA and endovascular therapy) in ischemic strokes and the fact that, with each passing
minute, a stroke progresses from ischemia to infarction, additional neurons are lost, and
functional outcomes worsen.
“Time is brain”
167
Suspected ____ stroke , patient has new, acute neurological deficits such as facial droop, weakness, gait disturbance or imbalance, numberless, slurred speech, altered mentation, or vision changes, started within the last 24hours.
Ischemic stroke
168
Suspected____stroke (intracerebral or subarachnoid hemorrhage) ; patient has sudden onset of severe headache (sometimes described as the worst headache is their life) with associated elevated blood pressure, nausea and or vomiting and or alter mental status within the last 24 hours.
Hemorrhagic stroke
169
In Adults
Normal blood pressure:
systolic pressure < ___ mmHg and
diastolic pressure < ___ mmHg
120
80
170
In adults
Severe hypertension:
systolic pressure ≥ ___ mmHg and/or
diastolic blood pressure≥ ___ mmHg.
180
120
171
____is a life-threatening condition defined by persistent, inadequate delivery of oxygen and nutrients to meet cellular demands
Shock
172
Consider 4 potential causes of shock :
1- Hypovolemia (e.g., bleeding, vomiting, or diarrhea)
2-Cardiogenic (e.g., acute MI or cardiac dysrhythmia)
3-Distributive (i.e., neurogenic, septic, anaphylactic, drug overdose/toxicity)
4-Obstructive (e.g., pulmonary embolism, cardiac tamponade, tension pneumothorax)
173
Mortality rates for patients in shock vary widely based on the cause, but the common causes
of shock, including sepsis, trauma, and cardiac failure, have mortality rates of ____%
20-50%
174
The most common cause of shock of unclear cause is ___ shock.
septic
175
Mild to Moderate pain:
pain rated in the ____ range on a scale of 1-10.
1-5
176
Moderate to Severe pain: pain rated in the ___ range on a scale of 1-10.
5-10
177
Patients who are unable to self-report level of pain or have a difficult time communicating their condition can be asked to rate their pain using the ___ scale.
FACES scale
178
____ is a sudden change in behavior caused by an episode of disordered electrical activity in the brain, can pnesent with a variety of abnormal neurologic findings depending on the part of the brain that is involved.
Seizure
179
____Seizure: a seizure involving a small part of the brain that may or may not affect consciousness/awareness. The symptoms vary depending entirely on the part of the brain that is involved at the start of the seizure.
Focal seizure
180
____Seizure: a seizure involving both halves (hemispheres) of the brain. Loss of consciousness always occurs and may be accompanied by spasms, stiffening, shaking, muscle contractions or loss of muscle tone.
Generalized seizure
181
____ seizure: a seizure occurring between 6 months and 5 years of age, associated with fever but without evidence of intracranial infection (i.e., meningitis) or other defined cause. Febrile seizures are divided into two categories, simple or complex, based on clinical features.
Febrile seizure
182
_____ Febrile Seizure: most common type, characterized by a generalized seizure that lasts less than 5 minutes and does not recur in a 24-hour period.
Simple
183
____ Febrile Seizure: characterized by a seizure that has a focal onset (e.g.,
shaking limited to one limb or one side of the body, last longer than 5 minutes or occurs more than once in 24 hours.
Complex
184
If the child experienced a simple febrile seizure with complete return to normal neurologic baseline at time of EMS assessment, ___ transport may be considered.
BLS
185
If the child experienced a complex febrile seizure or has persistent altered mental
status at time of EMS assessment, __ transport shall occur.
ALS
186
Most seizures are self-limited lasting ___ minutes and will need only supportive care
(e.g., suctioning, oxygen, and attention to airway management). Most seizures will not
need treatment with midazolam.
1-3 minutes
187
Involuntary muscle movements, often referred to as ____, may accompany syncope due to cardiac causes or hypoxia.
myoclonic jerks
188
Febrile seizures occur in 2-4% of children younger than ___ years of age with peak
occurrence between ____ months old. Most children have their febrile seizure on the
first day of illness and, in some cases, it is the first symptom that the child is ill.
