Guidelines Flashcards
(237 cards)
1
Q
What age classifies an adult
A
Greater than 13 years or signs of puberty
2
Q
What age classifies a pediatric patient
A
1 to 13 years of age or signs of puberty
3
Q
What age classifies an infant patient
A
One month to one year of age
4
Q
What age classifies a neonate patient
A
Birth to one month
5
Q
For purposes of admission criteria, the Lee health system considers any patient less than how many years old to be pediatric
A
18
6
Q
For purposes of trauma alert criteria, adult his age (blank) and above
A
16
7
Q
For purposes of trauma alert criteria, pediatric age is a (blank) and below
A
15
8
Q
What are the three things to assess during a general impression that determines sick versus not sick
A
Appearance, work of breathing, circulation to scan
9
Q
What does the CABDE assessment stand for
A
Circulation Airway Breathing Disability Exposure
10
Q
What are the three things assessed to gauge circulation status
A
Central and peripheral pulses
Major hemorrhage
Skin
11
Q
When checking central and peripheral pulses assess for
A
Present or absent
Regular or a regular
Rate and quality
12
Q
When assessing skin check for
A
Color, temperature, condition
13
Q
What are the four categories
When checking Airway status
A
Natural
Artificially secured
Compromised
Obstructed
14
Q
When assessing breathing status check
A
Work of breathing
Respirations
Auscultate lung sounds
15
Q
When assessing respirations assess for
A
Present or absent
Regular or a regular
Rate and quality
16
Q
Check these four things when assessing disability status
A
Defibrillation
Motor/Sensory
Blood glucose
Cervical
17
Q
When assessing exposure look for
A
Evaluate illness or injury by removing clothing
Medical or bracelets or ID
18
Q
Sample stands for
A
Signs/Symptoms Allergies Medications Pertinent medical history Last oral intake Events leading to present illness or injury
19
Q
OPQRST stands for
A
Onset Provocation/palliation Quality Region/radiation/referred Severity Time
20
Q
What detailed exam consist of checking AVPU, Glasgow coma scale, stroke assessment, pupil response, Pain scale, sedation scale
A
Neurological
21
Q
A full set of vital signs consist of
A
Pulse, blood pressure, respirations, skin color, temperature and condition, capillary refill
22
Q
Documentation related to what consists of emergency information form, medical records, medical error, DNR form, etc.
A
Patient’s history
23
Q
How many differential Impressions of a case Should you form
A
Three
24
Q
What is an example of a triple differential for altered mental status
A
Hypoglycemia vs. stroke vs. Organic brain syndrome
25
What is an example of a triple differential for acute coronary syndrome
STEMI vs Unstable angina
| Vs Pulmonary emboli
26
What is an example of a triple differential for a shoulder injury
Shoulder fracture vs shoulder dislocation vs shoulder contusion
27
Ventilation target is what with a normal capnograph
etCO2 35mmHg - 45 mmHg
28
Oxygen target is what with a normal plethysmograph
Sp02 94%-99%
29
What is the primary approach for the pleural Needle decompression
Anterior, second or third intercostal space, midclavicular Line
30
What is the secondary approach for the pleural needle decompression
Lateral, fourth or fifth intercostal space, midaxillary line
31
What should you correct in open pneumothorax with
An appropriate vented occlusive dressing
32
EMTs may start IVs under the supervision of who and in the upper extremity only
A credentialed paramedic
33
What are the four approved insertion sites for an IO
Proximal humerus
Proximal tibia
Distal femur
Distal tibia
34
What is the primary site for an IO in an adult
Proximal humerus
35
What is the primary site for an IO in pediatrics
Distal femur or proximal humerus
36
First line therapy for a closed system hypotension hypo perfusion is what
Crystalloid fluid Resuscitation
37
What is the preferred balanced Based isotonic crystalloid
Lactated ringer’s solution
38
What is the BP target
Permissive hypotension, restoration of peripheral pulses
39
You should mitigate non-compressible hemorrhages by
Rapid transport and crystalloid Fluid resuscitation
40
Any Patient that receives IV or I owe medications must have what
A running. Crystalloid Infusion
41
No medications will be administered directly through what
A medication porch or saline lock
42
What is the blood glucose target
60 mg/dL - 300 mg/dL
43
You should splint or immobilize mobilize Fractured or dislocated limbs and what position
A natural or functional one
44
What is the treatment for a closed femur fracture
Traction split
45
