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Flashcards in EMS Standing Orders Deck (202):
0

If at least ONE of the following conditions is found, CPR may be withheld:

Lividity
Rigor mortis
Blunt or penetrating trauma without signs of life
Decomposition
A valid DNR is discovered

1

If ALL of the following are present , CPR may be withheld:

1. Known downtime greater than (30) minutes
2. Asystole
3. Pupils fixed and dilated
4. No respirations
5. Without hypothermic mechanism for arrest

2

When there are multiple critical trauma casualties and insufficient resources, choices will have to be made in regard to resource allocation:

Triage Situations

3

Physician in attendance: This order, verbal or in writing, must be given by a Florida licensed ____ or ____ to be legal:

MD or DO

4

When in doubt, especially when it is not the patient who requested our service, ____ consent should be obtained:

verbal

5

Exceptions to patients under the age of 18 who can refuse care:

1. Emancipated minors
2. Self sufficient minor
3. Married minors
4. Minors in the military

6

Patients may not refuse care under the following circumstances:

1. AMS (GCS less than 15)
2. Suicide attempt (verbal or actual)
3. Mental retardation or deficiency
4. Not acting as a reasonable person would
5. Patients under the age of 18 (except exceptions)

7

To be considered valid, the DNR must meet the following criteria:

-The form states it is a DNRO and specifies that the patient is not to be resuscitated.
-Original is signed and dated by the patient's physician. Photocopies are acceptable.
-The form has been signed and dated by the patient or the patient's surrogate or proxy.
-The DNR order is not withdrawn by the patient, the patient's attending physician, or the pt's healthcare surrogate or proxy.
-Identity is verified by the driver's license, other photo ID or form a witness in the presence of the patient.

8

In mutual aid circumstances, personnel should follow the ____ agency's patient treatment protocols:

transporting

9

BLS Airway: If ventilation is required for more than ___ minutes, an LMA should be inserted:

2

10

Ventilation Rates: Adults

10 breaths/min (1 breath every 6 seconds)

11

Ventilation Rates: Children

20 breaths/min (1 breath every 3 seconds)

12

Ventilation Rates: Neonates

40 breaths/min

13

Patients with advanced airways should be ventilated at a rate of _____ breaths/minute (1 breath every 6-8 sec)

8-10

14

Perform MICCR (CPR for PEDS) with the patient in a ___ degree heads up position and defibrillate as needed:

30

15

Begin compressoins for infants and children with a pulse less than ___ with signs and symptoms of poor perfusion (altered mental status):

60

16

History of present illness: OPQRST:

Onset
Palliative (What makes the s&s better)
Provoke (What makes the s&s worse)
Previous (Previous similar episodes)
Quality
Radiation
Severity
Time

17

Endotracheal intubation shall be confirmed by:

1. Direct visualization
2. Esophageal Intubation Detector (EID)
3. Colormetric paper
4. Continuous EtCO@ monitoring

18

EZ IO primary site is the:

proximal tibia

19

EZ IO secondary site is the:

humeral head

20

Which EZ IO site needs insertion by or approval of EMS 2:

humeral head

21

EZ IO will be established after 2 unsuccessful IV attempts.

True

22

The goal is having an access site within ___ seconds:

90

23

Only EMS 2 has the authority to insert or designate use of EZ IO in priority ___ patients:

2

24

EtCO2 should be applied to all patients:

1. In respiratory distress or requiring vent support (ETT, etc)
2. AMS with respiratory difficulty or compromise
3. Sedated patients or patients receiving pain meds

25

All ALS patients shall have continuous EKG monitoring in 2 leads.

True

26

Patients who present with any of the following cardiac or possible cardiac symptoms shall have a 12 lead ECG performed:

1. Chest/arm/neck/jaw/upper back/shoulder/epigastric pain or discomfort.
2 Palpitations, or rate greater than 100 or less than 60
3. Syncope, lightheadedness, general weakness, or fatigue
4. CHF, SOB, or hypotension
5. Unexplained diaphoresis or nausea

27

12 lead ECG's shall be repeated ever ___ minutes and upon a ROSC:

10

28

Patients under the age of 18 who weigh ___ kg or less are considered pediatric patients:

36

29

Patients under the age of 18 who weigh more than ___ kg or more shall be treated under the adult section of these protocols:

36

30

PEDS: Fluid boluses are ___mL/kg and may repeat 2x for hypotension. Max of ___mL/kg:

20, 60

31

The preferred method for ventilating pediatric patients is with a ___ in conjunction with an oral or nasal airway:

BVM

32

If there is a discrepancy between the Broselow tape and these protocols, the protocols shall supersede the Broselow tape:

True

33

PED Age Classifications: Neonates:

birth to 1 month

34

PED Age Classifications: Infants:

1 month to 1 year

35

PED Age Classification: Children:

1 year to puberty

36

Once a child reaches puberty use the adult guidelines for CPR.

