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EMS Protocols Flashcards

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1
Q

Who is our medical director and assistant medical director

A

James Roach
Alex Torres

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2
Q

For unresponsive patients if ventilation is required for more than ____ what should be done

A

2 minutes
Upgrade airway

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3
Q

What is the preferred way for ventilating a pediatric patient

A

BVM in conjunction with OPA/NPA

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4
Q

Infants and children with an advanced airway during CPR should be ventilated at what rate

A

1 breath every 6 sec

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5
Q

Ped patients who’ve had recent illness with fever, stridor, or drooling should not have

A

NPA or OPA placed. Don’t stress patient

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6
Q

O2 should only be administered to maintain O2 levels of

A

95% or 90% for COPD/asthma patients

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7
Q

TBI patients shall receive what

A

15 lpm via NRB

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8
Q

Pregnancy 3rd trimester trauma patients shall receive

A

15 lpm via NRB

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9
Q

Intubation shall be confirmed by

A
  • Visualization of tube passing chords
  • Auscultation
  • Continuous EtCO2 monitoring
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10
Q

Ventilatory rates for adults with and without pulse

A

Both 1 breath every 6 sec

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11
Q

Ventilatory rates for children with and without pulse

A

1 breath every 3 sec (pulse)
1 breath every 6 sec (without)

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12
Q

Ventilatroy rate for neonates

A

40 breath/minute

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13
Q

For peds after BVM ventilation of ___ for infants/children and ___ for neonates, what should be done

A

1 minute
30 sec (neonate)
Begin compressions if heart rate still below 60 bpm

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14
Q

What patients should be monitored if EtCO2 cannula is available

A

Respiratory distress
AMS
Sedated patients
Ketamine administered
Seizure
Ventilatory support

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15
Q

Vital signs for priority 3 and priority 2 patients include

A
  • At least 2 sets and every 15 minutes (priority 3)
  • Vitals every 2 minutes
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16
Q

Adult hypotension is defined as

A

Systolic less than 100

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17
Q

How do we define a pediatric patient

A

Absence of puberty

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18
Q

Ages for adult/ped medical and adult/ped trauma

A

Medical: Adult 18 or older, Ped 17 or younger

Trauma: Adult 16 or older, Ped 15 or younger

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19
Q

What does APGAR stand for

A

Appearance
Pulse
Grimace
Activity
Respirations

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20
Q

Hypotension for neonates, infants, children 1-10, and children greater than 10

A

SBP less than 60
SBP less than 70
SBP less than 70 + age in years x2
SBP less than 90

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21
Q

Heart rates:
Newborn-3 months
3 months-2 years
2 years-10 years
Greater than 10

A

85-205
100-190
60-140
60-100

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22
Q

Describe priority 1, 2, and 3 patients

A

1: Cardiac, trauma or respiratory arrest
2: Unstable with life threats
3: Stable no life threats

