EMS4Dirty Flashcards
(132 cards)
1
Q
1020 Scope of Practice
A primary assessment consists of general appearance with initial emphasis on ________, __________ and ________________.
This is accomplished with a full head to toe assessment.
A
airway, breathing, and circulation
2
Q
1030 Consent and Capacity
A person who presents with subjective and/or objective signs and/or symptoms or a complaint which results in evaluation and/or treatment. This person is defined as a:
A
Patient
3
Q
1030 Consent and Capacity
A ________________ does not require treatment, transport, or cooperation from the patient. If a technician perceives a medical problem that requires evaluation, a patient encounter has been made and a full patient care report must be completed.
A
Patient encounter
4
Q
1030 Consent and Capacity
________ is the basis of informed consent.
A
Capacity
5
Q
1030 Consent and Capacity
______________ is a global assessment and legal determination made by a judge in court.
A
Competency
6
Q
1030 Consent and Capacity
If medical personnel are concerned for the safety of a minor and the parent or legal guardian refuses treatment and transport, contact the ___________________________ and law enforcement for guidance.
A
Rescue District/Battalion Chief
7
Q
1030 Consent and Capacity
A ________________ is an individual authorized to make medical decisions on behalf of an incapacitated patient.
There are three types:
A
health care agent
Durable Power of Attorney
Health Care Surrogate
The Proxy
8
Q
1030 Consent and Capacity
A _______________________ form authorizes a designated individual to handle affairs and conduct business on a patients behalf. This form is completed in advance of a patient becoming incapacitated. In Florida, this also may include language that allows the designated decision maker to also make medical decisions.
A
Durable Power of Attorney
9
Q
1030 Consent and Capacity
A ______________________ form authorizes a designated individual to make health care decisions on a patient’s behalf.
More commonly utilized compared to Durable Power of Attorney.
A
Health Care Surrogate
10
Q
1030 Consent and Capacity
If an individual is incapacitated and did not previously complete an advance directive, decisions regarding the patient’s medical treatment are made by a designated __________.
These can include:
A
Proxy
Judicially appointed guardian
Patient’s spouse
An adult child of the patient
A parent of the patient
The adult sibling of the patient, or collective of siblings
An adult relative of the patient who exhibited special care and concern and it familiar with the patient’s activities, health, and religious or moral beliefs
A close friend of the patient
A clinical social worker licensed pursuant to chapter 491
11
Q
1080 Patient Restraints
Approved Methods
Law enforcment:
(3)
JFRD Personnel:
(4)
A
Law Enforcement:
Handcuffs
Plastic ties
“Hobble” restraints
JFRD Personnel:
Appropriate Sedative
Soft limb restraints
Stretcher straps/harness
Wide cloth restraints
12
Q
1080 Patient Restraints
When restraints are in use, circulation to the extremities shall be evaluated at least every ___ minutes.
A
5
13
Q
1090 Patient Care Report
The Rescue Officer will ensure the EMS field copy is completed and provde the _________ copy to the hospital.
A
white
14
Q
1090 Patient Care Report
The ONLY approved JFRD format for PCR Narrative as shown below in that order:
A
CC
HPI
PE (Physical exam)
Tx (Treatment) Note: unseccessful interventions must also be documented
15
Q
1090 Patient Care Report
Monthly, completed paper refusals will be forwarded to the _____________________.
A
Quality Improvement Office
16
Q
1110 Quality Improvement
The intention of Quality Improvement will be to ___________.
A
train
17
Q
1110 Quality Improvement
The program will review present standards of practice at least ___________
A
annually
18
Q
1110 Quality Improvement
Administration of the continuous Quality Improvement Program will be the responsibility of the: (4)
A
Medical Director
Division Chief of Rescue
Deputy Division Chief/Rescue
Quality Improvement Officer
19
Q
1110 Quality Improvement
The Director/Fire Chief will appoint the Quality Improvement Officer after receiving recommendations from the _________________.
A
Division Chief of Rescue.
20
Q
1110 Quality Improvement
The Medical Director and QI Officer will communicate on a _________ basis.
A
weekly
21
Q
1110 Quality Improvement
The Quality Improvement program will be a dynamic process, changing with the identified needs of the department and consisting of the following three aspects:
A
Proactive
Concurrent
Retrospective
22
Q
1110 Quality Improvement
The Quality Improvement Officer, Division Chief of Rescue, and Medical Director will apply an ______________________ (ASC) with benchmarks based upon JFRD Rules, this Emergency Medical Services SOG and national standards.
A
Accepted Standard of Care
23
Q
1110 Quality Improvement
Proactive Quality Improvement –> _________ to the delivery of patient care by JFRD personnel.
Concurrent Quality Improvement –> supervision and evaluation of practices for quality ________ the delivery of patient care by JFRD personnel. This will be accomplished by the Rescue District/Battalion Chiefs and the Medical Director.
Retrospective Quality Improvement –> evaluation of practices for quality _________ the delivery of patient care by JFRD personnel.
A
prior
during
after
24
Q
1110 Quality Improvement
The ________________________ will appoint select individuals to the Quality Improvement Review Committee. The committe will meet as needed.
A
Divison Chief of Rescue
25
1110 Quality Improvment
Practices, which deviate from the SOG or the ASC, will be identified by: (4)
PCR database queries
Concerns regarding the delivery of patient care
Patient outcome reports fromthe area hospitals
Patient care complaints
26
1110 Quality Improvement
Rescue Captains MUST review the following reports monthly:
____ PCRs per month to include a sampling from all report authors assigned to that unit during the month, either permanently or temporarily, with an emphasis on refusals and calls of critical nature.
Rescue District/Battalion Chiefs
Must review all of the following reports _________, if not already reviewed by a Captain:
All Cardiac/Trauma Arrest reports
All "Alerts" (Trauma, STEMI, STROKE, etc.)
