Medical Protocols Flashcards by David Flores

Q

The EMT in the field is expected to follow protocols without deviations unless he or she receives a…

A

VERBAL ORDER FROM AN ON-LINE MEDICAL CONTROL PHYSICIAN

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Q

Personnel may perform only to the level that they are…

A

LOCALLY CERTIFIED

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Q

In protocols WITHOUT a medical control bar, all treatments may be given by_____, and it is unlikely personnel will receive orders for any other treatments if______

A

STANDING ORDER

MEDICAL CONTROL IS CONTACTED

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Q

Non-protocol orders may be requested, with justification by field personnel, or be______

A

INITIATED BY THE MEDICAL CONTROL PHYSICIAN

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Q

Care ordered by the Medical Control Physician not contained in specific protocols shall:

(LONG ANSWER) A, B, C

A

A. Follow rules promulgated under:
Texas Administrative Code, Title 25, Part 1, Chapter 157 (Emergency Medical care) Texas Health and Safety Code Chapter 773 (EMS and Trauma Systems)

B. BE WITHIN THE SCOPE OF THE EMT’S LOCAL LEVEL OF CERTIFICATION AS DEFINED BY EPFDEMS MEDICAL PROTOCOL SECTION 1- GENERAL #11 (UNIVERSAL PATIENT TREATMENT), AND PROTOCOL SECTION 1- GENERAL #10 (EPFDEMS MEDICATIONS)

C. Be documented in the Medical Control section of the electronic patient care report by EPFDEMS personnel. Med control section will include the Medical control Phy # giving the order, AND THE ORDER

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Q

Medical control responsibilities include being ____ to provide medical advice and ____ orders

A

AVAILABLE

TREATMENT

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Q

ROUTINE CAUSES FOR CONTACTING MED CONTROL

When advice, support or direction is needed regarding appropriate patient management and/ disposition_____

A

THE RIGHT TO CONTACT MED CONTROL IS NEVER DENIED.

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Q

ROUTINE CAUSES FOR CONTACTING MED CONTROL

Advanced Life support requiring Med control orders____

A

BELOW THE BAR

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Q

ROUTINE CAUSES FOR CONTACTING MED CONTROL

Pt refusing transport who appears to need med attention; Med Control should be called for____

A

“Physician ADVICE to PATIENT”

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Q

ROUTINE CAUSES FOR CONTACTING MED CONTROL

Physician Bystander____

A

ACCEPTING RESPONSIBILITY FOR PATIENT CARE

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Q

ROUTINE CAUSES FOR CONTACTING MED CONTROL

For Permission to DISCONTINUE_____ (LIFE SAVING)

A

RESUSCITATION ALREADY BEGUN

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Q

Med control must be contacted prior to discontinuing ANY____

A

ALS TREATMENTS (IV therapy, ECG monitoring, Med administration)

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Q

Communication failure- if standard radio contact cannot be initiated with med control____

A

Call dispatch (or any other recorded line) @ 832-4432
AND
Request a conference call to Med control at UMC

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Q

Unable to contract Med control for any reason? (lengthy explanation)

and
2.

A

May perform to the LIMITS of their LOCAL LEVEL OF CERTIFICATION
&
1. Paramedics auth to perform protocols below the bar which would normally require on-line med control IF the pt needs immediate therapy to prevent immediate death.

If actions that require med control are not urgent, they should be deferred until comm is reestablished.

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Q

ALL circumstances which there is a failure of comm devices or other COMM equipment failure shall be reviewed BY

A

THE MED DIRECTOR

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Q

EPFD Personnel involved will NOTIFY____ as soon as practical after the inability to____

A

FIRE ADMINISTRATION

CONTACT MEDICAL CONTROL

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Q

ALL skills listed under ECA/EMT-Basic and EMT-Advanced may be performed by____ without______

A

STANDING ORDER

CONTACTING MEDICAL CONTROL

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Q

EMT-B skills that don’t require contacting Med control:

A

Vital signs- including pulse ox and BGL

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Q

Spinal motion restriction that doesn’t require med control

4 Items

A

a. Rigid cervical collars
b. Backboards
c. extrication devices/ vests (KEDS)
d. cervical immobilization devices after patient is secured to backboard

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Q

Oxygen related items that can be used without contacting medical control

a. stable
b. Unstable/acute

A

a. Stable/ non-acute o2- 1-4 LPM via NC

b. unstable/acute o2- 8-15 LPM via Non-rebreather, BVM, or BAG VALVE TUBE of intubated pt’s at 100%

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Q

Lower flow rates of (?) may be used as long as bag remains x% full during______

A

8-10 LPM
50% full
Patient’s MAXIMUM Ventilatory effort

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Q

Positioning and suctioning for airway control don’t require

A

Contacting med control

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Q

Insertion of OPA or NPA airways don’t

A

Require contacting med control

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Q

Insertion of SUPRAGLOTTIC airway in medical or trauma or Cardiac arrest PT’s doesn’t

A

Require contacting med control

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BVM or demand-valve for PPV doesn't

Require contacting med control

Rapid PT extrication doesn't

Require contacting med control

*DOESN'T REQUIRE CONTACTING MED CONTROL* Application of____ to ISOLATED fractures of_____ or_____

Tractions splints FEMUR Tibia/Fibula

*DOESN'T REQUIRE CONTACTING MED CONTROL* | Electrical defibrillation with_____

Automated External Defibrillator (AED)

Stabilize and splint bone fractures and joint dislocations using (4 items)

1. Board splints 2. Wire or "ladder splints" 3. Pliable metal or "SAM" splints 4. Field-expedient means: Pillows or blankets, etc

*DOESN'T REQUIRE CONTACTING MED CONTROL* Six meds/actions that don't require med control 2(actions) 4 (meds)

1. CPR 2. Childbirth 3. Admin of aspirin 4. Oral Glucose 5. Epi auto injector 6. Admin of nebulized albuterol

Request for ambulance=

Considered a patient

Calls to 9-1-1 are not always intended to be an_______, although an ambulance may be dispatched (_______)

AMBULANCE REQUEST | Minor MVCs

If someone is not a legal adult (under the age of 18) they=

ARE a PATIENT

A person is NOT ALERT and ORIENTED to person, time, place, and event=

THEY ARE A PATIENT

Someone is a patient if they are under reasonable_____ of_____ or______ known or unknown.

SUSPICION ALCOHOL DRUG SUBSTANCE

If someone has signs or symptoms of an active medical illness or injury they=

ARE A PATIENT

If someone has a medical or psychological event=

THEY ARE A PATIENT

If someone suffers a trauma event (including a minor fall)

They are a patient

All patients MUST have a completed (2 items)

Patient Care Record and/or Patient refusal

If the involved party IS NOT a patient other responding Fire and Medical units will be____ and both_____ and ______ will need not be completed.

