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Sedgwick County Capt > Medical Protocols > Flashcards

Medical Protocols Flashcards

1
Q

The first step in medical termination of resuscitation is determining ______.

A. Patient normothermic
B. EtCO2
C. Pulseless

A

A. Patient normothermic

Hypothermic patients should be resuscitated, under most circumstances.

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2
Q

A patient who is pulseless, apneic, and has what two signs present should not be resuscitated?

A
  • rigor mortis

- decomposition

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3
Q

In the adult, what medical findings may prevent initiation of resuscitation?

A
  • down time over 15 minutes “and”
  • no bystander CPR “and”
  • initial rhythm asystole
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4
Q

If an adult remains in a persistent asystole/agonal rhythm without reversible causes for greater than ____ minutes, resuscitation may be ceased.

A. 10
B. 20
C. 30
D. 40

A

B. 20

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5
Q

If a child remains in a persistent asystole/agonal rhythm without reversible causes for greater than ____ minutes, resuscitation may be ceased.

A. 10
B. 20
C. 30
D. 40

A

C. 30

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6
Q

What are “agonal rhythms?”

A

Rhythms that do not produce adequate perfusion and lead to death:

  • asystole
  • pVT
  • VF
  • PEA
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7
Q

In the adult/peds medical arrest, failure to obtain ROSC or maintain ROSC for more than ____ minutes may prompt cease resuscitation.

A. 5
B. 10
C. 15
D. 20

A

A. 5

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8
Q

In the adult/peds medical arrest, if EtCO2 remains above ____ with CPR, resuscitation should be continued.

A

30 mmHg

consult onscene critical care paramedic or medical command regarding transport or potential cease resuscitation

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9
Q

In the adult/peds medical arrest, if EtCO2 remains between ____ with CPR, resuscitation should be continued while Medical Control is contacted.

A

10-30 mmHg

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10
Q

In the adult/peds medical arrest, if EtCO2 remains below ____ with CPR, resuscitation should be discontinued.

A

10 mmHg

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11
Q

Describe the MOA of Aspirin

A

Inhibition of Thromboxane A2 (and subsequent decreased platelet aggregation) through upstream cyclooxygenase (COX-2 PATHWAY).

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12
Q

Cautions in ASA admininstration

A
  • asthma
  • chronic liver disease

Should STILL be administered if STEMI is present.

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13
Q

Absolute contraindications for ASA

A
  • Hypersensitivity to ASA/NSAIDS/Salicilates

- pregnancy

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14
Q

What are the WSCEMSS indications for NTG?

A
  • decompensated HF with pulmonary edema

- Cardiac chest pain in ACS

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15
Q

What medication may decrease the vasodilatory effect of NTG and why?

A

Ergot (genus Claviceps - 1* a rye fungus);

1st type of Ergot poisoning - “St. Anthony’s Fire” - the serotonergic effect of ergot poisoning on monks in 1095 A.D.; dizziness, hallucinations, paralysis, etc.

2nd type: distal vasoconstriction 2/2 to ergot alkyoids

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16
Q

Most ED drugs, when used within ____ hours, preclude the use of NTG. What is the exception?

A

48 hours; Viagra/Revation (sildenafil) 24hrs

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17
Q

What is the N/S dividing line in Wichita?

A

Douglas Avenue

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18
Q

What is the E/W dividing line in Wichita?

A

Main street

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19
Q

List the mile markers West of Main

A 
1000 W - Seneca
2400 W - Meridian
3900 W - West
5500 W - Hoover
7100 W - Ridge
8700 W - Tyler
10300 W - Maize
119th
135th - Clearwater
151 W - Bentley
167 W - Colwich
183 W
199 W - Goddard
215 W
231 W
247 W - Andale
263 W - Viola
279 W - Mt. Hope
295 W - Garden Plain
311 W
327 W
343 W
375 W - Cheney
391 W
407 W - County Line (Kingman)
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20
Q

Mile Markers East of Main

A 
200 E - Broadway
1600 E - Hydraulic
3100 - Hillside
4700 - Oliver
6300 - Woodlawn
7900 - Rock
9500 - Webb
11100 - Greenwich
127 E
143 E
159 E - Butler County Line
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21
Q

Mile markers N of Douglas

A 
400 N - Central
13 N
21 N
29 N
37 N
45 N
53 N
61 N
69 N
77 N
85 N - Valley Center
93 N
101 N
109 N
117 N
125 N - Harvey Co. Line
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22
Q

Mile markers south of Douglas

A 
400 S - Maple
1500 S - Harry
2300 S - Pawnee
31 S
39 S - MacArthur
47 S
55 S
63 S - Patriot in Derby
71 S - Meadowlark in Derby, Grand in Haysville
79 S
87 S
95 S
103 S
111 S
119 S - County Line
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23
Q

Funky areas:

East of Main

A

200 E - Broadway

1600 E - Hydraulic

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24
Q

Funky areas:

West of Main

A

1000 W - Seneca

2400 W - Meridian

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25
Q

Funky areas:

North of Douglas

A

400 N - Central

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26
Q

Funky areas:

South of Douglas

A

400 S - Maple

1500 S - Harry

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27
Q

Clearwater
Bentley
Colwich

A

135
151
167

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28
Q

Goddard

A

199th

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29
Q

Andale
Viola
Mt. Hope
Garden Plain/Section Line

A

247
263
279
295

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30
Q

375

A

Cheney

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31
Q

Odd addresses

A

S/W

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32
Q

Even

A

N/E

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33
Q

VC-ST address

A

14800 W Saint Teresa

21st & 151st

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34
Q

Wesley West address

A

8714 W. 13th St. N

21st & Tyler

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35
Q

List the physical findings that make a code yellow trauma.

