San Diego County 2007/2008 Paramedic Information

Front 1

Adult Standing Order Skills

Back 1

-Cardioversion
-Defibrillation
-Glucose Monitoring
-Indwelling Devices
-Intubate (ET, Stomal, ETAD)
-Magill Forceps w/ direct laryngoscopy
-Nasogastric/Orogastric Tube Insertion
-Re-alignment of Fracture
-Removal of impaled object
-Valsalva Maneuver

Front 2

Combitube Contraindications

Back 2

-Foreign Body Airway Obstruction (Not A Listed Contraindication)
-Arousal By Narcan
-Tracheostomy or stoma
-Patient under 4 ft. tall
-Ingestion of caustic substances
-Gag reflex/responsive patient
-Esophageal trauma or disease

Front 3

SD BREATHES Intubation Confirmation

Back 3

-Size
-Depth
-Breath Sounds
-Rise & Fall
-Esophageal Detection Device (Toomey)
-Abdominal Sounds Absent
-Tube Misting
-Hospital Verification
-End Tidal CO2
-Signature (E.R. Doc)

Front 4

"Shock" Definition > or = 15 years old

Back 4

Systolic BP <80mmhg OR
Systolic BP <90mmhg AND exhibiting any of the following signs of inadequate perfusion:
-Altered Mental Status
-Tachycardia
-Pallor
-Diaphoresis

Front 5

"Shock" Definition <15 years old

Back 5

Systolic BP < [70 + (2 x age)] AND exhibiting any of the following signs of inadequate perfusion:
-Altered Mental Status
-Tachycardia (<5yrs >or= 180bpm; >5yrs >or= 160bpm)
-Pallor
-Diaphoresis
-Comparison of peripheral vs. central pulses

Front 6

ALTE Criteria

Back 6

An episode involving an infant less than 12 months of age which includes one or more of the following:
-Apnea
-Color change
-Marked change in muscle tone
-Unresponsiveness

Hint 6

Apparent Life Threatening Event

Front 7

Pediatric Definition

Back 7

Children appearing to be <15 years and appearing to weight less than 37 kg (81 lbs).
-Neonate = up to 30 days
-Infant = one month to one year

Front 8

"Unstable" Definition

Back 8

Systolic BP < 90 and chest pain, dyspnea, or altered LOC.

Front 9

Burn Center Criteria

Back 9

- >or= 20% 2'nd degree or >or= 5% 3rd degree of BSA
-Suspected respiratory involvement or significant smoke inhalation in a confined space.
-Significant injury of the face, hands, feet, perineum or circumferential burns.
-Significant electrical injury due to high voltage (greater than 110 volts).

Front 10

"Obviously Dead" Criteria

Back 10

-Rigor Mortis
-Decapitation
-Evisceration of heart or brain
-Ashes (Incineration)
-Decomposition

Hint 10

RDEAD

Front 11

Apgar Score Criteria

Back 11

*Appearance
-Blue/Pale = 0
-Body Pink/Extremities Blue = 1
-Completely Pink = 2

*Pulse
-Absent = 0
-Below 100 = 1
-Above 100 = 2

*Grimace
-No Response = 0
-Grimaces or whimpers = 1
-Actively Cries = 2

*Activity
-Absent/Flaccid = 0
-Some flexion of extremities = 1
-Active extremity motion = 2

*Respiratory
-Absent = 0
-Slow/irregular = 1
-Good Strong Cry = 2

Assess Apgar At 1 & 5 Minutes After Delivery.

Front 12

Glasgow Coma Scale (GCS) Criteria

Back 12

*Eye Opening
-Open Spontaneously = 4
-Open On Command = 3
-Open to Pain = 2
-Does Not Open = 1

*Verbal Response
-Answers Appropriately (A&Ox4) = 5
-Confused Answers (Not A&Ox4) = 4
-Inappropriate Response = 3
-Unintelligible Noises = 2
-No Verbal Response = 1

*Motor Response
-Follows Simple Commands = 6
-Localizes painful stimulus = 5
-Withdraws from pain = 4
-Decorticate (Flexion) = 3
-Decerebrate (Extension) = 2
-No Motor Response = 1

Front 13

Base Hospitals

Back 13

-Grossmont
-Sharp memorial
-Scripps Mercy
-Palomar
-Scripps L.J.
-Tri-City
-UCSD

Front 14

Trauma Centers

Back 14

-Sharp Memorial
-Scripps Mercy
-Palomar
-Scripps L.J.
-UCSD
-Childrens (Pediatric Trauma)

Front 15

Adult C-Spine Rule-Out Criteria

Back 15

-Awake & Oriented x 4
-No Drug/ETOH Influence
-No Neck/Back pain upon palpation
-No Competing Pain
-Cooperative

Front 16

Pediatric C-Spine Rule-Out Criteria

Back 16

-No Altered LOC
-Evidence of obvious injury absent
-Complete Spontaneous ROM without pain
-Kinematics Negative (Mechanism)

Hint 16

N.E.C.K.