What should you provide to all high acuity patients
Environmental protection and Thermo preservation
46
What is the temperature target Four Thermo preservation
98.6°F or 37°C
47
The phrase cold blood does not clot refers to what
Hitler’s method which states you should preserve body heat to mitigate the lethal Triad
48
What priority patient is unstable ALS that requires immediate medical attention for a life and or limb threatening illness or injury
1
49
What priority patient is a stable ALS patient that requires medical attention but not immediately in danger of life
2
50
What priority patient is a BLS patient that just requires non-emergent medical attention
3
51
A minimum of how many assessments are required for every patient transport
2
52
Transfer of care between the non-transport and transport providers is essential for what
A good patient outcome
53
What takes precedence over patient care in apparatus
Provider safety
54
What are the six medication right before the administration of any medication
```
Patient
Drug
Dose
Route
Time
Documentation
```
55
What should you perform before the administration of any medication and or critical procedure
A partner cross check
56
The maximum dose of pediatric medication should never exceed
The maximum adult dose except when specifically stated
57
What is a clinical mindset in a constellation of skills, tools and techniques that are deployed to establish and or manage non-natural airways
Airway management
58
The primary goal of progressive airway management is to
Start simple, work through the various levels and stop with the airway is patent
59
When placing an Advanced airway, every effort must be made to avoid
Iatrogenic hyper/hypocapnea
Hypotension
Bradycardia
SPO2 desaturation events
60
What is associated with worse outcomes among pediatrics, closed head traumatic brain injuries and poly trauma patients
Endotracheal intubation
61
True or false endotracheal intubation is also associated with interruptions and chest compressions during CPR
True
62
Indications for prehospital endotracheal intubation can be narrow to the following
Inability to ventilate and or oxygenate
Inability to manage secretions
Laryngeal Edema
63
If endotracheal intubation is required providers will adhere to what
The two and out philosophy
64
What is preferential To direct laryngoscopy
Video laryngoscopy
65
What is defined as passing the Laryngoscope blade and or endotracheal tube beyond the teeth with the intent to intubate the trachea
An endotracheal intubation attempt
66
What is the mechanical aspect of breathing in which air moves into the lungs and CO2 moves out of the lungs
Ventilation
67
Proper ventilation requires both
Adequate title volume and respiratory rate
68
What is defined as the addition of oxygen to any system, including the human body
Oxygenation
69
Oxygenation may also refer to the process of treating a patient with oxygen or
Combining a medication or other substance with oxygen
70
Considerations in determining a patient’s need for supplemental oxygen are determined from the patients
Presenting condition coupled with history and physical exam
71
What is a condition where a patient’s respiratory volume and rate can create uncertainty
Hyperventilation
72
During hyperventilation The lack of adequate CO2 causes a (blank) in the acid levels resulting in alkalosis
Drop
73
CO2 is a potent vasodilator or constrictor
Vasodilator
74
When CO2 drops as a result of iatrogenic hyperventilation blood vessels do what
Constrict
75
In the case of a brain injured patient, iatrogenic hyperventilation will
Reduce blood flow to the injury/ischemic zone (penumbra)
76
What is the Progressive airway management path in escalating order
Natural airway
Head positioning Airway axis alignment
Basic mechanical airways
Advanced airways
Cricothyroidotomy
77
The maneuvers of head tilt chin lift, John thrust, sniffing position, moving the head of the bed up, and ramping fall under
Head positioning and airway axis alignment
78
Extra glottic or endotracheal airways are what kind
Advanced
79
What are the three types of cricothyroid otomy
Needle , percutaneous, surgical
80
The primary treatment goals for patients suffering from inadequate oxygenation include
Preventing or correcting hypoxia
Optimizing ET CO2 and SPO2
Minimizing the effects of secondary and or iatrogenic injury
Decreasing airway resistance
81
What is an effective way to improve oxygenation in patients that are non-invasively or invasively ventilated
Positive and expiratory pressure for PEEP
82
What stents Open closed alveoli and recruits long thus increasing surface area for gas exchange
