Protocols Flashcards
(456 cards)
1
Q
Keep SPO2 above what %
A
92%
2
Q
What dose of chewable ASA is given for cardiac chest pain
A
160mg (81x2= 162, close enough)
3
Q
When do you initiate transport in cardiac chest pain
A
After giving ASA and started oxygen if sats are below 92%
4
Q
When do you insert a saline lock in cardiac chest pain
A
After initiating transport
5
Q
In cardiac chest pain what do you give if the BP is under 90 systolic after placing an IV lock
A
IV Normal Saline 250mL bolus
6
Q
In cardiac chest pain what do you give if the BP is over 90 systolic after placing an IV lock
A
Nitroglycerin spray 0.4mg SL
7
Q
What is the dose, route, max dose, and time between doses for nitroglycerin spray
A
0.4mg SL q5min (max 3 doses)
8
Q
What can a QL3 do after 3 doses of nitroglycerin spray w/ a BP over 90 systolic in cardiac chest pain
A
Monitor and contact SMA
9
Q
What can a QL5 do after 3 doses of nitroglycerin spray w/ a BP over 90 systolic in cardiac chest pain
A
Morphine 2.5mg IV slow push, dimenhydrinate 25-50mg PO/IM/IV, and contact SMA
10
Q
What is the dose, route, max dose, and time between doses for morphine in cardiac chest pain (QL5)
A
2.5mg IV slow push q5min (max 15mg, 6 doses)
11
Q
What is the dose, route, max dose, and time between doses for dimenhydrinate in cardiac chest pain (QL5)
A
25-50mg PO/IM/IV, one dose.
12
Q
What’s the dose of ASA to be chewed if the ASA isn’t chewable in cardiac chest pain
Should know
A
325mg
13
Q
How many doses of ASA do you give in cardiac chest pain
A
1 dose only
14
Q
What is the dose, route, rate, max dose, and time between doses for normal saline in cardiac chest pain
A
250mL IV bolus q10min (4 doses)
15
Q
What pulse is usually felt when above 90 mmHg systolic
A
Radial pulse
16
Q
How do you calculate the doses of nitroglycerin spray if the patient self administered doses before you arrived
A
Self administered doses don’t count, continue as if they didn’t take any nitroglycerin.
17
Q
If you can feel a radial pulse but can’t get a BP, can you give nitroglycerin spray
A
No
18
Q
Between doses of Normal Saline IV bolus what are you checking other than BP
A
Pulmonary edema
19
Q
What are the indications for cardiac arrest
A
No carotid pulse, decreased LOC, and not breathing
20
Q
In cardiac arrest what takes priority, AED or compressions (if AED is present)
A
AED, but try to do both at the same time until analyzing. Unless due to asphyxiation or hypothermia ( core temp under 30°C) where oxygenation and CPR takes priority
21
Q
If using a AED, what is the first thing you do when opening the AED and why
A
Turn it on, it will often have command promps that can’t be skipped and sometimes doesn’t turn on
22
Q
In cardiac arrest, when can you discontinue resusitation
A
After 3 consecutive no shock advised, core temp is greater than 30°C, no pulse after 30 min of continual CPR, or if the SMA directs you to discontinue.
23
Q
What age uses pediatric AED pads, and what do you do if pediatric pads aren’t present for this age group
A
Ages 1-8, use adult pads if ped pads aren’t present
24
Q
What are the indications of post cardiac arrest
A
Someone that was in cardiac arrest that now has a carotid pulse
25
How long after a post arrest should you constantly monitor a patient's pulse and why
10 min because of high likelihood of another cardiac arrest
26
How often do you take baseline vitals for a post cardiac arrest patient
q 5 min
27
When should you initiate transport for post cardiac arrest if you aren't in transit yet
ASAP after a set of vitals
28
What is considered breathing spontaneously
Over 12 resps per min
29
In post cardiac arrest what should you consider if the patient doesn't have spontaneous breathing
Advanced airway
30
What BP in post cardiac arrest do you give NS IV
Under 90 mmHg systolic
31
What is the dose, route, max dose, and time between doses for normal saline during post cardiac arrest
500mL IV bolus, only one dose
32
After verifying BP is over 90 mmHg systolic or you have already given normal saline IV, what can you do in post cardiac arrest
Consider urinary catheterization and contact SMA
33
What is a normal urine output during urinary catheterization during post cardiac arrest
0.5mL/kg/hr
34
Under what geographic setting can vital signs absent protocol be used
Operational
35
What are patients with no pulse, no respirations, and no other signs of life after being injured in a blast or penetrating trauma ON THE BATTLEFIELD considered and treated
Killed in action and resusitation is not attempted
36
What is performed in the vital signs absent protocol that isn't performed on a cardiac arrest protocol
Bilat needle decompression if trauma to truncal/torsal region, and 1L IV/IO bolus of normal saline or ringers
37
What can only be performed operationally when using respiratory protocols
Cricothyroidotomy
38
What is the criteria for a supraglottic airway in a airway obstruction or impeding obstruction
GCS of 8 or under and/or no gag reflex
39
What can you do if a supraglottic airway in a airway obstruction or impeding obstruction patient isn't effective
Cricothyroidotomy if operational or transport and contact SMA
40
What can you do if basic airway management isn't effective in a airway obstruction or impeding obstruction patient that has a GCS over 8 and gag reflex
Cricothyroidotomy w/ transtracheal block (time permitting) if operational or transport and contact SMA
41
Indications for asthma/COPD SOB protocal
SOB with hx of COPD, asthma, or wheezing
42
What two things do you instantly when arriving to a conscious SOB patient
Position of comfort (semi-fowlers) and SPO2
43
S/S of severe SOB compared to mild/moderate
Altered LOC, cyanosis, can't finish sentences, use accessory muscles, SPO2 under 90%
44
What is the dose, route, max dose, and time between doses for sulbutamol for mild/moderate SOB
4-8 puffs MDI q20min (3 doses) or 5mg neb q20min (3 doses)
45
After giving oxygen to someone with severe SOB what do you give
Salbutamol (Ventolin)
46
When in severe SOB should you initiate transport if you haven't already
After first dose of sulbutamol (Ventolin)
47
With severe SOB what can a QL3 do after initiating transport and treating with sulbutamol (Ventolin)
Place an IV lock and contact SMA
48
What can a QL5 give for severe SOB that a QL3 can't
Ipratropium bromide, epinephrine, and dexamethasone
49
What is the dose, route, max dose, and time between doses for sulbutamol for severe SOB
Salbutamol nebulized continuous or 2 puffs MDI q1min
50
What is the dose, route, max dose, and time between doses for ipratropium bromide for severe SOB
0.5mg nebulized q10min (max 3 doses) or 8 puffs MDI q10min (max 3 doses)
51
What is the dose, concentration, route, max dose, and time between doses for epinephrine for severe SOB
Epinephrine (1:1000) 0.3mg IM (max 1 dose)
52
What is the dose, route, max dose, and time between doses for dexamethasone for severe SOB
Dexamethasone 10mg IV/IM/PO (max 1 dose)
53
What do you do if mild/moderate SOB starts showing signs of severe SOB
Change to the severe SOB protocol
54
What is the indicator of an adult when using anaphylaxis protocol
Greater that 30kg
55
What is the first treatment given after identifying anaphylaxis
Epinephrine
56
When do you initiate transport if not already done in anaphylaxis
After epi and oxygen therapy started
57
How do you treat a patient with a hypotensive systolic BP while in anaphylaxis
Normal saline IV
58
After checking/treating BP during anaphylaxis, what is the next assessment done for possible treatment and how do you treat it
SOB/Wheezing, salbutamol (Ventolin)
59
After checking/treating SOB/wheezing during anaphylaxis, what is the next treatment
Diphenhydramine (benadryl)
60
What can a QL5 give after giving diphenhydramine during anaphylaxis
Dexamethasone
61
What is the dose, concentration, route, max dose, and time between doses for epinephrine for anaphylaxis in an adult
Epinephrine 0.3mg IM q5min (max 3 doses)
62
What is the dose, route, max dose, and time between doses for normal saline for anaphylaxis in an adult
Normal saline 1-2L IV/IO titrated to 90mmHg
63
What is the dose, route, max dose, and time between doses for salbutamol (Ventolin) for anaphylaxis in an adult
Salbutamol 4-8 puffs MDI q20min or 5mg nebulized q20min
64
What is the dose, route, max dose, and time between doses for diphenhydramine (gravol) for anaphylaxis in an adult
Gravol or benadryl?