Front 17

Needle Thoracostomy Indications

Back 17

-Severe Resp. Distress with unilateral, absent breath sounds.
**AND**
-Systolic BP <90 in intubated or positive pressure ventilated patients.

Front 18

Needle Thoracostomy Proper Sites for Procedure

Back 18

-4'th/5'th Intercostal Space Anterior Axillary Line *Preferred Site*
**OR**
-2'nd/3'rd Intercostal Space at Midclavicular Line

Front 19

Exclusion Criteria for CPR on a Newborn

Back 19

-Less than 500 grams
-Eyes Fused Shut
-Less Than 24 Weeks

Hint 19

-Weight
-Eyes
-Gestation

Front 20

Dopamine Drip Fast Field Formula

Back 20

Take the Weight in Pounds, drop the last number, Take 10% and subtract it, the number you get is the number of drips for 5mcg/kg/min. Multiply it for the desired mcg's needed.

Front 21

An EMT may discontinue CPR if presented with one of the following:

Back 21

-A DNR Medallion.
-Completed DNR Form.
-Written, signed order in Medical Record.
-An Advance Health Care Directive.
-Upon receipt of a BHPO.

Front 22

Adult Rule of Nines (Burns)

Back 22

Head - 9%
Chest/Abd. - 18%
Back - 18%
Left Arm - 9%
Right Arm - 9%
Genitalia - 1%
Right Leg - 18%
Left Leg - 18%

Front 23

Pediatric Rule of Nines (Burns)

Back 23

Head - 18%
Chest/Abd - 18%
Back - 18%
Left Arm - 9%
Right Arm - 9%
Left Leg - 14%
Right Leg - 14%

Front 24

Parkland Formula
Fluid Administration for burn patients

Back 24

BSA% x KG x 4

Deliver 50% of the total fluid in the first 8 hours.
Deliver 25% in each of the next two 8 hour sessions.

Front 25

12-Lead Placement

Back 25

Lead 1 - 4'th IC Space, Right of Sternum
Lead 2 - 4'th IC Space, Left of Sternum
Lead 3 - In Between V2 & V4
Lead 4 - 5'th IC Space, Midclavicular
Lead 5 - Anterior Axillary Line, Level with V4
Lead 6 - Midaxillary line, level with V4 and V5

Front 26

OPP Poisoning Symptoms

Back 26

-Salivation
-Lacrimation
-Urination
-Defication (Diarrhea)
-GI Distress
-Emesis
-Miosis

Front 27

Emergency Patient Definition

Back 27

1. Has a chief complaint or suspected illness or injury; or
2. Is not oriented to person, place, time, or event; or
3. Requires or requests field treatment or transport; or
4. Is a minor who is not accompanied by a parent or legal guardian and is ill or injured or appears to be ill or injured.

Front 28

Base Hospital Contact Criteria:

Back 28

1. Any emergency patient transported by paramedics, including transports by paramedic ambulance to a BLS destination following downgrade to BLS.
2. Any emergency patient treatment involving ALS medications or skills.
3. Any emergency patient assessment involving abnormal vital signs, or an altered level of conciousness.
4. Any suspicion that the emergency patient (or designated decision maker) is impaired by alcohol or drugs.
5. The emergency patient/DDM is unable to comprehend or demonstrate an understanding of his/her illness or injury.
6. The emergency patient meets criteria as a trauma center candidate.
7. The emergency patient is >65 years of age and has experienced an altered or decreased level of conciousness, significant mechanism of injury, or any fall.
8. An emergency patient who is a minor is ill or injured or is suspected to be ill or injured.
9. Whenever paramedics have a question regarding appropriate treatment or disposition of the patient.

Front 29

Drugs That Cause Tissue Necrosis

Back 29

-Calcium Chloride
-Dextrose
-Dopamine

Front 30

Beck's Triad
What are the signs/symptoms and what does it represent?

Back 30

Represents Cardiac Tamponade.
-Decreasing systolic BP (Narrowing Pulse Pressures).
-Muffled Heart Tones.
-Jugular Venous Distention (Increased Jugular Venous Pressure).