True

37

Resp. Rates - Neonates:

40-60 breaths/min

38

Resp. Rates - Infants:

30-60 breaths/min

39

Resp. Rates - Toddlers (1 - 3 y/o)

24-40 breaths/min

40

Resp. Rates - Preschooler (4 - 5 y/o)

22-34 breaths/min

41

Resp. Rates - School Age (6 - 12 y/o)

18-30 breaths/min

42

Resp. Rates - Adolescent ages (13 - 18 y/o)

12-16 breaths/min

43

PED HR - Newborn to 3 months:

85-205, mean 140 bpm

44

PED HR - 3 months to 2 years:

100-190, mean 130 bpm

45

PED HR - 2 years to 10 years:

60-140, mean 80 bpm

46

PED HR - Greater than 10 years:

60-100, mean 75 bpm

47

PED Hypotension - Neonates:

SBP less than 60

48

PED Hypotension - Infants:

SBP less than 70

49

PED Hypotension - Children 1 - 10 years:

SBP less than 70 + (age in years x 2)

50

PED Hypotension - Greater than 10 years old:

SBP less than 90

51

All priority 1 patients shall be transported to the closest hospital ER excluding ___.

VA

52

Pediatric priority one pt's shall be transported to ____ or ___ ER department:

St. Mary's or Palms West

53

Pregnant trauma patients in cardiac arrest shall be transported to SMMC Trauma Center.

True

54

All intubated trauma patients MUST be both ____ and ____ by the sending facility.

paralyzed and sedated

55

In MCI situations, only patients meeting ______ should be transported to trauma centers:

Trauma Alert Criteria

56

The guidelines for the Trauma Hawk include but are not limited to the following:

1. Scene to trauma center by ground transport is greater than 20 minutes
2. Trauma Alert with scene extrication time is greater than 15 minutes
3. Ground response time to the scene greater than 15 minutes
4. MCIs

57

The dividing line for WPBFR for transport destinations is:

Southern Blvd

58

For the purposes of transport, a pediatric patient is considered less than 18 y/o.

True

59

OB patients greater than ___ weeks and less than ___ weeks of gestation OR have anticipated complications with their pregnancy, shall be transported to St. Mary's.

greater than 20
less than 36

60

OB patients ___ weeks of gestation or greater, may be transported to GSH, if there are no anticipated complications.

36

61

Stable psychiatric patients shall be transported to:

1. WPH
2. SMH
3. JFK

62

Assist patient with Epi Pen administration under the following circumstances:

1. Pt's Ep Pen is prescribed to the pt and not expired
2. Patient presents with respiratory distress and/or hypotension (shock)

63

Give oral glucose to ADULTS ONLY if available.

True

64

Assist ventilations with a BVM and airway adjunct (NPA, OPA) for a respiratory rate less than ___ or greater than ___ with shallow respirtions.

10, 24

65

For respirations of ___ or less OR if tidal volume is inadequate, insert NPA/OPA and assist ventilations via BVM (1 breath every 6-8 seconds)

10

66

Respirations greater than ___ breaths per minute, maintain oxygen saturations at 95% or greater via NRB mast at 10-15 L/min.

24

67

Never apply ice directly to burns

True

68

For all burns, apply dry sterile dressing, a burn sheet may be used for large body surface area burns.

True

69

Chemical Burns: Remove pt's clothing and ensure that the pt is ____ prior to transport.

decontaminated

70

Remove contact lenses, with the exception of ____ eye injuries.

penetrating

71

Water can be given to responsive patients with an intact gag reflex for heat exposure.

True

72

Bites/Stings: Remove the venom sack if still in the skin, by scraping it off.

True

73

Do not administer Epi (1 : 1,000) within ___ minutes of Epi-Pen administration.

