PJ MED Cert Flashcards
Severe TBI (sTBI)
Demonstrate knowledge of the diagnosis and treatment of the protocol based on the Task Standard and the
Dx:
1. Declining level of consciousness
2. Fixed and dilated pupil(s)
3. Posturing or weakness on one side of body
4. Irregular, snoring respirations
Rx:
1. Prevent hypoxemia (secure the airway)
2. Prevent hypotension (establish IV/IO access)
3. 250 or 500cc 3% saline
4. Elevate the head 30 degrees if no shock
NOTE: Document GCS and neuro exam
Basilar Skull Fracture
Demonstrate knowledge of the diagnosis and treatment of the protocol based on the Task Standard and the PJ Med Handbook
Dx:
1. Raccoon eyes & Battle signs
2. CSF rhinorrhea or otorrhea (clear fluid from the nose or ears)
Rx:
1. None
2. GCS, neuro exam, MACE and transport to neurosurgeon
Penetrating Eye Trauma
Demonstrate knowledge of the diagnosis and treatment of the protocol based on the Task Standard and the PJ Med Handbook
Penetrating Eye Trauma: 1. Vision test: document highest level of function‐ read print, count fingers, hand motion, light perception, no light perception 2. Rigid eye shield 3. Antibiotics (PO if able)
Thoracic Trauma
Demonstrate knowledge of the diagnosis and treatment of the Task Standard and the PJ Med Handbook
Dx:
1. Chest trauma
2. Respiratory distress
Rx:
Perform these in order until patient experiences relief and improved VS:
1. Needle Decompression (ND) x 2 attempts at 4th or 5th intercostal space (ICS) in the anterior
axillary line
2. Finger thoracostomy and/or chest tube in the 5th ICS in the mid‐axillary line
3. Positive pressure ventilation (BVM, nu‐mask and blow, ventilator)
4. O2 if available
Acute abdomen
Demonstrate knowledge of the diagnosis and treatment of the protocol based on the Task Standard and the PJ Med Handbook
Dx: can be from trauma or medical problem
1. Rigidity
2. Rebound tenderness or severe focal tenderness
3. Distension
Rx:
1. NPO
2. IV access. NS (normal saline) if medical; or blood and TXA hemorrhagic shock
3. Ertapenem
4. NG tube for PFC
5. Fentanyl for pain
6. Zofran for nausea
7. Acetaminophen PO with sips of water for fever
Burns
Demonstrate knowledge of the diagnosis and treatment of the protocol based on the Task Standard and the PJ Med Handbook
USE 9,10,11,20,30 RULE
1. TBSA (total body surface area) ‐ there are 11 “9”s. 2 front torso, 2 back torso, 1 each
upper extremity, 2 each lower extremity, 1 head
2. Use Rule of 10 to start fluid resuscitation (10ml/hr x % TBSA, add 100ml/hr for each 10kg
above 80 kg)
3. Start fluid resuscitation with LR if >20% TBSA burned
4. Adjust IV fluids to maintain urine output 30‐50 ml/hr
5. Use ketamine for pain
6. Use dry sterile dressings to cover burns. If out > 12 hours debride dead skin once.
7. Put dry gauze between burned digits
8. Perform surgical airway for stridor or respiratory distress (this is generally gradual).
9. Escharotomy PRN for circumferential burns with progressive pain and tension to palpation.
NOTE: If LR not available, begin fluid resuscitation with NS up to 2‐4 L.
Crush injury and crush syndrome Phase 1: Immediate
Demonstrate knowledge of the diagnosis and treatment of the Task Standard and the PJ Med Handbook
Management
Phase 1: IMMEDIATE (while attempting extrication)
1. Perform MARCH PAWS.
2. Monitor O2 sat with pulse ox
-administer O2 if SpO2<90%.
3. Give initial bolus of 1‐2 L of NS PRIOR to attempts at extrication and continue at 1.5L/hr. - place 2 lines if able.
- Adjust to urine output (UOP) goal of >100–200mL/h if able.
a. If IV/IO crystalloids are not available, consider oral intake of electrolyte solution such
as water/rehydration salts, Pedialyte or a sports drink.
4. Ringer’s lactate is not recommended due to the potassium content, but can be used for first 2 liters if nothing else available.
5. Maintain urine output at greater than or equal to 200ml/hr. If possible, insert Foley catheter.
6. Monitor mental status.
7. Follow Pain Management Protocol (TMEP)
8. For infection due to associated wounds and not crush injury itself, consider‐ Ertapenem
(lnvanz) 1 gm IV.