All advanced airways
Minimum of _____ PCRs per month to include a sampling from all report authors assigned to their district. This number of reviews may have already been accomplished with criteria above
Specific reports identified by the _________________.
20 PCRs
monthly
30 PCRs
Medical Director
27
1110 Quality Improvement
The Quality Improvement Office will conduct _______ audits of Emergency-Pro patient care reports to ensure that the documentation satisfies the legal and billing processes required, up to and including the presence of a legal and legible responsibility signature captured ________ to departing the medical facility (as noted by the time stamp in the PCR).
daily
PRIOR
28
1110 Quality Improvement
The QI office receives automated daily queries of PCRs that have a responsibility signatue timestamp ________ the transport unit has ogne available from the medical facility.
AFTER
29
1110 Quality Improvement
All PCRs populated in the automated daily query will also be forwarded to the JFRD __________________ and will not be processed for billing/reimbursement until such time confirmation is received by the QI office that the PCR contains explicit documentation in the narrative section that the following occurred: The Rescue Unit returned to the medical facility to legally obtain the patient or receiving facility representative signature ________ the AVL data confirms the same, if data is available.
EMS Billing Manager
AND
30
1120 Reporting Abuse/Neglect
All employees are required to report known or suspected child or vulnerable adult abuse, abandonment or neglect. Anyone who knowingly and willfully fails to do so, or who knowingly and willfully prevents another person from doing so, commits a felony of the _________________, punishable as provided in Florida Statutes.
third degree
31
1120 Reporting Abuse/Neglect
Reporting Abuse:
OIC shall make the intial verbal report by calling the statewide toll-free number (1 800 962 2873 or 1 866 532 2873). Obtain name and ID number from the contact person
Report suspicions to emergency department physician
Notify the Rescue District/Battalion chief
Notify the Division Chief of Rescue via email within ____ hours indicating that you have reported the case to the FL Abuse/Neglect Registry, including ONLY the __________ and _____________ of the contact person. DO NOT provide any patient information in the email (HIPPA concern).
24 hours
first name
ID number
32
1130 Resuscitation Guideline
Unquestionable Death Criteria
(3)
In addition to the three above, the patient shall meet at least _______ of the following criteria:
The patient has lividity
The patient has clear signs of body decay or visible decomposition
The patient has rigor mortis
The patient has an open cranium with exposed brain matter
The patient is decapitated or has severed trunk
The patient has full thickness burns to the entire body
Unresponsive
Apneic
Pulseless
ONE
33
1130 Resuscitation Guideline
Trauma Death Criteria:
Blunt chest trauma or multi-system trauma patients meeting the following criteria shall be considered DOS:
(3)
Unresponsive
Apneic
Pulseless
34
1130 Resuscitation Guideline
Acutely Hypothermic patients in cardiac arrest shall be treated and transported
Includes submersion victims ________________
<60 minutes
35
1140 Transport/Destination
The follwing situations require transport: (only some are listed here)
Systolic B/P greater than _____ mmHg OR Diastolic B/P greater than ______ mmHg
Systolic B/P less than ___ mmHg
Pediatric patients ____ years of age or less who are symptomatic
Elderly patients ____ years of age or greater (Exceptions are non-symptomatic patients with mental capacity without a documented chief complaint or documented signed refusal of treatment/transportation).
180, 110
90
15 years
65 years
36
1140 Transport/Destination
Transport of Passengers
Exceptions:
Pediatric patients requiring a ________ or ________
School representative when a parent or guardian is not available
Geriatric patients requiring a ___________ or ___________
Patients with language barriers requiring a translator
Patients with speech disabilities requiring someone proficient in sign language
parent or guardian
guardian or caregiver
37
1140 Transport/Destination
The ____________________ may wave the maximum of two patients per Rescue Company in extenuating circumstances.
Transports of unstable patients should begin within ____ minutes when possible.
Distict/Battalion Chief
10 minutes
38
1140 Transport/Destination
Stable pediatric with a complex complaint and/or medical history: Transport to Baptist Medical Center - Downtown (__________________) or _________________________.
Wolfson Children's Hospital
UF Health Jacksonville
39
1140 Transport/Destination
Air Transport Units should be considered for critically ill or injured patients any time ground transport time to the closest appropriate hospital exceeds ____ minutes.
An ATU for direct flight to UF Gainesville Burn Center should also be considered for isolated burns without other significant trauma when:
2nd and 3rd degree burns greater than ____% of the total body substance area (TBSA)
3rd degree burns greater than ____% of the TBSA
2nd and 3rd degree burns with the threat of functional or cosmetic impairment to the face, hands, feet, genitalia, perineum or major joint
Patients in ________ or _________ arrest are NOT appropriate for an ATU
20 minutes
20%
5%
cardiac or trauma arrest
40
1150 Transport of Patients with Service Animal
Dogs whose sole function is to provide comfort or emotional support do not qualify as ________________ under the ADA.
service animals
41
1150 Transport of Patients with Service Animal
When it is not obvious what service an animal provides, only limited inquiries are allowed.
Personnel may ask only two questions:
1. Is the dog a service animal because of a disability?
2. What work or task has the dog been trained to perform?
42
1150 Transport of Patients with Service Animal
Personnel CANNOT ask about the person's _____________
disability
43
1150 Transport of Patients with Service Animal
Miniature horses generally range in height from ____ inches to ____ inches measured to the shoulders and generally weight between ____ and ____ pounds.
The regulations set out FOUR assessment factors to assist entities in determining whether miniature horses can be accommodated in their facility.
