Procedures

Question 1

what is a required diagnostic to be used when you intubate a patient?

Answer 1

ETCO2

Question 2

what are the 2 “relative contraindications” of intubations? IT can lead to worse outcomes…

Answer 2

pediatric pts and head injury pts

Question 3

If a ET tube becomes dislodged, what does DOPE stand for?

Answer 3

Dislodge
Obstruction
Pneumothorax
Equipment Failure

Question 4

how many attempts at ET tube can you try before you need to move onto a BLS airway?

Answer 4

2

Question 5

What are the the 4 contra indications to not nasal intubate a pt?

Answer 5

• Apnea
• Severe Mid-face trauma
• BLOOD THINNERS
• JAUNDICE

Question 6

how old does a pt need to be for a nasal intubation?

Answer 6

12 yo and up

Question 7

how soon do you need to notify EMS division about a cricothyrotomy?

Answer 7

24 hours

Question 8

when should you consider doing a cricothyrotomy?

Answer 8

when there is an away issue and an airway is needed, ALL other means of ventilation have been exhausted.

• CAN NOT INTUBATE CAN NOT VENTILATE

Ex:

• anaphylaxis
• burn
• choking (consider right main stem first)
• major facial trauma

Question 9

what are the contraindications for a cricothyrotomy?

Answer 9

less than 12 yo

Question 10

what are the major contraindications of using CPAP?

Answer 10

• BP <90
• pneumothorax
• Lack of airway protective reflexes
• Significant altered level of consciousness (unable to follow verbal commands)
• Trauma
• Resp or cardiac arrest

Question 11

When is ETCO2 mediatory to use?

Answer 11

Any ET tube placement.

Question 12

What does low CO2 values represent (<25)?

Answer 12

Low perfusion:

• Sepsis
• PE
• hyperventilation (hyperglycemia, acidosis, or anxiety)

Question 13

when you see the ETCO2 level dropping during CPR what is one thing you can do to see if you can make it go back up?

Answer 13

Switch the person doing compressions

Question 14

At what level of CO2 after 20 min of CPR likely represents low CO2 and poor outcome to justifying stopping CPR efforts?

Answer 14

10 mmHg

Question 15

A sudden spike in CO2 during CPR can indicate what?

Answer 15

ROSC

Question 16

ALL 3 have to be present to indicate needle thoracotomy for a tension pneumothorax?

Answer 16

• severe respiratory distress
• hypotension and signs of shock
• unilateral absent or decreased breath sounds

Question 17

When should you consider bilateral needle decompression?

Answer 17

Chest blunt trauma and there is traumatic pulseless arrest

Question 18

how many joules do you cardio vert an adult?

Answer 18

200J

Question 19

how many joules do you cardiovert a child?

Answer 19

0.5-1j/kg

Question 20

does the tachycardia cause the hypotension?

what blood pressure can you give a benzodiazepine to?

Answer 20

most like the hypotension is from the rapid heart rate.
88-90 systolic = benzo
<88 systolic = straight to cardiovert

Question 21

A-flutter or A-fib, should you cardio vert them right away?

Answer 21

NO, try to fix the cause with O2 and fluids. cardiovert in a-fib you can risk a stroke.

Question 22

What do you need to do if you have to pace a child under the age of 12yo?

Answer 22

contact base, it is rare that they need pacing.

Question 23

what are the starting values of pacing?

Answer 23

80 mAmps

80 beats per minute

Question 24

how much do you increase the mAmps if you have not gotten capture?

Answer 24

10 mAmps every 10-15 secs.

check the femoral pulse once you have electrical capture.

Question 25

what are the three indications that you can consider IO? When do you need to contact base?

Answer 25

- Cardiac arrest - Severe hypotension with poor perfusion - Hypoglycemic (unresponsive) and no IV access Contact base for any other circumstances

Question 26

Can you remove IOs in the field?

Answer 26

no

Question 27

how many attempts can you make an IO attempt in a single site?

Answer 27

1

Question 28

What are the contraindications for IO placement?

Answer 28

- fracture - compartment syndrome - prosthetic - infection

Question 29

Can EMTs do humoral head IO placements?

Answer 29

NO

Question 30

What age can you do a proximal tibia or a distal femur IO?

Answer 30

Age 1-12

Question 31

what age do you do a manual insertion of IO?

Answer 31

<1 yo

Question 32

After placing a tourniquet what is one thing you need to do?

Answer 32

mark the skin or the tourniquet with time and date of placement.

Question 33

What is the number one indication of the use of physical restraints?

Answer 33

if the pt is posing danger to themselves or providers

Question 34

What are the 4 indications for the use of physical restraints?

Answer 34

- significantly impaired (intoxication, medical illness, injury, psychiatric condition) and lacks decision making capacity. - pt who exhibits violent, combative, or uncooperative behavior and does not respond to verbal de-escalation - pt who is suicidal and concern of harming themselves - mental health hold and concern of elopement

Question 35

can law enforcement tell Ems to use restraints?

Answer 35

NO, must be under the clinical judgment of the provider

Question 36

are handcuffs an appropriate restraint tool?

Answer 36

no

Question 37

What are the major points to document when there was the use of restraints?

Answer 37

- description of the scene and the pt - efforts to de-escalate the pt - type of restraint used - condition of the pt when restraints were placed, and reevaluations of pt - condition of the pt when transferred to hospital - any injury of pt or of EMS staff NEVER use AxO4 for the pt mental status when use of chemical restraints

Question 38

Where can you NOT remove the probes of a taser?

Answer 38

- eye - genitals - close to major neuromuscular structures go to ER for removal

Question 39

What drug do you consider for a person who is hypotensive and needs pain management?

Answer 39

Ketamine