15

74

Anaphylactic Shock is characterized by the signs and symptoms of an allergic reaction, in addition to the loss of a radial pulse AND/OR a SBP of less than ___ mm/Hg:

80

75

Establish a second IV/IO in anaphylactic shock.

True

76

Pediatric: Max dose for Benadryl ___ mg

50

77

Pediatric: Anaphylactic Shock is characterized by s&s of allergic reaction, in addition to the loss of ______.

distal pulses

78

Anyphylactic Shock: If patient remains hypotensive NORMAL SALINE 500mL may repeat ___.

3x

79

Pediatric Anaphylactic Shock: If patient remains hypotensive NORMAL SALINE 20mL/kg bolus IV/IO, may repeat ___ prn.

2x

80

ADULT: Dose: Epi (1:10,000) Anaphylactic Shock:

0.1 mg (1mL), slow IV/IO, may repeat 2x prn in one minute intervals. MAX dose 0.3mg

81

ADULT: Dose: Epi (1:1,000) Allergic Reaction:

0.3mg (0.3mL) IM, may repeat 1x in 15 minutes prn

82

PED: Dose: Epi (1:1,000) Allergic Reaction:

0.01mg/kg (0.01mL/kg) IM. Max single doe 0.3mg. Repeat every 15 min as needed.

83

PED: Dose: Epi (1:10,000) Anaphylactic Shock:

0.01mg/kg (0.1mL/kg) Repeat pen for profound respiratory distress and/or hypotension. Max dose 0.3mg

84

AEIOU-TIPS

A - Alcohol
E - Epilepsy (Seizures)
I - Insulin (Hyper/Hypoglycemia)
O - Overdose (and Oxygenation)
U - Uremia (or Underdose)
T - Trauma
I - Infection (Sepsis)
P - Psychiatric (and Poisoning)
S - Stroke (and Shock)

85

Diabetic emergencies, retest glucose in ___ minutes:

10

86

ADULT: Glucagon Dose:

1 mg IN or IM

87

Oral Glucose Dose:

15g/tube May repeat 1x prn

88

If blood glucose level is greater than ____ mg/dl with s&s of DKA:

300

89

PEDS: If blood glucose levels are less than 60 mg/dl (newborns ___ mg/dl)

45

90

Oral Glucose not recommended for patients less than ___ years old.

2

91

PEDS: D10 5mL/kg IV/IO for birth to ___ years of age.

14

92

PEDS: D50 1mL/kg for > ___ but

14

93

PEDS: Zofran for patients greater than ___ y/o. Dose:

1 y/o
0.1mg/kg Max dose of 4mg

94

PEDS: Glucagon 0.5 mg IM/IN for patients less than ___ kb.

20 kg

95

PEDS: Glucagon 1 mg IM/IN for patients greater than ___ kg.

20 kg

96

Dextrose 10%: Mixture is:

1 amp of D50 into a 250 ml of D5W will yield D10.

97

Adults normotensive with s&s of dehydration or non-traumatic bleeding Normal Saline: Max of ____.

2 liters

98

Pediatric normotensive with s&s of dehydration Normal Saline 20mL/kg WIDE OPEN.

True

99

Consider Sepsis for all dehydrated patients.

True

100

Typically, Anitpsychotic, Antiemetic, or Antidepressant meds are responsible for Dystonic Reactions.

True

101

Minimum of ___cc flush before administering Calcium and Sodium Bicarb in the same line.

50

102

If patient is in cardiac arrest secondary to hyperkalemia ,administer ____ & ____ first, then follow standard Pulseless Algorhythm.

Calcium Chloride & Sodium Bicarb

103

____ occurs during assisted ventilations when air goes inbefore patient is allowed to fully exhale.

AutoPEEP

104

Increasing intrthoracic pressure DECREASES venous return to the heart which can result in hypotension.

True

105

COPD or Ashtma patients who develop poor bag compliance or hypotension during PPV should have PPV discontinused for ____ seconds for Adults and ____ for pediatrics.

20-40
10-20

106

CPAP (10-12 cm H2O)

True

107

CPAP contradinciations:

1. Discontinue CPAP for asthma patients whom's condition worsens after applying CPAP.
2. SBP less than 90mm/Hg
3. For patients with spontaneous respiratoins
4. For unconscious patients

108

Administer in-line nebulized albuterol of ALL intubated asthma patients.