Diphenhydramine 50mg IM/PO/ (IV QL5) q2hrs (max dose 400mg/daily [8 doses])
65
What is the dose, route, max dose, and time between doses for dexamethasone for anaphylaxis in an adult
Dexamethasone 10mg IV/IM/PO (max 1 dose)
66
What do you access after every dose of epinephrine
Airway obstruction and hypotension
67
If using an epi-pen, how long do you hold it in the muscle
5 sec
68
During anaphylaxis, how much fluid can fluid shift from the vascular space to the tissue space
35%
69
What weight difference are children separated into when calculating epinephrine dose to a child
Under 15kg and between 15-30kg
70
What is the dose, concentration, route, max dose, and time between doses for epinephrine for anaphylaxis in person between 15-30kg
Epinephrine (1:1000) 0.15mg IM q5min (max dose 3)
71
What is the dose, concentration, route, max dose, and time between doses for epinephrine for anaphylaxis in a child under 15kg
Epinephrine (1:1000) 0.01mg/kg IM q5min (max dose 3)
72
What is the dose, route, max dose, and time between doses for normal saline for anaphylaxis in a person under 30kg
Normal saline IV/IO 20mL/kg (2 doses)
73
What is the dose, route, max dose, and time between doses for salbutamol for anaphylaxis in a person under 30kg
Salbutamol 2 puffs MDI q20min or 2.5mg nebulized q20min
74
What is the dose, route, max dose, and time between doses for diphenhydramine for anaphylaxis in people under 30kg
Diphenhydramine 1mg/kg IM/PO/ (IV QL5) q6hrs, no max dose
75
What is the dose, route, max dose, and time between doses for dexamethasone for anaphylaxis in people under 30kg
Dexamethasone 0.6mg/kg IV/IM/PO (max at adult dose) (1 dose only)
76
If suspected massive external hemorrhage with no obvious source or amputation, what regions do you check in order
Inguinal region, legs, neck, axilla, then arms.
Then scalp, nose, and abdomen
77
What should you do after you have identified a massive bleed
Control with direct or indirect pressure (unless contraindicated)
78
For a wound that doesn't meet tourniquet approval, how would you treat it after direct/indirect pressure.
Packing with hemostatic dressing (if not contraindicated)
79
What do you do if tourniquet protocal failed to control the bleeding
Packing with hemostatic dressing
80
After packing a massive hemorrhage doesn't work, what do you attempt next
Apply a junction tourniquet (if not contraindicated)
81
What do you do if a junction tourniquet isn't effective or can't be used
Maintain pressure with hemostatic dressing
82
What do you do after you have finished controlling or treating a obvious massive bleed
Check for non-obivious massive hemorrhage and then significant external hemorrhage
83
After you have controlled or treated all obvious, non-obvious, and significant hemorrhages, what do you consider applying
Consider pelvic binder
84
After completing the massive hemorrhage protocol, what do you do next
Continue with casualty assessment
85
What cavities can't be packed
Abdo, thoracic, and cranial
86
If a hemostatic dressing fails at controlling a bleed, what do you attempt
Remove packing and attempt a 2nd application
87
How long should you maintain pressure on a hemostatic or plain packing
Hemostatic- 5min
Plain- 10min
88
What are the indications for a pelvic binder
Penetrating/blunt pelvic trauma, unexplained hypotension in blast/blunt trauma, lower limb part/full amputation, or pelvic pain/tenderness
89
What is the lethal triad in hemorrhage shock
Coagulopathy, acidosis, hypothermia
90
Indication of hemorrhagic shock in adult, child, infant
Adult: systolic BP less than 90mmHg (loss of radial pulse), or pulse greater than 110.
Ages 1-9: systolic BP less than 70 - (2 x age)mmHg
Under 1 year old: systolic BP less than 70mmHg
Or injury predicts hemorrhagic shock in future
91
What are injuries that you can predict hemorrhage shock in near future that isn't significant external bleeding
Penetration injury to chest/Abdo, severe hypothermia w/ trauma, unstable pelvis, femur fracture, blast injury, blunt truama to Abdo/back/chest.
92
When expecting hemorrhagic shock what 4 things are attempted before establishing an IV/IO line
Control external hemorrhages, airway/respiratory management, hypothermia prevention, and transport intitation
93
What can a QL5 do that a QL3 can't when treating hemorrhagic shock
TXA protocol
94
When do you do TXA in hemostatic shock protocol
After you have IV/IO access, is an adult, and initiated transport
95
When do you give fluid replacement IV/IO therapy, and what fluid is used
Hypovolemic protocol?