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23
Q

All intubated interfacility transfers must be

A

Paralyzed and sedated

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24
Q

If child, elder, or disabled adult abuse is involved, EMS is required by law to

A

Contact Florida Department of Children and Families

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25
If a witness is used to identify a patient with a DNR, what must be documented in report
Full name of witness Address and number Relationship of witness to patient
26
The granting of permission for health care without a formal agreement btwn patient and health care provider
Implied consent
27
What patients are able to refuse care
- Those with decisional capacity - Adult, 18 or older - Emancipated minor, self sufficient, or minor in military
28
Anaphylactic shock is characterized by what
S/S of allergic reaction with loss of radial pulse or SBP < 100
29
Protocol for mild and moderate/severe allergic reaction
Mild: Benadryl 50 mg IV/IO/IM over 2 min Moderate: Epi 1:1000 0.3 mg, may repeat x2 Albuterol 2.5 mg nebulizer Benadryl Solumedrol 125 mg IV/IO/IM
30
Protocol for anaphylactic shock
Push dose epi Normal saline 1L Benadryl, solumedrol, albuterol as noted for moderate reaction
31
Doses for pediatric allergic reaction
Benadryl 1mg/kg max 50 mg over 2 minutes Epi 1:1000 .01mg/kg max 0.3 single dose, repeat x2 Albuterol 2.5 mg nebulizer Solumedrol 2mg/kg Saline 20mL/kg
32
What does AEIOU-TIPS stand for
Alcohol Epilepsy Insulin Overdose Uremia Trauma Infection Psych Stroke
33
What patients should be transported regardless of post treatment glucose levels
Taking oral hypoglycemic meds (Glipizide, Glimepiride, Glyburide)
34
What are the ranges for hypo and hyperglycemia
<60 hypo >300 hyper
35
Hypoglycemia and hyperglycemia protocols
Hypo: oral glucose 15g if able to swallow D10 100mL IV Hyper: Normal saline 1L Zofran 4mg IV/IO/IM/PO if nauseous
36
If unable to establish IV for hypoglycemia what can be given
Glucagon 1mg IM
37
Doses for ped diabetic emergencies
Oral glucose 15G, (not for patients <2) D10 5mL/kg max 100mL Saline 20mL/kg Zofran 0.1 mg/kg Glucagon <20kg = 0.5mg, >20kg = 1mg IM
38
Characterized by intermittent spasmodic or sustained contractions of muscles in face, neck, trunk, pelvis, extremities, larynx
Dystonic reactions
39
Protocol for adult and ped dystonic reactions
Adult: Benadryl 50mg over 2 minutes Ped: Benadryl 1mg/kg max total 50mg over 2 minutes
40
Hyperkalemia protocol adult
Calcium chloride 1g slow IV/IO over 2 minutes Albuterol 10mg nebulizer Bicarb 50mEq, slow over 2 minutes
41
Hyperkalemia protocol ped
Calcium 20mg/kg, slow over 2 minutes Albuterol 10mg Bicarb
42
Seizure protocol adult
Versed 5mg IV/IO/IN/IM max 10mg If no effect after versed, Ketamine 100mg Additional 100mg if patient to be intubated
43
Seizure protocol ped
Actively cool Tylenol 15mg/kg PO if not seizing Versed 0.1mg/kg IV/IO, 0.2mg/kg IN/IM Ketamine if no effect 1mg/kg (diluted)
44
Temp range for sepsis
>100.4 or <96.8
45
Sepsis alert criteria
- Adult with suspected/confirmed infection - AND at least 2/3: - Hypotension - AMS - Tachypnea
46
Sepsis and septic shock treatment
- Call sepsis alert - Monitor EtCO2 - BGL - SpO2 at 95% or 90% (COPD) - Saline Septic shock push dose EPI
47
Stroke alert criteria
Race 1 or greater and onset/last known well within 24 hours
48
What is max race score and why
Max 9 Aphasia used for deficits on right Agnosia for deficits on left
49
What are the 2 pediatric comprehensive stroke centers in Broward
BHMC and JDCH
50
Stroke protocol
- Transport patient 30 degree elevation - 2 lpm NC for sat <95% - 18g in A/C