Cancelled Patient Care RECORDS Refusal FORMS

If there is any___, complete a_______ and/or______

DOUBT Patient Care RECORD REFUSAL

Level III patients___ attended by any EMT level crew member locally certified under the EPFDEMS Med director

May be

Level I and II patients____ attended by a Locally Certified EMT-Paramedic

MUST BE

If NO locally certified paramedic is available for any reason, the______ crew member will attend all level I or Level II patients

Highest locally certified

Although each individual is held responsible for his or her actions, the_________, is responsible for all patient care,_______ of who attends the patient

Highest locally certified crew member | REGARDLESS

A Physician on-scene can either be a ____ or a _____ in providing optimal care for a patient

Help | Hindrance

It is important to be______ (to an on-scene Physician)

Cordial

Who mediates disputes when there is an on-scene physician

Med control

When an ALS unit is dispatched under Medical direction a____

Physician/patient relationship is established.

The Pre-hospital provider on the scene is responsible for the management of the patient and acts as the

AGENT of the physician providing med control

Usual places for patient's private physician (not in a public place ex. mall)

Physician's office Patient's home or Nursing home

If a private physician is on-scene and ASSUMES responsibility for pt care the Pre-hospital provider should____ to their orders_____ those orders_____ with the established protocols

DEFER UNLESS CONFLICT

You must request Private Physician to____ his or her____, with printed_____, _____, and ______ number

``` document orders name signature DEA ```

The on-scene Physician's orders will be FORWARDED TO (for what reason)

EPFDEMS Admin for attachment to Pt's med record

On-line Med control Physician will be notified of the______ of the patient's private physician

PARTICIPATION

If private physician's orders conflict they shall be____

placed in communication with Med control

If med control and Private physician don't agree the private Doc must either (two things)

Continue to provide direct pt care and accompany pt to the hospital OR Defer all remaining care to Med control

Med control or on-line med control shall assume responsibility for the pt at anytime when______

The pt's private physician is not in attendance

Usual places for by-stander physician

``` Public place( MVA, mall, etc) Pt's home where a by stander or neighbor identifies themselves as a Doc ```

If a Doc is present and has satisfactorily ID'd themselves as a licensed Physician, and expressed they want to assume responsibility... (you should do what?)

A med control physician should be contacted

Med control is ultimately responsible for the patient unless and/or until (someone does what?)

The intervening Physician appropriately assumes responsibility of the patient

First thing | needed to ID an on scene physician

1. Must verbally state that they are a MD or DO currently licensed to practice in Texas

Second thing that must be done for on scene physician to be ID'd (one of the following three things)

1. Visually ID'd by on-scene EMT 2. Pic ID (driver's license) with name confirmed by On line med control or dispatch 3. Wallet copy of the medical licensure

Med control has three options when working with an intervenor physician

1. Managing case exclusively 2. Working with intervenor physician 3. Allowing intervenor to assume complete control

If intervenor takes control all of their orders should be

Repeated to Med control for record keeping purposes

``` Intervenor documentation should be done where? (two options) 1. or 2. with what info? ```

On Patient Care Record OR On a 8 1/2 by 11 paper with Phy's printed name, sig, and DEA #

Intervenor's orders will be forwarded to____ for______ to________

EPFDEMS Admin attachment Patient's med records

If Intervenor decides not to accompany pt to hospital it has to be______

approved by on-line physician

Fire personnel will not___ from authorized_____ and Medical procedures

Deviate | Local SCOPE of practice

Absence of vital signs___ authorize EMT to ____ that the patient has expired

Does not | Asssume

Only a____, _______, ________, or ______ is legally authorized to pronounce death

LICENSED PHYSICIAN DULY Authorized REGISTERED NURSE Judge Medical Examiner

In certain circumstances, however, death is obvious, and resuscitation efforts would be______and_____

FUTILE | INAPPROPRIATE

6 Things that are criteria for OBVIOUS DOS

``` Decomposition Decapitation Hemi-Section Incineration Rigor Mortis Dependent Lividity ```

*OBVIOUS DOS* Victims in_____ secondary to________(signs of brain and heart destruction), and with NO SIGNS OF LIFE noted by bystanders or pre-hospital care workers, including absence of pulse and respirations

Cardiac arrest | OBVIOUS MORTAL INJURIES

*OBVIOUS DOS* | Extenuating circumstances- 4 examples

HAZMAT incident Mass casualty incident Prolonged extrication Drowning victims under water for longer than one hour

Victims who were under water should be resuscitated IF

They were underwater for an undetermined amount of time OR LESS than ONE HOUR

If the first EPFDEMS unit makes pt contact and determines that it's an obvious DOS criteria is present they will....

Cancel responding units

Once resuscitation has been started by ANYONE it may not be discontinued without....

Order from Med Control physician

Determined that obvious DOS (in absence of duly registered nurse or Physician), and death appears to be natural with no extenuating circumstances or signs of foul play____ (request one of two agencies/people)

Notify dispatcher to request the appropriate law enforcement agency OR Medical examiner to be dispatched to scene.

Leave the body and scene_____, complete_______ noting obvious death criteria met.

"as-is" | Patient Care Record

Advise the family members that _____ ___ and/or the ___ ___ have been notified and will respond. Don't give an ETA.

Law enforcement | Medical Examiner

Fire unit may go ___ __ ______ and leave the scene

back in service

Fire comm will notify ___ _________ that the EPFD is leaving the scene a police response is still required to respond.

Law Enforcement

Any question regarding the circumstances of _____ or any signs of ___ ___exist, crews shall remain on scene, out of service, to protect evidence until the arrival of PD.

death | foul play

In order to terminate resuscitation efforts (age) patient must be

An Adult. >18

ALS length of care to terminate resuscitation (unwitnessed)

20 min

ALS length of care to terminate resuscitation (witnessed)

30 min

You can term resuscitation when this criteria is met? (Five items/actions)

A. observable rise and fall of chest B. Auscultation of breath sounds C. Absence of gastric sounds D. Capnography IV or IO access

EtCO2 of less than ______ with ______ chest compressions | In order to term resuscitation

20 mm hg | HIGH QUALITY

Termination of Resuscitation will not be done for (2 items)

Minors | Visibly pregnant patients

Termination of resuscitation will NOT occur with- Cardiac arrest associated with other circumstances (5 items)

``` Overdose Hypothermia Toxicological exposure Electrocution Airway obstruction ```

Termination of resuscitation will not happen if (law enforcement related)

Patient is a victim of a crime | In Law enforcement custody

Termination of resuscitation will not occur when (2 items) Public places

In a crowded place (excluding nursing homes and extended care facilities) If it would place personnel in danger

Termination of resuscitation will not be done if family

Does not accept termination

Avoid using euphemisms such as "Passed away", "No longer with us". Use terms such as....

Death, dying, or dead.

Avoid saying "I'm sorry" Use phrases like...

"You have my sympathy"

Chapter 672 of TEXAS ADMIN CODE (TAC), natural death act allows responding health care professionals to______ or ________

Withhold or discontinue the resuscitation of certain patients.

DNR=

Do NOT Resuscitate

DNR Identification devices State-approved_____ or_____ containing DNR symbol (______)

bracelet necklace any state

Number of Qualified relatives

Two persons if available

People who are QUALIFIED RELATIVES: 4 total

Patient's spouse Majority of pt's adult kids Patient's parents Patient's nearest living relative

DPAHC

Durable Power of Attorney for Health Care

Proxy-

Person authorized to make treatment decisions for the patient.

