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316 Cards in this Set
- Front
- Back
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Five sections of the clinical care guidelines?
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Administrative, Protocols, Formulary, Procedure guidlines, Appendices.
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Medical Control is defined as?
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Medical Director, Receiving physician, Lake Ems district 3.
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4 categories of unstable patients?
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1. Significant discomfort of cardiac origin 2. Severe dyspnea 3. Acute AMS 4. Hypotension with signs of decreased tissue perfusion
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Timeframe to determine need for ALS care by the paramedic?
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3 minutes
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Assessment and initial therapy by a paramedic should be completed in what time frame?
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15 minutes
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Patients with an IV line can be considered BLS?
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NO
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Can patient's with a saline lock be treated as BLS?
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Yes
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Age breakdown for medical patients...adult vs pediatric?
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8 yrs and up (Adult)
8 years and less then 80lbs(Pediatric) Infant= birth to 1 year old |
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Age breakdowns for trauma patients per state of Florida?
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Adult = 16 years or older
Pediatric = characteristics anatomically of a 15 year old and younger |
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St elevation in II, III, AVF?
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Obtain V4R
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Contraindications for Nitro?
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BP, Viagra, Cialis, ect. Allergy
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Use nitro with caution if what is possible?
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right sided infarct, BP will drop
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Last resort drug to help with pain and discomfort?
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Morphine (5 minutes between doses)
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Zofran may be given IM?
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Yes
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How many mm of elevation in 2 contiguous leads is needed for a STEMI alert?
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Just 1
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St depression in early V leads (V1,2,3)...we should assess?
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Posterior V7, V8, V9
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Cardiac patient: Initial assesment, then treat as follows?
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ASA, Nitropaste 1 inch, Morphine 2-5mg, Zofran 4mg, Two IV's, Treat dysrhytmias, treat Low BP (fluids, dopamine), transport
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First drug administered in a code situation?
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Vaso 40 units and EPI 1mg...Back to back
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Asystole/PEA do we use atropine?
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NOT anymore
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Airway choice in codes?
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King tube, no longer utilize ET tubes
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Decompress the stomach in cardiac arrest patients?
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Orogastric tubes
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ROSC with a patient intubated we can use what drug?
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Versed to maintain LOC.
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Asystole/PEA treatment after intial ABC's and CPR initiated?
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King tube, IV, Cold Saline 30ml/kg max of 2L, Epi/Vaso, Epi for rest of code 3-5 minutes, Sodium Bi-carb 1Meq/kg max of 50, H's and T's, discontinuation and ROSC
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Target number for Milli-amps in a pacing situation?
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85mA
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Versed contraindicated with a BP lower then?
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100
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HR<50 and unstable, what drug should be administered?
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Atropine .5mg (max of 3mg)
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Pacing should be started with what conditions present?
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HR<50 unstable
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Avoid atropine when what three conditions are present?
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2nd and 3rd degree blocks and MI
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Dopamine drip set up fo usage?
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400mf in 250 D5W, concentration of 1600mcg/ml. Use street rule, Weight in lbs minus 1
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Treatment for Bradycardia after intial assessment and 12 lead?
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Unstable: Atropine .5 (max of 3mg), Versed 2mg (max of 10mg) TCP, Dopamine. Stable: 12 lead, standby pacing in 2nd or 3rd degree blocks
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Inclusion criteria for Induced Hypothermia?
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>18, Advanced airway in place, Non-traumatic cardiac arrest
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Exclusion criteria for Induced Hypothermia?
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Traumatic cardiac arrest, Awake and alert after cardiac arrest
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Goal for temp drop in Induced hypothermia is how many degrees?
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1
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Two ways to determine MAP?
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1. next to BP on the monitor
2. (2x diastolic) + systolic --------------------------------- 3 |
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Goal for MAP after ROSC?
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70 or greater
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One differential to remember when using Induced hypothermia??
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Continue to treat orginal dysrhytmias that caused cardiac arrest
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Induced hypothermia procedure?
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Cold saline Bolus 30mg/kg Max of 2 liters, Advanced airway, ETCO2 > 20 mmhg, Nuero exam, Ice packs to head and axilla, Mag sulfate 1 gram IVP, Versed 2 - 10 mg for shivering, Dopamine for MAP.
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Target ETCo2 for induced hypothermia?
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40
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If rhythm does not convert with one or more doses of adenosine?
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Consider alternate treatment or rhythm.
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Dose treatment for SVT?
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6mg, followed by 12mg.
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Cardizem is used when?
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Afib RVR >150
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If using Adenosine or the vagal attempts and rhythm changes to irregular we?
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Switch to cardizem 10mg over 2 minutes
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If using Adenosine and the rate slows then speeds up again we do?
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Cardizem 10mg over 2 minutes
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If we cardiovert, we can premedicate with?
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Versed: 2mg IVP. Max of 10mg BP>100
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Energy levels for cardioverting A-fib?
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100, 200, 300, 360
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Energy levels for cadioverting SVT and A-flutter?
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50, 100, 200, 300, 360
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If delays occurr in cardioversion and condition is critical we?
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Defib at 360
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Cardizem contraindicated with a BP less then ?
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120
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How do we push Cardizem and dose?