9. Utilize cardiac/EKG monitoring during extrication and evacuation.
Endotracheal Intubation Indications
Demonstrate knowledge of the diagnosis and treatment of the Task Standard and the PJ Med Handbook
Dx:
1. Unable to maintain airway‐ altered consciousness, gurgling, etc.
2. Desaturation despite simple efforts and clinical deterioration‐ requires judgment in tactical
and austere settings
3. Respiratory rates >30 and <10
4. GCS <8 (unconscious TBI patients)
Rx;
5. Pass the tube:
A. If successful: remove stylet, ventilate patient.
B. If unable to pass the tube after 2 attempts, or the patient’s O2 sat fall below 90%, bag the
patient with 100% oxygen.
C. Place an SGA Device (e.g. LMA, I‐gel or King LT). If this is not successful (use O2
saturation and ET CO2), resume BVM if working. If not or resources do not allow BVM,
perform a cricothyroidotomy if unable to intubate or oxygenate the patient.
6. Proof of placement:
A. End tidal CO2 (ET CO2), auscultation of each lung and epigastrium, fogging of tube,
bilateral chest rise, absence of epigastric distension
5 Shock Types
Demonstrate knowledge of the diagnosis and treatment of the five types of shock based on the Task Standard and the PJ Med Handbook shock table
- Cardiogenic
Dx: Chest pain, diaphoresis, abnl EKG Rx: FONA, 500cc NS - Hemorrhagic
Dx: Bleeding, trauma Rx: Stop bleed, blood products, TXA - Anaphylactic
Dx: Wheezing, stridor, rash Rx: Epi, Benadryl, Zantac - Neurogenic
Dx: Paralysis, weakness, spine pain/deformity Rx: Epi, NS 1-2L - Septic
Dx: Fever, infection source Rx: Ertapenem, fluids, Epi, Decadron
C-Spine Clearance Procedure
Demonstrate knowledge of the C-spine clearance protocol based on the Task Standard and the PJ Med Handbook
State need to clear the C-spine for falls from heights, blunt trauma, MVA, blast. Steps to clear the C-spine: 1. No altered mental status, intoxication, pain meds, distracting injury
- No neck pain
- No midline spinal tenderness
- Normal neuro exam
- Yes/No - Patient can slowly rotate and nod head without pain
Acute Mountain Sickness
Demonstrate knowledge of the diagnosis and treatment of the protocol based on the Task Standard and the PJ Med Handbook
Dx:
1. Headache, listless, loss of appetite, nausea, vomiting, etc.
Rx:
1. Halt Ascent
2.Ibuprofen 800mg
3. Hydration
3. Diamox 250 mg BID until 2 days after resolved and still at altitude.
4. B. Dexamethasone (Decadron) 4mg PO q 6hr if patient is allergic to sulfa. If Dexamethasone
(Decadron) is administered, no further ascent until asymptomatic for 24 hours after last
Dexamethasone dose.
4. Hold any ascent until asymptomatic for 24 hours.
High Altitude Pulmonary Edema
Demonstrate knowledge of the diagnosis and treatment of the protocol based on the Task Standard and the PJ Med Handbook
Dx: 1. Shortness of breath at rest 2. Rales 3. Pink, frothy sputum Rx: 1. Descent 2. O2 3. Nifedipine 30mg & Albuterol
High Altitude Cerebral Edema
Demonstrate knowledge of the diagnosis and treatment of the protocol based on the Task Standard and the PJ Med Handbook
Dx: 1. Ataxia 2. Confusion Rx: 1. Assisted Descent 2. O2 3. Decadron
Dive Medical Emergencies
Demonstrate knowledge of the diagnosis and treatment of the protocol based the Task Standard and the PJ Med Handbook
Dx:
- Musculoskeletal or joint pain
- Skin-marble rash, hives, edema, itching, blotching, pain, discomfort
- Neuro symptoms & abnormal neurologic exam
- Pulmonary-dyspnea, dry cough
- Cardiac- substernal chest pain, hypotension
Rx:
- ABC’s & 100% O2
- Evacuate to a Dive Chamber
Crush Injury Phase 2: immediately prior to extrication
PHASE 2: lMMEDlATELY PRIOR TO EXTRICATION
10. Immediately prior to extrication, apply tourniquets to crushed extremities, if possible.
Phase 2 Recommended Additional Resuscitative Drugs
a. Sodium Bicarbonate ‐ give 1mEq/kg IV immediately prior to extrication (Bristojet 1‐2amps). Additional dosing of Sodium bicarbonate may be required if dysrhythmias or cardiac arrest persist after giving calcium chloride(1gm (10ml of a 10% solution); 2.25–14mEq IV repeated in 1 to 2 minutes) or gluconate
PERFORM EXTRICATION