51
What should be communicated to hospital for stroke alert
- LKW - Race score - Patient on blood thinners - B/P - BGL - ETA
52
When air goes in before the patient is allowed to fully exhale. When does this occur?
Auto PEEP During assisted ventilations
53
When do you assist ventilations with a BVM
Respiratory rate of <10 or >29 with shallow respirations
54
When is CPAP considered and examples
Moderate/severe respiratory distress. COPD, asthma, pneumonia
55
When is CPAP contraindicated
- Decreased LOC - Patients without spontaneous respirations - SBP <100
56
Adult respiratory distress protocol COPD
Albuterol 2.5mg neb CPAP Solumedrol 125mg IV/IM
57
Adult respiratory distress protocol asthma/severe asthma
Albuterol 2.5mg neb Solumedrol 125mg IV/IM Severe: CPAP (5-10 cm H2O) Albuterol Epi 1:1000 0.3mg IM may repeat x2 Mag Sulfate infusion Solumedrol
58
Ped respiratory distress protocol asthma mild
Albuterol 2.5mg neb Solumedrol 2mg/kg over 2 min
59
Ped respiratory distress protocol asthma moderate/severe
Assist vent with BVM Albuterol Epi 1:1000 0.01mg/kg may repeat x2 Mag sulfate infusion Solumedrol
60
Croup/Epiglottitis protocol
Epi 1:1000 3mL via nebulizer Don't stress patient Don't intubate or insert OPA/NPA
61
Croup symptoms
Usually <3 years old Sick for couple days Low grade fever Not toxic appearing
62
Epiglottitis symptoms
Usually 3-6 years old Sudden onset Tripod position High grade fever Drooling Poor general impression
63
Adult and ped facilitated laryngoscopy/supraglottic airway protocol
Adult: Etomidate 30mg IV/IO or Ketamine 200mg diluted IV Ped: Etomidate 0.3mg or Ketamine 1mg/kg
64
Post intubation sedation/paralysis protocol
Ketamine 200mg may repeat x1 Rocuronium 50-100mg IV/IO may repeat x1
65
Ped dose of rocuronium
1mg/kg IV/IO
66
For STEMI alerts where should the IV be placed
Right AC or anywhere on left arm
67
Adult chest pain protocol
12 lead Aspirin 324mg, unless pt. self admin 324mg within 24 hours Fentanyl 100mcg slow IV/IO/IM max 200mcg
68
Contraindications for aspirin
Allergy, active GI bleeding
69
STEMI alert protocol
12 lead Aspirin 324mg Fentanyl 100mcg slow IV/IO/IM max 200mcg
70
STEMI alert criteria
Elevation in 2 or more contiguous leads of 2mm or greater with concave (smiley face) Elevation in 2 or more contiguous leads (2mm or > in V2 and V3 or 1mm in all other leads) with convex (frown face)
71
STEMI mimics
QRS > 0.12 LVH Pericarditis Early repolarization < 2mm elevation with concave
72
CHF Protocol
Aspirin 324mg CPAP 10cm H2O Lasix 40mg IV Nitro paste 1" to anterior upper chest
73
Contraindications for nitro
SBP <100 EDD within 24-48 hours RVI
74
Condition in which heart suddenly can't pump enough blood to meet body's needs
Cardiogenic shock
75
Cardiogenic shock protocol
Follow CHF protocol Hypotension: push dose epi
76
What are the 2 LVAD hospitals in Broward
Memorial regional Cleveland clinic
77
Adult bradycardia protocol
Stable: monitor/transport Unstable: 12 lead Saline 1L Atropine 0.5mg IV/IO may repeat 3-5min max 3mg Push dose epi Pacing starting at 60bpm
78
Bradycardia is defined as heart rate <
60bpm
79
In presence of chest pain and high degree AV blocks with hypotension what should be done for bradycardia
Directly to pacing
80
Sedation for pacing
Etomidate 10mg IV/IO may repeat x1 Or Versed 5mg
81
Ped bradycardia protocol
Stable: monitor/transport Unstable: Oxygenate Push dose epi If no response pace at 80bpm
82
Ped sedation for pacing
Etomidate 0.15mg/kg or Versed 0.1mg/kg
83
Adult rapid A-fib A-flutter protocol
Stable: Cardizem 10mg IV/IO over 2 min If HR > 120 after 5 min give 15mg IV/IO over 2 min Unstable: Saline 1L DO NOT CARDIOVERT