``` If patient has ONE of the following CPR and other life sustaining measures SHOULD NOT be initiated a b c d e ```

``` Single page with texas DNR in upper left hand corner if from Texas Patient is correctly id'd on the form All required sections are completed All required sigs are present Duplicate copies ARE considered valid ```

Presences of a state-approved, signed Out-of-Hospital DNR form,___ _____ = valid

Any state

DNR bracelet or necklace description A B C

A. White plastic/ stainless steel with "Texas" or Texas shape with word "STOP" and words "DO NOT RESUSCITATE B. Stainless steel 1" diameter disk on a 16" to 18" length of SS chain with "DO NOT RESUSCITATE" on it C. Items will NOT be honored if not being worn by patient

Living wills and Power of Attorney are/are not considered valid DNRs?

ARE NOT

If there is any doubt of the validity DNR?

Life sustaining measures should be initiated until the discovery of a valid DNR or until pt is transferred to a higher level of care.

If patient with a DNR needs palliative care (define) what should you do?

Palliative- provide comfort | Follow standard protocols as directed by Med Control

____ stopping the resuscitation, rescuers should make clear to qualified relatives, proxy, or legal guardian(s) on scene that they are about to discontinue resuscitation efforts because of the DNR.

Before

If in Resp or Cardiac arrest, and resuscitation has_____ _____ ____ ______, and evidence is found of a state-issued Out-of-hospital-DNR order, the resuscitation should be_______

HAS ALREADY BEEN STARTED | DISCONTINUED

If there is_________, the DNR order is considered________ and resuscitation should continue.

OBJECTION | REVOKED

The discontinuation of resuscitation measures in the presence of a State-issued Out-of-Hospital DNR order ____ ______ require a _________ _______ order

DOES NOT | MEDICAL CONTROL

If a patient covered by a State-issued Out-Of-Hospital DNR order is_________, the Personnel transporting should make a ___________ ________ to bring the ________ form with the patient. Don't compromise the patient to secure the form.

Transported REASONABLE EFFORT ORIGINAL

If a patient covered by a State-issued Out-Of-Hospital DNR Order is being transported, and develops Cardiac or Respiratory Arrest_____ transport, personnel should______ life sustaining measures and _______ transport to the Emergency Department of the receiving hospital.

DURING WITHHOLD CONTINUE

DO NOT honor a DNR if (4 reasons)

Alterations to the form (something is marked through) Patient is pregnant You cannot conclusively match patient name to the form There are unnatural or suspicious circumstances

ANY DNR order may be______ at ____time by the patient, legal guardian, proxy, or qualified relatives.

Revoked | ANY

The revocation will involve _________ of wishes to responding Health Care Professionals,______ of the form, and____ of all or any DNR identification devices the patient may possess.

COMMUNICATION DESTRUCTION REMOVAL

Patients will be transported to the_________ _________ facility

Closest | Appropriate

Based on their _____ level, _______ patients will be transported to the closest appropriate_______ facility.

ACUITY TRAUMA TRAUMA

In some instances, this (the closest appropriate facility) will not be the closest_______ _______

Emergency Department

As with Trauma, other hospitals are sometimes designated for specialized care in______, ______, ____ exams, and _______ capabilities etc

STEMI Stroke SSA Hyperbaric

When two receiving facilities are____-______ from the scene, the patient's ______ of the two will be honored as the transport decision.

Equi-distance | preference

Med control __ __ contacted for _____ orders when there is any ______, or a problem, with transporting the patient to the closest appropriate facility.

May be Destination question

Legally, the only patient who can be transported______ his/her____ is one who constitutes a_____ to him/herself or_______, or is________ incompetent (minor, mentally disabled, etc)

``` Against Will Danger Others Legally ```

A patient who is alert and oriented to, _____, ______, ________, ______, and wished to refuse medical treatment, even for a very _______ condition, is ____ considered a danger to him/herself.

``` Person Place Time Events Serious NOT ```

A patient who has an _______ ________ status for any reason (________/______ ingestion, _____ injury, ______ state, _______ disability) may possibly be considered a danger to him/herself if he/she_____ treatment and transport.

``` Altered Mental Alcohol/Drug Head Postictal Mental Refuses ```

If a patient is a danger to him/herself or others/incompetent, does not want/consent to transport, and they require transport you should... 1. 2. 3.

1. Assure safety of crew. Struggling is to be avoided. Don't enter violent situation without PD. 2. Contact PD for restraint assistance 3. For safety, PD should accompany crew members in Rescue.

The_____ agency has the________ of transport.

Custodial | Discretion

Destination is determined by patient's ______ condition and ________ facility as specified by protocols.

Medical | Appropriate

If a patient's condition does not______ a destination, then the agency's requests will be______.

Specify | Honored.

Responders should always consider the ____ of the patient, _______, and responding________. ______ ________ will secure the scene ________ Medical responders enter.

``` Safety Community Medical providers Law Enforcement BEFORE ```

The use of_____ is important to responders.

PPE

The donning of_____, _____. and ____ to mitigate a possible exposure _____ be used during contact with a ______ patient.

``` Gloves Goggles Mask SHALL combative ```

With all_______, ________ _______ will be contacted and will________ the_______ process.

Restraining Law Enforcement complete restraining

Restraints should only be used in situations where the patient is________ _____ or a behavior that may be deemed a _____ to ____ or others.

Potentially Violent | Self

Administering restraints should be completed in a _______ and _______ manner. The should not inflict more _______ or _______.

Humane Professional Pain Injury

Provider should consider _______ ________ addressed in the _______ ______ protocol.

Medical Problems | Excited Delirium

Restraint shall allow the patient to be monitored for _____ ____ and other treatment. The method shall protected the _____, ________, ________ status and not to compromise ______ status of the patient.

``` Vital Signs Airway Respiratory Vascular Neurologic ```

Restraining in the ______ position should be avoided.

Prone

If this process (Prone) is used it should be a ________ measure until______ is gained.

Temporary | Control

Patients should be placed in a ___ OR____ point______ position.

4 6 Restraint

4 to 6 point restraint=

Both wrists Both ankles Strap Sheet above the knees

If backboard is Aux is used,___ careful attention to the _______ ______. Place_____ behind it_____ they become violent and begin striking their head on the board or the bar of the aux.

Pay Patient's head Padding IF

If the patient is in a______ position the patient should face the _____ ________, not the ______.

Lateral FD Personnel Wall

The use of the _____ can assist in the ______ of the patient over to the _____ _____ easier.

Board Transferring Hospital Bed

_____ restraints______ be used when possible over ______ restraints.

Soft Should Hard

List the 5 soft restraints

``` Cravats Sheets Posey Vest Velcro Padded Leather ```

If Law enforcement has applied handcuffs (______ ______) __ __ cuff the patient to the _____.