5 Years;
12 and 18 months
189
If patient restraint is necessary to prevent harm to the patient and others, provide soft four-
point restraints or handcuffs (law enforcement) and transport the patient in a ____ position. Circulation and motor sensory function shall be checked every ____ minutes while in physical restraints.
supine; 5 minutes
190
Consider use of Comprehensive Psychiatric Emergency Program (CPEP) if:
➢ Age 18 or greater and less than age 65.
➢ Vital signs and blood glucose level within normal ranges.
➢ There is an isolated behavioral problem.
➢ Transport should be completed by law enforcement.
➢ No medical problems or injuries that need to be evaluated at the hospital.
191
BLS and ALS providers may assist an adult patient with inhaling vapor from ______ for treatment of nausea and or vomiting.
an isopropyl alcohol wipe
(i.e., an alcohol prep)
➢open a single isopropyl alcohol wipe and place 1-2 cm from the patient’s nose.
➢ Instruct the patient to inhale deeply through their nose and exhale out their mouth.
➢ Inhale 3 times through the nose every 15 minutes, as tolerated.
192
Studies show that inhaling vapor from an isopropyl alcohol wipe provides significant
reduction in nausea within ____.
10 minutes of initiating aromatherapy.
193
when the glucometer reads “LO” the blood glucose level is < ____ mg/dL.
20
194
Administer oral glucose in the form of glucose gel or other appropriate high glucose content
fluid (such as orange juice) if the patient is:
➢ At least 4 years old AND
➢ Has a blood glucose level of < 70 mg/dL AND
➢ Displays signs and symptoms of hypoglycemia AND
➢ Is conscious enough to adequately swallow secretions, follow commands, and
maintain their own airway
195
Hypoglycemia Requiring Treatment
Adult:
Pediatric > 1month old:
Neonate <1 month old:
Adult:<70
Pediatric > 1month old: <70
Neonate <1 month old: < 45
196
Non-Transport of Hypoglycemic Patients; After successful treatment of a hypoglycemic diabetic emergency, Repeat blood glucose level is > ____ mg/dL.
100
197
_____is defined as a blood glucose level (BGL) ≥ 100 mg/dL, but specific prehospital treatment is reserved for patients who present with extremely elevated glucose and or with severe concomitant symptoms.
Hyperglycemia
198
when the glucometer reads “HI” the blood glucose level is > ____ mg/dL
500
199
Hyperglycemia Requiring ALS Treatment and Transport:
BGL ≥ ___ mg/dL with severe symptoms
or
BGL > 400 mg/dL
250 w symptoms
400
200
Consider NTL if BGL<___ mg|dL and otherwise NTL eligible
300
201
____dialysis: a treatment for kidney failure that removes toxins from the body by directly filtering the patient’s blood using a machine that functions like an electric kidney. Hemodialysis typically occurs at a dialysis center and usually needs to be performed every 2-3 days for a period of 3-5 hours per session.
Hemodialysis
202
____dialysis: a treatment for kidney failure that uses the internal lining of the abdomen (peritoneum) as a filter to remove toxins and waste products from the blood. During dialysis a cleansing solution is infused into the abdominal cavity via a permanent catheter through the abdominal wall. After several hours, the fluid with the filtered waste product is removed from the abdomen. Treatments can be done
anywhere including at home, work, or while traveling. This process must be done
frequently, usually four times per day.
Peritoneal dialysis
203
For Renal Failure and Dialysis Emergencies patients Do NOT take blood pressures on the arm with _____
a dialysis shunt/fistula.
204
Fistula bleeding after dialysis will often be from a small punctate needle access site.
Apply firm, direct pressure to the bleeding site.
Placing pressure with only “gauze and tape” will NOT stop the bleeding. The pressure needs to be applied with____.
gloved fingers directly over the bleeding site for 15-30 minutes using a firm two-hand technique.
205
If patient has significant life-threatening bleeding and direct pressure does not control
the hemorrhage, apply a tourniquet to the affected extremity at least _____ proximal to the bleeding shunt/fistula. Do NOT apply tourniquet directly over the shunt/fistula.
3 inches
206
____is a brief episode of non-traumatic loss of consciousness and postural tone that resolves spontaneously with a return to baseline mental status and neurologic function within seconds to a few minutes. It is typically resolved prior to EMS arrival.