84
Contraindications for Cardizem
Hypotension Wide QRS WPW Sick sinus syndrome Patient taking beta blockers
85
Stable SVT adult protocol
Vagal maneuver Adenosine 12mg rapid IV Failure to convert then give Cardizem 10mg over 2 min Cardizem 15mg if still >120
86
If hypotension occurs after Cardizem what should be done
Saline 1L Calcium chloride 1g IV/IO over 2 min
87
For WPW with rapid ventricular response what should be done
Amiodarone infusion
88
Unstable adult SVT protocol
Unstable = hypotension Patient alert: Adenosine 12mg rapid IV Altered patient: Cardioversion 200J Consider sedation prior
89
Ped stable SVT protocol
Vagal Adenosine 0.1mg/kg rapid IV If no change in 1 min adenosine 0.2mg/kg rapid IV
90
Unstable ped SVT protocol
Unstable = age appropriate hypotension Patient alert: Adenosine AMS: Cardioversion 1J/kg, increase to 2J/kg if not effective Etomidate 0.15mg/kg IV/IO over 15-30 sec
91
SVT rate in infants and children
Infant >220 bpm Children >180 bpm
92
Treatment for really wide complex tachycardia
NO AMIODARONE Calcium 1g IV/IO over 2 min Bicarb 50mEq IV/IO over 2 min
93
Adult stable wide complex tach protocol
Amiodarone infusion 150mg in 50mL over 10 min If ami no available then Lidocaine 100mg IV/IO, may repeat x1 after 5 min if no effect
94
Adult unstable wide complex tach protocol
Cardiovert 200J Failure to convert Amiodarone infusion If unstable after infusion cardioversion every 2 min prn
95
Ped stable wide complex tach protocol
Ami infusion or lidocaine 1mg/kg
96
Ped unstable wide complex tach protocol
Cardioversion 1J/kg, if no response 2J/kg, then 4J/kg Etomidate 0.15mg/kg
97
Adult poly v-tach (torsades) protocol stable/unstable
Stable: Mag sulfate 2g in 50mL, 10 drop set wide open Unstable: Etomidate 10mg IV/IO Defibrillation 200J Mag Sulfate 2g in 50 mL
98
Ped poly v-tach protocol
Stable: Mag sulfate 40mg/kg in 50mL Unstable: Etomidate 0.15mg/kg Defibrillation 2J/kg, 4J/kg, 10J/kg Mag Sulfate
99
All cardiac arrests shall be worked on scene for how long
20 minutes
100
Minimizing interruptions in compressions to
< 5 sec
101
The ResQPOD shall be used for what patients
Pulseless adult patient w/out chest trauma and ped patients >1
102
When can you terminate efforts after resuscitation has started
Persistent Asystole/PEA for 20 min EtCO2 <10 mmHg H's and T's addressed (Ultrasound w/no heart wall motion for PEA)
103
EtCO2 above ____ is ideal for resuscitation
20 mmHg
104
What are the H's and T's
Hydrogen ion Hyperkalemia Hypoxia Hypoglycemia Hypovolemia Hypothermia Tamponade Thrombosis Trauma Tablets/toxins Tension pneumo
105
When is the AutoPulse applied
After 3 rounds of 220 compressions
106
What should be given for hyperkalemia
Calcium 1g IV/IO over 2 min Albuterol 10mg nebulizer Bicarb 50mEq over 2 min
107
Agitated delirium cardiac arrest special consideration
Bicarb 50mEq over 2 min Cold Saline 30mL/kg max 1L
108
What should be done for 3rd trimester cardiac arrest patients
Manually displace uterus to left
109
Post resuscitation protocol
RATE RHYTHM BLOOD PRESSURE 12 Lead Remove ResQPOD Ice pack axilla and groin Saline 1L for hypotension Stop Epi drip
110
What are the age ranges for Jump Start triage system
1-8 years
111
on scene times for level 1 trauma should be
< 10 min If > 10 min needs to be documented in EPCR
112
GCS Motor response
1 no response 2 extension to pain 3 flexion to pain 4 withdrawal from pain 5 localize pain 6 obeys commands
113
GCS verbal response
1 no verbal response 2 incomprehensible 3 inappropriate words 4 confused 5 orientated
114
GCS eye response
1 no eye opening 2 opening to pain 3 opening to verbal 4 spontaneous
115