QL3: after getting an IV/IO line, normal saline (ped), normal saline or ringers (adult)
QL5: after getting an IV/IO on a ped, normal saline. After TXA protocol on an adult, normal saline or ringers
96
What is the dose, route, max dose, and time between doses for normal saline for hemorrhagic shock for a pediatric
20mg/kg normal saline IV/IO bolus
97
What is the dose, route, max dose, and time between doses for normal saline/ ringers for hemorrhagic shock adult
250mL bolus IV/IO, (max 1L, 4 doses)
unless expected TBI
98
When an adult is in hemorrhagic shock what can you do after you are in transit and giving IV/IO fluid therapy
Hypothermia management, consider a urinary catheter, and contact SMA
99
What is the dose, route, max dose, and time between doses for TXA for hemorrhagic shock
Tranexamic acid 1gram/10mL normal saline IV/IO slow push q1hr (max 2 doses)
100
Indication for burn management protocol
2nd or 3rd degree burns to greater than 20% body surface area
101
What is the first priority for burn management
Stop the burn
102
After you stop the burn in burn management what is the next step
Accessing airway/oxygen therapy
103
Why is oxygen therapy possibly dangerous with burn management
Ignition source (burnt clothes) can ignite the oxygen
104
What are signs in a burn victim that would make you consider to prepare a surgical airway
Soot in mouth, chest burns, neck burns, SOB, hoarse voice, SPO2 low
105
After you have assessed the airway and gave oxygen therapy to a burn victim, what do you do next
Hypothermia prevention and active warming
106
If a burn management patient has a BP below 90mmHg systolic, what must you consider when treating
If the hypotension is primarily caused by a hemorrhage, follow hemorrhagic shock protocol
107
What is the dose, route, max dose, and time between doses for ringers for burn management
500mL ringers IV/IO bolus (max 2 L, 4 doses)
108
After you have verified the burn management patient isn't hypotensive, what do you do next
Calculate total surface area of the burn and start the rule of ten or parkland formula burn protocols
109
What protocol should you start after rules of ten or parkland formula burn ptotocol
Pain protocol
110
After pain management for burn patients, what 3 things should you do
Transport if you haven't already, insert urinary Foley catheter, and contact SMA
111
What kind of dressing do you use on burns
Sterile, dry, non-adhesive dressings
112
What is the target urine output for a burn patient on a Foley catheter by kg and average for an adult
0.5mL/kg/hr
Adult: 30-50mL/hr
113
Before treating for pain what should you assess and consider
Assess cause and severity, consider IV lock
114
What pain management medications do you have to closely monitor airway/breathing/circulation
Ketamine, morphine, fentanyl
115
Pain management is divided into what age groups
Child: 4-16 y/o
Adult: greater than 16 y/o
116
What medications can be used in pain management for a child
Advil and tylenol
117
When can you give ketamine in pain management
Adult, severe pain, operationally
118
When can you give morphine in pain management
Adult, severe pain, no significant risk of shock/respiratory distress, operational
119
When can you give oral transmucosal fentanyl citrate in pain management
120
When can you transition from mild pain protocol to severe pain protocol in an adult
Pain is now severe or mild protocol pain management hasn't completely controlled the pain
121
What do you do if pain is completely controlled in a mild pain in an adult
Transport if not already occurred, contact SMA, continue with previous protocols if referred to pain protocol
122
What medications are used to treat mild pain and can be used with other mild pain medications
Advil or meloxicam
And/or tylenol
123
What do you give after giving fentanyl, morphine, or ketamine
Ondansetron or dimenhydrinate (gravol)
124
What do you do if you haven't yet controlled pain and no other pain management available
Transport, contact SMA, continue with previous protocol if referred to this protocol
125
How do you treat severe pain in a patient under 4 years old
Contact the SMA
126
With severe pain, if all medications are not indicated/available, what can be used
Mild pain management medications
127
What treatment can be added for pain management if opioids don't completely manage the pain
Ketamine
128
How do you treat emergence/recovery reaction to ketamine. Including dose, route, time between doses, and max dose
Midazolam 2mg IV/IM/IO q10min (max 4 doses)
129
What medications shouldn't be used for mild pain with a hemorrhage
Advil
130
What is the dose, route, max dose, and time between doses for Advil in a child in pain management
Advil 10mg/kg PO q8hrs
131
What is the dose, route, max dose, and time between doses for tylenol in a child in pain management
Tylenol 15mg/kg PO q6hrs
132
What is the dose, route, max dose, and time between doses for ketamine in an adult in pain management
Ketamine 25mg IV/IO slow push (1 min) q20min (max 4 doses/2 hrs)
Or
Ketamine 50mg IM/IN q30min (max 2 doses)
133
What is the dose, route, max dose, and time between doses for oral transmucosal fentanyl in an adult in pain management
oral transmucosal fentanyl 800ug transbucal q15min (max 2 doses)
134
What is the dose, route, max dose, and time between doses for morphine in an adult in pain management
Morphine 2.5mg IV/IO slow push (1 min) q5min (max dose 15mg/30min)
Or
Morphine 10mg IM q30min (no max dose)
135
What is the dose, route, max dose, and time between doses for advil in an adult in pain management
Advil 800mg PO q8hrs
136
What is the dose, route, max dose, and time between doses for meloxicam in an adult in pain management
Meloxicam 15mg PO (only one dose)
137
What is the dose, route, max dose, and time between doses for tylenol in an adult in pain management
Tylenol 1g PO q6hrs
138
What is the dose, route, max dose, and time between doses for ondansetron in adults in pain management
Ondansetron 8mg IV/IM/PO q8hrs
139
What is the dose, route, max dose, and time between doses for dimenhydrinate (gravol) in an adult in pain management
dimenhydrinate (gravol) 50mg IV/IM/PO q4hrs
140
What are the indications for minor TBI protocol
Operation, head injury w/ decreased level of concussion or concussion symptoms
141
Signs of an open globe injury
Full thickness Eye laceration, collapsed/severe distorted eye, prolapsed intraocular content, irregular pupil, shallow anterior chamber
142
How do you treat an open globe injury
Rigid eye shield, antibiotic protocol
143
What can a QL5 give for an open globe injury that a QL3 can't, and why/when
Ondansetron for adults. Used for nausea
144
What should you look for to remove if a patient has an eye injury
Contacts
145
What do you always do for a foreign body/substance if it doesn't have an open globe injury
Tetracaine eye drops
146
When do you not allow the patient to eat or drink when they have an eye injury
If it's an open globe injury or if it has a foreign body that can't be removed
147
How do you attempt to remove a foreign body/ substance from an eye after freezing
Irrigation and removal with moistened cotton tip applicator
148
If you can't successfully remove a foreign body from an eye, what do you do
Apply a rigid eye shield, contact SMA, transport
149
What must you do if you have removed a foreign substance/body from a patient's eye
Contact SMA
150
If there is an eye injury without an open globe injury or foreign body/substance, what do you do after freezing
Stain with fluorescein eye drops
151
What do you do regardless of your findings after fluorescein eye staining
Contact the SMA
152
After successfully treating an eye injury, what do you always do before discharge
Visual acuity test
153
What must a patient avoid with a open globe injury or having a foreign body of the eye
Avoid increased intraocular pressure (Valsalva, blowing nose, or pressure on the eye)
Eating
154
What is the dose, route, max dose, and time between doses for ondansetron for an eye injury
Ondansetron 8mg IV/IM/PO q8hrs
155
What is the dose, route, max dose, and time between doses for tetracaine for an eye injury
Tetracaine 0.5-1.0% 1-2gtts in eye (only one dose)
156
What is the dose, route, max dose, and time between doses for fluorescein for an eye injury
Fluorescein 1-2gtts in eye (only one dose)
157
What is an indication of chest trauma
Puncture/blast trauma to the torso from the umbilicus up. Or blunt trauma to chest/upper back
158
Indication of tension pneumothorax
Chest trauma w/
Severe/progressive respiratory distress or BP under 90mmHg systolic ( no radial pulse) or SPO2 below 90% or relief after needle decompression during VSA protocol
159
what is the immediate treatment of a open wound to the trunk region from the umbilicus up.