Hard restraints Do not Stretcher

Law Enforcement_____ _______ the patient in the ambulance __ the handcuffs are applied.

Will accompany | If

EMS crews ____ have means of________ releasing any restraints, medical _____ or a _____.

Must immediately scissors key

A patient should never be _____ or ________ with their arms and legs tied behind their backs.

"hobbled" | "hog tied"

The patient should be_______ restrained to the stretcher or______ by any means

Restrained | Sandwiched

Any type of restraint that would restrict the______, ______(_________) by direct pressure or hyperextension of the ________ wall= prohibited

Chest Abdomen Diaphragm Chest

No type of_____, ____ or object shall be placed over the patient's______

Towel Sheet Face

The use of a _______ ________ mask or shield may be used.

Loose fitting

If a patient continues to struggle after proper restraints the Paramedic should consider_______ _______ ________

Chemical restraint protocol

The responsibility of the patient will rest on the ______ _______ ________ individual

Highest medically trained

Documentation of restraint use should be________

Thorough

Ems personnel have a statutory obligation to report abuse of what ages? (3 items)

Children ( under 18) Elderly (65+) Disabled persons (18+ and disabled)

How long do you have to report the abuse of a child, elderly person, or a disabled person?

48 hours within encountering the patient/victim

You may ______ delegate the reporting to anyone else (reporting abuse)

NOT

Citations within the statue eliminate the usual "________ ________" restrictions that normally apply.

patient confidentiality

Abuse hotline #1 - call prior to when?

1800-877-5300 | Leaving your shift

Abuse hotline #2- call prior to when?

1800-252-5400 | Leaving your shift

You may also report abuse to______

Any EPPD officer

How to treat suspected abuse

Follow applicable protocols | Report suspicious and observations to receiving hospital physician and chain of command.

"Suspected abuse" | If patient/caretaker refuse transport?

Call for PD assistance

SSA protocol | _________ _________ is a priority after stabilizing life threatening injuries

Evidence preservation

*SSA protocol* | Do not allow patient to wash _____, _____, or ________ ______ etc

Hands Face Brush Teeth

*SSA Protocol* If patient has changed clothes, original clothings should be transported in a ________ _____ if possible (_____ ______), for evidence preservation

paper bag | not plastic

*SSA Protocol* | Reassure the patient that they are ____ ; provide _______ support as needed and appropriate.

Safe | Emotional

**SSA** | Unstable SSA patients should be transported to

Closest appropriate facility

*SSA protocol* Stable patients will be transported to a _____ facility to complete forensic exam by a ______ ______ ______ ______ (_____)

SSA Sexual Assault Nurse Examiner SANE

*SSA* Patient should be advised of the importance of being evaluated at a ______ designated facility for ______ examination as well as preservation of forensic evidence.

SSA | Adequate

*SSA* | When transmitting patient report; refer to patient of this nature as ____ or_____

SSA | Code 5

Indications of Supraglottic airway

Respiratory Arrest Cardiac Arrest After attempts at intubation are unsuccessful in a pulseless arrest Difficult airway anticipated and rapid airway control is necessary

Supraglottic airway contraindications- 7 things

Ability to maintain oxygenation and ventilation with a less invasive method Intact gag reflex Known esophageal disease Ingestion of caustic substance Tracheotomy or laryngectomy Suspected foreign airway obstruction Patient isn't within the appropriate size chart

Surpaglottic airway steps (first 4 steps)

1. Proper PPE 2. Select appropriate size 3. Test cuffs prior to insertion 4. Lubricate only lower cuffs with water soluble lube- don't lube over anterior openings

Head position for supraglottic airway Medical Trauma

Medical- sniffing/ slight cervical hyperextension | Trauma- in line spinal immobilization

``` Confirm supraglottic airway placement by: a. b. c. d. ```

Auscultation Chest movement Capno Waveform capno

King size 4-5 ft= size___ at ___-____ ML

3 | 45-60 ML

King size 5-6 ft= Size__ at ___-___ML

4 | 60-80 ML

6+= size_ at ___-___ ML

5 | 70-90

Removal of king airway if:

Can't be tolerated by patient | Airway is no longer patent and can no longer be adequately ventilated

King removal 5 steps

1. Place head in neutral position 2. Have suction available 3. Deflate cuffs completely 4. Open mouth using scissor technique 5. In one motion, smoothly slide King airway out.

With exception of____,_____,______, and ________ medications are for advanced or Paramedics.

``` Oxygen Aspirin Oral Glucose Epi-pen Albuterol ```

Applicable _______ _______/_____________ protocols allow admin of certain meds by _______ under the direction and ____ of a paramedic or_______

``` Hazardous material Mass casualty incident EMT-Bs supervision Medical control physician ```

Auto Pulse resuscitation system provides _____-____ automated CPR to victims of sudden cardiac arrest. The auto pulse has been shown to reduce_____ in the _____ during transport.

High-quality Interruptions Compressions

Autopulse- initial care

Current AHA CPR basic life support guidelines

*Auto-pulse* | Patient chest circumference permitted?

29.9-51.2 inches

*Auto-pulse* | Patient chest width permitted?

9.8- 15 inches

*Auto pulse* | Maximum patient weight permitted?

300 lbs.

*Auto pulse* | Age usage?

18 years and older

*Auto pulse* | Contraindications?

In cardiac arrest with Traumatic injuries | Under 18

*Auto pulse* Step 1 Expose patient's____ by removing all clothing. CPR ______ pad and ______ pads applied to chest while performing _______ CPR.

Chest Feedback Defribillator Manual

*Auto pulse* Step 2 Turn on auto pulse and _____ it above the patient's_____ on the ground using the ____ on the auto pulse.

Align Head Guides

*Auto pulse* Step 3 Sit up patient and_____ auto pulse into position and putting patient on the auto pulse ______ the patient's _______ with the _____ ____, making sure the patient is _____ on the auto pulse.

``` Slide Aligning Airpits Yellow line Centered ```

*Auto pulse* Step 5 Press the bands______ to ____ and secure the velcro fastener. Give a gentle ____ to the life band to ______ extend it while placing it over the patient's______.

Together Engage Pull Fully

*auto pulse* | Warning- do not...

Touch the patient or the life band while auto pulse platform is analyzing the patient's size.

*Auto pulse* | After a ___ second pause, verify ______ and ____, compressions will start_______ at 30 to 2 ratio.

3 Alignment Size Compressions

*Auto pulse* | Turning off steps

Stop/Cancel followed by On/Off.

*Auto pulse* | Stop/Cancel button does what?

Cease the compression cycles and relax the life band.

*Auto pulse* Do not _____ life band ____ removing it. _____ the life band may cause the auto pulse to report a ____ and will require specific steps to clear the fault.

