GENERAL INFORMATION

Question 1

What are the 6 rights of drug administration

Answer 1

Right patient, right drug, right dose, right time, right route, right documentation

Question 2

What are IO sites allowed for adults?

Answer 2

proximal humerus, proximal tibia, distal tibia

Question 3

what are the IO sites allowed for pediatric?

Answer 3

distal femur
proximal tibia
distal tibia
proximal humerus (only if the surgical neck can e palpated)

Question 4

Where should all IM injections be administered?

Answer 4

lateral thigh p. 12

Question 5

What size needle should be used for IM injections in adults? Max per site?

Answer 5

21-23 gauge 1.5 inch needle

4 mL maximum per site

Question 6

What size needle should be used for IM injections in pediatrics? Max per site?

Answer 6

23 gauge 1” needle
1 mL maximum per site
- if > 1 mL needs to be administered, split the dose between the thighs

Question 7

What does MAD stand for?

Answer 7

Mucosal atomizaton device

Question 8

What medications can be administered via MAD device?

Answer 8

Versed
Narcan
Fentanyl
Ketamine

Question 9

What is the desired dose when using the MAD device? What is the max?

Answer 9

0.3 mL - 0.5 mL per nostril

max 1 mL per nostril

Question 10

What are the dilution instructions for push-dose pressor epinephrine? (1:________). What will it yield?

Answer 10

1: 100,000
- Dilute: discard 9 mL of Epi 1:10,000 (0.1mg/mL) and draw up 9 mL of Normal Saline to create Push-dose pressor Epi 1:100,000. This will yield 10 mcg/mL.

Question 11

What are the dilution instructions for Benadryl?

Answer 11

dilute with 9 mL normal saline for IV/IO administration

Question 12

What are the dilution instructions for Ketamine?

Answer 12

ensure Ketamine is diluted per specific protocol

Question 13

What patients are considered pediatric?

Answer 13

Patients who have not reached puberty

Question 14

Who should be treated as an adult?

Answer 14

patients who have reached puberty

Question 15

What is the preferred method of vascular access during pediatric cardiac arrest?

Answer 15

IO

Question 16

What should be used as the primary reference point for determining the appropriate patient care for pediatrics?

Answer 16

the child’s age

Question 17

if the child appears shorter or taller than the stated age or if the age is unknown, use the __________

Answer 17

“Handtevy” system length-based tape

Question 18

What 4 things should be referred to the Handtevy system when treating pediatrics?

Answer 18

Medication dosages/infusions
Equipment
Electrical therapy
Vital Signs

Question 19

Pediatric age classifications - Neonate:

Answer 19

birth to 1 month

Question 20

Pediatric age classifications - infants

Answer 20

1 month to 1 year

Question 21

Pediatric age classifications - children

Answer 21

1 year to puberty

Question 22

what defines female puberty?

Answer 22

breast development

Question 23

what defines male puberty?

Answer 23

underarm, chest or facial hair

Question 24

Once a child reaches puberty use _________ for treatment

Answer 24

the adult guidelines

Question 25

In AVPU what does A refer to?

Answer 25

Alert to person, place, time and event (AAO x 4)

Question 26

In AVPU what does V refer to?

Answer 26

Verbal: responds only to verbal stimuli

Question 27

In AVPU what does P refer to?

Answer 27

Pain: responds only to painful stimuli

Question 28

In AVPU what does U refer to?

Answer 28

Unresponsive

Question 29

Patients with AMS consider: __________

Answer 29

AEIOU-TIPS

Question 30

AEIOU-TIPS STANDS FOR?