Cover with hand and apply a chest seal
160
When do you initiate transport during a chest Truama protocol
After verifying no open chest wounds or after dressing the open chest wounds
161
If no indications of a tension pneumothorax what do you do in the chest trauma protocol
Continue with casualty assessment before continuing chest truama protocol
162
What do you do if you have the indications of a tension pneumothorax again and an open chest wound
Burp the chest seals
163
If indications for a tension pneumothorax are present and burping wasn't effective or there are no open wounds. What is the next treatment
Needle decompression performed on the affected side/sides.
164
What is attempted if needle decompression isn't effective to an affected side/sides
Attempt a second at the other approved need decompression site
165
If treating a previously effective needle decompression site again, how do you landmark
Laterally or posterior of the original site
166
What is the first thing you do other than initiate BLS to a TBI injury that meets severe criteria
Initiate transport
167
Indication on sever TBI
Head injury w/ a GCS of 8 or less
168
How do you assess brain injury during a severe TBI protocol
Pupil size/reactivity
GCS
Gross focal neuro signs/deficits
169
With severe TBI what are the criteria for a impeding brain herniation
Dilated and unreactive pupils, progressive neurologic deterioration, cushings triad, extensor posturing, or asymmetric pupils
170
What are the symptoms of Cushing triad
Increased systolic BP, widening pulse pressure, and bradycardia
171
If no indication of impeding brain herniation in a severe TBI, what SPO2 range do you want
Between 95-99%
172
What is the systemic BP you want to maintain above with severe TBI. With and without hemorrhage
Greater than 110 with no hemorrhage
Greater than 100 with hemorrhage
173
When maintaining BP in a severe TBI w/ or w/o herniation, what fluid solution is used and what is the dose, route, rate, and max dose
Normal saline 250mL IV bolus (max 4 doses)
174
What is the core temp to maintain with a severe TBI patient
35.5-37.2 °C
175
What will a QL5 give to a severe TBI patient w/ herniation
3% hypertonic solution 250mL IV bolus q3hrs (max 2 doses)
176
What is the preferred head position of a severe TBI patient with herniation
Elevated 30° (sniffing position)
177
What is the ventilation method of a severe TBI patient with herniation
Hyperventilate 20 breaths/min or EtCO2 of 30mmHg. Until herniation resolves or 20min.
178
?Indication of performing a other source of external hemorrhage?
Significant hemorrhage that hemodynamic status is believed will become compromised without treatment
179
When do you apply direct pressure to a scalp bleed
No deformity or instability on palpation, meaning damage due to skull fracture is unlikely
180
How do you treat a scalp bleed with a skull fracture
Dressing without direct pressure
181
Without a skull fracture what can a QL3 do to control a scalp bleed other than direct or pressure
Hemostatic dressing/packing
182
What 2 additional things can a QL5 due to control a scalp bleed without a skull fracture
Whip stitch or stapler
183
What is the first thing you do to control a massive epistaxis or a neck hemorrhage
Direct pressure
184
After direct pressure, what can a QL3 due to treat a epistaxis or neck hemorrhage
Hemostatic dressing/packing
185
What can a QL5 do to treat a massive epistaxis or a neck hemorrhage
Foley catheter with packing
186
When can't you use a Foley catheter on a massive epistaxis
Suspected basal skull fracture
187
How do QL5 and QL3's treat an Abdo evisceration
Rinse with sterile water
Direct pressure on visible bleed location or cover region with hemostatic dressing
Cover exposed bowel with moist sterile dressing and/or a water-impermeable cover
188
After controlling the bleed of all significant hemorrhages what do you do next
Continue with casualty assessment
189
What adds extra difficulty when dealing with a massive epistaxis or neck hemorrhage compared to other significant bleeds
Have to manage the airway at the same time
190
Indication of narcotic overdose
Decreased level of consciousness w/ a respiration rate less than 10/min and a history that suggests narcotic use
Pinpoint pupils increase the likelihood of narcotic overdose
191
What are 2 things to be prepared for when treating a narcotic overdose
Seizures and hostile patients
192
What is the therapeutic intent of giving naloxone (narcan)
To improve respirations to greater then 10/min, and SpO2 to 92% or greater
193
After getting the indications to start narcotic overdose protocol, what is the first thing you do other than assess
Verify systolic BP is 90mmHg or above using BP cuff or if radial pulse is present
194
What do you do if the systolic BP is 90mmHg or higher when first starting your narcotic overdose protocol
Attempt to initiate an IV lock
195
If the systolic BP is under 90mmHg or you can't get IV access when starting your narcotic overdose protocol, what do you do
Give naloxone IM, SC, or IN
196
What is the most important support being given to a patient in narcotic overdose before narcan stops the overdose
Ventilations
197
After giving the first dose of naloxone to a patient in narcotic overdose w/ a systolic BP under 90mmHg, what do you do
Obtain IV or IO access to give IV/IO normal saline
198
After systolic BP is greater than 90mmHg or you have reached the max dose of IV/IO normal saline, after 1 dose of naloxone during a narcotic overdose. What do you do
Continue naloxone treatments
199
What is the dose, route, max dose, and time between doses for naloxone in an adult during narcotic overdose
Naloxone 0.8mg IM/SC q3min (max 5mg)
Naloxone 0.4mg IV/IO q3min (max 5mg)
Naloxone 5mg q3min (max 20mg)
200
If you reach max dose of naloxone during narcotic overdose protocol and still haven't increased resperations over 10/min, what do you do
Contact the SMA for guidance
201
First thing performed after identifying a seizure after initiating BLS
Obtain blood glucose
202
What is considered hypoglycemia
Less than 4mmol/L
203
what do you do if a seizure patient is hypoglycemic
Start hypoglycemic protocol and remain in the protocol if it resolves the seizure
204
During the seizure protocol what do you do if you confirm convulsive status epileptics before having IV/IO access
After ruling out hypoglycemia, give midazolam IN than attempt to get a IV/IO line for future doses
205
During the seizure protocol what do you do if you confirm convulsive status epileptics after having IV/IO access
If hypoglycemia has been ruled out, give midazolam IV/IO
206
When should you contact the SMA after verifying convulsive status epilepticus
As soon as possible as long as it doesn't delay midazolam doses or transportation
207
Indication of convulsive status epilepticus
Continuous convulsive seizures lasting longer than 5min
Or
2 or more seizures within 5 minutes without return of normal mental status in between
208
How do you administer 0.5mL or less IN
Every dose in opposite nostrils
209
How do you administer more than 0.5mL IN
Half the full dose in each nostril
210
What is the dose, route, max dose, and time between doses for midazolam in an adult during seizure protocol
Midazolam 5mg IV/IO/IN than 2.5mg IV/IO/IN q5min until seizure stops
211
What is the dose, route, max dose, and time between doses for midazolam in an pediatric patient (under 50kg) during seizure protocol
Midazolam 0.1mg/kg IV/IO/IN than 0.1mg/kg (max 2.5mg) IV/IO/IN q5min until seizure stops or total dose of 0.6mg/kg
IV/IO is slow push over 1-2 min
212
Antibiotic protocol indications
Open wounds with surface contamination with delay of transit beyond 2hrs, open globe injury, suspected bowel injury, burn injury with visible infection
213
Before giving antibiotics what should you consider
Initiating a IV/IO
214
When can you give moxifloxacin during antibiotic protocol/ who can?
