Protocol Flashcards
(118 cards)
1
Q
Eye Opening
A
Spontaneous 4
To speech 3
To Pain 2
None 1
2
Q
Best Verbal Response (BVR)
A
Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 none 1
3
Q
Best Motor Response
A
Obeys 6 Localizes 5 Withdraws 4 Abnormal Flexion 3 Abnormal extension 2 None 1
4
Q
A mentally competent patient is considered to give informed consent when any of the following occur:
A
Patient gives verbal permission to treat
Patient gives written permission to treat
Patient does not object as you begin assessment.
5
Q
If the medical personnel are concerned for the safety of minor and the parent or legal guardian refuses treatment and transport, contact
A
the rescue district/battalion chief and law enforcement for assistance with transport
6
Q
A patient shall be defined as
A
a person who presents with subjective and/or objective signs and/or symptoms or a complaint which results in evaluation and/or treatment
7
Q
A patient encounter is dependent on
A
neither treatment nor transport nor cooperation from the patient. If a technician perceives a medical problem that requires evalution a patient encounter has been made and a full patient care report must be completed.
8
Q
Access to the storage safe can be achieved by
A
breaking the seal, then use the appropriate key or entering the individual paramedic’s PIN number and pressing the pound key.
9
Q
Completed JFRD Controlled Substance Daily Checklists will remain with the notebook until collected by
A
the District/Battalion Chiefs and forwarded to the Quality Improvement Officer
10
Q
Discrepancies concerning controlled substances will be
A
Reported to Rescue District/Battalion Chief
Recorded in the company logbook, including circumstances
Documented in the Explanation section of the JFRD Controlled Substance Daily Checklist
Investigated by the Quality Improvement Officer and Rescue District/Battalion chief with a discrepancy report provide to the Division chief of Rescue and the JFRD Medical director
11
Q
Controlled substances with expiration date listing only the month and year will be
A
considered as expired on the first day of the month listed.
12
Q
Monthly 23rd,24th, or 25th
A
Chief inspection of controlled substance
13
Q
Controlled substance inventory
ALS Engine
A
Minimum- Midazolam 5mg
Maximum - Midazolam 10mg
14
Q
Controlled substance inventory
Rescue Units
Minimum
A
Etomidate/Amidate-60 mg
Fentanyl 200mcg
Ketamine 500mg
Midazolam-15 mg
15
Q
Controlled substance inventory
Rescue Units
Maximum
A
Etomidate/Amidate- 100mg
Fentanyl- 400mcg
Ketamine - 1500mg
Midazolam- 25mg
16
Q
Controlled substance inventory will be determined and authorized by
A
Division chief of Rescue and the Medical Director
17
Q
IV Fluids/Medications
Inventory
Medications with a specific expiration date:
Medications that have an expiration date of a month and a year
A
Expire on that date
expire at the end of that month
18
Q
The JFRD is responsible for the
A
welfare of the patient and all medical treatment at the scene of an emergency
19
Q
Law enforcement is responsible for
A
traffic control and general scene management.
20
Q
Blood draw on patients
In your report, record
A
the date printed on the blood draw kit and the investigating officer’s name.
21
Q
Restrained patients shall be
A
placed in a supine postion
22
Q
Frequently assess the patient to ensure that the
A
airway is patent, distal limb circulation is adequate and that restraints can be released quickly should the patient’s condition deteriorate.
23
Q
The Intention of Quality Improvement will be
A
to train.
24
Q
When JFRD personnel suspect that abuse or neglect to a child or vulnerable adult has taken place, they shall initiate the following
A
Treat related injuries
Transport all suspected cases
If transport is refused:
Request law enforcement at the scene
Stay with patient until Law enforcement arrival
Notify the Rescue District/Battalion Chief
25
Resuscitation efforts may be terminated only when all of the following criteria exists
Arrest was not witnessed
No shocks provide prior to JFRD arrival
Patient is > 18 years old
Rhythm remains asystole after providing 20 minutes of full ACLS
26
Acutely hypothermic patients in cardiac arrest shall be
treated and transported
| Includes submersion victims
27
If law enforcement denies you access to the scene
You must obtain the law enforcement officers name and badge number.
