Smo - Chapter 500

Front 1

what are the 7 steps to treating a patient with Standard Trauma / Shock ?

Back 1

1) Initiate C-spine precautions and immobilization
2) Provide Oxygen as needed.
3) If LOC is decreased then provide 100% Oxygen / BVM with assisted ventilations as needed.
4) Control visible hemorrhage.
5) Shock Management:
6) Maintain SBP at 90-100mmHg.
G) Begin Cardiac Monitoring, record, and evaluate
EKG strip.

Front 2

What should you consider if LOC is decreased and you provide 100% Oxygen / BVM with assisted ventilations is needed?

Back 2

Consider need for EARLY INTUBATION (Paramedic).

Front 3

what are the steps for Shock Management?

Back 3

1. Control visible hemorrhage.
2. Trendelenburg position and protect for heat loss as needed.
3. Establish at least (1) large bore IV Normal Saline.

Front 4

In shock management, if SBP is less than 90 mmHg what should you do?

Back 4

1 Establish (2) large bore IV’s with 250cc bolus.
2 Watch for fluid overload.

Front 5

FOR SPINAL immobilization the process of Helmet Removal is critical. What steps should be taken?

Back 5

Personnel should not remove the helmet or shoulder pads prior to transportation unless one of the following apply:
1. If the helmet and chin strap don’t hold the head securely, such that immobilization of the helmet does not also immobilize the head.
2. If the helmet and chin strap design prevent airway control or provision of ventilation even after removal of the face mask.
3. If the face mask cannot be removed after a reasonable period of time.
4. If the helmet prevents immobilization in an appropriate position for transport.

Front 6

when a patient is being treated for possible spinal injury and has on an a helmet, when should the helmet be removed?

Back 6

All helmets, with the exception of football, will be removed while maintaining neutral spinal alignment prior to application of spinal immobilization.

Front 7

what are the steps for treating an Abdominal / Pelvic Trauma patient?

Back 7

1. Maintain high index of suspicion for associated injuries

2 Contact Medical control for repeat NS IV boluses as needed for additional patient care orders

Front 8

what steps do you take to treat a patient with Soft Tissue Trauma / Avulsed Teeth?

Back 8

A) Control hemorrhage with direct pressure.
B) Apply sterile dressings to opened wounds.

Front 9

When you are treating a patient with a Complete-Amputated Body Part, what are the first things you do to assist?

Back 9

A) Control bleeding.
B) Wrap in sterile Normal Saline moistened gauze.
C) Wrap in dampened towel.
D) Place in plastic bag.
E) Place bag on ice

Front 10

when placing a Complete Amputated body part on ice, what 4 things should you NEVER do?

Back 10

1. NEVER FREEZE PART.
2. NEVER ALLOW DIRECT CONTACT WITH ICE.
3. NEVER FLOAT PART IN SOLUTION.
4. NEVER USE ANTISEPTICS.

Front 11

When you are treating a patient with a Partial-Amputated Body Part, what are the first things you do to assist?

Back 11

A) Cover amputated part in sterile Normal Saline moistened gauze.
B) Splint in position.

Front 12

when a patient has an Avulsed tooth or teeth, what steps should you take in assisting this patient?

Back 12

A) Maintain airway, suction vigorously as needed.
B) Handle tooth by the crown only.
C) Manage bleeding from gum tissue.
D) Rinse tooth with Normal Saline.
E) Do not replace primary (baby) teeth.

Front 13

when a patients tooth is out of the socket what should you do to save the tooth?

Back 13

1. Replace tooth back into socket if possible unless
patient is unable to maintain airway.
2. If unable to replace tooth, place tooth in Normal
Saline /gauze.

Front 14

in treating a burn patient, what are the immediate steps taken?

Back 14

Remove patient from burning process.
DO NOT ATTEMPT RESCUE unless you know and are able to utilize safety/protection methods for flame, chemical, electrical, radiation, and inhalation situations.

Front 15

When should you consider the need for early intubation In treating a burn patient?

Back 15

1. Burns to the face.
2. Singed eyebrows or nasal hair.
3. Burns in the mouth.
4. Sooty (carbonaceous) sputum.
5. Hoarseness.

Front 16

when treating a patient who has an electrical burn, what do you assess first?

Back 16

Assess entrance/exit wounds of electrical burns.