Answer 30

``` Alcohol Epilepsy (seizures) Insulin (hyper-/hypoglycemia) Overdose/Oxygenation Uremia (kidney failure) Trauma Infection (sepsis) Psychiatric Stroke/Shock ```

Question 31

What are the vital signs we assess?

Answer 31

Pulse (RRQ), Respirations (RQ), Temp, Pulse Ox, BP (cap refill), EtCO2, BGL

Question 32

Priority 3 patients shall receive at least ___ sets of vitals

Answer 32

2

Question 33

Priority 2 patients shall receive vitals ________

Answer 33

every 5 minutes

Question 34

When should we take a manual blood pressure?

Answer 34

to confirm any abnormal or significant changes of an automatic blood pressure cuff reading

Question 35

Prior to administration of a drug what should be done?

Answer 35

6 rights | check blood pressure

Question 36

hypotension for adults is defined as a systolic BP

Answer 36

< 90 mmHg

Question 37

ETCO2 monitoring shall be utilized for the following patients: (7)

Answer 37

- patients requiring ventilatory support (e.g. BVM, ET tube, SGA, CPAP) - patients in respiratory distress - patients with altered mental status - patients who have been sedated - patients who have received pain medication - seizure patients - suspected sepsis RSV PASS

Question 38

A BGL shall be documented for patients with any of the following: (9)

Answer 38

- history of diabetes - AMS - General weakness - seizure - syncope/lightheadedness - dizziness - poisoning - stroke - cardiac arrest DD WSC PASS

Question 39

All ALS patients should be continuously monitored in lead

Answer 39

II

Question 40

12 and 15 lead ECG's shall be performed on the following patients:

Answer 40

- Chest/arm/neck/jaw/upper back/shoulder/epigastric pain or discomfort - palpitations - syncope, lightheadedness, general weakness or fatigue - CHF, SOB, HGN, or hypotension - unexplained diaphoresis or nausea

Question 41

12 and 15 lead ECG's shall be repeated every __ minutes and upon ___

Answer 41

10, ROSC

Question 42

When transporting patients with 12 and 15 lead ECGs who have had repeated ECG's every 10 minutes or received ROSC how long whould cables be connected to the patient.

Answer 42

until patient is turned over to the ED staff

Question 43

What does OPQRSTA stand for?

Answer 43

Onset: did the symptoms appear gradually or suddenly? Palliative: what makes the symptoms better? Provoke: what makes the symptoms worse? Previous: previous similar episodes? Quality: what kind of pain? pressure, squeezing, aching, dull Radiation: does the pain or discomfort radiate? where? Severity of pain; 1-10 scale (utilize faces pain scale for pediatrics) Time: Associated: What are the associated signs and symptoms

Question 44

Who gets an NPA?

Answer 44

Semi-conscious patients with an intact gag reflex unless contraindicated

Question 45

Who gets an OPA?

Answer 45

Unresponsive patients without a gag reflex shall have an oropharyngeal airway inserted, unless contraindicated

Question 46

DO NOT withhold oxygen if the patient is

Answer 46

dyspneic or hypoxic

Question 47

Spo2 maintain 95% for

Answer 47

all patients except COPD & asthma

Question 48

maintain spo2 90% for

Answer 48

COPD and asthma

Question 49

O2 administration for all stroke patients

Answer 49

2 Lpm n/c (increase oxygen therapy as needed)

Question 50

O2 administration 15 Lpm via NRB regardless of sp02. (5 patients)

Answer 50

``` All 3rd trimester pregnancy trauma patients All head injury patients Decompression sickness Carbon monoxide exposure Cyanide exposure ```

Question 51

If oxygen saturation cannot be maintained....

Answer 51

ventilatory support should be provided

Question 52

In certain patients, excessive ventilation rates may be

Answer 52

harmful

Question 53

overzealous positive pressure ventilation can impair

Answer 53

venous return cardiac output cerebral perfusion

Question 54

ultimately the patients _____ and _____should determine the ventilation rate for the patient

Answer 54

SpO2 and EtCO2

Question 55

EtCO2 should be ___ to ____ mmHg

Answer 55

35 to 45

Question 56

Ventilatory Rates: patients with a pulse:

Answer 56

1 breath every 6 seconds

Question 57

Ventilatory Rates: patients without a pulse:

Answer 57

1 breath every 10 seconds. Coordinate compressions and ventilations to avoid simultaneous delivery

Question 58

Ventilatory Rates: patients with ICP and/or Hernation

Answer 58

Maintain EtCo2 between 30-45 mmHg and sp02 > 90% while continuously monitoring BP

Question 59

What is the preferred method for ventilating pediatric patients?

Answer 59

BVM with oral or nasal airway

Question 60

Pediatric patients who can't protect their airway, are unable to maintain oxygen saturation despite BVM ventilation, and/or can't be effectively ventilated with a BVM should be upgraded to a

Answer 60

Supraglottic Airway (SGA) (age-specific) followed by intubation if needed.

Question 61

DO NOT ATTEMPT TO AGGRESSIVELY NORMALIZE CAPNOMETRY/ETCO2 READINGS IN THE FOLLOWING 2 PATIENTS. Why?

Answer 61

Cardiac arrest pre/post ROSC Bronchospasm (i.e., asthma, COPD) High EtCO2 levels are acceptable and even desirable in these patients

Question 62

Priority 1 patients

Answer 62

patients in cardiac or respiratory arrest

Question 63

Priority 2 patients

Answer 63

unstable patients with immediately life-threatening conditions

Question 64

Priority 3 patients

Answer 64

Stable patients with no immediately life-threatening conditions

Question 65

Placing patients in the prone position is

Answer 65

contraindicated due to risks of asphyxiation