1. Whether the miniature horse is ______________
2. Whether the miniature horse is under the owner's __________
3. Whether the facility can accommodate the miniature horse's ______, ______ and ________.
4. Whether or not the miniature horse's presence will compromise legitimate safety requirements necessary for safe operation of the facility.
24 inches to 34 inches
60 and 100 pounds
1. housebroken
2. control
3. type, size, and weight
44
1160 Transport of Injured Police Canines (K9)
If the canine is with the Jacksonville Sheriff's office (JSO), the transport destination shall be selected from either of the two clinics listed below as they provide 24/7 emergency veterinary care and are also contracted by the JSO.
BluePearl Pet Hospital (Orange Park location) - 275 Corporate Way, Ste. 100
(904) 278-0287
BluePearl Pet Hospital (Southside location) - 3444 Southside Blvd, Ste. 103
(904) 646-1287
45
1170 Trauma Transport
The CAD system will display the appropriate apparatus that normally responds to the listed address in order of ______________.
priority
46
1170 Trauma Transport
Adult Trauma Scorecard Summarized:
Any ONE of the following conditions = Trauma Alert
Airway - pt receives active airway assistance beyond the administration of ______.
Circulation - lacks a radial pulse with a sustained HR greater than ____ BPM
Has a systolic BP of less than ___ mmHg
Best Motor Response (BMR) - Pt exhibits a score of __ or less on the motor assessment component of the GCS.
Spinal - There is the presence of __________; or loss of ______________. Suspicion of a spinal cord injury
Cutaneous - 2nd or 3rd degree burns to _____% or more of total body surface area
Amputation ____________ to the wrist or ankle
Any penetrating injury to the _______, ________, or ___________.
Long Bone Fracture - _______ or more long bone fracture sites
Airway - O2
Circualtion - 120 BPM, 90 mmHg
BMR - 4
Spinal - paralysis, sensation
Cutaneous - 15%, proximal, head, neck, torso
Long Bone Fracture - 2
47
48
1170 Trauma Transport
Trauma Scorecard Adult Summary:
Shall be considered a trauma alert when any TWO of the following conditions are identified:
Airway - The pt has a RR ____ or greater
Circulation - The pt has a sustained HR of ______ BPM or greater
BMR - Pt has a BMR of ____ on the motor component of GCS.
Cutaneous - The pt has a soft tissue loss from major degloving injury or major flap avulsion greater than _____"
Sustained a gunshot wound to the ________________
Long Bone Fracture - Signs or symptoms of a single long bone fracture resulting from a ________________
Fall from _____ ft or greater
Age - The pt is ____ years of age or older
Mechanism of Injury - The pt has been ___________ from an (enclosed) motor vehicle
The driver of the MV has impacted with the steering wheel causing steering wheel deformity
Airway - 30 or greater
Circulation - 120
BMR - 5
Cutaneous - 5 inches
Extremities
Long Bone Fracture - motor vehicle collision
10 ft
Age - 55 years
Mechanism of Injury - Ejected
49
1170 Trauma Transport
Pediatric Trauma Scorecard Summary:
Trauma pts with the anatomical and physical characteristics of a person __________ years of age or less.
This list only needs ONE identified for a pediatric trauma alert.
Airway - In order to maintain ventilation, the pt is ____________, or the pts breathing is assisted or needs adjuncts to assist ventilatory efforts
Circulation - Pt has faint or non-palpable ________ or __________ pulse
Pt has a systolic BP of less than ______ mmHg
Consciousness - Pt is altered/in ________
Spinal - Presence of ___________ or loss of ____________
Fracture - Evidence of an open ____________ fracture, or there are multiple fracture sites or multiple dislocations
Cutaneous - Major __________ or major flap avulsion
2nd or 3rd degree burns to ____% or more of the total body surface area
Amputation ___________ to the writst or ankle
Penetrating injury to the _______, ________. or __________
Airway - intubated
Circulation - carotid or femoral
50 mmHg
Consciousness - coma
Spinal - paralysis, sensation
Fracture - longe bone
Cutaneous - degloving
10%
Proximal
head, neck or torso
50
1170 Trauma Transport
Pediatric Trauma Scorecard Summary:
Shall be considered a pediatric trauma alert when any TWO of the following conditions are identified:
Consciousness - Signs of ____________; or ther is loss of consciousness
Circulation - The carotid or femoral pulse is palpable, but the ______ or _______ pulses are not
Systolic BP less than _____ mmHg
Fracture - Signs or symptoms of a single ____________________
Size - Pediatric trauma pts weighing ____ kilograms or less, or the body lenth is equivalent to this weight on a pediatric length and weight emergency tape (the equivalent of ____ inches in measurement or less)
Consciousness - amnesia
Circulation - radial or pedal
90 mmHg
Fracture - closed long bone fracture
Size - 11 kilograms or less, 33 inches
51
1170 Trauma Transport
The __________________ of the EMS provider issuing the trauma alert or the ______________ at the receiving trauma center or hospital, are the only people authorized to change the trauma alert status.
Medical Director, physician
52
Patients with ___________ involvement may deteriorate rapidly, load and go is a priority.
multi - system
53
Infants and children less than ____ lbs., use Pedi-Immobilizer.
60 lbs
54
The _______ injured patient with a decreased ______ is more likely to suffer airway compromise than the standard trauma patient
head, LOC
55
Protective ___________ should be removed
helmets
56
If the helmet is removed, the __________________ also need to be removed
shoulder pads
57
In cases of isolated spinal injuries, ______________ is less critical, and care should be taken in performing proper spinal immobilization.
scene time
58
High cervical injury may cause _______
apnea
59
_____________ patients may deteriorate rapidly. Load and go is a priority.
Chest Trauma
60
In regards to Chest Trauma pts
Transport to a ________________ when discoloration, severe tenderness, crepitus, respiratory distress, or decreased breath sounds are present.