Front 17

for major burns to a patient, what do you do to the patient prior to transporting?

Back 17

For Major Burns, place the patient on a burn-sheet or clean sheet. Dry sterile dressings can be applied to the extremities or face.

Front 18

What DONT you do to a burn?

Back 18

put a cold or iced dressing on the patient

Front 19

Treatment of burns:
In order to help keep the pt warm and prevent further heat loss during transport, what should you never do?

Back 19

NEVER TRANSPORT IN WET SHEETS, WET TOWELS, OR WET CLOTHING

Front 20

for patients who are younger than 10 years old and older than 50 what degrees of burns would be sent to a burn center?

Back 20

2 degree and 3 degree burns in combination > 10% BSA

Front 21

What degree of burns in a patient of any age group should be sent to a burn center?

Back 21

2 degree and 3 degree burns in combination > 20% BSA with patients of any age group.

Front 22

Other than 2nd and 3rd degree burns, what other kind of burns would be sent to a burn center?

Back 22

1. significant electrical burns, including lightening injury
2. significant chemical burns
3. inhalation injuries

Front 23

Thermal & Electrical Burns:
Remember to keep the burn patient warm. What type of burns should be treated with a local cooling such as wet dressing?

Back 23

Only burns of less than 10% of Body Surface Area (BSA) should be treated with local cooling such as wet dressings.

Front 24

Thermal & Electrical Burns:
Pre-hospital treatment should be directed at pain relief rather than what?

Back 24

Fluid overload

Front 25

Thermal & Electrical Burns:
Remember that burn victims have often suffered other trauma. These patients should primarily be managed as what?

Back 25

multi system trauma patients

Front 26

Treating a patient with chemical burns what steps would you take to assist them?

Back 26

A) Prevent exposure to medical personnel
B) Move patient to a safe location.
1. Remove all clothing.
2. Brush off powdered chemicals.
3. Irrigate with copious amounts of water.
4. Irrigation takes priority over transportation unless irrigation can be continued enroute to ED.
5. Large Body Surface Area involvement may require shower irrigation

Front 27

Chemical Burns:
DEFINE - PHENOL

Back 27

A powerful caustic cleaning agent that is insoluble in water.

Front 28

Chemical Burns:
DEFINE - DRY LIME

Back 28

A strong corrosive agent that reacts with water to produce heat.

Front 29

Chemical Burns:
What should you do if a patient has been in contact with DRY LIME?

Back 29

a. Brush off as much dry lime as possible and then
rinse area with copious amounts of water.
b. When using water, the lime will react with it
rather than with the water of body’s soft tissues.

Front 30

Chemical Burns:
DEFINE - SODIUM

Back 30

An unstable metal that will react violently with water. It is normally stored under oil since it will react with oxygen.

Front 31

What do the initials CS stand for?

Back 31

Compartment syndrome

Front 32

Crush Injuries/Compartment Syndrome:
Where would you find CS on the body?

Back 32

CS has been found wherever there is a compartment: hand, forearm, upper arm, abdomen, buttock, and entire lower extremity.

Front 33

Crush Injuries/Compartment Syndrome:
The Paramedic should maintain a ______ when dealing with complaints of extremity pain.

Back 33

The Paramedic should maintain a high level of suspicion

Front 34

Assessment of Crush injuries/compartment syndrome:
Literature warns that, with the exception of _____ and _____________________, these traditional signs are not reliable and the presence or absence of them should not affect injury management.

Back 34

Pain and Paraesthesia

Front 35

Assessment of Crush Injuries/Compartment Syndrome:
You should maintain a high level of suspicion in any injury that causes limb pain, including:

Back 35

1. High-velocity injuries particularly are worrisome.
2. Determine mechanism of injury.
3. Long bone fractures.
4. High-energy trauma.
5. Penetrating injuries and gunshot wounds, often cause arterial injury, which can quickly lead to CS.
6. Venous injury may cause CS; do not be misled by palpable pulses.
7. Crush injuries.

Front 36

Assessment of Crush Injuries/Compartment Syndrome:
what are the earliest clinical indicator of CS?

Back 36

Pain with certain movements, particularly passive stretching of the muscles, is the earliest clinical indicator of CS

Front 37

Assessment of Crush Injuries/Compartment Syndrome:
Affected limb may begin to feel ________.