A
  • Chest wall instability, deformity, or significant focal bony
    tenderness
  • Significant abdominal pain, tenderness, or bruising (i.e. seatbelt
    sign) related to acute traumatic event
  • Two or more proximal long-bone fractures
  • Amputation proximal to wrist or ankle
  • Pelvic fracture
  • Open or depressed skull fracture
  • Paralysis or new neuro defici
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36
Q

Code yellow mechanism criteria.

A

Mechanism:
- Fall:
- adult > 20 feet
- child > 10 feet or 3 x height of child
- High risk auto crash
- ejection (partial or complete) from automobile
-death in same passenger compartment
- Auto vs. pedestrian or bicyclist thrown, run over, or with > 20mph
impact
- Motorcycle crash > 20 mph

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37
Q

Code yellow mechanism and physical findings require a _____ trauma center.

A

Level I

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38
Q

Pediatric patients are evaluated primarily with the _____.

A. Mnemonic OPQRST
B. Pediatric Assessment Triangle
C. Monitor, Vitals, and Blood Glucose

A

B. Pediatric Assessment Triangle (Apperance, Work of Breathing, Circulation to Skin)

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39
Q

Explain the parts of the pediatric assessment triangle

A

“ABC”

  • Appearance
    • TICLeS
      • muscle Tone
      • Irritability
      • Consolable
      • Look/gaze
      • Empty
      • Speech/cry
  • work of Breathing
    • adventitious breath sounds
    • retractions
    • nasal flaring
    • tripod position
  • Circulation
    • cool skin
    • pale skin
    • mottled skin
    • cyanosis
    • capillary refill
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40
Q

If a pediatric patient’s HR is under ____, go to the cardiac arrest algorithm.

A. 40 BPM
B. 50 BPM
C. 60 BPM
D. 70 BPM

A

C. 60 BPM

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41
Q

What vital signs must be included in the pediatric assessment?

A
  • Pulse
  • RR
  • Capillary refill
  • Breath sounds
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42
Q

What are the required V/S for an adult assessment?

A
  • BP
  • Pulse
  • RR
  • SpO2
  • Pain scale
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43
Q

What other adult assessments may be utilized based upon your clinical impression?

A
  • GCS
  • Cap refill
  • Temp
  • EtCO2
  • 12-lead
  • Breath sounds
  • Neuro assessment
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44
Q

What is the primary divider between a focused physical and head to toe examination in the adult/peds trauma patient?

A

Presence of a localized injury (focused assessment) versus no localized injury (head to toe).

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45
Q

Initial assessment of the trauma patient (the “primary survey”) is focused on ______.

A. ABCs/correcting major life threats
B. Identifying minor injuries
C. Scene safety

A

A. ABCs/correcting major life threats

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46
Q

What V/S are required for all peds/adult trauma patients?

A
  • BP
  • RR
  • HR
  • Breath sounds
  • Cap refill
  • GCS/AVPU
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47
Q

Cardiac or respiratory arrest is a triage ______.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

A. Blue

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48
Q

A patient with an LOC less than verbal or acute GCS under 14 is triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. Red

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49
Q

STEMI on 12-Lead ECG is triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. Red

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50
Q

Suspected strokes with a last normal time under ___ hours are code red patients.

A. 1 hour
B. 3 hours
C. 5 hours
D. 7 hours

A

C. 5 hours or less

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51
Q

High risk/complicated OB patients greater than ____ weeks gestation are code red patients.

A. 20 weeks
B. 28 weeks
C. 30 weeks

A

A. 20 weeks

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52
Q

An acute GCS under ____ requires a level 1 trauma center.

A. 8
B. 10
C. 12
D. 14

A

D. 14

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53
Q

A systolic BP of under 90 mmHg or signs of shock is a triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. red

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54
Q

Respiratory rates under 10 or greater than 29, or requiring respiratory support are triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. red

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55
Q

Penetrating injury to head, neck, torso, or extremities proximal to knee/elbow are triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. red

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56
Q

Partial thickness burns greater than ___ of total BSA is a code red trauma and requires transport to the trauma center.

A. 10%
B. 20 %
C. 30%
D. 40%

A

A. 10%

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57
Q

What regions of the body that, when burned, constitute a code red patient?

A
  • face
  • hands
  • genitals
  • perineum
  • crossing major joints (think issues with eschars)
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58
Q

A ____ degree burn in any age group is a code red trauma alert.

A

third

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59
Q

Any electrical burn, including lightning injury, is a triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. red

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60
Q

Chemical burns are a triage ____ patient.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. red

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61
Q

Inhalation burns/injury are a triage ____ patient.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. red

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62
Q

Burns in a patient with any pre-existing conditions that might affect management/mortality are considered a are a triage ____ patient.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. red

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63
Q

Any patient with burns and concomitant trauma is considered a _____ triage.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

B. red

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64
Q

Pts who require advanced airway management (like medication, monitoring, non-invasive management) are considered triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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65
Q

A patient with an LOC of verbal (or baseline LOC change) or an acute GCS of 14-15 is a triage _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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66
Q

Suspected cardiac chest pain without STEMI on 12-lead is considered triage _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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67
Q

Suspected stroke greater than 5 hours last seen normal is considered triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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68
Q

A patient with a potentially toxic ingestion is a triage _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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69
Q

Obstetric patients with impending delivery or uncomplicated field delivery is a triage _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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70
Q

Following blunt trauma, a patient over 20 weeks gestation with abdominal and/or back pain following blunt trauma is code _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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71
Q

Newborn with APGAR over 8 is triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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72
Q

Potential long bone fracture is triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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73
Q

Adult patients with fall greater than ____ feet is code ___ and requires a level I trauma center.

A

20; yellow

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74
Q

Peds patients with fall greater than ____ feet or ____ times the child’s height is code ___ and requires a level I trauma center.

A

10; 3; yellow

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75
Q

What high risk auto crash findings cause a patient to be a code yellow and require Level I trauma center?

A
  • Ejection

- Death in same compartment

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76
Q

Auto versus pedestrian/bicyclist becomes a code yellow trauma when what conditions are met?