Elderly patients on ________________ should also be transported to a ________________.
Trauma center
anticoagulants, Trauma center
61
Sucking Chest Wound:
Apply vented ____________________ if available
Halo Chest seal
62
Tension Pneumothorax:
Unilateral absent breath sounds _______ severe respiratory distress or signs/symptoms of tension pneumothorax such as hypotension, tachycardia and hypoxia
with
63
Mechanism of injury is the most important indicator of ___________________. The best treatment for the pt with severe ____________________ is rapid transport.
abdominal trauma, abdominal trauma
64
Abdominal Trauma:
Transport to a Trauma Center when _______________ and/or severe tenderness are present.
discoloration
65
Abdominal Trauma:
Apply ____________ gauze if available for life threatening hemorrhage.
Abdominal Evisceration:
Cover with ______________ and moisten with _______________.
hemostatic
sterile dressing, intravenous fluid
66
Trauma Pregnancy:
Signs and symptoms of __________ may be delayed due to increased maternal blood volume.
shock
67
Immobilizing a pregnant pt greater than _____ weeks may impair ventilation as the fetus and the uterus press against the diaphragm.
After immobilization is complete and the patient is secure, elevate the pts right side of the LSB approximately ____ inches. This will displace the uterus and fetus to the left side and off the inferior vena cava.
20 weeks
6 inches
68
Extremity Trauma:
This guideline does _______ apply to a multi-system trauma patient.
Transport to a Trauma Center when _______ fractures are present.
Splint all areas of ___________ or _____________.
Reduce fractures (open or closed) by _______ traction if absence of distal pulses.
Amputation:
Place the amputated part in ______________, moisten with intravenous fluids
Keep amputated part _________
Do not ________ vessels
NOT
open fractures
tenderness or deformity
axial
sterile gauze
cool
clamp
69
Crush Injury:
The patients overall health status, total amount of entrapped body surface area, ______ of the entrapment and _______ of the object dictate the extent of the symptoms.
Crush injury is to be distinguished from a simple entrapment.
length, weight
70
Taser Trauma:
Only ________________________ are permitted to remove probe(s)
law enforcement officers
71
Burns:
Burns are classified according to ________ (Thermal, Electrical, and Chemical) and ___________.
Burn Trauma Alert Criteria:
Adult - Partial/full thickness burns to ____% or more BSA
Pediatric - Parial/full thickness burns to ___% or more BSA
type, thickness
15%
10%
72
Rule of 9s for Burns:
Adult:
Head ___%
Arm ___%
Torso ____%
Leg ____%
Genitalia ____%
Toddler/Infant:
Head ____%
Arm ____%
Torso _____%
Leg _____%
Genitalia ____%
Adult:
Head 9%
Arm 9%
Torso 36%
Leg 18%
Genitalia 1%
Toddler/Infant:
Head 18%
Arm 9%
Torso 36%
Leg 13.5%
Genitalia 1%
73
Burns Treatment:
Chemical burns - (not involving Lime, Carbolic Acid, Sulfuric Acid, Solid potassium or Sodium metals)
Irrigate with intravenous fluids for ____ minutes
Chemical Burns involving Lime, Carbolic Acid, Sulfuric acid, Solid potassium or Sodium metals
Do not ______ wounds with water, intravenous fluids or sterile water
Contact receiving physician for treatment
Superficial burns
Apply ___________ dressing if needed
Partial-Thickness/Full-Thickness burns
Apply ____, sterile dressing
Leave blisters intact
20 minutes
flush
burn gel
dry
74
Electrical Trauma:
In electrocutions that involve multiple patients, reverse triage shall be applied and patients in cardiac arrest shall be worked _________.
first
75
Eye Trauma:
Transport to Trauma Center when ____________ eye trauma is present
Direct trauma:
Patch both eyes gently without _________ to the globes
Maintain patient in the ___________ position to reduce leakage of fluids from the eye
If blood is noted in anterior chamber, place the pt in ______________
Chemical/Irritant Exposure (pepper spray, tear gas)
Irrigate affected eye with __________________ during transport
Apply _____ sterile dressings to both eyes
Atraumatic
Patch both eyes gently without _________ to the globes
pressure
supine
semi-fowler's
intravenous fluids
dry
pressure
76
Hemorrhage Control
Life threatening - Immediately apply ____________
Non-life threatening:
Control with ________ pressure to bleeding area or vessel
Apply _______ dressing
Apply _________ bandage on top of any perviously applied dressing
tourniquet
direct
trauma
pressure
77
Bleeding Head, Neck or Torso:
Life Threatening:
Control with _______ pressure to bleeding area or vessel
Apply ______________ gauze if available. Otherwise, apply _________ dressing.
Apply _____________ bandage on top of any previously applied dressing.
Non life threatening
Control with ________ pressure to bleeding area or vessel
Apply ________ dressing
Apply _________ bandage on top of any previously applied dressing
Advanced Trauma Care Bags are carried on all field _______________.
direct
hemostatic gauze, trauma
pressure
direct
trauma
pressure
chief vehicles
78
Chest Pain
Patients with chest pain should receive Aspirin unless contraindicated or perviously taken within ___ hours.
Contraindications for 324 mg PO:
Allergies to salicylates
Active GI bleeding
Contraindications for 81 mg PO
Caution in ___________ patients
History of GI bleeding
Use of anticoagulants
2
pregnant
79
Stroke:
Use BE-FAST to ______________ presence of a stroke
Balance
Eyes
Face
Arm
Speech
Time
IDENTIFY
80
Stroke
Perform the Los Angeles Motor Scale (LAMS) assesment to determine the _______________ of the stroke.
LAMS 3, 4, or 5 are indicative of a potential large vessel occulsion that requires mechanical thrombectomy.