Back 37

tense or hard as if filling with fluid

Front 38

When treating patients with Care of Crush Injuries/Compartment Syndrome, what should you do?

Back 38

Start IV fluids as well as other care should be started as soon as safely possible even if the patient is still entrapped.

Refer to GCFES OPERATIONS OPERATING GUIDELINES Chapter 6, Section 700.

Front 39

Care of Crush Injuries/Compartment Syndrome:
CS can develop rapidly after an arterial injury. Therefore what is essential at this point?

Back 39

Speed of transport

Front 40

Care of Crush Injuries/Compartment Syndrome:
For ALS care what medication can be given?

Back 40

Sodium bicarbonate 1 meg/kg or as directed by medical control

Front 41

Traumatic Arrest:
Victims of blunt trauma who have arrested at the scene after initiation of ALS procedures have a mortality rate nearing ___%.

Back 41

100%.

Front 42

Traumatic Arrest:
what should you consider if trauma appears minor or condition appears inconsistent with mechanism of injury?

Back 42

Consider possible medical arrest

Front 43

Trauma In Pregnancy:
What should you Initiate for spinal injuries.

Back 43

C- spine precautions and immobilization for suspected spinal injuries

Front 44

Trauma in pregnancy:
What should you do when initiating c-spine precautions and immobilization on a woman who is 20wks gestation?

Back 44

Elevate right side of backboard approximately 15 degrees

Front 45

what are the 9 steps to care for patients with Trauma in pregnancy?

Back 45

1) Initiate C-spine precautions and immobilization for suspected spinal injuries.
2) Provide Oxygen as needed.
3) Assess externally for the presence of uterine contractions.
4) Assess for vaginal bleeding and/or leaking amniotic fluid (no internal exam).
5) Subjectively assess fetal movements.
6) Begin Cardiac Monitoring, record, and evaluate EKG strip.
7)Establish at least (1) large bore IV Normal Saline KVO.
8) Maintain a high index of suspicion for other injuries.

Front 46

Helmet Removal:
A properly fitted football helmet securely holds the head in a position of ____ ____ ___ provided the athlete is wearing shoulder pads.

Back 46

neutral spinal alignment

Front 47

Determination of Spinal Immobilization:
Presentation- Do you think the pt has a potential cervical spinal injury based on mechanism of injury/high index of suspicion or presumed trauma?

Back 47

If yes, then immobilize pt. If no, then assess Loss of consciousness

Front 48

Determination of Spinal Immobilization:
Loss of Consciousness- Is the pt presently unconscious or did the pt have a loss of consciousness prior to your arrival?

Back 48

if yes, then immobilize pt. If no, then assess pt's mental status.

Front 49

Determination of Spinal Immobilization:
Mental Status- Is there decreased mental status, impairment of alertness, ETOH or drug involvement, significant distracting injury or other problems associated with mental status?

Back 49

If yes, then immobilize pt. If no, then assess pt's pain.

Front 50

Determination of Spinal Immobilization:
Pain- Does the pt complain of neck pain?

Back 50

If yes, then immobilize pt. If no then assess pt's neurological deficits.

Front 51

Determination of Spinal Immobilization:
Neurological Deficits- Are there any motor or sensory deficits? (paresthesias, loss of movement, inability to move, etc)

Back 51

If yes, then immobilize pt. It no, then assess pt's point tenderness.

Front 52

Determination of Spinal immobilization:
Point tenderness- is the neck tender to palpation?

Back 52

if yes, then immobilize pt. If no, then assess pt's symptoms.

Front 53

Determination of Spinal immobilization:
Symptoms- Is there pain or symptoms on spontaneous range of motion? Is there obvious angulation or neck injury present?

Back 53

If yes, then immobilize pt. If no, then pt does not need spinal immobilization.

Front 54

What degree of burns that involve the face, hands, feet, genitalia, or perineum or those involving skin overlaying major joints would require referral to a burn center?

Back 54

2nd and 3rd degree burns

Front 55

3rd degree burns greater than ____% BSA in any age group would require referral to a burn center?

Back 55

>5%

Front 56

Treatment of Burns:
If there is sufficient time before transport, what 2 things should you do for the pt?

Back 56

1. Place sterile dressings between the digits of the affected hands and/or feet.
2. Wrap hands in a "light grip" position.

Front 57

Treatment of Burns:
What can you administer for pain control?