Cut Before Cutting Fault

Level I medical- airway

Compromised or uncorrectable

Level I- Breathing

Signs or symptoms of acute respiratory distress

Level I- Circulation

Signs or symptoms of shock or impending shock

Level I- Disability Any presenting sign or_____ that in your____ judgement is highly suspicious of ______ mortality OR (Will list these in other cards)

Symptom | Best

Depressed level of consciousness =

Level I

Level 1 hypertension

Systolic ABOVE 220 | Diastolic ABOVE 120

Level 1 Hypotension

Systolic BELOW 90

Level 1 brady or tachycardia ______ by any other ______ indicator

Accompanied | Unstable

Abnormal respiratory rate, depth, and/or effort; abnormal lung sounds=

Level 1

_____or Cyanotic skin=

Level 1

_______ not associated with a hot environment=

Diaphoresis Level 1

______ (or similar)____ pain with or without accompanied radiation, nausea, sense of____ doom, or_____=

Crushing Similar Denial Level 1

Stroke/TIA signs and symptoms within _____ hours of last seen normal with a positive ___ ______ ____ _______. (_______) =

24 hours Pre-hospital Stroke Assessment Code Brain

Level 2 _____ lights and sirens to the ______ appropriate facility with the __________ of that hospital's____ to care for the patient.

Without Closest Consideration Ability

Level 2 ___ medical emergency with ___ vital signs having a significant medical history, and _____ of the indicators for an ______ patient.

Any Stable None unstable

Level 2 | ___ patient with a ____ index of _____.

Any High Suspicion

Level 2 _____ med control for _____ to upgrade to ____ and ____ with the patient remaining a Level 2 to the _______ appropriate______

``` Contact Permission Lights Sirens Closest Facility ```

Level 3 | Transport_____ lights or siren to the patient's ______ of ______ following the _____ transport policy.

Without Facility Choice Current

Level 3 Criteria: ____ patient with no _______ Medical_______ and non-______ medical complaint; ___ medical patient who does not meet _____ 1 or ____ criteria

``` Stable Significant History emergency Any Level II ```

The ______ patient with no _____ ____ requires ______ protection.

Unconscious Gag Reflex Airway

O2 sats at _____ may warrant______ intervention with ______ administration with ventilatory ______ with the goal to maintain spO2 of ___ to ___.

``` <85% Immediate 100% assistance 93% 99% ```

OPA should be used on all patients______ a gag reflex

Without

Maintain a good seal, with______ from other_______ ______

Assistance Crew Members

ETCo2 normal values=

35-45 mgHg

A supraglottic airway may be inserted by _____ skill levels. (The use of Colorimetric is____ if no ______ is available)

Any Mandatory ETCo2

____ attempts may be made to insert a ________ airway

Two | Supraglottic

Secure____ ______ and ______ strap before_____ the patient. Follow the commands of Auto Pulse as given.

Shoulder Straps Waist Moving

The auto pulse has a _________ mode that will give __________ without pause when an ________ airway is in place.

Continuous Compressions Advanced

After either a_________ resuscitation or ________ of activities, press the ______/______ button followed by the___/___ button. The _____/_____ button will cease the compression cycle and relax the life band. The ____/___ button action will power down the auto pulse.

``` Successful Termination Stop/Cancel On/Off Stop/Cancel On/Off ```

Open the_____ fastener and ____ or _____ roll the patient ____ the auto pulse platform, as necessary.

Velcro Lift Log Off

Discard the life band as it is a ______- use component. Treat the life band as ________ medical_____ and dispose of it accordingly.

Single Contaminated Waste

*Alt Mental Status* | Inappropriate response to ____ or ______ stimuli

Verbal | Physical

``` *Alt mental status* Hypo/Hyper________ Hypo/Hyper________ Hemi_______ Fever OD ```

Glycemia Thermia paresis

*Alt mental status* | Check ____ and _____ pulses

Central | Peripheral

*Alt mental status* | ____ OD or Drug ___________, contact_______ control

Drug Paraphernalia Poison

*Anaphylaxis* | Position patient ____-_____ position (_______), IF conscious.

Semi-Fowler | Reclined

*Anaphylaxis* | If patient is _____, place supine with _______ elevated.

Unconscious | Legs

*Anaphylaxis* | Attempt to _______ allergen affecting patient.

Ascertain.

*Anaphylaxis* If patient is exhibiting signs/symptoms of _____ allergic reaction, to include ______ distress, and/or _____, contact ______ ______ for possible _________ auto-______ administration.

``` Severe Respiratory Shock Medical Control Epinephrine Injector ```

``` *Anaphylaxis* Adult- 0._ _:___ Pediatric- 0.__ _:____ ```

0. 3 1: 1000 0. 15 1: 2000

*CO* | CO is a ______, odorless, ______ gas by product of most _____ reactions

Colorless Invisible Combustion

*CO* Indication- CO screening should be performed on all ______, _______, and _____ staff during rehab. Be aware of those in ________ to the event. I.e _____ and all_____ of the buildings with CO detector activations.

``` Patients Firefighters Command proximity Police occupants ```

*CO* | Symptoms- 9 total

``` Headache Dizziness Weakness Vomiting SOB Chest Pain Palpitations (tachypnea) Nausea May describe flu like symptoms Confusion/alt mental status ```

*CO* ______ patient(s) and all_____ from area to _____ air Obtain an _____ of______ time, if possible

``` Evacuate Personnel Fresh Estimate Exposure ```

*CO* | Support ___'s _____ flow _____ via____

ABC's High Oxygen MNR

*CO* CO poisoning typically will yield normal _______ _______ levels, despite _________ intoxication. Treatment should ____ be guided in any way by readings obtained.

Pulse Oximetry Significant NOT

*CO* Measure SpCO level (available on _____ and ______) When using SpCo monitoring attention to ____ probe _______ and _____ from light will ____ accuracy of measuring SpCO levels.

``` Battalions LifePak 15 Proper Placement Shielding Improve ```

*CO* | If ___ is altered in any way, measure ___ _____ _____ with ________.

``` LOC Blood Glucose Level Glucometer ```

*CO* | <3%=

No Further evaluation of SpCO required & Transport is the Patient's prerogative.

*CO* | SpCO 3%-10%

If noted as a smoker this may be normal for them. | Transport- Assess for signs and symptoms. Symptomatic/Asymptomatic and should be medically evaluated.

*CO* | >3% greater than 25%

With LOC, neurological impairment admin high flow 02, consider CPAP if Avail. Transport to a hospital with HBO (Hyperbaric Oxygen) Level 1

*CO* | >3 but less than 25%

Not exhibiting decreased levels of consciousness or neurological impairment admin high-flow O2. Monitor for other signs of CO poisoning. Transport- Level 2 to the closest appropriate facility.

*CO* | >15%

Prenant patients with SpCO reading of greater than 15%, even if asymptomatic, administer high flow O2. Level 1 medical- transport to hospital with HBO- Hyperbaric oxygen.