If they can take oral medication and an adult
QL3 and QL5
215
When can you give clindamycin during antibiotic protocol and who can?
Child/adult, IO/IV access, and allergic to penicillin
QL5
216
When can you give cefoxitin during antibiotic protocol/ who can?
Child/adult, IV/IO access, no penicillin allergy
QL5
217
When can you give cefoxitin during antibiotic protocol/ who can?
Child/adult, IV/IO access, no penicillin allergy
QL5
218
Ideally when is the latest you should administer antibiotics for a open globe injury
60min
219
What is the dose, route, max dose, and time between doses for moxifloxacin in adults
400mg moxifloxacin PO q24hrs
220
What is the dose, route, max dose, and time between doses for clindamycin in adults
600mg clindamycin IV/IO/IM q8hrs
221
What is the dose, route, max dose, and time between doses for clindamycin in children
10mg/kg clindamycin IV/IO/IM q8h
222
What is the dose, route, max dose, and time between doses for cefoxitin in adults
2g cefoxitin IV/IO/IM q8hrs (no max dose)
223
What is the dose, route, max dose, and time between doses for cefoxitin in children
30mg/kg cefoxitin IV/IO/IM slow push(not IM) q8hrs
224
What is the youngest age you can treat using antibiotic protocol
1 month
225
What is the indication to use hostile/violent patient protocol
On operation w/ uncontrollable adult threatening to harm themself/others or a threat to safety
226
What should you consider before using hostile/violent patient protocol
Caused by a medical condition
227
Can you combine haloperidol and midazolam in one syringe
Yes
228
What is a side effect reaction to haloperidol and how do you treat it with dose, route, and time between doses
Muscle spasms treated with diphenhydramine 50mg IV/IM q6hrs
229
What do you attempt before chemically restraining a patient
Verbal de-escalation
230
What are the medications used when chemically restraining a patient
Haloperidol and midazolam
231
What is the dose, route, max dose, and time between doses for haloperidol and midazolam in a violant adults
Haloperidol 5mg IM/IV/IO q10min (max 2 doses)
Midazolam 2mg IM/IV/IO q10min (max 2 doses)
232
Youngest age that you can use hypoglycemic protocol
4 y/o
233
Indication of hypoglycemic protocol
Decreased level of consciousness and signs/symptoms suggesting hypothermia
234
What is the first thing you do other than initiate BLS in hypoglycemic protocol
Check blood glucose
235
What is an acceptable blood glucose level in a hypoglycemic protocol
Greater than or equal to 4.0 mmol/L
236
What do you do if a patient is hypoglycemic and has a patent airway
Oral glucose
237
When do you initiate transport for a patient in hypoglycemic protocol
After attempting to initiate an IV or if the patient isn't hypoglycemic when first testing blood glucose
238
If the patient is hypoglycemic and you get an IV, what do you treat with
D10W
239
If the patient is hypoglycemic and you can't get an IV, what do you treat with
Glucagon
240
When do you give oral glucose after glucagon
If the airway is patent
241
After giving glucagon to a hypoglycemic patient what should be attempted
Initiate IV line
242
If the patient doesn't recover or deteriorates after giving glucagon what do you attempt if you don't have an IV line
Intimate an IO
243
After getting an IV or IO line after giving glucagon, what should you check
Blood glucose
244
What do you do if blood glucose increases above 4mmol/L after treating hypoglycemia
Discontinue D10W, rechecking blood glucose q30min, and contact SMA
245
What do you do if the patient initially isn't hypoglycemic while running a hypoglycemic protocol other than initiate transport
Consider other causes / unconscious NYD protocol. Contact the SMA
246
What is the dose, route, max dose, and time between doses for D10W in a hypoglycemic adults
D10W 100ml IV/IO bolus q10min (2 doses)
247
What is the dose, route, max dose, and time between doses for D10W in a hypoglycemic pediatric
D10W 2ml/kg IV/IO bolus q15min (2 doses)
248
What do you do if the patient is still hypoglycemic after giving 2 doses of D10W for adults and peds
Adult: reduce D10W to 100ml/hr
Peds: change to saline lock
And
Contact SMA
249
What is the dose, route, max dose, and time between doses for glucagon in a hypoglycemic adult
Glucagon 1mg IM/SC (one dose only)
250
What is the dose, route, max dose, and time between doses for glucagon in a hypoglycemic adult
Glucagon 0.5mg IM/SC (one dose only)
251
After getting an IV or IO line after giving glucagon, what should you give if they are still hypoglycemic
D10W
252
Indications for unconscious NYD protocol
Unconscious adult with an unknown cause
253
What the first step thing you do in unconscious NYD protocol other than initiate BLS
Initiate transport
254
What 3 things do you check/do during an unconscious NYD protocol for treatment, and what order
Check blood glucose, give naloxone, check for hypovolemia
255
If no treatment works in unconscious NYD protocol what should you do
Contact SMA
256
If naloxone improves respiratory distress or level of consciousness what does that mean
It's probably a narcotic overdose and narcotic overdose protocol should be used
257
What is the dose, route, max dose, and time between doses for naloxone in unconscious NYD protocol
Naloxone 0.4mg IV/IO
Naloxone 0.8mg IM/SC
Naloxone 4mg IN
One dose unless taking narcotic overdose protocol
258
Indication of hypothermia
Core temp less than 35°C or signs/symptoms of hypothermia
259
What core temp is mild hypothermia
32-35°C
260
What core temp is moderate hypothermia
28-32°C
261
What core temp is severe hypothermia
Less than 28°C
262
Signs/symptoms of mild hypothermia
Shivering, vasoconstriction extremities, apathy, slurred speech, ataxia, and impaired judgement
263
Signs/symptoms of moderate hypothermia
Altered level of consciousness, decreased pulse, decreased respirations, diluted pupils, NO SHIVERING
264
Signs/symptoms of severe hypothermia
Coma, apnea, asystole, nonreactive pupils
265
During hypothermia protocol, what is the first thing you do other than initiating BLS
Check blood glucose for hypoglycemia
266
If a hypoglycemia is present in a hypothermia patient what do you do
Do the hypoglycemia protocol before returning to hypothermia protocol
267
What do you consider for treatment plan after verifying no hypoglycemia in a hypothermia protocol
Consider saline lock
268
What are the 3 ways to treat hypothermia to rewarm, in order
Remove cold/wet clothes and insulate/shield from the environment. Passive rewarming. Finally active rewarming.