28
If patient not assessed by medical staff within 15 minutes of arrival
consult with charge nurse or nurse manager for guidance; if there is an issue contact your district/battalion chief
29
Rescue personnel will transfer patient to the hospital stretcher in a timely and expedient manner. If the transfer is delayed
more than 30 minutes notify FRCC.
30
If, after informing patient of the state guidelines, the patient still insists on transport to another facility, transport will proceed according to patients wishes
This must be documented in Emergency Pro in the Trauma section of the Incident Tab.
31
Emphasis should be placed on early identification of
cardiac arrests with continuous well performed compressions, defibrillation and rapid transport
32
Use of an AutoPulse is contraindicated
in trauma patients
33
Trauma V-fib/Pulseless V-Tach
| Administer medications starting with
Epinephrine 1 mg (1:10,000)IV/IO
Repeat Epinephrine every 3 to 5 minutes(consistently)
Do not mix with any other drugs
34
Recurrent VF/VT give
Amiodarone 300mg Iv/IO
| Repeat Amiodarone once at 150 mg IV/IO
35
Forr Torsades de Pointes
Polymorphic VT
Refractory VF/VT
Give Magnesium Sulfate 2 grams IV/IO
36
Magnesium Sulfate is to be used as the first antiarrhythmic of choice
in Torsades(polymorphic VT)
37
H's and T's and their appropriate treatments
| Hypovolemia
fluid challenge with 2L max
38
H's and T's and their appropriate treatments
| Hypoxia
100% O2 with use of BVM and appropriate airway adjunct
39
H's and T's and their appropriate treatments
| Hydrogen Ion= acidosis
```
Sodium Bicarbonate 1mEq/kg IV/IO
Condtraindications
None is Asystole/PEA
Precautions
Do not mix with other drugs and flush line well after injecting
Inactivates Epinephrine when mix
Inactivates Dopamine when mix
```
40
H's and T's and their appropriate treatments
| Hyperthermia/Hypothermia
cool or warm as needed
41
H's and T's and their appropriate treatments
| Hypoglycemia
D50W 25grams IV/IO for a BGL less than 60 mg/dl
42
H's and T's and their appropriate treatments
| Toxins/Tablets
Narcan 1mg- 2mg IV/IO
43
Shock Trauma
| Orotracheal intubation
Administer Ketamine 2mg/kg IV/IO
44
Administer Midazolam in
2-5 mg increments IV/IO to maintain sedation, may repeat once in 10 minutes
Greater than 64 years old, administer in 2 mg increments
45
Midazolam contraindication
Intolerance to benzodiazepines
hypotension
Precaution: May cause hypotension
46
Head Trauma
| Orotracheal intubation
Administer Etomidate 0.5 mg/kg IV/IO over 30 seconds
Peak effect: 1 minute, do not try to intubate for one minute
Duration: 3-5 minutes
47
Etomidate Contraindications
Known sensitivity
Cardiac/Trauma arrest
Precaution: Pregnancy
48
If Etomidate is not successful at completing sedation(ie trismus, combative) and post Etomidate systolic BP is
greater than 110mm/Hg, administer Midazolam 2-5 mg
49
In cases of isolated spinal injuries
scene time is less critical and care should be taken in performing proper spinal immobilization.
50
High cervical injury may cause
apnea
51
Spinal Trauma
| Dopamine
5-10 mcg/kg/min IV/IO
52
Dopamine contraindications
Hypovolemic shock
Tachydysrhythmias
Precautions:
Patient receiving monoamine oxidase inhibitors
53
Chest Trauma patients may
deteriorate rapidly. Load and go is a priority
54
Sucking chest wound
apply Vaseline-type occlusive dressings to cover the wounds
Cover the occlusive dressing with sterile 4x4
Tape the dressing on three sides
55
Mechanism of injury is the
most important indicator of abdominal trauma
56
The best treatment for the patient with severe abdominal trauma is
rapid transport
57
Abdominal Evisceration
Never replace abdominal viscera
Cover with sterile dressing and moisten with NS( may need to periodically remoisten)
Secure the wet dressing in place if possible.