Back 57

Fentanyl 1 mcg/kg up to 100 mcg for pain control (paramedic only)

Front 58

Thermal & Electrical Burns:
Important historical information includes what?

Back 58

1. any inhalation problems
2. closed spaced exposure
3. duration of exposure and time elapsed since burn
4. chemical exposure
5. significant past medical problems

Front 59

Suspect ______ whenever significant pain occurs in an extremity following any injury.

Back 59

Compartment syndrome

Front 60

Assessment of Crush Injuries/Compartment Syndrome:
Often, pt complains of _____ out of proportion to examination and a ______ sensation or _____.

Back 60

Pt complains of SEVERE PAIN out of proportion to examination and a BURNING sensation or TIGHTNESS.

Front 61

Care of Crush Injuries/Compartment Syndrome:
If CS is suspected, you should perform only the necessary lifesaving procedures in the field. This includes starting ______.

Back 61

2 large bore IV's with NS, fluid loading is essential

Front 62

Traumatic Arrest:
Traumatic arrest secondary to penetrating thoracic injuries can _________.

Back 62

can be resuscitated and saved

Front 63

Traumatic Arrest:
There is a higher rate of survival in victims of ____ ____ penetrating injuries.

Back 63

low velocity

Front 64

Trauma in Pregnancy:
In the case of maternal death, continue ______ until a postmortem cesarean can be performed.

Back 64

aggressive resuscitative efforts (CPR/ACLS)

Front 65

You are on scene with a 21 YOM patient suffering from an amputated ring finger on his left hand. All vitals are stable. In order to preserve the finger that the patient handed you, you must do all of the following EXCEPT:

A. wrap in sterile NS moistened gauze
B. wrap in a dampened towel
C. place in a plastic bag
D. place finger in direct contact with ice

SMO 503.001

Back 65

D. place finger in direct contact with ice

Front 66

All of the following are criteria for a referral to a burn center except:

A. 2˚ and 3˚ burns in combination >10% BSA with patients <10 years and >50 years
B. 2˚ and 3˚ burns in combination >25% BSA with patients of any age group
C. 2˚ and 3˚ burns that involve the face, hands, feet, genitalia, or perineum or those involving skin overlaying major joints
D. 3˚ burns >5% BSA in any age group

SMO 504.002

Back 66

B. 2˚ and 3˚ burns in combination >25% BSA with patients of any age group

Front 67

According to the rule of nines, the anterior portion of the adult torso is what percentage?

A. 9%
B. 18%
C. 27%
D. 36%

SMO 504.002

Back 67

B. 18%

Front 68

According to the rule of nines, the head of a child under the age of 1 would be what percentage?

A. 18%
B. 9%
C. 9.5%
D. 18.5%

SMO 504.002

Back 68

A. 18%

Front 69

If you suspect a spinal injury in a female that is at 20 weeks gestation or more you should immobilize the patient to a LSB and elevate the board at what angle?

A. 10
B. 15
C. 20
D. 35

SMO 508.000 A

Back 69

D. 35

Front 70

You are on scene with a 42 YOM patient that has dry lime covering both of his arms. He appears to be in no obvious distress. After assuring the scene is safe and no further exposure will occur you should,

A. place cold packs in the patient’s armpits
B. flush with copious amounts of water
C. brush as much lime off as possible
D. establish two large-bore IVs

SMO 504.004 C2

Back 70

C. brush as much lime off as possible

Front 71

In patient’s suffering from burns what is the max dose of Fentanyl you may administer prior to calling medical control for additional doses?

A. 200 mcg
B. 50 mcg
C. 3 mcg/kg
D. 100 mcg

SMO 504.001 K

Back 71

D. 100 mcg

Front 72

A properly fitted football helmet securely holds the head in a position of neutral spinal alignment provided the athlete is wearing shoulder pads.

A. True
B. False

SMO 501.002 A

Back 72

A. True

Front 73

What signs are you looking for in a burn patient to consider the need for early intubation?

SMO 504.001 B

Back 73

-Burns to the FACE
-Burns IN the MOUTH
-Singed EYEBROWS
-Sooty SPUTUM
-Hoarseness

Front 74

Shock management should consist of maintaining a SBP at:

A. 80-90
B. 100-120
C. 90-100
D. 110-120

SMO 501.000 F

Back 74

C. 90-100