A
  • Thrown
  • Run over
  • Impact over 20 mph
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77
Q

A motorcycle crash over ____ is a code yellow trauma alert.

A

20 mph

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78
Q

Chest wall instability/deformity/significant focal bony tenderness is a code ____ patient.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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79
Q

Significant abdominal pain/bruising/tenderness related to an acute trauma is triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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80
Q

2+ long bone fractures is a triage _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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81
Q

Amputation proximal to wrist/ankle is a code _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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82
Q

A pelvic fracture is a code ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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83
Q

Open/depressed skull fracture is triage ____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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84
Q

Paralysis or new neuro deficit is a triage

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. yellow

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85
Q

Adults over 55 YO on anticoagulant therapy (do/do not) require a level I trauma center.

A

do not

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86
Q

What high risk auto crash findings are traumas, but do not require level I transport?

A
  • Intrusion over 12” by occupant

- Intrusion over 18” at any location

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87
Q

Patients who are alert/oriented (or at baseline mental status), with normal V/S for age, and do not require emergency care are triage _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

D. Green

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88
Q

Patients who are experiencing suicidal thoughts or psychiatric medication non-compliance are triage _____.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

E. Orange

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89
Q

T/F: elderly patients with AMS/confusion/combativeness are triaged orange.

A

False. These patients often have underlying problems (dementia, sepsis, etc.) that may result in AMS. (altered mental status)

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90
Q

If medication is required to calm/protect a patient, they are triage _____ at minimum.

A. Blue
B. Red
C. Yellow
D. Green
E. Orange
A

C. Yellow

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91
Q

In the case of suspected ischemic chest pain, what is your first step in treatment?

A. 12-Lead ECG
B. 324 mg ASA PO
C. 0.4 mg NTG SO
D. 50 mcg Fentanyl IV

A

B. 324 mg ASA PO

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92
Q

Outline the treatment of an STEMI on 12-lead ECG.

A
  • After 324 mg po ASA and 12-lead:
    • Call STEMI alert as soon as possible
    • Place defibrillator pads (in case of arrest)

-consider Fentanyl IV/IM/IN

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93
Q

In the case of an inferior STEMI (II, III, aVF), what is administered in hypotension?

A

250-500 cc NS under 90 SBP over 90 SBP consider it

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94
Q

In adult chest pain treatment, use what medication is a contraindication of nitroglycerin?

A

ED/pulmonary HTN drug use in prior 48 hours

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95
Q

If an adult patient does not have an inferior MI, what may be administered to combat pain prior to narcotics?

A

0.4 mg SL nitroglycerin

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96
Q

SL NTG may be repeated q___min if SBP is over 90 mmHg.

A. 2
B. 3
C. 4
D. 5

A

B. 3 minutes

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97
Q

IV/IM Fentanyl for 50-74 kg.

A

50 mcg

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98
Q

IV/IM Fentanyl for over 75 kg.

A

75 mcg

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99
Q

IV/IM Fentanyl for geriatric patients

A

25 mcg

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100
Q

IN Fentanyl for 50-74 kg patients.

A

100 mcg

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101
Q

IN Fentanyl for over 75 kg patients.

A

100 mcg

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102
Q

IN Fentanyl for geriatric patients.

A

50 mcg

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103
Q

If pain is improved with 3+ SL nitroglycerin and SBP is over 90 mmHg, what may be given?

A

2% NTG ointment - 1” on the anterior chest

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104
Q

What is the defibrillation dose for adult cardiac arrest with shockable arrests (pVT/VF)?

A

360 J

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105
Q

What is the preferred method of ventilation for adult cardiac arrest?

A

BLS airway/ I Gel

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106
Q

A patient presents with pulseless electrical activity. Every two minutes _____ should be administered.

A

1 mg 1:10,000 IV epineprine

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107
Q

What are the shockable rhythms of adult cardiac arrest?

A
  • pulseless ventricular tachycardia (pVT)

- ventricular fibrillation (VF)

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108
Q

What are the drugs and repeat times for pVT and VF?

A
  • 1 mg 1:10,000 IV epinephrine q4 minutes PRN
  • 300 mg IV amiodarone x1
  • Repeat 150 mg IV amiodarone x1 4 minutes after 300 mg of amiodarone
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109
Q

In the absence of ROSC in the adult cardiac arrest, what should be considered?

A

A. cease resuscitation protocol

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110
Q

Treatment of hypovolemia suspected in adult cardiac arrest.

A

1-2L chilled normal saline

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111
Q

Treatment of suspected hypoglycemia in adult cardiac arrest.

A

25 g IV dextrose

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112
Q

Treatment of suspected narcotic overdose in adult cardiac arrest.

A

2 mg IV/IM/IN naloxone*

*only if not intubated

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113
Q

Treatment of Torsades de Pointes in adult cardiac arrest.

A

2 g IV magnesium sulfate

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114
Q

Treatment of suspected tension pneumothorax in adult cardiac arrest.

A

needle decompression

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115
Q

Treatment of suspected cyanide/smoke inhalation in adult cardiac arrest.

A

5 g IV hydroxocobalamin

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116
Q

Treatment of suspected TCA overdose in adult cardiac arrest.

A

100 mEq IV sodium bicarbonate

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117
Q

Outline the position of the 12-lead electrodes

A

V1 - right 4th ICS
V2 - left 4th ICS
V3 - 1/2 between V2 and V4
V4 - left 5th ICS, mid-clavicular line
V5 - Horizontal to V4, anterior axillary line
V6 - Horizontal to V5 - mid-axillary line

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118
Q

Describe position 1 of the BLS triangle

A

Location: Patient right
Assess unresponsiveness/pulselessness
Initiates: compressions
Switches off with position 2 in counting in 20s
Switches off with position 2 in off-cycle 20:1 BVM ventilations

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119
Q

Describe position 2 of the BLS triangle

A

Location: Patient left
Initiates: Metronome; NRB mask; defib pads
Operates: AED/LP
Switches off with position 1 in counting in 20s
Switches off with position 1 in off-cycle 20:1 BVM ventilations

120
Q

Describe position 3 of the BLS triangle

A

Location: Patient head
Initiates: Airway management
Applies BVM/OPA at 660 compressions
Monitors end-tidal and assesses airway compliance.