Level 2 trauma criteria
1 Falls >12 adult, >6 peds 2 Extrication > 15 min 3 Rollover 4 Death of occupant in same passenger compartment 5 Major intrusion 6 Separation from bicycle 7 Fall any height on blood thinners 8 Paramedic judgement
116
Rule of 9's for adult burns
Head - 9 Torso - 18 Back - 18 Each arm - 9 front/back Each leg - 18 front/back Groin - 1
117
Treatment 1st and 2nd degree burns < 15% or 3rd degree <5%
Apply dry sterile dressing or burn sheet
118
Treatment 2nd degree burns >15% or 3rd degree >5%
Apply dry sterile burn sheet Saline 1L
119
Dry and liquid chemical burns treatment
Liquid chemical: irrigate with water/saline Dry chemicals: brush off prior to irrigation
120
BSA percentages for ped
Head and neck - 21% Each arm - 10% Back - 13% Abdomen - 13% Buttocks - 5% Each leg - 13.5% Groin - 1%
121
What is Cushing's Triad
Widening pulse pressure Irregular respirations Bradycardia
122
What is the preferred site for needle decompression
3rd intercostal space midclavicular
123
Where is finger thoracostomy performed
3rd intercostal space mid axillary
124
What should not be done for impaled objects in the abdomen
Palpation of the abdomen as it may cause further injury
125
What should be done for abdominal evisceration
Cover protruding tissue with moist sterile dressing, then cover with dry sterile dressing Keep patient calm
126
What can be used for junctional wounds
Israeli bandage
127
How many attempts can be made to place extremity back to anatomical positions
No more than 2
128
What makes it difficult to assess for shock in pregnant patients
Heart rate increases in 3rd trimester Blood pressure decreases in 2nd Cardiac output increases
129
All 3rd trimester pregnancy trauma patients shall receive
15 lpm via NRB
130
Trauma patients in cardiac arrest should have what performed
Bilateral needle decompression or finger thoracostomy
131
If trauma patient does not regain pulses after decompression or thoracostomy what should be done
Resuscitation efforts terminated
132
What is the Marches protocol and what is it used for
Used for hemorrhagic shock Massive bleeding control Airway Respiratory Circulation Hypothermia care Eye injuries Spinal motion restriction
133
What are signs and symptoms of neurogenic shock
Skin warm/dry Hypotension w/bradycardia Paralysis
134
What is tranexamic acid and what does it do
Antifibrinolytic Stabilizes fibrinogen and decreases plasmin formation
135
Contraindications for TXA
Injuries > 3 hours Age < 5 Non traumatic bleeding
136
What is adult and ped dose for TXA
Adult: 2g in 100mL 3 drops per sec over 5 min Ped: 15mg/kg in 100mL, 3 drops per sec over 5 min
137
Dose for adult and ped whole blood
Adult: 1-2 units (500mL = 1 unit) Ped: 15mL/kg
138
In the event whole blood is not available what can be used as a substitute
Low titer liquid plasma or O+ PBRC
139
What are the contraindications for whole blood
Religious objection Women of childbearing age should have confirmed hemorrhagic shock
140
LTOWB has a ____ shelf life
21 day
141
Adult beta blocker overdose protocol
If hypotensive Saline 1L Poison control Glucagon 1mg/min IV/IO Pace @60 bpm for refractory bradycardia Etomidate 10mg for sedation Push dose epi
142
Pediatric beta blocker overdose protocol
Saline 20mL/kg Poison control Glucagon 1mg/min until hypotension resolves (0.5mg for pts. <20kg) Etomidate 0.15mg/kg sedation Pace @80 bpm Push dose epi
143
Adult calcium channel blocker overdose protocol
If hypotensive Saline 1L Calcium chloride 1g slow over 2 min Etomidate 10mg sedation Pace @60 bpm for refractory bradycardia Push dose epi
144
Ped calcium channel blocker overdose protocol