58
Extremity Trauma
| Adult and pediatric Fentanyl
1 mcg/kg (Maximum single dose 100 mcg) Slow IVP only
May repeat once in 10 minutes
Total max dose 200 mcg
59
Fentanly Contraindications
Hypotension (systolic blood pressure less than 90 mmhg)
Respiratory depression
Precaution:
Rapid administration may cause chest wall rigidity
60
Crush injury
| Adult
20 ml/kg Normal Saline; max 2L
include 50 mEq of Sodium Bicarbonate with initial normal saline liter prior to removing the compressive force
monitor for evidence of fluid overload
61
Crush injury
| Pediatric
20 ml/kg Normal Saline max 2L
Include 1 mEq/kg of Sodium Bicarbonate (Max dose 50mEq) with initial Normal Saline liter Prior to removing the compressive force
62
Crush Injury
| Life threatening dysrhythmias
peaked T waves or widening QRS complex
Calcium Chloride 5mg/kg (max dose 500 mg) over 2 minutes
Precaution: possible crystallization when mixed with Sodium Bicarbonate
63
Only law enforcement officers are permitted to
remove probes
64
Chemical burns
irrigate with NS for 20 minutes
65
Chemical burns involving Lime, Carbolic Acid, Sulfuric Acid, Solid Potassium or Sodium metals
Do not flush wounds with water, normal saline, sterile water, etc
Contact receiving physician for treatment
66
Superficial burns
Apply burn gel dressing if needed
67
Partial Thickness burns
apply dry, sterile dressings
| leave blisters intact
68
Full-Thickness burns
```
apply dry, sterile dressing
Adult and pediatric pain management
Fentanyl 1-2 mcg/kg (Maximum single dose 200 mcg) slow iv/io only
may repeat once in 10 minutes
Total max dose 400 mcg
```
69
On lightning strike scenes where there are multiple patients
reverse triage shall be applied and patients in cardiac arrest shall be worked first
70
Eye trauma
| Direct trauma
Patch both eyes gently without pressure to the globes
Maintain patient in supine position to reduce leakage of fluids from the eye
If blood is noted in anterior chamber, place the patient in semi-fowlers
Stabilize any impaled object and cover affected eye dim lights for patient comfort
71
Eye trauma
| Chemical/Irritant Exposure (ie pepper spray, tear gas)
irrigate affected eye with normal saline during transport
Apply dry sterile dressings to both eyes
Dim lights for patient
Tetracaine 2 drops to each eye before and after irrigation
may be repeated every 10 minutes
72
Tetracaine contraindications
known hypersensitivity to tetracaine or other ophthalmic anesthetics
Open ocular trauma
73
Eye trauma
| Atraumatic
Patch both eyes gently without pressure to the globes
| Dim lights for patient comfort
74
Patients presenting with chest pain should receive
Aspirin unless contraindicated or previously taken within 2 hours
Aspirin 324 mg PO, chewed
75
Aspirin Contraindications
```
Allergies to salicylates
Active GI bleeding
Precautions:
History of GI bleeding (consider Aspirin 162 mg po)
Use of anticoagulants
Pregnancy
```
76
Normotensive (SBP > 110 mmHg) and evidence of Acute Coronary Syndrome
NTG 0.4 mg SL every 5 minutes until pain is resolved or systolic BP drops below 110 mmHG
77
NTG Contraindications
Systolic BP less than 110 mmhg
| Hypovolemia
78
Pain management for STEMI patients only
Fentanyl 1 mcg/kg Slow IVP only ( Maximum single dose 100 mcg)
79
Chest pain
| Hypotensive (SBP
Administer Normal Saline bolus of 250 ML
Repeat as necessary up to 1L to maintain a systolic BP of 90 mmHg
If patient develops pulmonary edema stop IV fluid administration and administer Dopamine 5-10 mcg/kg/min IV and titrate to effect
80
Dopamine Contraindications
Hypovolemic shock
Tachydysrhythmias
Life-threatening arrhythmia
81
If onset of symptoms are 2 hours or less
Patient shall be transported to the nearest Comprehensive or Primary Stroke Center unless an exception exists.