269
After rewarming patient with hypothermia, what 2 things should you do
Contact SMA, bladder catheterization.
270
What are secondary conditions caused by hypothermia
Dehydrated, undernutrition, fatigue, arrhythmias
271
Indications of hyperthermia
Core temp greater than 40°C or signs/symptoms of hyperthermia
272
What differentiates between heat exhaustion and heat stroke
Depressed central nervous system
273
After removing the clothes and start cooling a patient in heat exhaustion what should you do next
Encourage PO rehydration and transport
274
After initiating BLS for heat stroke what is the important next step
Remove from heat/ immediate evac
275
After removing clothes and start cooling for a heat stroke patient what is left for treatment
1L normal saline IV/IO bolus
Contact SMA, consider urinary catheterization
276
Signs of heat cramps
Involuntary muscle spasms often in calves, arms, abdomen, and back due to heat
277
Signs/symptoms of heat exhaustion
Nausea, heat cramps, h/a, fatigue, light headed, pale/cool/clammy, HEAVY SWEATING
278
Signs/symptoms of heat stroke
NO SWEATING, core temp over 40°C, confusion, irrational behavior, tachycardia early, bradycardia late, hypotension, rapid/shallow breathing, hot skin, loss of consciousness, seizure, coma
279
Who can use the dive related emergency protocol
QL5
280
What is the indication of dive related emergency protocol
A diver with signs/symptoms of arterial gas embolism or decompression sickness
281
What is the recommended position of a dive related condition
Supine if conscious
Recovery if unconscious
282
Who is the SMA to contact with regard to a dive related emergency condition
Dive medicine consultant
283
Immediate treatment for dive related emergency conditions before contacting SMA
100% oxygen therapy
1L normal saline bolus IV/IO (2 doses)
284
What should be asked to the SMA with regards to transportation of a diver
Transport to closest medial treatment facility or recompression facility
285
Indication of arterial gas embolism
Within 5-10 minutes of surfacing:
Loss of consciousness, neurological deficits, chest pain, SOB.
286
Indication of decompression sickness
Severe symptoms in 1-3hrs:
Neurological deficits, vertigo, SOB, chest pain
most symptoms within 24hrs of decompression:
Joint pain, paresthesia, skin rash/swelling
287
If transporting a dive related emergency condition by air, what should you recommend to the air crew
To fly as low as safely possible
288
In what environment can you use the nerve agent exposure protocol
Operationally
289
What does CRESS acrynom stand for
Consciousness (unconscious/seizure)
Respiration (increased or decreased)
Eyes (pinpoint)
Secretions (increased)
Skin (sweaty)
Other (vomiting, incontinence, bradycardia)
290
Severity of nerve agent exposure
Mild: pinpoint pupils, minor sections
Moderate: non-ambulatory, excessive secretion, confusion
Severe: cyanosis, unconscious, convulsions, respiratory distress, significant bradycardia
291
What are the 3 B's of nerve agent toxicity
Bronchospasm, bradycardia, bronchorrhea
292
If you have identified signs/symptoms of nerve agent exposure, what should you do before decontamination drills
Mild symptoms: straight to decontamination drills.
Mod/severe symptoms: obidoxime/atropine auto-injector and diazepam auto-injector
293
How often do you reassess a patient until evacuation to a decontamination center
q5min
294
After decontamination drills how do you treat seizures and time between doses
Diazepam auto-injector q5min until seizure stop
295
How to treat nerve agent toxicity after decontamination drills w/ time between doses
Continue with obidoxime/atropine auto-injector q15min (max 3 doses)
After max dose: atropine auto-injector q5min
296
Contraindications of acetaminophen (tylenol), prehospital
Hypersensitivity, known G6PD deficiency, liver failure.
297
Adverse effects of acetaminophen (tylenol), prehospital
Uncommon
298
Contraindications of acetylsalicylic acid (ASA/aspirin), prehospital
Hypersensitivity to NSAIDs, bleeding disorder, active gastrointestinal bleeding
299
Caution of acetylsalicylic acid (ASA/aspirin), prehospital
History of asthma or nasal polyps
300
Adverse effect of acetylsalicylic acid (ASA/aspirin), prehospital
Gastrointestinal complaints, nausea, heartburn
301
Cautions of atropine, prehospital
Can cause anticholinergic toxicology (acute glaucoma w/ blindness, agitation, delirium, confusion, drowsiness, tachycardia).
302
Adverse effects of atropine
Tachycardia, h/a, restlessness, insomnia, dizziness, dry/hot skin, photophobia, urticaria, dry mouth, impaired GI mobility, blurred vision, mydriasis
303
Cefoxitin containdications
Hypersensitivity to drug or cephalosporin antibiotics
304
Cefoxitin caution
Allergy to penicillin
305
Cefoxitin adverse reaction
Diarrhea, h/a, rash, urticaria/pruritus, allergic reaction
306
Clindamycin contraindications
Hypersensitivity, liver impairment, under 1 month old
307
Clindamycin cautions
Ulcerative colitis or crohns
308
Clindamycin adverse reactions
Hypotension, nausea/vomiting, diarrhea/Abdo pain, urticaria/rashes, thrombophlebitis
309
Dexamethasone contraindications
Hypersensitivity, Anaphylaxis to other corticosteroids, systemic fungal infection
310
dexamethasone cautions
Emotionally unstable/psychotic tendencies (exacerbate conditions), diverticulitis, peptic ulcer, congestive heart failure, hypertension, immunocompromised
311
Dexamethasone adverse effects
Salt/water retention, potassium loss, hypertension, Anaphylaxis, hyperglycemia
312
Where should you not inject dexamethasone IM
Deltoid
313
D10W caution
Suspected head injury (contact SMA)
314
Contraindications for dimenhydrinate (gravol)
Glaucoma, chronic lung disease, difficulty urinating due to prostatic hypertrophy.