If hypotensive Saline 20mL/kg Calcium chloride 20mg/kg slow over 2 min Pace @80 bpm for refractory bradycardia Etomidate 0.15mg/kg for sedation Push dose
145
Adult cocaine overdose protocol
Versed 5mg IV/IO/IN/IM, may repeat x1 Agitated pts: Ketamine 200-400mg IM or 200mg IV
146
What are some common tricyclic antidepressants
Amitriptyline, Desipramine, Doxepin
147
What is the pneumonic for TCA overdose
Mad as a hatter Red as a beet Hot as hell Dry as a bone Blind as a bat
148
Adult TCA overdose protocol
If hypotensive Saline 1L For pts. with QRS >.01 seconds, bicarb 50mEq slow over 5 min Max 150mEq
149
Ped TCA overdose protocol
If hypotensive Saline 20mL/kg For pts. with QRS >.08 seconds, bicarb 8.4%/4.2% 1mEq slow
150
Adult Narcotic overdose protocol
Maintain SpO2 95% Narcan 0.5-2mg max 10mg
151
Ped narcotic overdose protocol
Maintain SpO2 95% Narcan 0.5mg or 1mg IN Max 10mg
152
Restrained patients shall be positioned
Supine
153
When Ketamine is not available for adult violent patients what can be given
Haldol 5mg IM and Benadryl 50mg IM
154
Chemical restraint protocol
Ketamine 200-400mg IM. may repeat x1 max single dose 400mg Allow patient to hyperventilate Don't hold patient in prone position or hands cuffed behind back
155
What is an adverse reaction to Ketamine and treatment
Hypersalivation: give Atropine 0.5mg Laryngospasm: almost always resolves with high flow O2
156
Rapid cooling for temp >103 degrees
Ice pack to axilla and groin Cold Saline 1L Bicarb 50mEq IV/IO over 2 min
157
What are the special considerations for ketamine and what should be done instead
Over 65 Head Trauma <50kg Other sedatives on board Give 200mg IM for these patients
158
Pain management can be given to all patients with the exception of
Pregnant women near term (32 weeks or greater) or active labor
159
What is the front line medication for pain
Fentanyl, Ketamine is preferred for hypotensive patients and opiate contraindications
160
Adult pain management protocol
Fentanyl 100mcg slow may repeat x1 after 5 min Zofran 4mg for nausea/vomiting secondary to fentanyl
161
For continued pain management what should be given
Ketamine given after Fentanyl for severe pain Dose: 25mg may repeat x2 every 5min. Max 75mg
162
Ped pain management protocol
Fentanyl 1mcg/kg IV/IO 1.5mcg/kg IN/IM Zofran 0.1mg/kg
163
What are the 2 hyperbaric chamber hospitals we transport to?
Mercy hospital Miami St. Mary's Palm Beach
164
What is the max height a decompression sickness patient can be transported in air rescue
Max 500 ft.
165
No drowning victim is to be pronounced dead on scene if
Possibility of hypothermia exists
166
What is the immediate priority in fatal/non fatal drownings
Ventilation
167
Adult and ped heat cramps and exhaustion protocol
Move patient to shaded area or A/C Hydrate Monitor for AMS Saline 1L
168
Adult and ped heat stroke protocol
Move patient to rescue ASAP Obtain temp Temp <103, Saline 1L Temp >103, apply ice packs and chilled Saline 1L
169
Adult and ped snake bite protocol
Mark edema with pen If dead snake on scene take pictures If hypotensive Saline 1L Benadryl
170
Adult and ped dog, cat, wild animal bite protocol
Wound care Clean wound with soap and water Pain management
171
Insect stings protocol
Consider allergic reaction Scrape stinger off Clean with soap and water Pain management Zerym spray
172
Adult and ped marine envenomation protocol
Consider allergic reaction Immerse in non-scalding water Wash with soap and water Zerym spray Pain management
173
Marine animal sting protocol
Consider allergic reaction Rinse with sea water Zerym spray Remove large tentacles with forceps Pain management
174
Human bites protocol