Face ___ to ___
Arm ___ to ___
Grip ___ to ___
Total of 5
SEVERITY
Face 0 to 1
Arm 0 to 2
Grip 0 to 2
81
Acute Stroke
If symptoms present greater than ____ hours, any hospital is appropriate, and a Stroke Alert is not indicated.
Comprehensive Stroke Center needed when:
LAMS score of 3, 4 or 5 with onset up to ____ hours.
All suspected strokes with onset greater than ___ hours and less than ___ hours
Patient wakes up with stroke symptoms
Suspicion of subarachnoid hemorrhage/intercranial hemorrhage, __________ severe headache (___________ headache) or sudden decrease in LOC
Current or recent ____ bleeding
Trauma, surgery or invasive procedure within last ____ months
Currently on __________________
Bleeding disorders
Always check ____ first
24 hours
24 hours
3 hours, 24 hours
sudden, thunderclap
GI
3 months
anticoagulants
BGL
82
Acute Stroke
Primary Stroke center:
LAMS score of 0, 1 or 2 with onset up to ___ hours when that facility is the closest stroke center
Notify FRCC of Stroke Aert, destination, LAMS score, onset time and ETA.
Place pt in the ____________ position.
Always check ______ first
3
Semi fowlers
BGL
83
Acute Heart Failure/Pulmonary Edema
Place pt in the _______________ position
Consider early use of the _________ to treat pulmonary edema
full fowlers
CPAP
84
Hypertension
Hypertensive Urgency (systolic BP greater than _____ mmHg and diastolic BP greater than _____ mmHg) can present with or without symptoms.
Place pt in the _______________ position.
220 mmHg, 120 mmHg
semi fowlers
85
Cardiac Arrest (Shockable)
Check for responsiveness, check ofr breathing, check for carotid pulse (should not take more than ___ seconds)
Continue to provide defibrillation every ____ minutes if shockable rhythm is noted upon reassessment
After each defibrillation, IMMEDIATELY continue CPR, starting with compressions for ___ minutes then reasses
If the provider is alone, the use of a BVM in single rescuer CPR is no longer recommended.
Consider the follwing possible causes of cardiac arrest and their appropriate treatments:
_________ and ______________________
Provide _____% O2 with use of BVM and appropriate airway adjuncts
10 seconds
2 minutes
2 minutes
hypoxia and hyperthermia/hypothermia
100%
86
Cardiac Arrest (Non-shockable)
The emphasis should be placed on early _________________ of cardiac arrest
Check responsiveness, check for breathing, check ofr carotid pulse (should not take more than ____ seconds)
Consider the following possible causes of cardiac arrest and their appropriate treatments:
Hypoxia
Provide ____% O2 with use of BVM and appropriate airway adjunct
Hyperthermai/Hypothermia
Cool and warm as needed
identification
10 seconds
100%%
87
Respiratory Distress
In the patient with severe respiratory compromise, treatment should be aggressive to prevent respiratory ________. Lung sounds and degree of distress should guide treatment.
Monitor SpO2. However, SpO2 is not a reliable indicator of the patients level of distress.
Administer O2 via proper adjunct to maintain oxygen saturation of ___% or greater
Assess ___________
arrest
95%
temperature
88
Reactive Airway Disease (Asthma, COPD)
Administer O2 via proper adjunct to maintain oxygen saturation of ___% or greater
Consider early use of _________
Determine respiratory rate, depth and quality
95%
CPAP
89
Respiratory Arrest
Provide ____% oxygen via BVM with an airway adjunct(s) (OPA OR NPA)
100%
90
Foreign Body Airway Obstruction
Conscious
If patient is pregnant or obese, perform ______________ instead of abdominal thrusts
Unconscious
Reposition airway and remove object with ______________
Begin CPR as indicated
Suction as indicated
Assist ventialtions with appropriate BVM with a _______________ airway
If foreign body cannot be removed, supraglottic airway is ___________________
chest thrusts
magil forceps
nasopharyngeal
contraindicated
91
Hyperventilation
Consider possible underlying cause
Administer O2 via _______ until hyperventilation has resolved, then administer O2 via proper adjunct to maintain oxygen saturation of ____ or greater
DO NOT administer ____ re-breathing techniques
Assess ____________
NRB
95%
CO2
temperature
92
Abdominal/Flant Pain
Place patient in ______________.
position of comfort
93
Alcohol Related Illness
Prevent aspiration by placing patient in the __________ position.
Look for underlying causes
Determine BGL
recovery
94
Allergic Reaction/Anaphylaxis
Maintain oxygen saturation of ___% or greater
Anticipate rapid deterioration and the need for ____________ airway
95%
supraglottic
95
Altered Consciousness
Prevent aspiration by placing patient in the _________ position
Determine BGL
If GCS is equal to or less than __ or inability to protect airway, instert supraglottic airway
Unknown etiology
Consider other treatable neurological or metabolic disorders
Assess for ______ trauma and consider use of C-collar
recovery
8
head
96
97
Diabetic
Treatments based on blood glucose level and level of consciousness
Hypoglycemia
Conscious and alert patient (GCS greater than or equal to ___) with BGL less than ____ mg/dL administer oral Glucose Paste ____ grams (__ tube)
May repeat once in ___ minutes if BGL is still less than ____ mg/dL
14
60
15 grams, 1 tube
10 minutes, 60
98
Nosebleed
If other injuries do not exist, prevent aspiration of blood by placing the patient in a _________ position with their head _______________.