True

109

CROUP characteristics:

1. Usually less than3 y/o
2. "Sick" for a couple of days
3. LOW grade fever
4. Not "toxic" appearing

110

EPIGLOTTITIS characteristics:

1. Usually 3-6 y/o
2. Sudden Onset
3. HIGH grade fever
4. Bad general impressoin
5. Drooling/Dysphagia
6. Tripod position

111

PEDS: For febrile seizures lasting longer than ___ minutes, or if the seizure stops and the patient has another seizure, administer Versed.

5

112

PEDS: Versed DOSE:

0.1 mg/kg. Max single dose 2.5 mg. Max dose of 5mg

113

PEDS: Ativan DOSE:

.05mg/kg. Max single dose of 1mg. Max dose of 2mg!!

114

It is imperative that once sepsis is identified, that the patient is kept from becoming ____.

hypotensive

115

Sepsis: Initiate Treatment for patients with the following:

1. 18 years and older and NOT pregnant
and
2. Suspected or documented infection
and
3. At least TWO SIRS criteria:
-Pulse greater than 90
-Respirations greater than 20
-Temp >100.4 or less than 96.8 F
and
4. Hypoperfusion as manifested by any ONE of the following:
-SBP less than 90mmHG
-Mean Arterial Pressure (MAP) of less than 65
-Lactate level >4 mmol/L (if lactate monitor avail)

116

Sepsis: Normal Saline ___ liters, regardless of blood pressure.

2

117

Fentanyl or MS can be administered to all patients complainin of pain with the exception of pregnant patients near term (__ weeks or greater).

32

118

PEDS: Fentanyl (greater than __ years old). DOSE:

2 y/o
1mcg/kg. Max single dose of 50mcg/kg.
Max total dose of 150mcg.

119

STROKE ALERT CRITERIA CHECK LIST

Cincinnati Pre-Hospital Stroke Scale
•Facial Droop
•Arm Drift (palm up)
•Speech (Slur or inappropriate use of words)
•Time (Last seen normal)
-Visual Fields
-Lower Extremity Weakness
-Finger to Nose
-Sudden onset of a severe headache with neurological symptoms
-Double Vision
Call a STROKE ALERT for failure of any of the above…. AND
Deficit not due to low blood sugar
Deficit not likely due to head trauma

120

Stroke: Normal Saline 500cc Bolus (REGARDLESS of BP)

True

121

tPA EXCLUSIONS

• Onset of stroke symptoms greater than 2 hours
• Seizure prior to stroke symptoms
• Prior stroke or serious head injury within the previous 3 months
• Major Surgery within 14 days
• Known history of intracranial hemorrhage
• Gastrointestinal or urinary tract bleeding within 21 days.

122

Bradycardia in the presence of an MI go directly to transcutaneous pacing.

True

123

ADULT: Transcutaneous pacing start rate at ___ BPM and increase prn to maintain BP.

60

124

If unable to establish IV/IO access, begin ___ until an acceptable BP is obtained.

pacing

125

PED Bradycardia: Ensure proper ____ and ____ first, as hypoxia is most likely to be the cause of the bradycardia.

oxygenation and ventilation

126

After oxygenation and ventilation for 1 minute for infants/children and ___ seconds for neonates, begin chest compressions if the HR remains below 60 BPM with s&s of poor perfusion (AMS).

30

127

PED Bradycardia: If no response to Epinephrine start pacing at ___ BPM and increase the rate as needed.

80

128

Pediatric sedation Etomidate (greater than 1 y/o) DOSE:

0.1mg/kg

129

Chest Pain: The right ___ and anywhere on the left is acceptable site for IVs.

AC

130

Withold ASA if:

Patient administerd 162mg of aspirin within 24 hours

131

If patient self-administered less than 162 mg of ASA within 24 hours, administer ____

full 162 mg dose

132

An IV must be established prior to NTG administration.

True

133

Contraindications for NTG:

1. SBP less than 90 mmHg
2. EDD (Viagra & Levitra within 24 hrs and Cialis within 48 hours)
3. Right Ventricular Infraction
4. HR less than 50 or greater 100 BPM

134

ST-Segmaent Elevation of __mm or greater in two or more contigous leads ( __mm in V2 and V3)

1, 2

135

The most used drug per year by WPBFR is ____ @ 379.