121
Q

Describe the role of Code Commander in resuscitation.

A
  • Owns the clinical care.
  • Interprets and responds to ECG findings.
  • Ensures accurate documentation (coordinates with BLS Team Leader)
  • Owns advanced airway interventions
  • Responsible for coordinating with medical command about cease resuscitation.
122
Q

Describe the role of the PM position in resuscitation.

A
  • Assists code commander
  • ## Initiates IV/IO access
123
Q

Describe the role of the PM position in resuscitation.

A
  • Assists code commander
  • Initiates IV/IO access
  • Assess airway intervetions/ETCO2 monitoring
124
Q

What type of airway is preferred in the pediatric cardiac arrest?

A. BLS airway
B. ALS airway - SGA
C. ALS airway - ETT

A

A. BLS airway

125
Q

Evaluation of the patient’s cardiac rhythm is done every ___ minutes.

A. 2
B. 3
C. 4
D. 5

A

A. 2

126
Q

Defibrillation of the pediatric arrest is done at _____.

A. 1 J/kg
B. 2 J/kg
C. 4 J/kg

A

C. 4 J/kg

Is this ALWAYS? There’s no 2J/kg first, then 4 J/kg next?

127
Q

1:10,000 IV epinephrine is administered q ____ minutes in the peds arrest.

A. 2
B. 3
C. 4
D. 5

A

C. 4

128
Q

What are the Hs of pediatric cardiac arrest and how are they treated?

A

Hypoglycemia - dextrose IV

129
Q

What are the Ts of pediatric cardiac arrest and how are they treated?

A

Toxins

  • smoke inhalation - hydroxocobalamin
  • TCA od - sodium bicarbonate

Torsades
- Magnesium sulfate

Tension pneumo - needle decompression

130
Q

What is the mnemonic for common causes of altered mental status?

A 
A - alcohol
E - epilepsy, electrolytes
I - insulin
O - overdose
U - uremia (kidney failure)
T - temp, trauma
I - infection
P - poisoning (CO)
S - shock
ETCO2
131
Q

What is one of the first assessments performed in AMS patients?

A. 12-lead ECG
B. BGL
C. ETCO2

A

B. BGL

132
Q

Based on a blood glucose under 50 mg/dL in an adult patient, what medication may be administered if an IV is obtained?

A. 25g D50 Dextrose
B. 0.1 mg/kg Glucagon
C. 1 mg Glucagon

A

A. 25g D50 Dextrose IV

Dextrose 25g is administered to ALL patients regardless of age/weight in adult patients

133
Q

Based on a blood glucose under 50 mg/dL in an adult patient, what medication may be administered if an IV is not obtained?

A. 25g D50 Dextrose IM
B. 0.1 mg/kg Glucagon IM
C. 2 mg Glucagon IM

A

C. 2 mg Glucagon IM

Is administered to ALL patients regardless of age/weight in adult patients

134
Q

BGL is re-evaluated after ____ when dextrose or glucagon is administered.

A

5-10 minutes

135
Q

If a patient has a glucose over 300 mg/dL, what should be evaluated?

A

Signs/symptoms of dehydration.

136
Q

If a patient with AMS and has S/S of dehydration, what should be administered?

A

NS IV bolus

- 250-500 mL NS(20mL/kg)

137
Q

If a suspected narcotic overdose is present (pinpoint pupils, respiratory depression), what should be administered?

A

0.4 mg IV/IM/IN Naloxone to achieve adequate respirations.

138
Q

A positive Cincinnati Pre-Hospital Stroke Scale over ____ hours PTA of EMS requires supportive care and transport to the hospital of patient’s choice.

A. 6
B. 12
C. 18
D. 24

A

D. 24

139
Q

If a patient was last seen normal less than ____ or woke up with stroke-like symptoms, the patient should undergo the RACES assessment.

A. 6
B. 12
C. 18
D. 24

A

A. 6

140
Q

If after utilizing the RACES score, and a patient scores between 0-4, to where should they be transported?

A. Any hospital of patient’s choice
B. St. Francis/Wesley Main
C. St. Francis only

A

B. St. Francis/Wesley Main

141
Q

If after utilizing the RACES score, and a patient scores between 5-9, to where should they be transported?

A. Any hospital of patient’s choice
B. St. Francis/Wesley Main
C. St. Francis only

A

C. St. Francis only

142
Q

What is an LVO Stroke alert?

A

“Large vessel occlusion.”

143
Q

The first step in assessing a seizure patient is determining ______.

A. ABCs
B. BGL
C. 12-lead ECG

A

A. ABCs

144
Q

After assessing a seizure patient’s ABCs, what is evaluated next?

A. BGL
B. 12-lead ECG
C. Pregnancy

A

A. BGL

145
Q

The minimum BGL of a seizure patient should be ____.

A

50 mg/dL

146
Q

If a patient is experiencing an active seizure, or recurrent seizures without a lucid interval, what is evaluated next?

A

Whether or not the patient is in third trimester of pregnancy with signs of eclampsia.

147
Q

IM/IN Midazolam for adult seizure geriatric patient.

A

5 mg

148
Q

IM/IN Midazolam for adult seizure patient weight over 75 kg.

A

10 mg

149
Q

T/F: The adult, non-pregnant patient with recurrent seizure may receive magnesium sulfate.