Syncope
207
____ is an early sign/symptom of potential impending syncope. It usually lasts for seconds to minutes and may be described by the patient as dizziness, lightheadedness, “nearly blacking out” or “almost fainting.” It is typically resolved prior to arrival of EMS.
Near- syncope
208
If heat exhaustion or cramps are suspected, move the patient to a ____ and obtain a temperature.
cool environment
209
If heat stroke is suspected, initiate immediate aggressive cooling techniques such as
_____ provide mechanical cooling.
removing as much clothing as possible,
cold packs
at the groin, under the axilla and around
the neck;
covering the patient with a cool wet sheet and
set windows and ventilation system in the EMS unit
210
Hypothermia is defined as a core temperature below ____°F.
95°F
211
Patients in cardiac arrest with suspected severe hypothermia shall not be considered dead until _____.
re-warming has been completed at a medical facility.
212
In the event of cold water drowning, the patient shall not be considered deceased until ____.
re-warming has been completed at a medical facility
213
Administer Naloxone (Narcan) if a narcotic (opiate) overdose is suspected and the patient
has any two of the following:
➢ Pinpoint pupils
➢ GCS ˂13
➢ Respiratory depression
214
Patients receiving Narcan should receive care at the ____ level and should be transported to the hospital for further evaluation and treatment.
ALS
215
Contact Poison Control on channel ___ or call 1-800-222-1222 for assistance in managing
specific overdoses. Any medication interventions recommended by Poison Control must first be approved by Medical Control.
H-11
216
Attempt to identify the insect, reptile or animal that caused the injury, if safe to do so. ____ transport a living snake/animal/spider to the hospital. Determine if the patient has access to anti-venom that can be transported to the hospital with them.
DO NOT
217
General Indicators of Carbon Monoxide Exposure:
1-Victims who have been rescued from or had a prolonged exposure to smoke at a fire ground
2-Victims who have been exposed to caron monoxide due to other sourcesof incomplete combustion
3- Exposure or overdoseto Methylene Chloride (commercial paint remover)
218
The most important decision to make with a patient in labor is whether to ____.
attempt delivery in the field or
transport the patient to the hospital.
219
During delivery Once the head emerges, suction the newborns ____ to clear secretions.
mouth then nose
220
Once delivery is accomplished, clamp the cord at ____ from the navel and cut between
the clamps.
6” and 8”
221
occurs when the umbilical cord presents itself outside of the uterus while the fetus is still inside.
Prolapsed cord
222
During prolapsed cord, Palpate the cord for a pulse. If no pulse is obtained, push the newborn’s head or presenting part back into mother only _______.
far enough to regain a pulse in the umbilical cord
223
If the head is not delivered within 3 minutes, place a gloved hand in the vagina, with your
palm toward the newborn’s face utilizing a ____ technique with your fingers. Push the vaginal
wall away from the newborns face to create a space until delivery of the head.
“V”
224
In the event of active post-partum hemorrhage from the vagina, apply a firm uterine massage
starting from the _____.
pubis toward the umbilicus clockwise.
225
In the event that the patient has experienced a miscarriage and the fetus is > 20 weeks in
gestation:
Provide newborn resuscitative measures and transport to the closest appropriate hospital.
the fetus is ≤20 weeksin gestation:
➢ Ensure that the fetus is pulseless and apneic. If so **do not attempt resuscitative measures**
➢ If there is any question as to the approximate gestation of the fetus, provide resuscitative measures.
➢ If the fetus presents with spontaneous respirations and/or pulses, provide newborn
resuscitative measures and transport to the closest appropriate hospital. If there is a
question as to whether the fetus is viable or not; contact Medical Control for direction.
226
Forgeneral trauma management . Initiate primary assessment utilizing “MARCH” algorithm; which consist of:
M-Massive Hemorrhage
A-Airway
R-Respiratory / Breathing
C-Circulation
H-Head Injury / Hypothermia Prevention
227
When transferring care to trauma center staff use structured handoff format (“AT-MIST”) to
ensure all critical information is communicated:
➢ A – age
➢ T – time of incident
➢ M – mechanism
➢ I – injuries noted
➢ S – symptoms/signs
➢ T – treatments provided
228
DCAP-BTLS-IC is mnemonic acronym to remember specific soft tissue injuries to look
for during a person’s assessment after traumatic injury. DCAP-BTLS-IC is
D – Deformities
C – Contusions
A – Abrasions
P – Penetrations/punctures
B – Burns
T – Tenderness
L – Lacerations
S – Swelling/edema
I – Instability
C – Crepitus
229
Patients with major hemorrhage, hemodynamic instability, penetrating torso trauma, or
signs of traumatic brain injury often require rapid surgical intervention. Transport should
not be delayed. Scene time should NOT exceed _____.