82
If onset of symptoms are greater than 2 hours and up to 6 hours or the patient wakes up with stroke symptoms
Patient shall be transported to the nearest Comprehensive stroke center
83
Acute Stroke
| Hypoglycemia (
With vascular access
D50W 12.5 grams IV. Repeat BGL by finger stick in 5 minutes
If no improvement and BGL is below 60, repeat D50W 12.5 grams
84
Hypertension
| Place patient in
semi-fowlers position
85
Hyperkalemia in dialysis patients who may have missed dialysis
Calcium Chloride 5 mg/kg (max dose 500mg) over 2 minutes
86
Post Resuscitation Care
| Midazolam Contraindications
Systolic BP
87
If rhythm was converted with defibrillation prior to administering initial Amiodarone dose
150 mg Amiodarone in 100 cc NS bag over 10 mins
88
Post resuscitation care
| Bradycardia with Hypotension BP 9Systolic Bp
Administer Atropine 0.5 mg IV/IO every 5 to minutes (Maximum total dose 3mg)
89
V-tach or runs of V-tach (6> consecutive PVCs)
150 mg Amiodarone in 100cc NS bag over 10 mins
90
Narrow regular QRS (SVT)
Administer Adenosine 6mg rapid IV ( may attempt vagal maneuvers before administration of Adenosine) If adenosine 6 mg unsuccessful, administer adenosine 12 mg rapid IV
91
Adenosine contraindication
Third degree heart block
| Known WPW syndrome
92
Wide regular or irregular QRS (A flutter & A Fib)
Amiodarone 150 mg in 100ml NS run over ten minutes with 60 gtts/ml infusion set.
Contraindications
Hypersensitivity to medication
93
Tachycardia
| Unstable patient
Symptoms include CP or SOB, hypotension and altered mental status
94
Unstable
| Narrow regular QRS (SVT)
Synchronized cardioversion at 50J
| repeat as needed with escalating doses up to 100J
95
Unstable
| Narrow irregular QRS
Synchronized cardioversion at 120 J
| Repeat as needed with escalating doses up to 200 J
96
Unstable
| Wide regular QRS
Synchronized cardioversion at 100 J
| Repeat as need with escalating doses up 200 J
97
Symptomatic bradycardia is a combination of slow heart rate with symtoms such as
altered mental status, ongoing chest discomfort, hypotension or signs of shock
98
Unstable patient with bradycardia
Presenting with poor perfusion evidenced by slow heart rate and hypotension
Atropine 1mg IV/IO repeat once in 3 to 5 minutes
99
If bradycardia still refractory
Epinephrine Drip at 2-10 mcg/min
| 1mg (1:1000) Epinephrine mixed in 100cc normal saline
100
Asthma
| Mild distress
Wheezes only
Albuterol 5 mg and Atrovent 0.5 mg. May repeat as needed. Subsequent nebulizer treatments will contain only Albuterol 5mg
101
Asthma
| Moderate Distress
Wheezes/decreased breath sounds/accessory muscle use.
Albuterol 5 mg and Atrovent 0.5 mg. May repeat as needed. Subsequent nebulizer treatments will contain only Albuterol 5mg
Magnesium Sulfate 2 grams IV in 100ml of NS, infused over 5 minutes with a 60 ggts/ml set
Solu-medrol 125 mg IV
102
Asthma
| Severe Distress
Wheezes/stridor/decreased breath sounds with little or no air movement/accessory muscle use/tripoding.