Front 31

Cushing's Triad
What are the signs/symptoms and what does it represent?

Back 31

Represents an increase in intracranial pressure ( + ICP).
-Dropping Pulse Rate (Bradycardia)
-Rising Blood Pressure (Hypertension)
-Altered Respirations (Cheyne Stokes...)

Front 32

Signs of Trauma

Back 32

-Deformaties
-Contusions
-Abrasions
-Penetrations/Punctures
-Burns
-Tenderness
-Lacerations
-Swelling

Hint 32

DCAPBTLS

Front 33

Drugs we can give down the ET tube: SD County

Back 33

-Lidocaine
-Epinephrine
-Atropine

Double Your Normal Doses, and dilute to 10cc's adult, 3cc's kids.

Front 34

Narcan is effective against what drugs:
Protocol Book Lists 16

Back 34

-Codeine
-Darvon
-Demerol
-Dilaudid
-Fentanyl
-Heroin
-Lomotil
-Methadone
-Morphine
-Nubain
-Oxycontin
-Paragoric
-Percodan
-Stadol
-Talwin
-Vicodin

Front 35

Causes Of PEA
H's & T's

Back 35

-Hypovolemia
-Hypoxia
-Hydrogen Ion (Acidosis)
-Hyper/Hypokalemia
-Hypothermia
-Hypoglycemia

-Toxins
-Tamponade (Cardiac)
-Tension Pneumothorax
-Thrombosis (Coronary, Pulmonary)
-Trauma

Front 36

Causes of Chest Pain

Back 36

-Angina
-Unstable Angina
-MI
-Pericarditis
-Pericardial Tamponade
-PE
-Pneumonia
-Aortic Dissection
-Esophagitis
-Costochondritis
-Musculoskeletal
-Pancreatitis
-Stress
-Pneumothorax
-Pulmonary Contusion
-Myocardial Contusion
-Hernia
-Cholecystitis
-Ulcers
-Tracheaitis
-Reflux (Heartburn)
-Psychological

Front 37

Trauma Criteria
Physiologic/Anatomic/Mechanism

Back 37

Physiologic - GCS < 14, Abnormal Vital Signs, Appearance, Work of Breathing and/or Circulation. (Systolic BP <90 'Adult', <60 'Peds', or Respiratory rate <10 or >29)

Anatomic - Significant anatomic injury

Mechanism - Sustaining a significant MOI, which may be indicative of severe underlying injury.

Front 38

Trauma Tree Anatomy of Injury Box

Back 38

-Flail Chest
-Combination trauma with burns
-Two or more proximal long-bone fractures
-Child Abuse-Known or suspected with significant injury
-All penetrating injuries to head, neck, torso, or extremities proximal to elbow/knee
-Amputation proximal to mid-hand &/or mid-foot
-Suspected Pelvic fractures
-Limb paralysis
-Crush injury including hand, foot, or greater area
-Neuro/Vascular deficit of extremities

Front 39

Trauma Tree Evidence of MOI or High Energy Impact Box

Back 39

-Ejection from/off vehicle
-Auto impact speed >40 mph
-Auto vs. bike or pedestrian with >5mph impact
-Intrusion into occupied passenger space >12 inches to frontal area or >8 inches to side area adjacent to impact.
-Fall >3 times patient's height or >15 feet
-Vehicle rollover with unrestrained patient
-Motorcycle crash >20mph
-Exposure to blast or explosion
-Pedestrian thrown or run over

Front 40

Trauma Tree Co-Morbid & Other Mechanism Factors Box

Back 40

-Age <5 or >55
-Cardiac &/or Respiratory Disease
-Insulin-dependent diabetes, cirrhosis, or morbid obesity
-Patients with bleeding disorders or on anticoagulants
-Shoulder restraint w/o lap belt
-Head injury with LOC reported
-Major auto deformity >20 inches
-Pregnancy
-Immuno-suppressed patients
-Vehicle rollover
-Extrication time > 20 minutes
-Death in same passenger compartment

Front 41

Base Hospital Contact is Not Required When:

Back 41

-Obvious Death
-Discontinuation of CPR for DNR/DPAHC on scene
-Release of minor on scene who is neither ill nor injured if parent/guardian requests or a responsible adult (nurse,police,ect..) so requests. (Document the Release)
-Patients who wish to be released and do not meet base hospital contact criteria.
-Dispatched BLS call where ALS treatment not anticipated nor required.