10 minutes.
230
If the patient has burns (thermal, chemical or airway) transport adult patients to the burn
center at ____. and pediatric patients to ___.
Medstar (Hospital 4)
Children’s National (Hospital 2).
231
There are 4 types of blast injury
1-Primary injury: occurs due to the over pressurized blast wave. Most severe injury
occurs at air-fluid interface in the brain, lungs, eardrums, and bowel.
2-Secondary injury: due to projectiles propelled by the blast. Any body part may be
affected.
3-Tertiary injury: due to person being thrown by the blast wind into a solid object. Can
result in crush injury.
4-Quaternary: all other explosion related injuries, illness or disease not described above
including exacerbation or complications of existing conditions (e.g., COPD
exacerbation)
232
If the burns are ≤____ body surface area, cover with Waterjel Emergency Burn Dressing or
if not available sterile dressings soaked in a saline solution.
10%
233
If the burns are >____% body surface area, cover with Waterjel Emergency Burn Dressing or if not available sterile dry dressings. Ensure that the patient is kept covered and warm to
prevent the loss of body heat with mylar blanket.
10
234
Crush _____: a description of a mechanism of injury. Any body part that suffers any traumatic crushing force has sustained. The injury to the soft tissues, muscles, and nerves can be due to the primary direct effect of the trauma and or ischemia related to prolonged compression.
Crush injury
235
Crush _____: systemic manifestations resulting from crush injury, which can
result in organ dysfunction (predominantly acute kidney injury) and or death. Crush
syndrome is the consequence of muscle injury resulting in the spilling of intracellular
contents into the blood stream. The most concerning is the release of potassium and
myoglobin.
Crush Syndrome
236
In general, the CAT tourniquet is expected to be effective on the thigh of pediatric
patients as young as _____ and
arms beginning around ___ of age.
6 to 12 months tight
5 years arm
237
Extremity Trauma / External Hemorrhage Management, ____ may be more effective for infants and young children.
Direct pressure and wound packing
238
A properly applied tourniquet in a conscious patient is very painful. Treat with ALS pain medication. ____ loosen a tourniquet to relieve pain.
Do NOT
239
Remove _____ from the injured limb.
jewelry and potentially constricting clothing
240
For impaled foreign bodies, ems should ____.
Stabilize impaled object to prevent movement.
Control bleeding around the stabilized impaled object. Do NOT remove impaled foreign bodies.
241
Management of exposure to chemical agents: Irrigate the eye(s) immediately with normal saline for a minimum of ____ minutes utilizing IV tubing, a nasal cannula, or Morgan lens. Eye irrigation should commence on scene as soon as possible and be continued throughout transport.
20 minutes
242
Pregnant patients should be transported in the ____ position if clinically and logistically feasible.
left lateral recumbent
243
Pregnant women in cardiac arrest, with a gestational age ___weeks, may be candidates for a peri-mortem c-section upon arrival at the trauma center. Ideally, this procedure is performed within ____ of maternal cardiac arrest. Notify receiving trauma center for preparation as soon as possible.
> 20 weeks;
5 minutes
244
The primary goal of caring for an injured pregnant patient is to stabilize the ____ first, as fetal outcomes are directly correlated with maternal resuscitation.
mother
245
Traumatic Brain Injury Transport patients < ____ old to Children’s National Hospital (H2).
15 years
246
Early signs of neurologic deterioration after head injury include:
o Confusion
o Agitation
o Drowsiness
o Vomiting
o Severe headache
247
The preferred position for SMR is flat and supine. However, there are three circumstances under which raising the head of the stretcher to 30 degrees should be considered:
i. Respiratory distress
ii. Suspected severe brain injury
iii. Promotion of patient compliance
248
Spinal Motion Restriction required for Falls greater than ____ feet
10 feet
249
Level 1 Trauma Center: provides the highest level of trauma care to injured patients. Has a full range of specialists and equipment available 24 hours per day and thus can provide total care for every aspect of injury. Level 1 trauma centers in the region include:
H2-children’s national
H4- medstar
H5- Howard university
H8- George Washington university
H29- inova Fairfax
250
Level 2 Trauma Center: provides comprehensive trauma care, regardless of the severity of the injury.