*Diabetic* | History of _____ excess: ,_____ missed meal, _____, vomiting or______

Insulin overdose exercise Diarrhea

Diabetic | Respirations- 3 items

Shallow, slow, or snoring

*Diabetic* | What do you do about 02?

Provide 02, monitor Sats

*Diabetic* | BGL of

60 | Symptomatic

*Diabetic* | If patient is____ and able to swallow with an ____ ___ reflex administer 1 ___ of instant glucose or _____ ________

``` Alert Intact Gag tube Sugar Substitute ```

*Excited Delirium* | Patients that are hyper _______ with _______ behavior and are _______ to pain, combative, hyper___, and _____cardic

``` Aggressive Bizarre Impervious Hyperthermic Tachycardic ```

*Excited delirium* Patient's are typically in a struggle with _____ _________ that involves physical, ______ chemical (tear gas, _____) or ECD use (_____) followed by a period of ____ and sudden _____. This is a _________ emergency!

``` Law enforcement Noxious Mace Taser Quiet Death Medical ```

*Excited delirium* | If patient is ________- apply ____ packs to neck, ______ and _____ or cooling with water, ______ (do not promote______)

``` Hyperthermic Cold Axilla groin fanning ```

*Hyperglycemia* Patients with hyperglycemia may progress to _______ __________ (___) that may cause severe ______ and Metabolic _________.

Diabetic Ketoacidosis DKA Dehydration Acidosis

*Hyperglycemia* | Pulses: ______cardic and _____ pulses

Tachycardic | Thready

*Hyperglycemia* | Respirations=

Kassmaul

*Hyperglycemia* Patient may present with ____tension, dry ______ membranes, skin may be___ (consider ____thermia), and a _____ odor (fruity smell)

``` Hypotension mucous Cool Hypothermia Ketone ```

*Hyperglycemia* Other symptoms may be ______ pain, nausea, vomiting, poly_____ which is excessive ______, and poly____ which is excessive _____. Along with sustained _____ glucose levels.

``` Nausea Polyuria Urination Polydipsia Urination Elevated ```

*Hyperglycemia* | As a basic you can evaluate _____ status, administer ______ and _____ oxygen saturations, and check ____.

Mental Oxygen Monitor BGL

*Hyperglycemia* | A patient is considered hyperglycemic if they are >___mg/dl and _________

250 | Symptomatic

*Hypertension & Hypertensive Crisis* Assess for _______ of breath, _______ mental status, ______ headache, ______ (nose bleed), ______ (ringing ears), change in ______ acuity, ______, ECG_____, Nausea, and ______.

``` Shortness Altered Vertigo Epistaxis Tinnitus Visual Seizure Changes Vomting ```

*Hypertension & Hypertensive Crisis* BLS- ___'s per patient's ____, ______ monitoring, _____ signs, and there is epistaxis ____ to stop by______ nostril or _____ clip.

``` ABC needs Glucose Vital Attempt Pinching Nose ```

*Hyperthermia* | ____ cooling is essential

Rapid

*Hyperthermia* | Three types of heat emergency=

Heat Cramps Heat Exhaustion Heat Stroke

*Hyperthermia* Any heat related condition with a temp of >___ F or ____C or any _____ _____ of ________ should be treated as heat stroke and transported ______.

``` 104 40 Altered Level Consciousness Rapidly ```

*Hyperthermia* | Remove patient to a _____, _____ area.

Cool | Shaded

*Hyperthermia* Remove patient's ______ and cool patient with wet _____; low-pressure ____ ______ may be used to continually re-___ the patient.

``` Clothing Sheets Water Hoses wet ```

*Hyperthermia* | Manually __ the patient to promote cooling by ________.

Cool | Evaporation

*Hyperthermia* | Apply ____ packs to, ____, axilla, and _____.

Cold Neck Groin

*Hyperthermia* | DO NOT ____ __ ____. Dangerous reversal to ______ may occur.

Pack in Ice | Hypothermia

*Hypothermia and Frostbite* | Hypothermia core body temp BELOW___ and ___ celcius

95. 0 | 35. 0

*Hypothermia and Frostbite* | Mild hypothermia= ___ to ____ F and ___ to ____ C.

95 90 35 32

*Hypothermia and Frostbite* | Moderate Hypothermia is ___ to ___ F and ___ to ___ C

90.0 82.0 32 28

*Hypothermia and Frostbite* | Severe hypothermia is

82 | 28

*Hypothermia and Frostbite* | If a patient is not in _____ arrest, and they have adequate respirations _____ handling could cause _____ arrest.

Cardiac Rough Cardiac

*Hypothermia and Frostbite* A patient who isn't in cardiac arrest with adequate respirations should be _______ to a _____ environment, have _____ clothing removed, _____ in dry blankets, and have their ____ covered and _____ against further heat loss.

``` Moved Warm wet covered head insulated ```

*Hypothermia and Frostbite* Frostbite injuries should be handled as follows: _____ remove _____ from injured part, _____ injured part from ____, trauma, and ______. Loosely _____ injured parts with _____ sterile dressing.

``` Gently Clothing Protect Pressure Friction Cover Dry ```

*Hypothermia and Frostbite* | Do not ____ or ___ a frostbitten area. Do not attempt __-______ of the injured part.

Massage Rub Re-warming

*Hypothermia and Frostbite* Cardiac arrest with respirations less than 5 per minute. Ventilate _____ at _-__ per minute. Basic BLS with application of ___. After first ____ (if given), ______ use of AED, and proceed with BLS and CPR only. Continued _________ is contraindicated in acute hypothermia.

``` Slowly 8-10 AED Shock Discontinue Defibrillation ```

*Nausea and vomiting* | Criteria- Nausea, ______ vomiting or those ______ vomiting after arrival with no other ______ or _____.

Prolonger Actively Symptoms Complaints

*Nausea and vomiting* Assess and support ___'s Oxygen and airway _____ to maintain Sp02 of at least __% Place patient is position of _____. ______ ______ recumbent position, or ____ with legs elevated with ____ at hips unless ______ compromise or ____________. Asses ___ and treat for _______ if protocol is met

``` ABC Maintenance 94 Comfort Left Lateral Supine Flexion Respiratory Contraindicated BGL Hypoglycemia ```

*Near Drowning* Info needed: Description and ______ of fluid in which submerged. _____of time submerged. More than ____ hour = refer to obvious DOS protocol. Those _____ than ___ hour or ______ time should be ________. Note _____ and type of _____. Consider a diving incident. Possibility of _____ or _____/medication consumption.

``` Temperature Note One Less One Unknown Resuscitated Depth Type Alcohol Drug ```

*Near Drowning* Airway management- ______, oral, ______, suction Lung sounds: ___- or signs of _______ edema, ________ distress. _____ spine ______ to removing patient from ______ Wet clothing should be ____. Keep patient ___ and _____.