Epinephrine 1:1000 0.3-0.5 mg IM( 0.3mg appropriate for >50 years old)
CPAP in conjunction with an in-line Albuterol/Atrovent
Albuterol 5 mg and Atrovent 0.5 mg. May repeat as needed. Subsequent nebulizer treatments will contain only Albuterol 5mg
Magnesium Sulfate 2 grams IV/IO in 100ml of NS, infused over 5 minutes with a 60 ggts/ml set
Solu-medrol 125 mg IV/IO
103
COPD
| Severe Distress
Wheezes/stridor/decreased breath sounds with little or no air movement/accessory muscle use/tripodingCPAP in conjunction with an in-line Albuterol/Atrovent
Albuterol 5 mg and Atrovent 0.5 mg. May repeat as needed. Subsequent nebulizer treatments will contain only Albuterol 5mg
Magnesium Sulfate 2 grams IV/IO in 100ml of NS, infused over 5 minutes with a 60 ggts/ml set
Solu-medrol 125 mg IV/IO
104
Abdominal/Flank pain
| Place patient in
position of comfort
105
Alcohol-related illness
| Maintain aspiration prophylaxis by
placing the patient in the recovery postion
106
For all alcohol syndrome and malnourished patients prior to
D50W administration
Thiamine 100 mg IV/IM
Contraindication
Known hypersensitivity
107
Allergic Reaction/Anaphylaxis
| Mild reaction
(without respiratory compromise)
| Benadryl 25 mg slow IV push or IM
108
Allergic Reaction/Anaphylaxis
| Moderate reaction
(without respiratory compromise)
Benadryl 25 mg slow IV push or IM
Solu-Medrol 125 mg slow IV push or IM
109
Allergic Reaction/Anaphylaxis
| Moderate reaction
(with respiratory compromise)
Benadryl 25 mg slow iv push or IM
Albuterol 5mg and Atrovent 0.5 mg. Subsequent nebulizer treatments will contain only albuterol 5mg
Solu-Medrol 125 mg slowIV push or IM
110
Allergic Reaction/Anaphylaxis
| Severe reaction/anaphylaxis
(severe respiratory distress and/or cardiovascular compromise)
Epinephrine 1:1000 0.3-0.5 mg IM (0.3 mg appropriate for >50 years old)
Albuterol 5mg and Atrovent 0.5 mg. Subsequent nebulizer treatments will contain only albuterol 5mg
Benadryl 25 mg slow IV/IO push or IM
Solu-Medrol 125 mg slow IV/IO push or IM
111
Altered Consciousness
| If respiratory depression present or unable to protect airway
Narcan 0.4 mg IV/IO/IM
| If no change in 2 minutes, may repeat Narcan to a total max dose of 1 mg
112
Nose Bleed
| Hemorrhage cannot be controlled
Neo-Synephrine 2 gtts in affected nostril
113
Neo-Synephrine Contraindications
Nose bleed secondary to Hypertension (Bp> 160/110)
Nose bleed secondary to head injury and CSF drainage
Hypersensitivity
114
Gastrointestinal related nausea and vomiting
Phenergan 12.5 mg ( 6.25 if greater that 64 years old) IV diluted in 100 ml of NS, infused over several minutes with a 60 gtts/ml set
May repeat dose once after 15 minutes if vomiting persists.
Contraindication
Pediatric patients
115
Signs of poor perfusion include
```
Cool mottled skin
Diminished pulses
altered mental status
increased capillary refill time ( greater than 3 seconds)
Tachycardia
Systolic BP less than 90 mm/hg
```
116
Excited delirium can mimic several medical conditions including
hypoxia
hypoglycemia
stroke
intracranial bleeding
117
Excited delirium
| If medication is required to calm the patient
administer Ketamine 4 mg/kg IM
118
The hypothermic heart is
irritable; excessive movement may result in ventricular arrythmias