Clean with soap and water DLE for investigation Pain management
175
CO is toxic to humans when encountered in concentrations
Above 35 parts per million
176
For any suspected CO exposure what should be done
Administer high flow O2 and transport to closest ED with helipad
177
Cyanide exposure protocol
O2 NRB @ 15lpm Alert battalion Cyanokit 5g over 10-15 min, may repeat x1 Cyanokit given in separate/dedicated line
178
Ped Cyanide exposure protocol
O2 NRB @ 15lpm Cyanokit 70mg/kg over 10-15 min, may repeat x1 Cyanokit given in separate/dedicated line
179
What history should be obtained for pregnant patients
# previous viable births (para) previous preg (gravida) # previous births (para) Last menstrual cycle Water break Due date Frequency/length contractions Feeling to push
180
Patients <20 weeks can be transported to
Closest ED
181
Patients >20 weeks w/abdominal or pelvic pain can be transported to
Closest ED
182
Patients >20 weeks w/minor concerns can be transported to
Closest ED
183
Stable patients >20 weeks can be transported to
OB hospital of choice within 40 minutes
184
>20 weeks and in cardiac arrest transported to
Closest OB hospital
185
>20 weeks and trauma transported to
Trauma/OB hospital
186
What is Breech birth
Buttocks presentation
187
Breech birth protocol
If head does not deliver in 3 minutes place mother knee to chest position
188
This usually occurs in first trimester and may present with sudden onset severe lower abdominal pain/vaginal bleeding
Ectopic pregnancy
189
S/S of ectopic pregnancy
Pain to left shoulder Grey turner's sign abdominal distention/tenderness
190
Usually occurs before 20 weeks gestation
Spontaneous abortion
191
For spontaneous abortion if gestational age is >22 weeks and fetus is not out of placenta what should be done
Separate fetus and start neonatal resuscitation
192
What are some third trimester complications
Abruptio placenta Placenta previa Uterine rupture
193
S/S of abruptio placenta
Sudden onset sever pain Painful uterine contractions Vaginal dark red bleeding May present in shock
194
S/S of placenta previa
Painless vaginal bleeding Bright red blood
195
S/S of uterine rupture
Sudden, intense abdominal pain and vaginal bleeding
196
Pre eclampsia is characterized by what symptoms
HTN AMS Visual disturbances Headache Pulmonary edema
197
Eclampsia is characterized by what symptoms
Any S/S of pre eclampsia with seizure or coma
198
What is the criteria to determine if a patient is pre eclamptic or eclamptic
2 consecutive BP, SBP >160 or DBP >110 5 min apart AND one of following S/S: AMS, Headache, Visual disturbances, P Edema
199
Pre eclampsia protocol
Mag Sulfate 2g in 100mL wide open Labetalol 20mg IV, 1 dose max
200
Eclampsia protocol
Mag sulfate 4g in 100mL wide open Mag sulfate 2g IM, lateral thigh Labetalol 20mg IV Follow seizure protocol if seize
201
If upon delivery of the head there is meconium staining present, what should be done
Use bulb syringe to clear mouth FIRST then nose before delivering shoulders
202
What is the procedure upon delivery of the newborn
Dry, warm, stimulate baby Wait for cord to stop pulsating (3-5 min) Clamp and cut cord
203
What is the proper way to cut the umbilical cord
Place first clamp 4" away from newborn Milk cord away from newborn Place 2nd clamp 2" away from from first towards mother Cut between clamps
204
When do we record an APGAR and what does it stand for
At 1 and 5 minutes Appearance Pulse Grimace Activity Respirations
205
Nuchal cord protocol
- Check for presence after delivery of head - If around neck gently hook finger under loop and pull over baby's head - If unable to, clamp cord in 2 places and cut between clamps