``` Ventilations Nasal Rales Pulmonary Respiratory Stabilize Prior Water Removed Warm Dry ```

``` **Respiratory** BLS steps _____ patient in a _____ of comfort _______ Oxygen as ____ The goal is patient care is to reach an Oxygen sat of ___ ```

Place Position Administer needed 96%

**Respiratory** | Caution- High _______ of _____ may suppress the COPD patient's _______ to an ________ level.

Concentrations Oxygen Respirations Inadequate

**Respiratory** COPD- Cautions Be prepared to ________ ventilations but __ ____ decrease oxygen ________.

Assist DO NOT Concentrations

**Respiratory** COPD cautions ______ withhold oxygen from a ______ patient. The goal of patient care for a COPD patients is to reach an oxygen saturation of __-__%

NEVER Hypoxic 88-92%

*Respiratory* If a patient has a ______ and _____ inhaler, you may ____/____ them to take puffs as prescribed. (some patients may have _____ puffs prescribed)

``` Prescribed Unexpired Assist Allow Several ```

*Respiratory* | Be prepared to assist _______ with ___ for patients who are ______ (__resp/min)

``` Ventilations BVM Bradypnic 10 Tachypnic 30 ```

*Seizures* Assess and support ___s Airway management, o2, Pulse ox, and maintain sats of >__% __ ___ force anything between ____. Anticipate ______ Protect patient from injury. ____ hazardous objects away from patient and protect ____ and _____ spine from injury.

``` ABC 94% DO NOT Teeth Vomiting Move Head Cervical ```

**Seizure** __ ___ forcefully ____ an actively seizing patient. Protect _-____ if patient fell. If no trauma, place patient is position of ____, or ___ _____ ____ position.

``` Do not Restrain C-Spine Comfort Left Lateral Recumbent ```

*Seizure* | If pediatric patient with temperature >___._ (__ C) provide supportive care and ______ cooling by ______ the patient.

100.4 38 Passive Undressing

*Seizure* | If patient is actively seizing for _ or more minutes, look for a history (Trauma,____, Pregnancy, _____ ________)

5 COPD Severe Hypertension

*Sepsis* | Recent surgery __ __ days

<10

*Sepsis* Symptom Cough with thick _______

Sputum

``` **Sepsis Symptom** #s Temp >___ F (__ C) or __ Resp >__ Systolic ```

``` 101 38 96.8 36 90 20 90 65 ```

**Sepsis** | O2 saturation >__%

94

**Asthma* | Status _______ is an acute exacerbation of asthma that does not respond to standard treatments of ________ and _______

Asthmaticus Bronchodilators Steroids

**Asthma* | Approx ___,___ deaths _____ worldwide due to ______.

250,000 Annually Asthma

*Asthma* | Goal for for patient care is to reach a 02 sat of __%

96%

*Asthma* Symptoms include wheezing, _____ __ _____, _____ tightness, and coughing. Other possible signs include _____ and cyanosis.

Shortness of breath Chest Retractions

*Asthma* | Sats for a patient with COPD=

88-92%

``` *Asthma* Patient can be admin'd Albuterol: Between ages of _ and __ Physician ________ history of asthma Been prescribed a ____-____ before Is _____ and/or _____ of _____. ```

``` 5-70 Diagnosed Beta-agonist Wheezing Short of breath ```

*Asthma* If patient has a previous ______ history (Angina, AMI, HF, Dysrhythmias) contact ___ ______ for authorization to admin ________.

Cardiac Med Control Albuterol

*Asthma* | Nebulized albuterol may be admin'd _____ for a total of _____ doses if condition does not improve.

Twice | 3

*Stroke* | Symptom- Unusual or severe _____ or ____ pain.

Neck | Face

*Stroke* | Aphasia/Dysphasia=

Unable to speak, slurred speech, or difficulty speaking

*Stroke* | Sensory loss to ___ or ___ limbs

One | More

*Stroke* | Ataxia= 3 things

Poor balance Clumsiness Difficulty walking

*Stroke* | Non-traumatic, visual ______/____ (_____ effect)

Disturbance Loss Curtain

*Stroke* | O2 sats =

>94%

*Stroke* | Position patient with ___ and ___ elevated to __ degrees, or in ______ of ______.

Head Chest 30 Position of comfort

*Stroke* | Focus history= last ___ seen ______ signs/symptoms

Time | without

*Stroke* | Protect ________, if noted __________, evaluate body temperature.

Extremeties | hemiparesis

*Level 1 trauma* Airway: Obstruction and/or _______ Respiratory rate: Respiratory ______, or Respiratory _____ of __/min Systolic:

``` Intubation Compromise Rate 10 29 90 13 ```

*Level 1 trauma Pedi* | Respiratory rate

20 1 Ventilator

*Level 1 Pedi* | Systolic < 70+ (_x___)

2 | Age

*Level 1* | All penetrating injuries to the:

``` Head Neck Torso Groin Extremities proximal to the Knee or Elbow ```

*Level 1* | Chest wall deformity/instability=

Flail chest

*Level 1* | Limb ________

Paralysis

*Level 1* | Amputation ______ to the ____ or _____

Proximal Wrist Ankle

*Level 1* | Pelvic _____

Fractures

*Level 1* Open or ______ skull _____

Depressed

*Level 1* | C____, De-______, or _______ pulseless extremity

Crushed De-gloved Mangled

*Level 2 Trauma* | ____ mechanism of injury and the _____ of ____-energy impact. Transport to trauma center ______ lights and sirens

Assess Evidence High Without

*Level 2 trauma* Contact ______ _____ for permission to upgrade to _____ and ____ with the patient remaining at the level II status for the _____ appropriate ______ hospital.

``` Medical Control Lights Sirens Closest Trauma ```

*Level 2 trauma- Burns* | __ Degree burns= involve the ____ (including ears), ____, feet, ____, perineum or ______ joints.

``` 2nd Face Hands Genitalia Major ```

*Level 2 trauma*- burns >__% total BSA & ___ degree burns

10 | 3rd

*Level 2 trauma- falls* | _____ falls greater than ___ ft (1 story = __ft)

Adult 20 10

*Level 2 trauma- falls* | Children falls >__ or __ times the height of the child

10 | 2

*Level 2 trauma- high risk auto crash* Intrusion, including_____ >__ inches occupant site > __ inches ___ site in the occupants (_______) compartment. Ejection (_____ or ______) from vehicle ______ in the same passenger compartment Vehicle ______ data consistent with high risk of injury

``` Roof 12 18 any Interior Full Partial Death Telemetry ```

*Level 2 trauma* ____ versus pedestrian/bicyclist thrown, run over, or with significant (>__) impact. Motorcycle collision > __ MPH

Vehicle 20 20

*Level 3 trauma* | _____ patient not meeting Level 1 or 2 criteria.