PEEP
83
PEEP increases (blank), Which improves pulmonary reserve between breaths
Functional reserve capacity
84
In prehospital care, the range of PEEP is generally what
5-15 cmH2O
85
Classic settings for PEEP are
5,7.5,10,12.5,and 15
86
Tight lung patients, reactive airway disease, typically do better at what PEEP setting
5 cmH20
87
Wet lung patients typically require what PEEP setting
7.5 -15 cmH20
88
PEEP greater than 15cmH20 Can result in an increase in intrathoracic pressure thus causing
A decrease in venous return and cardiac output
89
PEEP Is contra indicated in what type of patients
Cardio pulmonary arrest and grossly hypotensive
90
What has been shown to improve oxygen saturation in apneic patients during advanced airway management placement
Apneic nasal oxygenation
| Nasal cannula at 15lpm
91
What is the escalating desired pathway for progressive ventilation and oxygenation management
Eupneic
Truncal positioning-airway axis alignment
Passive oxygenation
Non invasive ventilation /oxygenation
Invasive ventilation/oxygenation
92
Nasal cannula, high flow nasal cannula, nonrebreather mask, nebulizer, controlled mechanical ventilation, bag mask ventilation fall under what type of oxygenation
Passive
93
CPAP, Controlled mechanical ventilation, bag mask ventilation fall under what type of oxygenation
Non-invasive ventilation/oxygenation
94
Controlled mechanical ventilation, PEEP, bag mask ventilation-PEEP fall under
Invasive ventilation/oxygenation
95
A common pitfall in ventilation is to over ventilate patients by providing
Too much Tidal volume or too fast minute rate
96
When they normally breathing patient takes a breath, and intrathorasic pressure does what
It decreases allowing air to be drawn into the lungs
97
In patients that receive positive pressure ventilation, intrathoracic pressure is
Increased
98
Unregulated PPV will have a dramatic adverse effect on
Circulation and perfusion
99
When attention is not paid to PPV volume and rate, the patient can be harmed as a result of the imbalance between what
Alveolar ventilation and pulmonary capillary blood flow
100
An imbalance Between alveolar ventilation and pulmonary capillary blood flow is known as
Ventilation/ perfusion (VQ) miss matching
101
Iatrogenic V/Q Miss matching can be mitigated by the use of what two things
Controlled mechanical ventilation (CMV) Devices or automated transport ventilators
(ATVs)
102
Ventilation volume in rate should be guided by the use of what and in concert with American heart Association guidelines
Wave form capnography or ET CO2
103
Supine positioning can result in a market reduction in what respiratory factor
Functional residual capacity
104
Pulmonary patients should be transported in what position
Semi Fowler’s
105
What two devices are preferential to bag mask ventilation (BVM)
Controlled mechanical ventilation (CMV) or automated transport ventilator (ATV)
106
What two things are required for all advanced airway/ ventilation cases
Waveform capnography (ET CO2) and pulse oximetry
107
What can be used for initial CO2 detection when continuous waveform capnography is not immediately available
Color metric ET CO2 device
108
What is the treatment for a partial FBAO
Encourage coughing and reevaluate
109
What is the treatment for a complete and conscious FBAO in an adult
Abdominal thrusts
110
What is the treatment for a complete and conscious FBAO In an infant
Five back slabs and five Chest thrusts
111
In an unconscious adult with an FBAO that you can’t ventilate what is the treatment
Laryngoscopy , McGill forcep removal, Surgical/needle Cricothyroid otomy
112
The use of patient restraints is authorized in all instances where a patient’s behavior may
Jeopardize the safety of the patient or crew
113
What may be used when a patient Lacks decisional capacity to make rational decisions and exhibits behavior that may disallow necessary medical treatment
Restraints
114
Patients will not be restrained and what position
Prone
115
Distal neurovascular function she’ll be checked and documented after application of restraints and every how many minutes after
10
116
After restraint application what must be checked every 10 minutes
Pulse
Motor
Sensation
117
When a patient is restrained, distal pulses and capillary refill time of less than how many Seconds should be obtained
2 seconds
118
In the event of a short transport time, the results of a minimum of how many sets are to be documented before you reach the facility with a Restrained patient
2
119
First consideration for transport is