Provides 24-hour availability of all essential specialties, personnel, and equipment to care for most trauma patients. Level 2 trauma center in the region includes:
H16– university of MD capital region medical center
H22- suburban hospital
H23- Walter reed national military medical center
H26- Virginia hospital center
251
Level 3 Trauma Center: has the resources and capability to perform emergency resuscitation, surgery, and stabilization for many injured patient. Does not have the full availability of trauma specialists but has transfer agreements with a level 1 or level 2 trauma center that provide back up specialty resources as needed.
Currently there are no level 3 trauma Centers amongst our receiving hospitals.
252
Minimize scene time for all trauma patients to < ____.
10 minutes.
253
If a paramedic engine and BLS ambulance are on scene with a Red Criteria trauma patient, providers shall NOT delay transport by requesting a medic transport unit. The engine company paramedic shall upgrade ____.
the BLS ambulance to minimize scene time
(goal < 10 minutes) in Red Criteria trauma patients
254
BLS ambulances shall NOT wait for a prolonged or delayed ALS resource (i.e., paramedic engine or medic transport unit) when caring for a Red Criteria trauma patient. BLS ambulances shall____
initiate transport to the closest level 1 trauma center and request ALS intercept if logistically and geographically feasible.
255
Technology-assisted children refer to those children who depend on medical devices to support bodily function. In all cases utilize the _____ to assist or perform necessary troubleshooting measures because they are often trained in performing those functions.
caregiver
256
All Fire/EMS personnel are required _____ of suspected child / elder abuse or neglect to the Police agency responsible for the area in which the call occurred or the DC Child and family Services Agency
to report cases.
Do not initiate the report in front of the patient, parent, or caregiver. DO NOT CONFRONT OR
BECOME HOSTILE TO THE PARENT OR CAREGIVER.
257
6 Characteristics of the Abused:
1. If less than 5 years old, is likely to be passive.
2. If over 5 years of age, is likely to be aggressive.
3. Does not look to the abuser for support, comfort, or reassurance.
4. May cry without any expectation of receiving help.
5. May be quiet and withdrawn.
6. May be fearful of the abuser.
258
5 History Suggestive of Abuse:
1. The history does not match with the nature or severity of injury.
2. The parents’ and/or caregivers’ account is vague or changes.
3. The “accident” is beyond the capabilities of the patient (e.g. a 12 month old that
burns self by turning on the hot water in the bath tub).
4. There is a delay in seeking help.
5. The parent and/or caregiver may be inappropriately unconcerned about the
patient’s injury.
259
8 Physical Assessment Suggestive of Abuse:
1. Fractures in children under 2 years of age.
2. Repeated fractures not explained well.
3. Injuries in various stages of healing.
4. Frequent injuries.
5. Bruises or burns in patterns (e.g. iron or cigarette burns, cord marks, bite or pinch
marks, and bruised to head, neck, back or buttocks).
6. Widespread injuries over the body.
7. Obvious physical neglect (malnutrition, lack of cleanliness).
8. Inappropriate dress (e.g. very little clothes in winter).
260
7 Characteristics of the Abuser:
1. Crosses all religious, ethnic, occupational, educational, and socioeconomic
boundaries.
2. May resent or reject the child.
3. May have feelings of worthlessness about self or about the child.
4. May have unrealistic expectations of what the child is capable of doing.
5. May be very critical of the child.
6. Oftentimes the abuser is repeating what was learned as a child (the abuser was more
than likely abused as a child).
7. May be overly defensive rather than concerned.
261
Grasp the dart itself firmly with one hand and pull to remove one dart at a time. Place the other hand on the patient’s skin at least ____inches away from the puncture. Do not scrape yourself with the dart’s barb upon removal. Do not remove by pulling on the wire. Carefully observe the end of the dart to confirm that the barb is present. If barb is not visible, the dart
has not been fully removed. (See below.) Return the dart, wires, etc., to the police.
four
262
A multiple or mass casualty incident is an emergency scene that creates a number of patients
sufficient to significantly overwhelm available resources.