315
Dimenhydrinate (gravol) cautions
Contact SMA before use with alcohol or sedatives due to increased sedation
316
Dimenhydrinate (gravol) adverse reactions
Drowsiness, dizziness, dry mouth, nausea, excitement in children
317
When pushing Dimenhydrinate (gravol) IV/IO, what rate/concentration is used
Slow push over 2min w/ 15mL of normal saline/25mg gravol
318
How do you treat nausea for a child, or an adult outside a protocol?
Contact the SMA for approval, ask for dosage for child
319
Diphenhydramine (benadryl) contraindications
Hypersensitivity, acute asthma, neonate
320
Diphenhydramine (benadryl) cautions
Angle-closure glaucoma, urinary obstruction, symptomatic prostatic hypertrophy, stenosing peptic ulcer, elderly, children (paradoxical excitation)
321
What is the dose change for diphenhydramine (benadryl) for a patient older than 60
1/2 the Norma dose
322
Diphenhydramine (benadryl) contraindications adverse affects
Hypotension, tachycardia, palpitations
Drowsiness, dizziness, coordination. Difficulty
h/a, nervousness, paradoxical excitement, euphoria, confusion, insomnia
N/V/D, dry mouth, urinary frequency/retention/difficulty, tremors, paresthesia, blurred vision
323
Epinephrine contraindications
No contraindications for anaphylaxis
324
Epinephrine adverse effects
Tachycardia, arrhythmias, angina, flush skin, anxiety, tremors, h/a, dizziness, nausea/vomiting, dry mouth, urinary retention/obstruction, weakness/trembling, wheezing/dyspnea, diaphoresis
325
Epinephrine cautions
Elderly, diabetes mellitus, cardiac arrhythmias, thyroid disease
326
What do you do after injected epinephrine IM
Massage the site
327
Fentanyl lozenge containdications
Respiratory depression, current episode of severe asthma/COPD, head injury, hypersensitivity to opioids, possible gastrointestinal obstruction, suspected they will have Abdo surgery
328
Fentanyl lozenge cautions
Lung disease, SOB, pregnancy/nursing
329
Fentanyl lozenge adverse reactions
Nausea, constipation, somnolence, h/a, CNS depression
330
Instructions to patients when using Fentanyl lozenges
Place in cheek and close mouth, don't suck, don't chew
331
What is done differently with Fentanyl lozenge second dose
Put in other cheek
332
Fluorescein contraindications
Ruptured global injury
333
Fluorescein adverse reactions
Irritation/stinging to the eye, blurred vision,
334
Dose of glucose gel used in hypoglycemia
Upto 1 tube
335
Glucagon contraindications
Hypersensitivity, pheochromocytoma
336
Glucagon cautions
Acute or chronic alcohol ingestion
337
Glucagon adverse reaction
Nausea and vomiting
338
Haloperidol contraindications
Severe CNS depression, hypersensitivity, spastic disorders (Parkinson's)
339
Haloperidol cautions
Risk of orthostatic hypotension, seizure disorder, severe hepatic/renal impairment
340
Ibuprofen (advil) contraindications
Hypersensitivity to NSAIDs, GI ulcers, bleeding, inflammatory bowel disease, severe liver/kidney illness, hyperkalemia, systemic lupus erythematous, pregnant
341
Ibuprofen (advil) cautions
High blood pressure
342
Ibuprofen (advil) adverse effects
Nausea, diarrhea, epigastric pain,heart burn, Abdo cramps/pain, bloating, dizziness, h/a, nervousness, rash, pruritus, anemia, decreased appetite, edema, fluid retention
343
Ipratropium bromide (atrovent) contraindications
Hypersensitivity to atropinics/aerosol components
344
Ipratropium bromide (atrovent) caution
Bronchospasm (slower effect than others)
345
Ipratropium bromide (atrovent) adverse reactions
Aerial arrhythmias, tachycardia, dry mouth, cough
346
Ketamine contraindications
Hypersensitivity
347
Ketamine cautions
Psychosis, cardiovascular disease, increased ocular pressure
348
Ketamine adverse effects
Catalepsy, diplopia, nystagmus, tachycardia, increased blood pressure
349
Ringers lactate contraindications
28 days old or younger
350
Ringers lactate caution
Blood transfusion, TBI's (make brain swelling worse)
351
Meloxicam contraindications
Hypersensitivity, asthma, NSAIDs (causes urticaria), post coronary bypass graft
352
Meloxicam cautions
Risk of heart attack or stroke, alcohol (risk of GI bleeding), pregnancy, breast-feeding
353
Meloxicam adverse reactions
Cardiovascular thrombotic events, GI bleeds, ulcerations/perforations, hepatotoxicity, heart failure/edema, renal toxicity/hyperkalemia, Anaphylaxis, serious skin reaction, hematology toxicity
354
Midazolam contraindications
Hypersensitivity to benzodiazepines
355
Midazolam cautions
Hypotension, taking opioids, pediatric patients, hemodynamic instability, elderly, liver disease
356
Morphine contraindications
Hypersensitivity, severe respiratory distress/hypotension, head injury, decreased LOC
357
Morphine caution
Pregnancy, elderly, intoxicated, respiratory conditions
358
Moxifloxacin contraindications
Hypersensitivity to quinoline antibacterial agents
359
Moxifloxacin cautions
NSAIDs, epileptic risk
360
Naloxone contraindications
Hypersensitivity
361
What do you do after injecting narcan SC
Massage the site
362
Nitroglycerin spray contraindications
Severe hypotension, hypersensitivity, vasodilator medications: Viagra/Levitra 24hrs, Cialis 48hrs
363
How do you assist a patient take their own nitro tablets
Under the tongue, sublingual
364
Normal saline containdication
Pulmonary edema
365
Ondansetron contraindications
Hypersensitivity
366
Ondansetron cautions
Long QT syndrome
367
How long should you slow push ondansetron
No less than 30sec, preferably 2-5min
368
Oxygen therapy cautions
COPD
369
Salbutamol (Ventolin) contraindications
Hypersensitivity
370
Salbutamol (Ventolin) cautions
Nil
371
Tetracaine protocol concentrations
1% or 0.5%
372
Tetracaine contraindications
Anaphylaxis to anaesthetics, open globe injury
373
Tetracaine cautions
Premature baby, taking sulfonamide medication
374
Tranexamic acid (TXA) contraindications
DVTs, pulmonary edema, cerebral thrombosis, hypersensitivity, hematuria
375
Tranexamic acid (TXA) cautions
No cautions over 18 years old
376
Xylocaine concentrations/epi use
1% or 2% w/ epi
377
Xylocaine contraindications
Hypersensitivity to anaesthetics
378
1% concentration of xylocaine is how many mg/ml
10mg/ml
379
Max xylocaine dose with and without epi
With epi - 7mg/kg or 500mg
Without epi - 4.5mg/kg or 300mg
380
Hypertonic saline is at what concentration
3%
381
Hypertonic solution cautions,
Congestive heart failure or severe renal dysfunction
382
Igel Contraindications
Gag reflex, trismus, limited mouth opening, trauma/mass/abscess affecting igel insertion, or risk of creating a full stomach (sepsis, morbid obesity, pregnancy, gastro-intestinal surgery)
383
Igel max peak airway pressure of ventilation
40cm H2O
384
Max time a Igel can be used in a patient
4hrs (call SMA)
385
Size 3,4,5 Igel colours and patient weight associated
3 - yellow - 30-60kg
4 - green - 50-90kg
5 - orange - 90+ kg
386
What kind of lubricant can be used with an Igel
Water based lubricant
387
How do you confirm igel placement
Auscultate epigastric region/lungs, confirm thorax rise evenly, and CO2 detector
388
What do you do if the teeth line on an Igel is above the teeth
Reattempt insertion (jaw thrust) and then lower the igel size if same result.
