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41 Cards in this Set

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Adult Standing Order Skills
-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
Combitube Contraindications
-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
SD BREATHES Intubation Confirmation
-Breath Sounds
-Rise & Fall
-Esophageal Detection Device (Toomey)
-Abdominal Sounds Absent
-Tube Misting
-Hospital Verification
-End Tidal CO2
-Signature (E.R. Doc)
"Shock" Definition > or = 15 years old
Systolic BP <80mmhg OR
Systolic BP <90mmhg AND exhibiting any of the following signs of inadequate perfusion:
-Altered Mental Status
"Shock" Definition <15 years old
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)
-Comparison of peripheral vs. central pulses
ALTE Criteria
An episode involving an infant less than 12 months of age which includes one or more of the following:
-Color change
-Marked change in muscle tone
Apparent Life Threatening Event
Pediatric Definition
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
"Unstable" Definition
Systolic BP < 90 and chest pain, dyspnea, or altered LOC.
Burn Center Criteria
- >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).
"Obviously Dead" Criteria
-Rigor Mortis
-Evisceration of heart or brain
-Ashes (Incineration)
Apgar Score Criteria
-Blue/Pale = 0
-Body Pink/Extremities Blue = 1
-Completely Pink = 2

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

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

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

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

Assess Apgar At 1 & 5 Minutes After Delivery.
Glasgow Coma Scale (GCS) Criteria
*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
Base Hospitals
-Sharp memorial
-Scripps Mercy
-Scripps L.J.
Trauma Centers
-Sharp Memorial
-Scripps Mercy
-Scripps L.J.
-Childrens (Pediatric Trauma)
Adult C-Spine Rule-Out Criteria
-Awake & Oriented x 4
-No Drug/ETOH Influence
-No Neck/Back pain upon palpation
-No Competing Pain
Pediatric C-Spine Rule-Out Criteria
-No Altered LOC
-Evidence of obvious injury absent
-Complete Spontaneous ROM without pain
-Kinematics Negative (Mechanism)
Needle Thoracostomy Indications
-Severe Resp. Distress with unilateral, absent breath sounds.
-Systolic BP <90 in intubated or positive pressure ventilated patients.
Needle Thoracostomy Proper Sites for Procedure
-4'th/5'th Intercostal Space Anterior Axillary Line *Preferred Site*
-2'nd/3'rd Intercostal Space at Midclavicular Line
Exclusion Criteria for CPR on a Newborn
-Less than 500 grams
-Eyes Fused Shut
-Less Than 24 Weeks
Dopamine Drip Fast Field Formula
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.
An EMT may discontinue CPR if presented with one of the following:
-A DNR Medallion.
-Completed DNR Form.
-Written, signed order in Medical Record.
-An Advance Health Care Directive.
-Upon receipt of a BHPO.
Adult Rule of Nines (Burns)
Head - 9%
Chest/Abd. - 18%
Back - 18%
Left Arm - 9%
Right Arm - 9%
Genitalia - 1%
Right Leg - 18%
Left Leg - 18%
Pediatric Rule of Nines (Burns)
Head - 18%
Chest/Abd - 18%
Back - 18%
Left Arm - 9%
Right Arm - 9%
Left Leg - 14%
Right Leg - 14%
Parkland Formula
Fluid Administration for burn patients
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.
12-Lead Placement
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
OPP Poisoning Symptoms
-Defication (Diarrhea)
-GI Distress
Emergency Patient Definition
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.
Base Hospital Contact Criteria:
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.
Drugs That Cause Tissue Necrosis
-Calcium Chloride
Beck's Triad
What are the signs/symptoms and what does it represent?
Represents Cardiac Tamponade.
-Decreasing systolic BP (Narrowing Pulse Pressures).
-Muffled Heart Tones.
-Jugular Venous Distention (Increased Jugular Venous Pressure).
Cushing's Triad
What are the signs/symptoms and what does it represent?
Represents an increase in intracranial pressure ( + ICP).
-Dropping Pulse Rate (Bradycardia)
-Rising Blood Pressure (Hypertension)
-Altered Respirations (Cheyne Stokes...)
Signs of Trauma
Drugs we can give down the ET tube: SD County

Double Your Normal Doses, and dilute to 10cc's adult, 3cc's kids.
Narcan is effective against what drugs:
Protocol Book Lists 16
Causes Of PEA
H's & T's
-Hydrogen Ion (Acidosis)

-Tamponade (Cardiac)
-Tension Pneumothorax
-Thrombosis (Coronary, Pulmonary)
Causes of Chest Pain
-Unstable Angina
-Pericardial Tamponade
-Aortic Dissection
-Pulmonary Contusion
-Myocardial Contusion
-Reflux (Heartburn)
Trauma Criteria
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.
Trauma Tree Anatomy of Injury Box
-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
Trauma Tree Evidence of MOI or High Energy Impact Box
-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
Trauma Tree Co-Morbid & Other Mechanism Factors Box
-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
-Immuno-suppressed patients
-Vehicle rollover
-Extrication time > 20 minutes
-Death in same passenger compartment
Base Hospital Contact is Not Required When:
-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.