Multiple Casualty Incident: ___ patients
Mass Casualty Incident: ______ patients
Multiple Casualty Incident: <9 patients (does not need to be declared)
Mass Casualty Incident: 9 or more patients (needs to be declared)
263
____is an acute infectious disease caused by the spore-forming bacterium Bacillus Anthracis. There are inhalation, cutaneous, and intestinal.
Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all.
Anthrax
264
____is a very potent protein toxin made from mash left over after processing castor beans for oil. It is considered a threat as a biological weapon primarily because it is widely available; it is a category B agent/disease with a high fatality. It is water-soluble, odorless, tasteless and not inactivated by heat.
Ricin poisoning
265
The Environmental Protection Agency (EPA) recommends that no more than ____ additional decontamination attempts be performed for individuals with significant contamination remaining following the first decontamination attempt.
two
266
All providers should attempt to maintain a distance of ___feet or more from the patient when feasible and when it does not interfere with indicated patient care for Coronavirus disease 2019 (COVID-19).
6 feet
267
IGEL Size 5 (Orange) is for ____.
Large adult
90+ kg
268
IGEL Size 4 (Green) is for ____.
Medium adult
50-90 kg
269
IGEL Size 3 Small (Yellow) is for ____.
adult /
large pediatric
30-60 kg
270
IGEL Size 2 (Gray) is for____ .
Small pediatric
10-25 kg
271
IGEL Size 1.5 (Light blue) is for ____.
Infant 5-12 kg
272
IGEL Size 1 ( Pink) is for___.
Neonate
2-5 kg
273
Most adult patients will be managed with a size___IGel.
4 IGEL
274
When putting in IGEL, if there is early resistance during insertion, a___ is recommended.
“jaw thrust” or
“insertion with deep rotation”
275
-The i-gel® is easy to use, insertion can normally be achieved in less than ___, by a proficient user.
"5 seconds
276
The ___ is a truly anatomical device, achieving a mirrored impression of the pharyngeal, laryngeal and perilaryngeal structures, without causing compression or displacement trauma to the tissues and structures in the vicinity
i-gel
277
The preferred site for needle decompression in adults is the ___ intercostal space
(between ribs ____) at the anterior/mid axillary line.
4th intercostal space
(between ribs 4 and 5)
278
the preferred site for needle decompression in children ____ intercostal space (between ribs ____)
at the mid clavicular line.
2nd intercostal space
(between ribs 2 and 3)
279
for chest decompression: Advance the needle with catheter through the parietal pleura until a “____” is felt and air or blood exits under pressure through the catheter.
Pop
280
When using an AED on infants and children ___ years old or less or weighing less than ___ lbs (25 kg), use of reduced energy pediatric specific pads is recommended.
8 years old; 55lbs
281
Daily Check of Zoll AED 3 BLS; is to ensure the defibrillation pads cables ______.
Is always connected to the defibrillator.
282
The green check located to the right of the on/off button displays when the AED is _____.
AED is ready to use ;
do not use or keep in service the Zoll AED 3 Defibrillator if the green check is not dis played in the AED status indicator window.
283
All interruptions in CPR shall be as short as possible and no greater than ___.
10 seconds.
284
If “Shock Advised” EMS should____.
continue chest compressions while the AED is charging
285
the AED shall be placed in a position where ____.
the provider performing chest compressions can see the CPR feedback prompts.
286
Once the monitor/defibrillator is charged, hold compressions and assertively state “____” and visualize that no one, including yourself, is in contact with the patient.
CLEAR
287
If the defibrillator is not discharged within ___ seconds after reaching the selected energy level, the monitor/defibrillator automatically disarms itself
60 seconds
288
Perform manual chest compression for at least ____, two-minute cycles prior to deploying the
LUCAS chest compression system.
least two, two minute cycles
289
Contraindications of LUCAS – Chest Compression Device Patient is too small or too larger. These signs are identified by ____.
Patient is too small: if LUCAS alerts with 3 fast signals when lowering the Suction cup ,and you cannot enter the PAUSE mode or ACTIVE mode.
Patient is too large: if you cannot lock the upper part of LUCAS to the back plate without compressing the pt chest.