The facility of the patient’s choice
120
What is the key to delivering the right patient, to the right facility, the first time
Informed consent
121
Mode of transport (ground, air or water) is determined by who
The highest medical authority providing direct patient care
122
Status of transport (lights and siren Use) is determined by who
The EMS transport provide her with the highest medical authority providing direct patient care
123
The decision to run lights and sirens should be justified by the need of what
Time sensitive medical intervention that is beyond the capabilities of the transport unit
124
Patients, regardless of age, were transported in cardiopulmonary arrest or deteriorate to cardiopulmonary arrest in transit, shall be transported where
To the closest facility
125
Stroke alert patient should be transported to
The closest. STEMI/percutaneous coronary intervention (PCI) facility
126
Stroke alert patient should be transported to the closest
Comprehensive stroke center
127
Trauma alert patients, regardless of age or pregnancy status, shall be transported where
The closest trauma center
128
Septic alert patients may be transported
To any admit facility
129
Adults with simple extremity fractures (SEFx) Or dislocations May be transported to
Any facility
130
Children with simple extremity fractures (SEFx) or dislocations, excluding the elbow, may be transported to
Any facility
131
The term to describe an isolated, closed, distal extremity below the elbow or knee) fracture or dislocation without neurovascular compromise or need for surgical intervention is
Simple extremity fracture
| SEFx
132
True or false, elbow fractures or dislocations in children are not considered SEFx
True
133
Adults that may require orthopedic surgery or have a neurovascular injury should be transported to the closest
Adult orthopedic admit the facility
134
Adults that have a high probability for general medical surgical admission (GMSA) can be transported to
Any facility
135
Children that have a high probability for general medical surgical admissions (GMSA) should be transported to the closest
Pediatric admit facility
136
Possible appendicitis, bowel obstruction and or any signs of peritoneal irritation in any pediatric are all high probability for what
To be a general medical surgical admission
| GMSA
137
Obstetrical patients greater than or equal to 20 weeks gestation shall be transported to an
OB/GYN receiving facility
138
Where should high risk Obstetrical patients be transported to
Neonatal intensive care receiving facility
139
Where should patients within an Imminent Obstetrical emergency Be transported to
The closest
| OB/GYN facility
140
Oncology alert patients (on or receiving chemotherapy with a fever 100.4°F or greater) shall be transported to
An oncology admit facility
141
Following appropriate prehospital Decontamination, patient exposed to hazardous materials can be transported to
Any facility
142
Patients with a high probability for hyperbaric oxygen therapy can be transported to
Any facility
143
Venomous snake and spider bites or stings can be transported to
Lee Memorial Hospital and all Collier County facilities
144
Mammal and Marine bites or stings can be transported to
Any facility
145
Lee Memorial Hospital
Trauma alert
Adult ortho
146
Golisano Children’s hospital of SWFL
Pediatric admit
OB under 18 years of age
OB less than 20 weeks gestation
Ped ortho
147
Lehigh regional medical center
Adult ortho
148
Cape Coral Hospital
OB/GYN
Adult ortho
149
Golf Coast medical center
STEMI alert/ PCI
Stroke alert (comprehensive)
Adult ortho
Oncology alert
150
Health Park medical center
STEMI alert PC
OB/GYN
neonate
151
For mixed transports (i.e. parent and child), both parents shall be transported to
Health Park
152
Naples community Hospital
STEMI alert/ PCI
Stroke alert comprehensive
Adult ortho
Oncology alert
153
Physicians regional medical center PR
STEMI alert PCI
Stroke alert
Adult ortho
154
Naples community Hospital
Stroke alert comprehensive
Ped
OB/GYN
Neonate
Adult ortho
Ped ortho
155
Physicians regional medical center. CB
Adult ortho
156
Fossett Memorial Hospital
STEMI alert PCI
Stroke alert comprehensive
Adult ortho
Oncology alert
157
Bayfront health Punta Gorda
Oncology alert
158
Bayfront health Port Charlotte
STEMI alert PCI
Stroke alert comprehensive
Ped
OB/GYN
Neonate
Adult ortho
Ped ortho
159
Inglewood community Hospital
STEMI alert PCI
Adult ortho
160
Bayfront health Venice regional
STEMI alert PCI
161
Sarasota Memorial Hospital
STEMI alert PCI
Stroke alert comprehensive
Trauma alert
Ped
OB/GYN
Neonate
Adult ortho
Ped ortho