206
Prolapsed cord protocol
- Place mother in knee to chest position - Gloved hand into vagina, push newborn up and away from cord - Wrap exposed cord in moist sterile dressing
207
How do you transmit a 12 lead to hospital
- Turn on hotspot - Take 12 lead - Locate open envelope with 12 on it to left and select it - Scroll down to and select the destination - Transmit
208
Blood alcohol sampling procedure
Must be done in back of rescue Only use DLE blood draw kit Never use alcohol prep
209
What should the EMS run report contain when doing a blood alcohol sampling
- Blood sampling kit used - Name DLE officer requesting blood sample - Time of draw
210
What should be obtained for every vital set taken
4 lead snapshot
211
The Zoll X series utilizes what kind of energy which allows what?
Rectilinear biphasic energy Allows shocks at lower energy with greater efficacy
212
An adult bougie will allow ET tubes down to what size
Size 6.0
213
Contraindications for the AutoPulse
Traumatic cardiac arrest Patients weight >300 lbs. Under 18 Can be used on patients <18 with adult body characteristics
214
Cardioversion is generally unnecessary for heart rates less than
150 bpm
215
What are the needle sizes and weight for IO needles
15mm (pink) 3-39kg 25mm (blue) 3kg and > 45mm (yellow) 40kg and >
216
IO infusion pain management conscious
Lidocaine 40mg slow over 2 min Allow to sit for 60 sec 5-10mL Saline flush May repeat Lidocaine 20mg
217
What are some types of nerve agent auto injectors
Mark 1 Atropen CANA kit
218
What are the tag color for START and JumpSTART triage and what do they mean
Green - Ambulatory Yellow - Delayed Red - Immediate Black - Deceased Blue - HAZMAT exposure
219
What are the respiratory rates needed for JumpSTART triage
Between 15 and 45 times a minute
220
The Stryker power pro stretcher is powered by what kind of battery
24 Volt
221
How do you dilute Benadryl
1mL Benadryl in 9mL Saline = 5mg/mL
222
How do you dilute Fentanyl
2mL Fentanyl in 8mL Saline = 10mcg/mL
223
How do you dilute Ketamine
Dilute 5mL (500mg) Ketamine in 50mL Saline = 10mg/mL
224
How do you dilute Bicarb
Discard 25mL of 8.4% Bicarb, draw up 25mL Saline = 4.2% Bicarb
225
What are some simple asphyxiants
CO2 Propane Nitrogen Methane
226
Inhalation exposure protocol for Ammonia, Hydrogen Chloride and Chlorine
Albuterol 2.5mg nebulizer Bicarb 3mL of 8.4% with additional 3mL saline via nebulizer
227
Adult level 1 trauma red criteria
- Active airway assistance - No radial w/ sustained HR >120 or BP <90 - Multiple long bone fractures - 2nd or 3rd degree burns > 15% BSA - Penetrating injury to head, neck, torso - BMR 4 or less/presence of paralysis - Paramedic judgement - GCS 12 or less
228
Adult level 1 trauma blue criteria
- Sustained respiratory rate 30 or > - Sustained HR 120 or > - Single long bone FX due to MVA or fall 10ft or > - Major degloving >5 inches or GSW to extremities - BMR = 5 - Ejection from vehicle/deformed steering wheel - Blood thinner >55 years - Blunt abdominal injury
229
Pediatric level 1 trauma red criteria
- Assisted or intubated - AMS, paralysis, suspected spinal injury, loss sensation - Faint/non palp carotid/femoral pulse - SBP <50 - Any open long bone FX or multiple FX - Major soft tissue, amputation proximal to wrist/ankle - 2nd/3rd burns to 10% - Penetrating injury to head, neck, torso - Paramedic judgment
230
Pediatric level 1 trauma blue criteria
- Amnesia or reliable HX of LOC - Carotid or femoral palp, no pedal pulse or SBP <90 - Single closed long bone FX - Blunt abdominal injury - Red, purple <11kg (24 lbs.)

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