389
Why do pediatric sizes of igels not have teeth line
Greater variable of length in that age group
390
What must be available when removing a Igel airwsyy
Suction
391
What is encouraged for the patient to do with a rib fracture
Deep breaths/coughing
392
What should be avoided with a rib fracture
Rib immobilization
393
What can happen within 24hrs of pulmonary contusion
Deterioration to possible respiratory failure
394
How do you burp a chest seal
Release pressure by pushing down during an exhalation and reseal
395
When do you attempt a needle decompression if burping is ineffective
After 2 burping attempts
396
Landmarks for needle decompression
2nd intercoastal midclavicular line or 4/5th intercoastal anterior axillary line
397
How do you insert a needle decompression in a intercoastal space
Directly above the inferior rib
398
What do you do with a needle after removing it from the cathelon
Re-sheath the needle if you have a limited supply of needle decompression cathelon sets
399
What is Beck's triad
Muffled heart sounds, JVD, hypotension
400
Indications of a cardiac tamponade
Beck's triad, paradoxical pulses
401
Describe transtracheal block procedure
Inject xylocaine 1% subcutaneous 2mL above/below/directly over the cricothyroid membrane, and 4mL into the trachea (aspirating to verify airway placement)
402
When do you flush an IV lock
After insertion, 6hrs of inactivity, before/after medication administration, if blood is in the lock
403
Convert kg to lbs
2.2 x kg = lbs
404
How many mg in a gram
1000
405
What to consider when reconstituting a medication
Verify the amount of fluid to reconstitute, what fluid is compatible, verify completely reconstituted before administration
406
When verifying drip rate, what steps are taken
Calculate 15sec average, than 30sec, than 1min
407
IV rate formula
[ Volume infused (mL) x admin set (gtts/ml) ] / total time of infusion
= Gtts/min
408
IO contraindications
Fractured bone/infection/excessive tissue/osteoporosis/previous IO IM last 48 hrs at site
409
What must you do after placing an IO to allow flow
Flush vigorously
410
How long can you leave in an IO
24hrs (contact SMA)
411
What site do you use for IO on peds
Proximal tibial
412
When is the only time you connect a syringe directly to an IO port without a lock
Used to remove the IO
413
How to size an NPA
Nose to earlobe
414
GCS spontaneous eye opening
Eyes 4
415
GCS eye opening with verbal stimulus
Eyes 3
416
GCS eye opening to pain
Eyes 2
417
GCS no eye opening
Eyes 1
418
GCS oriented verbal speaking
Voice 5
419
GCS confused verbal speaking
Voice 4
420
GCS inappropriate words
Voice 3
421
GCS incomprehensible speaking
Voice 2
422
GCS no verbal response
Voice 1
423
GCS obey commands
Motor 6
424
GCS localized pain
Motor 5
425
GCS withdraws from pain
Motor 4
426
GCS abnormal flexion
Motor 3
427
GCS abnormal extension
Motor 2
428
No motor response
Motor 1
429
Rule of nine- entire head
9%
430
Rule of nine- chest
9%
431
Rule of nine- abdo
9%
432
Rule of nine- entire arm
9%
433
Rule of nine- entire back
18%
434
Rule of nine- upper leg
9%
435
Rule of nine- lower leg
9%
436
Rule of nine- genital region
1%
437
Rule of nine- child entire head
14%
438
Rule of nine- infant entire head
18%
439
Target urinary output with pediatric burn patients
O.5-1.0 mL/kg/hr
440
Calculation for parkland formula for 24hrs
3 x kg x (%2/3rd degree burns)
441
Parklands formula amount separated by time
1/2 - 1st 8hrs
1/4 - 2nd 8hrs
1/4 - 3rd 8hrs
442
When calculating parkland formula how do you calculate the fluid used to bring the pediatric patient out of hypovolemia
Subtract the fluid given from the first 8hr calculation
443
Rules of 10 fluid replacement formula
%TBSA x 10 + (100 for every 10kg over 80kg) = ml/hr of IV therapy
444
Blood loss for each class of hemorrhagic shock in adults
1 - under 750ml
2 - 750-1500ml
3 - 1500-2000ml
4 - over 2000ml
445
Total time in a d-tank when administering at 15L/min
~22min
446
Grades of a pen torch test for shadowing of the anterior chamber. What grade is normal
Grade 1: greater than 2/3 shadowed
Grade 2: 1/3-2/3 shadowed
Grade 3: less than 2/3 shadowed
Grade 4: no shadowing (normal)
447
What does MISTAT stand for
MOI
Injury/illness
S/S vitals
Treatment
Age
Time of injury
448
When sending a MISTAT how do you identify a patient
ZAP number or differentiating reference instead of name.
Local 1, enemy 1, friendly 1, etc
449
What are the lines required to be passed up by the medic on ground when sending a 9-liner
3,4,5,8
450
What is line 3 of a 9-liner
# of patients / priority
451
What is line 4 of a 9-liner
Special equipment required
452
What is line 5 of a 9-liner
# of patients of each mobility type
453
What is line 8 of a 9-liner
# of patients by nationality & professional status
NATO military, embedded interpreter, POW
454
What are the priorities in a 9-liner
P1 - hospital in 1hr
P2 - hospital in 4hr
P3 - hospital in 24hr
455
What are the types of patients on line 5 of a 9-liner
Stretch, walking, escort, and other(describe)
456
What are the 6 potential sites of a massive hemorrhage
External, Abdo cavity, thoracic cavity, retroperitoneal space, pelvic fracture, long bone fracture