Control hemorrhage by pinching the nostrils
To facilitate clotting instruct the patient ot hold pressure for at least ____ minutes and not to sniff, blow or manipulate the nasal passages in any way
sitting, leaning forward
20 minutes
99
Headache
Headaches with an elevated temperature, nausea/vomiting and/or altered mental status may indicate ______________ or a neurological event.
meningitis
100
Shock Medical
Shock patients may deteriorate rapidly. Signs of poor perfusion include cool mottled skin, diminshed pulses, altered mental status, increased capillary refill time (>___ seconds), tachycardia AND systolic BP less than ____ mm/hg
Place pt in the supine position with legs __________.
2 seconds, 90 mm/hg
elevated
101
Non-Fatal Drowning
Determine ______________ time
Consider __________ for patients with pulmonary edema
Anticipate rapid deterioration and the need for _________________ airway
Maintain body warmth and correct as necessary
submersion
CPAP
supraglottic
102
Decompression Sickness
Place pt in the recover position (______________)
Monitor SpO2 and provide ______% O2 via NRB
Retrieve _______________ (if appropriate) and ensure transport with patient or try to obtain depth and length of dive from patient or bystanders
DO NOT transport to __________________.
left side
100%
dive computer
stand-alone ED
103
Combative Patient
________________ can mimic several medical conditions including hypoxia, hypoglycemia, stroke, or intracranial bleeding. All patients suspected of expoeriencing _______________ must be transported.
A previously combative patient who suddenly becomes quiet should raise a red flag
Approved JFRD physical restraints (3)
Document the follwing in the PCR:
The patients behavior necessitating placement of restraints
The type of restraint used
Status of circulation distal to restraints at least every ___ minutes
Excited Delirium, excited delirium
5 minutes
104
Hyperthermia
Move pt to a cooler environment and remove any clothing or gear
Oral and/or tympanic readings are typically less accurate and ________ than actual body ________ temperature
Apply and practice cooling measures (application of ice pack/wet towels to _______, ________, _________ etc. and fanning the skin) to reduce body temperature to less than ______ degrees as quickly as possible
If ice water immersion cooling has been initiated by health care professionals or athletic trainers, consider allowing continued treatment for up to an additional _____ minutes after arrival
lower, core
neck, azillae, groin
104 degrees
10 minutes
105
Hypothermia
Place patient in the _________ position
Handle patient gently
The hypothermic ________ is irritable
Increase temperature in patient compartment to at least ____ degrees
supine
heart
85 degrees
106
Bites and Stings
Instects and Spiders
Remove __________ if present and cleanse with ______________
Marine stings
Remove any clinging tentacles by _____________ rinse (if unavailable, intravenous fluids) or by using a gloved hand
Avoid rinsing with _________ water
Stings involving eye(s)
Irrigate affected eye with _______________
Snake bites
Remove any ____________________
Immobilize extremity
Mark initial _______________ area with pen and note time
Apply _________ dressing
stinger, peroxide
saltwater
frsh water
intravenous fluids
constricting bands
edematous
sterile
107
Overdose/Poisoning
If substance is known, contact Poison Control at 1-800-222-1222
If possible, bring medication or substance _______________
Seizures may develop in many OD/poison/ingestion situations:
Airway assistance by be necessary based on ________, __________________ and __________________.
For all suspected _____________________ exposures, notify Haz Mat team
Signs and symptoms include Diarrhea, Urination, Miosis, Bradycardia, Bronchorrhea, Bronchospasm, Emesis, Lacrimation and salivation
Duodote Kits are currently carried by _______________ and _______________
Acute Dystonic Reaction to anit-psychotics (___________)
Signs and symptoms include painful musce spasms of the face, neck and beck
ingested
LOC, respiratory effor, airway patency
organophosphate
HazMat Rescues and Rescue Chiefs
Haldol
108
Carbon Monoxide/Cyanide Exposure
Dertermine the carboxhemoglobin saturation (SpCO) if possible:
Abnormal values:
Non smoker - greater than ___%
Smoker - greater than ___%
Airway/breathing managment
Monitor SpO2 readings may be falsely _______ in the presence of Carbon Monoxide
Administer _____% O2 via NRB
Suspected Cyanide poisoning
_________________ is the most common source
Signs/symptoms include heacache, confusion, dyspnea, chest tightness, nausea, ALOC, seizure, vomiting, hypertension (______), hypotension (_______), tachypnea (_______), apnea (_______), dilated pupils
Do NOT transport to _______________
5%
10%
high
100%
Smoke inhalation
early, late
early, late
Stand-alone ED
109
Left Ventricular Assist Device (LVAD)
A properly functioning device produces a continuous ___________ sound, which can be heard with ascultation of the chest.
Patiens always carry a ____________ which contains ___ extra fully charged batteries, a _________ controller, and an emergency guide. Make sure you ALWAYS bring this emergency backup equipment with them to the hospital.
Call the number listed on the devide for the on-call LVAD coordinator and you MUST transport to _________________.
In most of these patients, a ________ will not be palpable. This is because the LVAD unloads the ventricle in a continuous fashion and therefore the aortic valve may not open with each contraction.
A manual _____________ may not be obtainable. An _____________ cuff should be used and is likely to measure a narrow pulse pressure
Your treatment of the patient will be based on the ________________________. In these patients, the normal range for the MAP is greater than _____ and less than _____.
_______________ may not be accurate due to the continuous flow nature of the LVAD monitoring
whirling
back up bag, 2, second
Mayo Clinic
pulse
BP, automated
mean arterial pressure
60, 90
Pulse oximetry
110
Left Ventricular Assist Device (LVAD) continued
The most common complications associated with an LVAD patient are the increased risks for stroke, bleeding disorders, arrhythmias, dehydration, and ______ sided heart failure
Ensure modular cable connections are tight as shown below. If the ___________ line is showing, turn the connector to the ________ position.
If the patient is unconscious, unresponsive to stimuli and pulseless:
If the LVAD is operating (able to ascultate whirling sound) DO NOT PERFORM ________.