A

True

150
Q

Signs/symptoms of eclampsia

A

SBP over 140 mmHg or DBP over 90 mmHg

AND 1+ of the following:

  • Proteinuria
  • Renal impairment (proteinuria, high creatinine)
  • Liver disease (epigastric pain, liver tenderness, elevated AST/ALT)
  • Neuro problems (seizure, visual disturbance, clonus)
  • Hematologic changes (thrombocytopenia - , hemolysis, DIC)
  • Fetal grown restriction

Severe if SBP over 160 or DBP over 110, or if sever organ dysfunction

151
Q

Medical control may be contacted for orders if a patient experiences another seizure following ____ dose(s) of benzodiazepines.

A

2

152
Q

Hyperthermia is considered a temperature over ______.

A

104*F

153
Q

What is considered “mild” hypothermia?

A

90-95F/32-35C

154
Q

What is considered “moderate“ hypothermia?

A

86-90F/30-32C

155
Q

What is considered “severe“ hypothermia?

A

Under 86F/30C

156
Q

What are the possible causes of non-environmental factor induced hyperthermia?

A
  • Antipsychotics
  • Tranquilizers
  • Cyclic antidepressants
  • Amphetamies
  • MAOIs
  • Anti-Ch drugs
  • Illicit drugs
157
Q

What are the S/S of mild hypothermia?

A
  • amnesia
  • poor judgement
  • hyperventilation
  • bradycardia
  • shivering
158
Q

What are the S/S of moderate hypothermia?

A
  • Loss of coordination
  • Decreasing RR/depth
  • No shivering
  • bradycardia
159
Q

What are the S/S of severe hypothermia?

A
  • Decreased LOC
  • Slow respirations/apnea
  • A-fib
  • decreased BP
  • decreased HR
  • Ventricular irritability
160
Q

What are the “progressive techniques” of patient cooling in hyperthermia?

A
  • removed from hot environment
  • remove clothing
  • mist/sponge with water
  • ice packs in axillae and/or groin
161
Q

In the case of traumatic drowning with cardiac arrest, the Trauma Cease Resuscitation Protocol (T-3) should be implemented if submersion is over ______.

A. 30 minutes
B. 60 minutes
C. 90 minutes

A

C. 90 minutes

162
Q

What warming techniques are used in hypothermic patients?

A
  • remove from cold environment
  • remove wet clothing
  • cover with dry sheets/towels/warm blankets
  • give warm IV fluids
163
Q

How does cardiac arrest in the hypothermic patient vary?

A

Mild hypothermia: no change

Moderate hypothermia: Double time between medications; defibrillated as usual

Severe hypothermia: Epinephrine ONLY with doubled time between administration; single defibrillation for pVT/VF

164
Q

Ingestion of a stimulant requires management under what protocol?

A

Behavioral emergencies (M-10)

165
Q

______ must be administered in a dedicated IV line, mixed with no other drugs.

A. Glucagon
B. Hydroxocobalamin
C. Ondansetron
D. Atropine

A

B. Hydroxocobalamin

166
Q

Which medications require orders from a physician for administration in the case of suspected poisoning?

A
  • Atropine
  • Calcium chloride
  • Zofran/glucagon
  • Hydroxocobalamin
167
Q

For symptomatic organophosphate poisonings, what must be given?

A, Atropine
B. Calcium chloride
C. Zofran/glucagon
D. Hydroxocobalamin

A

A, Atropine

168
Q

For hypotension associated with beta-blocker/calcium-channel blocker OD:

A, Atropine
B. Calcium chloride
C. Zofran/glucagon
D. Hydroxocobalamin

A

C. Zofran/glucagon

169
Q

For magnesium toxicity/calcium-channel blocker overdose:

A, Atropine
B. Calcium chloride
C. Zofran/glucagon
D. Hydroxocobalamin

A

B. Calcium chloride

170
Q

For suspected cyanide poisoning, what must be given?

A, Atropine
B. Calcium chloride
C. Zofran/glucagon
D. Hydroxocobalamin

A

D. Hydroxocobalamin

171
Q

In the case of suspected dystonic reactions from anti-psychotics, what may be given to adult, non-geriatric patients?

A

50 mg diphenhydramine IV/IM

172
Q

Known TCA ingestion with wide-complex rhythms are given ______.

A

Sodium bicarbonate

173
Q

TCA overdoses with wide-complex rhythms in patients between 50-74kg are given ______.

A

50 mEq sodium Bicarbonate IV

174
Q

TCA overdoses with wide-complex rhythms in patients over 75 kg are given ______.

A

75 mEq sodium Bicarbonate IV

175
Q

Atropine is administered for organophosphate overdoses. By what mechanism does it affect S/S?

A. By freeing glucose from glycogen.
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
D. Overcoming calcium channel blockade/increases force of contraction.

A

B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.

176
Q

By what mechanism does glucagon treat calcium channel overdose?

A. By freeing glucose from glycogen.
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
D. Overcoming calcium channel blockade/increases force of contraction.

A

C. Stabilizing the cardiac membrane by yet unknown mechanism.

177
Q

By what mechanism does glucagon treat beta-blocker overdose?

A. By freeing glucose from glycogen.
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
D. Overcoming calcium channel blockade/increases force of contraction.

A

C. Stabilizing the cardiac membrane by yet unknown mechanism.

178
Q

By what mechanism does glucagon treat insulin overdose?

A. By freeing glucose from glycogen via enzymatic activity (activation of PKA creates a step-wise series of reactions to cleave liver glycogen)
B. Competes with ACh on muscarinic receptors to reduce secretions and increase heart rate.
C. Stabilizing the cardiac membrane by yet unknown mechanism.
D. Overcoming calcium channel blockade/increases force of contraction.

A

A. By freeing glucose from glycogen via enzymatic activity (activation of PKA creates a step-wise series of reactions to cleave liver glycogen)

179
Q

The first step in management of the syncope/ditziness patient is:

A. Assessment of ABCs
B. BGL
C. 12-Lead ECG

A

A. Assessment of ABCs

180
Q

If a syncope/dizziness patient presents with a blood glucose under ____ mg/dL, proceed to the AMS protocol.