Oncology alert
162
D1
Lee Memorial Hospital
163
D2
Golisano children’s hospital of SWFL
164
D3
Lehigh regional medical center
165
D4
Cape Coral Hospital
166
D5
Golf Coast medical center
167
D7
Health Park medical center
168
D6
Naples community hospital baker DT
169
D13
Physicians regional Medical Center PR
170
D14
Naples community Hospital North
171
D15
Physicians regional Medical Center CB
172
D9
Fawcett Memorial Hospital
173
D10
A front health Punta Gorda
174
D11
Bayfront health Port Charlotte
175
D8
Inglewood community Hospital
176
D12
Bayfront health Venice regional
177
D16
Sarasota Memorial Hospital
178
What county does Lee Memorial Hospital, Golisano Children’s Hospital of SWFL, Lehigh regional Medical Center, Cape Coral Hospital, golf Coast medical center, and health Park medical center reside in
Lee
179
What county does Naples community hospital baker, physicians Regional medical center PR, Naples community Hospital North, and physicians regional medical centerCB reside in
Collier
180
What county does faucet Memorial Hospital bayfront health contact order and pay front health Port Charlotte reside in
Charlotte
181
What county does Inglewood community Hospital, bayfront health Venice regional, and Sarasota Memorial Hospital reside in
Sarasota
182
D31
Coconut point
183
D32
NCH Bonita
184
D35
Bayfront a Cape Coral
185
D34
NCH north east
186
D33
Northport ER
187
Northport ER
Ped
OB/GYN
Adult ortho
Ped ortho
Oncology alert
188
What county does Coconut point NCH Bonita and bayfront Cape Coral standalone ER’s reside in
Lee
189
What is the only standalone ER in Collier County
NCH Northeast
190
What is the only standalone ER in Sarasota County
Northport ER
191
Air medical transport should be used when it critically ill and or injured patient will benefit from
Faster transport and reduced out of hospital time
192
You should place air medical transport on standby when
The call information obtained by Dispatch suggests the need for it
193
You should request air medical transport within the first how many minutes of patient contact
2
194
Request air medical transport within the first two minutes of patient contact if they fall under these two priorities
Priority 1: patients exceed ground transport time of 30 minutes
Priority 2: Patients that are in accessible by roads
195
True or false, any on scene first responder may request air medical transport
True
196
Who, weather on scene or not, may request air medical transport based on available information at that time
Any LCEMS supervisor
197
Lee control may provide information to Air medical transport and request a what to expedite response time
an Auto launch
198
Air medical crews may request information from Lee control and decide to
Auto launch
199
True or false, after initial assessment, the highest medical authority providing direct patient care should cancel air medical transport if the patient’s condition does not warrant the service or meet the criteria
True
200
The following patients are not appropriate for air medical transport
CPR in progress
Hazmat patients
Priority 3 patients
201
Contact Lee control and notify them if you have more than one patient because what needs to happen
Additional air resources need to be requested
202
Who is responsible for determining if the weather will permit the mission to be accepted By the air resource
The pilot
203
Who is responsible for preparing and securing landing zones
The fire department
204
Who occupies the controller roll on an LZ
Fire department personnel
205
All LZ’s should be a minimum of what dimensions day or night
100x100
206
Hard surface LZs must be illuminated at the corners with
Strobe and or a steady burn light source
207
Once established, the LC controller will ensure what other task The duration of the event
LZ security
208
What is provided in the LZ report From the controller to the pilot
The type of surface
(Hard or soft)
Wind direction and speed
Any potential hazards
(Wires, fences , signs )
209
Ground to air radio traffic should be limited to
LZ information only, no patient information
210
The LZ controller Should clear the aircraft for takeoff by
Looking around the LZ into the sky for any Other Air craft traffic in the vicinity
211
If at any time the LZ becomes unsafe for takeoff or landing, the LZ controller will transmit what phrase
Abort, abort, Abort
212
Ground providers shall comply with who’s instructions regarding patient packaging and aircraft loading and offloading
The air crew member’s
213
A patient shall be defined as any individual who meets one or more of the following criteria