290
Pre-position the LUCAS stabilization strap under the patient’s ___ and around the ____.
under the patient’s neck and around the
shoulders
291
Pad placement: ____ placement should be utilized as the first line approach for synchronized cardioversion
anterior/posterior
292
The CPR Leader/Coach position shall be the responsibility of ____. The CPR Leader/ Coach shall provide leadership to and organization of on-scene personnel to ensure the below positions (runner/compressor, ventilator) are filled and that performance meets the department’s standards of care.
293
Runner/Compressor is usually ______.
Immediately assesses responsiveness and checks for the presence of a carotid or femoral pulse.
Important Note: pulse should only be checked for a maximum of 10 seconds, if no definite pulse is felt, assume the patient is in cardiac arrest and immediately start CPR.
First member to arrive at the patient's side.
294
"Hovers,” no more than ____ inches over the patient’s chest during any pause in chest compressions, including defibrillation attempts, in order to minimize the interruption in compressions or “hands off” time.
two
295
The helmet removal procedure is a guideline designed in two parts. They are:
Part I is for those patients wearing a motorcycle, bicycle, or other non-football type head protective device.
Part II is designed for those patients wearing a football helmet.
296
A _____ is the preferred tourniquet. If none is available, a blood pressure cuff inflated to a pressure sufficient to stop bleeding can be tried only until a commercially made tourniquet is available.
commercially made tourniquet
297
Do not apply a tourniquet _____.
over a joint
298
Only gauze with an _____ may be packed into a wound cavity.
x-ray detectable strip
299
The term______ is used to describe any pelvic fracture that significantly disrupts the pelvic ring. These injuries combine an anterior pelvic injury causing widening (opening) of the pubic symphysis, and a posterior pelvic fracture or ligamentous injury. Open book pelvic injuries result in a risk of major hemorrhage and result in a high incidence of death or disability.
Open book pelvic fracture
300
_____is a commercially available pelvic stabilization device. The SAM Pelvic Sling™ II is one such device.
Pelvic binder
301
it is strongly recommended that providers avoid “____” the pelvis as this may further displace fracture fragments and dislodge already formed blood clots. Instead, gently palpate the bony structures of the pelvis and lower spine for tenderness.
rocking
302
Pelvic fractures most frequently occur in patients ____ y/o who sustain high-energy, side-impact mechanisms of injury such as high-level falls or MVC’s.
15-28
303
The most feared complication of a pelvic injury is ____.
rapid and uncontrolled hemorrhage into the retroperitoneal space.
304
______: a team of hospital-based clinicians, led by an attending trauma surgeon, that is on-call at a local trauma center to respond to entrapments and entanglements that requsire advanced surgical procedures to extricate or resuscitate a patient.
Surgical strike team
305
ALS:
The SNORES bundle of care should be initiated for all patients undergoing procedural dissociation unless logistically not possible due to confined space/technical rescue operations. SNORES is
S - SpO2 monitoring
N - Nasal ETCO2 monitoring
O - Oxygen at a minimum of 6 L via nasal cannula
R - Reassess airway status and vital signs frequently
E - ECG 3 lead monitoring
S – Sugar/glucose check
306
SAMPLE is_____
signs/symptoms,
allergies,
medications,
past history,
last oral,
events leading to
307
What will be complying with DCFEMS protocols regarding patients exhibiting excited delirium?
A member initiates rapid cooling by applying ice packs to a hyperthermic patient.
308
What about applying spinal motion restriction (SMR) is CORRECT?
SMR, when indicated, should be applied to the entire spine.
309
What is one of the inclusion criteria for the Department’s cardiac arrest protocol?
The patient has abnormal breathing.
310
Adult patients exhibiting signs and symptoms of a cerebral vascular accident (CVA) should be screened using the VAN tool. What does the N in VAN stand for?
Neglect
311
According to the D.C. Fire and EMS Department Emergency Medical Services Manual and Pre-Hospital Treatment Protocols, an adult whose blood glucose level is below _____ mg/dL is considered hypoglycemic and should be treated.
70
312
A prolapsed cord occurs when the umbilical cord presents itself outside of the uterus while the fetus is still inside. When this occurs during an OB-GYN emergency, the provider should place the mother in which of the following
positions?
The knee-chest position.