Albuterol

136

All 12 lead ECG's shall have the patients:

last name and first initial

137

PEDS: Sickle Cell: Morphine Sulfate DOSE:

0.1mg/kg slow IV/IO/IM. Max single dose of 4mg, may repeat every 5 min prn. Max total dose 8mg.

138

Rapid A-Fib and A-flutter are defined as VENTRICULAR rates greater than ____ BPM.

150

139

Cardizem Contraindications:

-Hypotension
-Wide Complex QRS
-Hx of WPW or Sick Sinus Syndrome
-Use with caution for pt's taking beta blockers

140

If hypotension develops after Cardizem administration, administer ____ mL of Normal Saline and ____ mg of Calcium Chloride

500 , 500

141

Unstable A-Fib and A-Flutter, if patient still remains hypotensive after fluid bolus call ______ for further orders.

Medical Control

142

PED Bradycardia: If no response to oxygenation and ventilation (no AV heart block), next step is:

Atropine 0.02mg/kg (0.2mL/kg) Minimum single dose of 0.1mg. Max single dose of 0.5mg. May Repeat 1x prn

143

PED Bradycardia: Epi (1:10,000) Dose:

0.01 mg/kg (0.1mL/kg) IV/IO. Repeat every 3-5 minutes prn

144

Cardiogenic Shock: Left Ventricular Failure: Pulmary Edema and Hypotension your initial treatment is:

Dopamine 5-20 mcg/kg/min. Titrate to SBP 90 mmHg.

145

Cardiogenic Shock: RVF: Positive V4R, Clear Lung Sounds, and Hypotension, if patient remains hypotensive after fluids administration:

Dopamine 5-20 mcg/kg/min. Titrate to SBP 90 mmHg.

146

For STEMI Alerts or suspected STEMI Alerts, the ___ hand and wrist should be avoided if at all possible for IV Access.

right

147

The ___ AC and anywhere on the left is acceptable of IV access in regards to STEMI Alerts.

right

148

Contraindications for Aspirin:

-Allergy
-Active GI bleeding

149

Withhold ASA is patient administered 162mg of ASA withing 24 hours.

True

150

Mild to moderate chest pain, treatment:

-Aspirin: two 81mg baby aspirin (162mg total)
-NTG: 0.4 SL Max 3 doses

151

In rare occasions, Fentanyl may cause _____.

hypotension

152

Fentanyl: Dose for Moderate to Severe Chest Pain:

50 mcg slow IV/IM/IN. Max total dose 150mcg.

153

Morphine Sulfate: Dose for Chest Pain:

5mg slow IV/IO/IM. Max total dose 10mg

154

All STEMI Alerts are considerers priority ___ patients.

2

155

STEMI ALERT Criteria: ST-Segment Elevation of ___mm or greater in two or more contiguous leads ( __mm in V2 and V3)

1 , 2

156

The following are STEMI mimics:

-QRS complexes greater than 0.12 (LBBB, Pacemaker, etc.)
-Left Ventricular Hypertrophy
-Pericarditis
-Early Repolarization

157

Patient presentations indicative of myocardial ischemia that DO NOT meet STEMI Alert Criteria should still be transported priority 2 to ____, ____, _____, _____, or ____.

GSH
JFK
Wellington
Palms West
PBGMC

158

CPAP (10-12 cm H20) Contraindications:

-SBP less than 90mmHg
-Decreased LOC

159

CHF (Pulmonary Edema): First dose of NTG may be administered prior to 12 lead is SBP is greater than ____

150

160

CHF: SL NTG may be given concurrently with NTG paste for SBP greater than ____.

150

161

Regular, narrow complex tachycardia of 150 BPM or greater without discernible P-waves and/or flutter waves:

SVT

162

SVT Adult: Adenosine dose:

6mg rapid IVP, with 20mL flush. If no change in one minute, 12mg IVP with 20mL flush.

163

Unstable SVT Adult: If patient is Alert:

Adenosine 6mg IVP. If no change, 12mg IVP with 20mL flush each

164

Unstable SVT Adult: if patient has altered mental status consider sedation prior to cardioversion Etomidate ____ mg IV/IO. May repeat 1x prn.

6mg

165

Unstable SVT Adult: if cardioversion fails:

Call For Orders

166

PED SVT: Adenosine dose:

0.1mg/kg rapid IV/IO with 10mL flush. Max dose 6mg.