Medical or trauma complaint
Illness or injury
New altered mental status
Any individual in the same event that Is significantly ill and or injured
Demonstrates a high index of suspicion for illness or injury
214
Who is a designated decision maker when a patient is not of decisional capacity or has legally transferred their healthcare decision making to another party
Responsible party
215
What are the two phrases used when the unit arrives in the vicinity of a given location but no event or person involved could be found or located
Unable to locate
No patient found
216
What is the phrase used when the unit arrives on scene and the person involved does not meet “patient” criteria
No Care required
217
What is the phrase for the instance when a unit arrives on scene, makes contact with the person involved, the PI is determined to be a patient, and evaluation and/or intervention is performed and the patient ultimately declines to be transported to the hospital (refusal form required)
Treated, no transport
218
What is the phrase used when the unit arrived on scene, makes contact with the person involved, the PI is determined to be a patient, ultimately refuses evaluation, treatment and declines to be transported to the hospital ( refusal required)
Treatment and transport refused
219
What are the three components to a valid refusal of care
Competence
Decisional capacity
Informed refusal
220
Competence to refuse care is defined by
1. 18 years of age or older, or legally emancipated
| 2. A parent or legal guardian get refuses on behalf of their minor child
221
Decisional capacity to refuse care is defined by
Orientation
Gate and or coordination
Speech pattern
Insight and judgment
Psychiatric decompensation
222
All patients undergoing the refusal process must be oriented defined by
Being awake, alert, and oriented x 4 (Person Place time and situation)
223
Staggering gate, or inability to stand and ambulate may indicate in an impairment That alters
Decision making capacity
224
Slurred, incoherent or otherwise inappropriate speech patterns me indicate an impairment that alters
Decision making capacity
225
(Blank): Patients being able to express good insight into the nature of their condition, and convey a reasonable plan to deal with the condition is acceptable as Decisional capacity to refuse care.
Insight and judgment
226
Patient experiencing suicidal or homicidal ideation’s or gestures, audio or visual hallucinations, and/or other forms of delusional behavior that alters decision making capacity reveals (blank) , rendering someone unable to refuse Carr
Psychiatric decompensation
227
What is defined by patients being fully informed about their medical condition, the risks and benefits associated with the proposed treatment and the risks associated with refusing evaluation, treatment, and or transportation
Informed refusal
228
Medical emancipation:
Are you female who is (blank) May consent to medical care relating to her pregnancy and can make medical decisions on behalf of the unborn were born child
18 years of age who is unmarried, pregnant and or has a minor child
229
What are the three categories of legal emancipation
18 years of age or at least 16 who is married
Is enlisted in military service
Or has been declared emancipated by court order
230
No mine are less than how many years of age can be emancipated in Florida
16
231
Patient able to refuse care must be
Competent
Have decisional capacity
Informed of all the risks
232
Patient unable to refuse care
Incompetent < 18 yo
Lacks decisional capacity
AMS
Suicidal ideation’s or gestures
Mental defect disability or deficiency
Severely altered or impaired vitals
233
If a patient is determined to be incompetent and relax decisional capacity, they may be evaluated, treated and transported under what term
Implied consent
234
What a reasonable individual would consent to under the same circumstances is called
Implied consent
235
If the patient is evaluated, treated and transported on the basis of implied consent, providers should use reasonable measures to ensure safe transport to
The closest appropriate facility
236
True or false, to obtain a refusal of care you have to perform a primary assessment, history and physical examination; including a complete vital sign assessment
True
237
True or false, to obtain a refusal of care procedure you must fully informed the patient or responsible party about his or her medical condition, the risks and benefits associated with the proposed treatment and the risk associated with refusing evaluation, treatment, and or transportation
True