A. 70
B. 60
C. 50
D. 40

A

C. 50

181
Q

When faced with a syncope/dizziness patient with a BGL over 50 mg/dL, what should be evaluated next?

A

ECG: 4-lead

182
Q

If there is any arrhythmia besides _____ in the syncope/dizziness patient, a 12-lead ECG is warranted.

A

Sinus tachycardia

183
Q

_______ is a tool utilized to determine the cause of dyspnea (asthma/COPD versus CHF).

A

End-tidal CO2:

  • bronchospastic waveform is found found in Asthma/COPD
  • normal waveform found in CHF
184
Q

For bronchospasm, adults are administered _______ and _______ in a nebulized form.

A
  • 6 mg albuterol

- 1 mg ipratropium

185
Q

Bronchospastic adults may receive what medication after Duo-Neb?

A

125 mg IV Solmedrol or 60 mg PO Prednisone

  • Steroids take a long time to act (appx. 4-6 hours), but act to counteract the inflammatory process associated with allergy/asthma.
186
Q

In the adult respiratory patient for whom Duo-Neb and steroids are not improving their condition, __________ may be administered.

A

2 gm Magnesium IV/15 minutes

187
Q

_______ may be administered to adult dyspnea patients for whom Duo-Neb, steroids, and magnesium has been unsuccessful.

A

0.3 mg 1:1,000 epinephrine IM

188
Q

Magnesium for geriatric adult respiratory distress.

A

1 gm

189
Q

Magnesium for non-geriatric adult respiratory distress.

A

2 gm

190
Q

By what mechanism does CPAP assist in pneumonia?

A

There may be pulmonary edema 2/2 inflammation and the infectious process. CPAP acts to maintain alveolar opening as it would in CHF/pulmonary edema.

191
Q

What are the S/S of suspected pulmonary edema?

A
  • rhales
  • JVD
  • peripheral edema
192
Q

CPAP may be administered in adult dyspnea patients if the SBP is over _____.

A

90 mmHg

193
Q

SL or topical NTG may be given to adult dyspnea patients if you suspect their dyspnea is related to ______.

A

CHF/pneumonia

194
Q

For the pediatric respiratory distress, oxygen should be titrated to _____.

A. over 90%
B. Over 92%
C. Over 94%
D. Over 96%

A

C. Over 94%

195
Q

For the pediatric respiratory distress, what are the S/S that would indicated possible sepsis?

A

fever, decreased PO intake, dehydration

196
Q

For the pediatric respiratory distress, if no inspiratory stridor is present, what is administered first?

A. Methylprednisone IV
B. Albuterol/Ipratropium
C. NS bolus at 20 mL/kg
D. Prednisone PO

A

B. Albuterol/Ipratropium

197
Q

In pediatric respiratory distress, what is the dose of albuterol/Ipratropium?

A

6 mg nebulized albuterol

1 mg ipratropium

198
Q

What is the mechanism of action of albuterol?

A

alpha and beta receptor agonist, which acts to:

  • Increase heart rate, increase cardiac contractility, increase peripheral vasoconstriction (alpha effects)
  • Promote bronchodilation (beta effects)
199
Q

What is the mechanism of action of ipratropium?

A

Acts to reduce bronchoconstriction by blocking muscarinic receptors in bronchial smooth muscle.

200
Q

Ipratropium is a compound produced by mixing isopropyl bromide and _____.

A

atropine

201
Q

In peds respiratory distress, what are the mild/moderate S/S that would prompt administration of steroids?

A
  • No retractions
  • No extremis (hypotension, AMS, etc.)
  • No bronchospastic waveform on capnography
  • ETCO2 under 35 mmHg with increased RR
  • No hypoxia (SpO2 under 94%)
202
Q

In peds respiratory distress, assessment of severe bronchospasm includes what findings during physical?

A
  • prior intubation
  • prior ICU stay
  • Hx of asthma
203
Q

In severe peds respiratory distress and not with suspected croup, what should be administered quickly?

A. 1:1,000 epinephrine IM
B. 5 mg albuterol
C. 125 mg solumedrol

A

A. 1:1,000 epinephrine IM

204
Q

S/S of croup:

A
  • Severe inspiratory and expiratory stridor (seal-like cough)
205
Q

Initial treatment for croup involves ______.

A

humidified oxygen

206
Q

Stridor at rest in the peds respiratory distress patient should be given ______.

A

nebulized albuterol

207
Q

What protocol do you go to if patient is not normal thermic in Medical Cease Resuscitation protocol?

A

Environmental Emergencies (M7)

208
Q

What two actions must be taken when calling a stemi?

A

Call EMS stemi alert, place defib pads

209
Q

Which patients get a 12-lead ECG asap?

A

Syncope, suspected cardiac chest pain, dysrhythmia or suspected ischemic equivalent

210
Q

When do you give supplemental oxygen?

A

if pulse oximetry is <92 on room air, patient with abnormal breathing, or signs of inadequate perfusion

211
Q

How many times should stable patients be evaluated?

A

2, every 15 minutes minimum

212
Q

If initial AIC is not transporting what should be documented?

A

time of transfer, name of provider assuming care

213
Q

What 3 types should you pre alert dispatch for?

A

STEMI, Stroke, Trauma

214
Q

After significant status changes and/or interventions what should happen?

A

Vital repeated

215
Q

What questions to include with all pediatric patients?

A

immunization history, number of wet diapers/urine output, oral intake?

216
Q

When do you consider assisting ventilations in a peds patient?

A

signs of inadequate ventilation, altered mental status, signs of inadequate perfusion

217
Q

4 items to include in a pre alert to receiving hospital?

A

Chief complaint, brief assessment vitals if available, treatments, eta

218
Q

How long should an initial assessment in a trauma take?

A

<1 minute

219
Q

Which type of trauma gets supplemental oxygen?