Stable

*Considerations for transporting patient to a trauma center* Older adults: ____ of death increases after __ SBP

``` Risk 55 110 65 Low Ground Severe ```

*Trauma Special considerations* | Children ____ be triaged ________ to a pediatric _____ trauma center.

Should Preferentially Capable

*Trauma- anti-coagulation and bleeding disorders* | Watch those with head injuries for ______ deterioration.

Rapid

*Trauma & burns* | Burns with trauma mechanism triage to ________ trauma facility

Appropriate

**Department Protocol** ___ patients will be transported Level 2 or Level I for a ____ drowning. If physiological ____ or ____ are present. Transport to the appropriate ______ designated hospital.

``` All Near Signs Symptoms Trauma ```

**Abdominal Trauma** | If evisceration is present, ____ with ____ dressing _____ with sterile normal saline and _____ loosely in place.

Cover Sterile Moistened Bandage

**Abdominal Trauma** | __ ____ attempt to replace protruding ____ into abdominal cavity.

Do Not | Tissue

**Burns: Thermal, Chemical, Electrical and Inhalation Injuries* Ensure _____ process is _____ The use of ____ water or _____ ______ solution and the removal of any smoldering ______ should be applied if indicated.

``` Burning Stopped Tepid Normal Saline Clothing ```

**Burns: Thermal, Chemical, Electrical and Inhalation Injuries* Do not ___ ___ clothing that is ____ to a burn, ___ around it.

Pull Away Stuck Cut

**Burns: Thermal, Chemical, Electrical and Inhalation Injuries* Look for evidence of _______ injury. (H_______, S______, So___ S____, F____ B___, or singed Nasal or Facial hair.

``` Inhalation Hoarseness Stridor Sooty Sputum Facial Burns ```

**Burns: Thermal, Chemical, Electrical and Inhalation Injuries* __ ____ use the __________ airway in a patient with Thermal or Chemical airway injury. If airway management is indicated, ____________ airway is the preferred adjunct.

Do Not Supraglottic Orapharengeal

**Burns: Thermal, Chemical, Electrical and Inhalation Injuries* Remove J____, B____, S____ from burn areas. Apply a ____ sterile ____, clean or ______ sheet to burned area. Keep _____ intact. Monitor to prevent _______ Estimate burn size with ______

``` Jewelry Belts Shoes Dry Dressing Sterile Blisters Hypothermia Rule of Nines ```

**Burns: Thermal, Chemical, Electrical and Inhalation Injuries* Second Degree burns- transport any patient with >__% BSA and burns involving the F___, (including ears), h___, f___, g____, p____, or major ____ associated with trauma to a _____ center as a level___.

``` 10 Face Hands Feet Genetalia Perineum Joints Trauma Two ```

*Chemical Burns* _____ contaminated clothing ____ area immediately with ______ amounts of water. Use s_____, g____ h____, or low pressure Fire Suppression app if necessary.

``` Remove Flush Copious Shower Garden Hose ```

*Chemical Burns* If ___ are affected, have patient remove C____ L____ if present and irrigate with _____ amount of _____ water or ____ at the scene and _____.

``` Eyes Contact Lenses Copious Sterile Saline Enroute ```

*Chemical Burns* In ____ chemical burns (____ lime, etc) addition of ____ may produce a very _______ substance. To treat, remove the patient's____ and _____ the ______ _____ away from the skin. Then ______ with copious amounts of water.

``` Dry Dry Water Corrosive Clothing Brush Dry Chemical Irrigate ```

*Electrical Burn* Conduct ____-___ exam for ____ & ____ burns, P____, Muscle Spasms, and abnormal pulse and or _/_. Asses for F____ and D______ associated with severe M_____ S____ or Falling. _____ induced by electrical shock may mimic r____ m____ DO NOT ______ Cpr.

``` Head toe Entry Exit Paralysis B/P Fractures Dislocations Muscle Spasms Tetany Rigor Mortis Withhold ```

*Lightning strike* After a lightening strike or other high-voltage contact involving _____ patients apply "_____ triage." Patient in Cardiac Arrest are __ priority for _____ treatment and transport.

Multiple Reverse Top Advanced

*Chest Trauma* Assess b_____ s____. Cover suspected _____ chest wounds with an _______ dressing (sealed on _ sides) Stabilize Fr____ and/or f____ segments

``` Breath sounds Open Occulsive 3 Fractures Flail ```

*Chest trauma* | Be v_____ for developing T______ Pneumothorax

Vigilant | Tension

*Chest Trauma* If Tension Pneumothorax is s_____, release the ____ over the wound and allow any air under p____ to escape. Then r____ the wound with _ sides of dressing secured and one f___ edge, and monitor the patient.

``` Suspected Seal Pressure re-seal 3 free ```

*Epistaxis* If epistaxis is spontaneous and the patient is a____ with s_____ vital signs, have the patient L____ F____ (if there is no neck or spine injury), and using M______ pressure, P_____ the nostrils together.

``` Alert Stable Lean Forward Moderate Pinch ```

*Epistaxis* Pt with epistaxis is hypotensive/ Altered, with no trauma mechanism, what do you do?

Place them in a lateral recumbent position. Admin 02 Be aware of vomiting

*Epistaxis* | If epistaxis due to trauma

Immobilize C spine.

*Eye injury* Laceration to eye/eye lid ___ ____ apply pressure to the eye ball Cover ___ eyes with loose dressing ______ avulsed parts in a clean plastic bag

Do not both Preserve

*Eye Injuries* Foreign bodies Do NOT ____ eye Noted foreign body _____ to _____ with normal saline

Wipe ATTEMPT IRRIGATE

*Eye Injuries* | Non-impaled= cover____ eye(s)

BOTH

``` *Eye injuries* Impaled- ___ ____ remove. ______ with a paper cup and bulky dressing. Cover the ______ eye. ```

Do NOT Stabilize Unaffected

*Eye Injury* | Avulsed eye=

Cover+sterile dressing+ sterile saline/normal saline/ tap water+ ASAP

*eye injuries* | Chemical burns=

Irrigate+ tap water/ saline/ normal saline+ asap+ throughout transport.

*Fractures/Dislocations* Assess _____ circulation and sensory & motor function before and after splinting (CMS) For suspected _____ and ____ fractures a ______ splint is REQUIRED

Distal Femur Pelvic Traction

*Fractures/dislocations* | Severely _______ fractures with compromised _____ may require alignment prior to _______.

Angulated Circulation Immobilization

*Fractures/dislocations* Dislocations of the E____, W_____, K____, or A_____ are emergencies in which time passed until r________ is critical in determining thee future use of the joint. Do not p_____ transport to carry out procedures or E______ immobilization.

``` Elbow Wrist Knee Ankle Reduction Prolong Extensive ```

*Fractures and Dislocations* | The two fractures which are immobilized by a sling and swathe are?

Clavicle | Humerus

Shoulder dislocation is treated how?

Splinted in position found

Elbow fracture OR Dislocation are immobilized how?

Splinted in position found

Radius/Ulna fracture is immobilized how?

Rigid splint and sling.

Wrist fracture is immobilized how?

Splint in position found

All victims of trauma have ______ injury until proven ______

Spinal | Otherwise