If LVAD is NOT operating, perform _________.
right
yellow, locked
CPR
CPR
111
Vaginal Bleeding
Determine the last __________________ (LMP)
Place patient in position of comfort
If pregnant and greater than ____ weeks, place patient in recovery position (______________)
Apply _______________ to vaginal area for significant bleeding
menstrual period
20 weeks, left side
trauma pads
112
Pre-Enclampsia/Enclampsia
Place patient in recovery position (__________)
Pre-eclampsia
Disorder of pregnancy after ______ weeks characterized by the onset of _________________ and high ______________.
Physical exam may reveal blood pressure greater than __________, tachycardia, tachypnea, pulmonary edema, confusion, and generalized edema
Eclampsia/Sever pre-eclampsia
Defined by altered ________ and blood pressure greater than ___________
Can occur postpartum (up to _________ after delivery)
left side
20 weeks, fluid retention and high blood pressure
140/90 mm/Hg
LOC, 160/110 mm/Hg
6 weeks
113
Imminent Delivery
Apply gentle _________ pressure to allow a slow, controlled deivery of the head
Gently guide the head _____________ to allow delivery of the ________ shoulder.
Gently guide the head _____________ to allow delivery of the ______ shoulder.
Once the newborn is delivered, maintain body position at same level as the ________ to prevent blood drainage from the umbilical cord
Wipe any blood or mucus from the newborn's nose and mouth with a ____________.
Record _________________.
Apply ___ clamps (___ to ___ inches apart), ___ to ___ inches from abdomen of the neonate
Assess and record APGAR at ____ minute and ________ minutes post delivery
__________ must be brought to the hospital for evaluation
Postpartum
Gently massage the _______ until firm
An additional PCR must be completed for the ____________.
perineal
downward, upper
upward, lower
vagina
sterile gauze
the time of birth
2 clamps 2 to 3 inches apart, 7 to 10 inches
1 minute and 5 minutes
Placenta
uterus
newborn
114
Imminent Delivery Continued
Nuchal Cord
Feel for the cord around the neck as soon as the head is delivered
If unable to remove, clamp and cut the ________.
Breech Delivery
If delivery is not immediate:
Place the mother in the ________________ position
If delivery is immediate:
Allow the ___________ or _________ to deliver on their own and support the trunk
If the head does not deliver within _____ minutes, use a gloved hand to make an airway for the neonate, using the fingers to make airspace
Limb or Brow Presentation
Place the mother in the _____________ position
Prolapsed Cord
Assessment should focus on the presence of _________ in the umbilical cord and relief of the pressure obstructing the blood flow within the cord
Place the mother in the _____________ position or _________ with hips elevated
Relieve pressure from the prolapsed cord if no pulses are detected in the cord
Use gloved hand to gently but firmy push the neonate's head back into the vagina; avoid pushing on the _____________.
Stop pushing upon return of pulses in the cord
Do NOT push the card back into the vagina, but keep __________ with soaked towels
Abruptio Placenta or Placenta Previa
Treat for __________ if indicated
cord
knee-chest
buttocks or feet
3 minutes
knee-chest
pulses
knee-chest, supine
fontanels
moist
shock
115
Newborn Stabilization/Resuscitation
The majority of newborns require no stabilization beyond drying, warming, positioning, suctioning and tactile stimulation.
APGAR Score:
Appearance: 0 (blue all over), 1 (acrocyanosis), 2 (Pink all over)
Pulse: 0 (absent), 1 (<100), 2 (greater than or equal to 100)
Grimmace/Irritability: 0 (no response or none), 1 (Grimace, weak cry), 2 (Sneeze, cough, vigorous cry)
Activity/Muscle Tone: 0 (limp/flaccid), 1 (Some motion/flexion of extremities), 2 (active motion)
Respirations: 0 (none), 1 (slow/irregular), 2 (vigorous cry or normal respirations)
acrocyanosis = blue limps and pink trunk/center mass
116
Newborn Stabilization/Resuscitation Continued
Administer __________ stimulation, if required by tapping _______ of feet
Assess and record APGAR ____ minute and ____ minutes post delivery
Position the infant in the ________ position with the neck in a neutral position. A ___" blanket roll under the shoulders will help maintain head position, if aggressive airway management is needed
Re-assess newborn every ____ seconds
Determine BGL by _____________
Consider specific treatment situations:
Pre-viable delivery is defined as _______ weeks or less
Resuscitation should not be initiated
Any treatment should be comfort only
Cyanosis isolated to the extremities (acrocyanosis)
Saturation may remain less than normal for up to ____ minutes after birth
Administer __________ O2
Heart rate less than _______ with labored breathing, apnea, persistent central cyanosis and/or no muscle tone:
Provide _____% O2 at ____ to ____ ventilations/minute via infant BVM
tactile, soles
1 minute and 5 minutes
neutral, 1"
30 seconds
heel stick
24 weeks or less
10 minutes
blow-by
100
100%, 40 to 60
117
Newborn Stabilization/Resuscitation
Heart rate less than ______
Administer chest compressions/ventilations
A ____ ratio of compressions to ventilation, with ___ compressions and ____ breaths to achieve approximately _____ events per minute to maximize ventilation at an achievable rate is recommended.
60
3:1, 90, 30, 120
118
Pediatric Assessment
A pediatric patient is ___ years of age or less. The only exception is the pediatric trauma alert patient, which is ____ years of age or less.
Assessment of pediatric patient requires _____________, _______________ and _____________.