A

Head trauma

220
Q

7 additional questions to ask ob patients during events leading up to calling 911

A

first day of last menstrual period,
estimated weeks gestation(if <15 weeks is there an ultrasound documented intrauterine pregnancy)
gravida/number of pregnancies’ including this one, para/number of deliveries
any known complications with this pregnancy
whether this is a single or multiple pregnancy
time on onset of labor, membranes have ruptured(when), discoloration of amniotic fluid
any vaginal bleeding, trauma that caused the bleeding or pain with the bleeding

221
Q

What to have with patient at all times in ob call

A

ob kit
oxygen
towel/sheet
pediatric bvm

222
Q

What is needed for pre alert on rapid fetal assessment or active labor?

A

pt age
G# P# A#
assessment including, weeks gestation, time of onset of labor, frequency of contractions, any bleeding, whether membranes ruptured
name of obgyn
treatments
eta
note if pt is code red (gestation <36 week in active labor, known abnormal presentation (breech, etc), known prenatal complications, distressed neonate delivered in field)

223
Q

Contraindications of Aspirin

A

Pregnancy
Hypersensitivity to aspirin, salicylates and NSAIDS

Caution if: asthma, chronic liver disease: single dose is still appropriate in STEMI

224
Q

At what age does a pediatric patient get the full tube of glucose

A

2 years or older gets full tube 24g of dextrose

225
Q

What are the contraindications of glucose?

A

Inability of patient to maintain own airway and prevent aspiration of oral medication
Hyperglycemia
Hypersensitivity to corn or corn products

226
Q

What are the contraindications for Nitroglycerin?

A

hypersensitivity to organic nitrates
use of ANY erectile dysfunction drug within 48 hours, except sildenafil(viagra) within 24 hours
use of pulmonary hypertension drug in women such as sildenafil(Revatio)

caution if: inferior wall MI with suspected right ventricular involvement (ST elevation in II, III F)

227
Q

Nitro Dose

A

.3-.6 mg every 5 minutes

sublingual tabs are .4 mg
topical is 2%

228
Q

Dose for albuterol

A

2.5 mg in 3 ml

initiate treatment with two bullets of nebulized albuterol

229
Q

Contraindications for albuterol

A

Hypersensitivity

Caution if: tachyarrhythmia (not sinus tach)

230
Q

What should be offered to every patient?

A

Unconditional offer of transport

231
Q

When requesting a paramedic level evaluation for patient declination of care what should that patient be retriaged as?

A

Yellow

232
Q

Triaged Red patient must have what level of evaluation for patient declination of care?

A

Medical director consult

233
Q

What should the provider give the patient declining care against medical advise?

A

info on specific treatments, benefits of treatments, and specific risks of declining treatment and transport

234
Q

What four things plus a full set of vital signs should a provider obtain to properly inform a patient declining care?

A

history of present illness/injury, circumstance of 911 activation(patient or 3rd party), past medical history, any history of self-injury or suicidality

235
Q

What are the components of being competent and have the capacity to understand risks

A

normal mental status
capacity for decision-making verified
absence of head injury

236
Q

Components to verify capacity for decision-making

A

absence of clinical intoxication(alcohol, drugs), normal speech no slurring
normal coordination(gait, fine motor function)
no nystagmus
normal ability to pay attention and respond appropriately to questions/requests

237
Q

Components of a patient safety net after declination of care

A

plan to seek care through another ave (PCP)
someone with them to call ems if patient status changes
advising they can call back for care at anytime
syncope or seizure patients should be instructed that they may not drive or operate machinery until cleared by physican
if patient declines to sign, witnesses to this conversation should be documented prefer pd with badge number

238
Q

Which patients should PD be involved with and not be allowed to decline care?

A

altered mental status and impaired judgment or active suicidality

239
Q

If a parent is reached by phone for minor declination of care what should be documented?

A

time, phone #, name, and relationship, and plan to retrieve the patient

240
Q

What exam must be completed to asses capacity?

A

mini-mental status exam

241
Q

What patient do to adequately reflect understanding of assessment, risks and benefits being communicated to them>

A

repeat back in their own words and reflect understanding of the assessment

242
Q

For patients with suspected cardiac chest pain or anginal equivalent what score should be giving to the patient when declining?

A

TIMI Risk Score, low intermediate or High

243
Q

In hypoglycemia patients what may be an early sign of concerning problems including infection, or heart attack?

A

low blood sugar in patients whose insulin dose has not changed may be the only sign

244
Q

What six elements and division leader agreement are required for hypoglycemic patients to decline care?

A

patient is insulin-dependent only, no oral agents, or long acting insulins like lantus and humalog
patient has eaten carbohydrates, no hx of vomiting or diarrhea or fever that led to low bgl
Someone with the patient to monitor patients mental status
repeat glucose level of at least 100 for iv dextrose or 70 for oral glucose
returned to baseline mental status and competent
plausible reason for hypoglycemic episode

245
Q

What are the long acting insulins that require medical director consult for patient to refuse?

A

Lantus or Humalog

246
Q

Division leader approval is needed for what patient declination of care situations?

A

incompetent patient
suicidal or homicidal ideation
declination in police custody
hypoglycemic patient who meets all 6 criteria

247
Q

Medical Director consult is required for which patient declination of care situations

A

triaged red

hypoglycemic that does not meet the six criteria

248
Q

Glucose assessment is indicated in which patients?

A

AMS, Combativeness, stroke like symptoms

249
Q

Patients with a glucose reading of high may show signs and symptoms of what?

A

inadequate perfusion, consider fluid resuscitation procedure

250
Q

CO level of 0-5% actions

A

supportive care, no further evaluation

251
Q

CO 6-15%

A

02 sat >90% if yes then are they showing S/S of co poisoning or hypoxia are the pregnant?
if yes give 100 02 via non rebreather

252
Q

actions above 15% co level

A

100% 02 transport to ed

253
Q

Smokers may have a CO baseline up to?

A

10

any above 10 must be evaluated they are always abnormal

254
Q

Which patient should get 02 therapy and transported even when normally wouldnt?