167

PED SVT: If no change in one minute after initial dose of Adenosine:

Adenosine 0.2mg/kg IV/IO with 10mL flush. Max dose 12mg

168

PED SVT: Synchronized cardioversion dose:

0.5j/kg, if not effective increase to 2j/kg

169

SVT in infants is considered greater than ___ BPM.

220

170

SVT in children is considered greater than ___ BPM.

180

171

PEDS SVT: QRS greater than ____ sec is considered a Wide Complex.

0.09 sec

172

Stable VT: Adult: Administer ALL 150mg, REGARDLESS, if the VT terminates.

True

173

Unstable VT Adult: If cardioversion terminates the VT and the patient returns to VT, begin cardioversion at the last successful energy setting and increase as needed.

True

174

PED: Stable VT: Amidodarone is infused over ___ minutes. 25 gtt/min using a Macro drip set. Max dose ___ mg.

20 , 150

175

PED: Unstable VT: If cardioversion is successful DO NOT administer antiarrhythmics.

True

176

Emphasis is placed on minimizing interruptions in compressions to no more than ___ seconds.

10

177

Infants and children with a heart rate less than ___/min with signs of poor perfusion shall have 2 person CPR initiated at 15:2

True

178

Medications should be delivered as soon as possible after the _____ (during compressions) and circulated for 2 minutes.

rhythm check

179

Follow all IVP medication administrations with a ___mL Flush NaCL (Adult Only).

20

181

Consider terminating efforts when an EMS Captain is on scene and:

1. Asystole/PEA has been documented for 15 minutes
2. All ALS interventions have been completed and reversible causes have been addressed.

182

Prolapsed Cord: Place mother in the knee to chest position and manually displace the uterus to the _____.

left

183

Prolapsed Cord: Wrap the exposed cord in what type of sterile dressing?

moist

184

Nuchal Cord: If you are UNABLE to free the cord, clamp the cord in TWO places and cut between the clamps

True

185

Meconium Staining: If meconium staining is present AND the infant has depressed respirations, limp and/or a heart rate of less than 100, DIRECT suctioning of the _____ must take place AFTER delivery, before the infant takes too many breaths.

trachea

186

Meconium Staining: Insert a laryngoscope and suction posterior pharynx with a ___F or ___F suction catheter so that you can visualize the glottis.

12, 14

187

Meconium Staining: Apply suction as the tube is slowly withdrawn for ____ seconds.

3-5

188

If meconium is present with the FIRST SUCTION:

1. Repeat suction until there is little additional meconium recovered OR
2. Neonates HR drops below 100, requiring PPV

189

Breech Birth: If the head does not deliver within ___ minutes of the body, elevate mother's hips and insert gloved hand into the vagina and push the vaginal wall away from the babies nose and mouth.

3

190

NEONATAL RESUSCITATION:

D-Bag-C-I-D
1. Dry, Suction, tactile stimulation, position
2. Bag & mask ventilation
3. Chest Compressions
4. Intubation
5. Drugs

191

Check a ____ on all infants requiring resuscitation.

BGL

192

Cut the umbilical cord by placing two clamps. The first ___in away from the infants abdomen and the second ___ in away from the infants abdomen.

4, 6

193

-Sudden onset of severe abdominal pain and tenderness
-Painful uterine contractions
-Vaginal Bleeding with DARK RED BLOOD
-Patient may present in shock

Placenta Abruptio

194

Characterized by PAINLESS vaginal bleeding (BRIGHT red blood):

Placenta Previa

195

Sudden, intense abdominal pain and vaginal bleeding:

Uterine Rupture

196

All patients with third trimester bleeding shall be transported to _____

SMH

197

All THIRD TRIMESTER patients in cardiac arrest should be treated if they are in ____ arrest and transported to SMH.

secondary

198

_____ usually occur in the FIRST trimester and may present with sudden onset of severe lower abdominal pain and or vaginal bleeding.

Ectopic pregnancy

199

Patients with amenorrhea, vaginal bleeding and abdominal pain are highly suspicious for an _____ pregnancy

ectocpic

200

Peri-umbilicus ecchymosis:

Cullen's sign

201

Ecchymosis of the flanks:

Grey Turner's sign

202

Spontaneous abortions usually occur before ____ weeks of gestation.

20