17, 15
observation, auscultation and palpation
119
Normal Vital Signs for Pediatrics:
Normal Respiratory Rate:
Infant (<1yr.) 30 - 53
Toddler (1-3 yr) 22 - 37
Preschooler (4 - 5 yr) 20 - 28
School-age (6-12 yr) 18-25
Adolescent (13-17 yr) 12-20
Normal Pulse Rate:
Infant: 100 - 180
Toddler: 98 - 140
Preschooler: 80 - 120
School-age: 75 - 118
Adolescent: 60 - 100
Lower Limit of Normal Systolic BP:
Infant: >72 (or strong pulses)
Toddler: >86 (or strong pulses)
Preschooler: >89
School-age: >97
Adolescent: >110
fucked
120
121
Pediatric Bradycardia
Symptomatic pediatric bradycardia: cool mottled skin, diminished pulses, altered mental status, increased capillary refill time (>___ seconds). Pediatric bradycardia is frequently caused by a ____________________ (hypoxia)
Monitor SpO2 and administer ______% O2 via NRB
If a patient ___ years old or less and has signs of poor perfusion with a heart rate ______ despite 100% O2 and ventilation for ___ minutes, initiate chest compressions
Assess temperature
Look for signs of _____________
2
respiratory disorder
100%
8 years, <60, 2 minutes
Hypothermia
122
Pediatric Tachycardia
Symptomatic pediatric tachycardia: cool mottled skin, diminished pulses, altered mental status, increased capillary refill time (>2 seconds)
Symptomatic Tachycardia = Infant greater than or equal to ______ or Child (1 - 17 years) greater than or equal to ______ with signs of poor perfusion
If the patient is asymptomatic look for underlying causes (______, ________, ______)
Administer ______% O2 via NRB
220, 180
fever, dehydration, pain
100%
123
Pediatric Shock
Shock patients may deteriorate rapidly. Signs of shock include hypotension, cool mottled skin, diminished pulses, altered mental status, increased capillary refill time (>2 seconds) and tachycardia
Place pt in _______ position
Administer O2 via proper adjunct to maintain oxygen saturation of ____% or greater
supine
95%
124
Pediatric Foreign Body Airway Obstruction
For infants (less than 1 year)
Severe Obstruction:
If possible, bare the infant's chest
Support the infant in prone position, deliver up to ___ back blows in the middle of the upper back
Continuing to support the infant, rotate to a supine position with the head ______ than the trunk
Deliver up to ___ quick downward chest thrusts in the same location as chest compressions
Unconscious:
Reposition airway and attempt to remove object with _______________.
5
lower
5
magil forceps
125
Pediatric Foreign Body Airway Obstruction
Child (1-17 years)
Severe Obstruction:
Abdominal thrusts (heimlich maneuver)
Unconscious:
Reposition airway and attempt to remove object with __________
Consider mechanical airway clearance device
magill forceps
126
Pediatric Respiratory Distress
The following signs and symptoms will be treated as Respiratory Distress: Increased respiratory rate, increased work of breathing, retractions, nasal flaring, SpO2 <____%
If unable to maintain oxygen saturation of greater than or equal to ___% with NRB, provide ____% O2 with BVM and positive pressure ventilations
95%
92%, 100%
127
Pediatric Cardiac Arrest (Shockable)
Children usually experience cardiopulmonary failure secondary to ________________ failure or _________ and rarely due to primary cardiac disease or primary cardiac arrest. The emphasis should be placed on early _________________ of cardiac arrest with continuous well-performed compressions and defibrillation.
Start cycles of ____ compressions to ___ breaths for 2 person CPR
Start cycles of ____ compressions to ___ breaths for single rescuer CPR
Pediatric pads should be used for patients _____ year of age
If the patient is too small, the Lucas device will alert with ____ fast signals when lowering the Suction Cup and will not enter the _________ mode or ____________ mode.
Utilize BVM and/or King Tube #___
Consider the following less common causes of cardiac arrest:
Hypoxia
Hyperthermia/Hypothermia
respiratory, shock
identification
15, 2
30, 2
8 years or younger
3, PAUSE, ACTIVATE
#1
128
Pediatric Cardiac Arrest (Non-Shockable) or symptomatic Bradycardia (less than or equal to ___ years old)
If NO pulse present, OR patient is ___ years or less and has a heart rate less than ____ with signs of poor perfusion despite oxygenation, ventilation, initiate CPR
Start cycles of ___ compressions to ___ breaths for 2 person CPR
Start cycles of ___ compressions to ___ breaths for single resucer CPR
If provider is alone, the use of a BVM in a single rescuer CPR is no longer recommended. Continuous, uninterrupted chest compressions with pause for _____ application/use only until assisting units arrive.
8
8, 60
30, 2
15, 2
AED
129
Pediatric Altered Consciousness
If GCS is less than or equal to ___ or inability to protect airway, insert supraglottic airway
8
130
Pediatric Diabetic
Treatments based on blood glucose level and level on consciousness:
Hypoglycemia (BGL <___ mg/dL or altered mental status) WITHOUT vascular access
Conscious and alert patient (GCS greater than or equal to ____) with BGL <____ mg/dL, administer oral Glucose paste ___ grams (1 tube)
May repeat once in ___ minutes if BGL still <___ mg/dL
Contraindications
Patient less than ___ years old
Altered LOC
Difficulty swallowing
60 mg/dL
14, 60 mg/dL
15 grams
10 minutes, 60 mg/dL
2 years old
131
Pediatric Seizures
Apply cooling measures when the patient has a temperature greater than or equal to ______ degrees
102
132
Pediatric Fever
Apply cooling measures when the patient has a temperature greater than or equal to ______ degrees
If the pediatric patient has a temperature greater than or equal to ______ degrees and the parent has ibuprofen or Acetaminophen:
Administer ibuprofen ____ mg/kg (not for children under ____ months) PO or
Acetaminophen ___ mg/kg PO
102
102
10 mg/kg, 6 months
15 mg/kg