A

Pregnant women exposed to CO

255
Q

Looking at etCO2 when is CPAP withheld?

A

Sharkfin is present

256
Q

ETCO2 waveform is prolonged what action to take?

A

CPAP,

257
Q

How many cycles of no bvm in CCR?

A

first 3 cycles

258
Q

What are the steps for cardiac arrest management flowchart (p-30)

A

Pulseless/apneic w/o incompatible with life signs
hypoxic arrest go to cpr
non hypoxic start ccr delay bvm vent to after first 3 cycles
Cardiac arrest protocol MC4-5), airway management p-10, cardiac arrest management procedure p-30
medical or trauma?
Rosc?
if no Medical Resuscitation protocol (MC-9)

259
Q

What is CCR designed to do?

A

sustain the highest possible aortic pressure

260
Q

In patients with suspected primary cardiac events what method of resuscitation will be used?

A

CCR

261
Q

In Cardiac Arrest Management what should be immediately brought to the patients side?

A 
AED or Monitor/ with waveform capnography
Metronome
Cardiac arrest checklist
BLS triangle
Standard jump bag
Airway management equipment 02 suction
262
Q

What is the minimum ppe for provider at the airway management position?

A

gloves, mask, eye protection

263
Q

AED pad placement

A

heart electrode lateral to the left nipple midaxillary line

other right upper torso lateral to sternum below clavicle

264
Q

What position obtains pulse with compressions at 180?

A

Code commander

265
Q

How many metronome beeps until resume compressions?

A

15

266
Q

At what point does the compressons stop and AED is in analyze mode?

A

at 220 position 2 presses analyze

267
Q

Compression ratio should be what?

A

90% or greater

268
Q

Any pause over __ seconds diminishes the compression ratio

A

3 seconds

269
Q

Non hypoxic medical arrest airway management is done by?

A

02 at 15lpm via non rebreather with oral airway

3 cycles of 220 compressions

270
Q

When 3 to 4 providers are onscene what must continually be monitored?

A

femoral pulse

271
Q

In patients with repeated rhythm changes resuscitation should continue until?

A

PT in asystole at least 15 mins or total of at least 30 mins of active resuscitation

272
Q

If EtC02 persistently < __ with CPR, may consider cease resuscitation by standing order at __ minutes

A

10, 20

273
Q

List 10 steps to mini mental status exam

A

orientation to time 1 point each total 5
orientation to place 1 point each total 5
Repeat 3 words 1 point each total 3
spell “world” backward or count backward by 3 from 20/ 1 point each total 5
remember previous 3 words 1 point each total 3
pt perform a 3 step command 1 point each total 3
name 2 objects you point at 1 point each total 2
read a sentence then perform its actions 1 point
patient write a sentence 1 point
draw to overlapping pentagons then patient does it 1 point

274
Q

How many points is considered competent in mini mental status exam?

A

over 21

275
Q

What are the reversable causes in an arrest situation?

A 
Hypovolemia
Hypo/Hyperkalemia
Hydrogen Ion (acidosis)
Hypoxia
Tension pneumothorax
Toxins
Thrombosis
276
Q

Patient with critical or serious hemodynamic, physiologic, or mental status changes or a significant expectation that patient will acutely decompensate in the short term

A

Code Red

277
Q

Loc less than verbal, or acute gcs < 14

A

code red

278
Q

High risk or complicated obstetric patient > 20 weeks gestation

A

Code red

279
Q

Newborn with APGAR score < or equal to 7 at 5 minutes

A

Code red

280
Q

What Trauma physiologic findings are code red and require Level 1 Trauma center

A

GCS < 14
SBP < 90 or signs of shock
Respiratory rate < 10 or >29 or need for respiratory support

281
Q

What Trauma mechanism is code Red and requires level 1 Trauma

A

Penetrating injury to head, neck, torso, or extremities proximal to knee or elbow

282
Q

Patient with currently non-critical, though potentially serious hemodynamic, physiologic, or mental status changes with potential for decompensation in the short term

A

Code yellow

283
Q

What triage is a patient that is non compliant with psychiatric medication

A

Code Orange

284
Q

How long does Rosc need to be present to restart the timer of cease resuscitation?

A

5 minutes or more will start the new timer.

285
Q

What is EXTREMIS s/s

A

Near arrest
unable to speak,
tachypnea
hypotension

286
Q

What are Anaphylaxis s/s

A 
sudden onset
severe flushing
rash, hives
severe bronchoconstriction
laryngospasm
anxiety
sense of impending doom
Loc decrease then unconscious
287
Q

What are Allergic reaction S/s

A 
gradual onset
mild flushing
rash, hives
mild bronchoconstriction
normal mental status
288
Q

In pediatric medical protocol what are the first two considerations of the protocol?

A

02 to maintain sat above 94

inspiratory stridor?

289
Q

What is the first consideration in adult respiratory distress protocol?

A

Suspected bronchospasm? (asthma, COPD)

290
Q

In the respiratory distress adult protocol if bronchospasm is not suspected what should be considered and actions to take?

A

CHF, pneumonia

02 above 94

291
Q

In neonate resuscitation triangle when to assist ventilation with bvm?

A

heat rate less than 100

or apneic after 30 seconds

292
Q

Neonatal resuscitation triangle compression ratio

A

3:1 with ventilations

120/min

293
Q

Categories of APGAR scoring

A 
Apperance
pulse
grimace
activity
respiration
294
Q

what gets a 0 on apgar

A 
pale, cyanotic blue
absent pulse
no grimace response
limp 
absent respiration
295
Q

What gets a 1 in APGAR

A 
pink body blue limbs
less than 100 pulse
grimace
some flexion
slow less than 30 or irregular
296
Q

What gets a 2 APGAR scoring

A 
Completely pink
over 100 pulse
cry, cough, sneeze
active motion
good crying

Sedgwick County Capt (40 decks)

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