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10mg slow over 2 minutes
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Narrow complex tach procedures stable?
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Initials care, Fluid challenge 250cc, vagal, adenosine 6mg, adenosine 12 mg, Rapid push, Cardizem 10mg slow push if irregular, must do 12 lead before cardizem, may repeat once 10mg, Consult dr if further needed.
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Narrow complex tach procedures for unstable patient?
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Initial care, fluid challenge 250cc, Cardioversion, delays consider Defib, Versed 2mg for sedation,
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Cradiac arrest we control the airway with?
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King Tube only
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First medication dose in VFIB/Vtach pulseless?
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40 vaso/Epi 1mg back to back
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If we use a bolus of amiodarone and it converts we then?
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Set up a maintenance drip
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Amiodarone drip set up?
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150mg in a 50 NS on a 10 drip set for 50 drops a minute
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Mag sulfate dose for VFIB or Vtach pulseless?
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Mix 1 gram in 10 cc NS, administer over 5 minutes and repeat once for a total dose of 2gm
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If arrest > 4minutes we?
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2 minutes of CPR before we assesss rhythm.
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If arrest < 4 minutes we?
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assess rhythm before CPR
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Dual shock with the same monitors may be used after?
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Medical consult and > 5 shocks at 360.
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Procedure for VFIB and Vtach pulseless?
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CPR, Defib 360, ROSC? induced hypothermia at any time, Vaso/Epi, Amiodarone 300mg, Epi, Amiodarone 150mg, Epi, Mag sulfate 1 Gram. Drug-shock -drug Epi for rest of code after above
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For witnessed/monitored V Tach...??
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Have patient cough
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Ig you give a bolus to V tach always?
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Start a maintenance drip if the rhythm converts
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A stable patient in a wide complex tach situation should receive?
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Amiodarone drip
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If an AICD fires and complexes werent witnessed what do we do?
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Do not admin Amiodarone drip. Must witness 6 complexes
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Pre medicate with Versed if BP is? Dose?
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>100 and 2mg
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Energy level starting points for wide complex tach?
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100, 200, 300, 360
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Mag sulfate for wide complex tach? Dose?
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1 gram in 10cc NS. admin over 5 minutes. Total dose of 2 Grams
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Procedure for stable wide complex tach?
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Initial procedures, 12 lead, Amiodarone 150mg in a 50cc, no response?, repeat, Unstable? move to that protocol, Mag sulfate 1 Gm IVP. After conversion: 12 lead ekg
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Procedure for unstable wide complex?
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Versed 2mg if BP >100, Max of 10mg. Cardioversion 100, escalate 200, 300, 360, Amiodarone150 mg over 10 minutes, No response? Mag Sulfate 1Gram for Torsades, further treatment: Consult medical control. After conversion 12 lead.
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Normal Rate for sutained Vtach?
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150-180
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Normal QRS for sustained V tach/
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> .12
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HR > then what for SVT?
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150
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QRS in SVT is?
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< .12
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Patient issues with their VAD?
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Try to contact the hospital
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Patients with a VAD may not have a ?
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BP or pulse
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EKG readings and ACLS drugs in VAD patients have what response?
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Readings are accurate and drugs can be used
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Patient unresponsive and pump on the VAD is not operaiting, do what?
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Contact the VAD coordinator and start CPR.
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Patient unresponsive and VAD is operating, we do what?
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EKG readings and treat per protocol.
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If you have to Defib a patient with a VAD, you should?
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Use anterior and posterior pad placement. Everything else is fine.
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Carbon monoxide patients may indicate what with the pulse ox?
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A false positive
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Important documentation when dealing with carbon monoxide patients?
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The exact time oxygen therapy began
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Before pushing any meds with Carbon monoxide patients, always apply?
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capnography
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CO poisonong causes cerebral edema, therefore unless hypotension exisits?
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Restrict use of fluids
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Carbon monoxide... Consider air transport if ground transport to a hyperbaric chamber is?
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Greater then 45 minutes
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Two indications for hyperbaric chamber with a CO poisoning?
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Coma
Period of Unconsciousness |
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Procedure for treating a Carbon Monoxide Patient?
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Remove patient from source
Initial care 100% O2 NRB Tight fitting Severe sign and symptoms...? BVM <10 or >30, 12 lead, hyperbaric No severe symptoms? Transport to IRF |
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What is a Cyano-kit made up of?
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Two 100ml vials. Each will drip over 7.5 minutes
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How do we get a cyano-kit?
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District 3 or command vehicle
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Treatment for Cyanide Poisoning?
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Remove patient from source
Initial Care 100% O2 NRB tight fitting Severe S/S? BVM, 12 lead, Admin Cyano-kit Not severe? Monitor, 12 lead, transport to IRF |
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SBP must be greater then what to admin Versed and Etomidate?
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100 otherwise just use etomidate
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If Versed and Etomidate work in DAI, then do not use?
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Succs
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DAI, if patients initial HR is lower then 50, do what first?
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Premedicate with 0.5 mg atropine
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LEMON stands for?
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Look externally
Evaluate 3-3-2 Mallampati score Obstructions Neck mobility |
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DAI procedure?
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Confirm need for Airway
Pre-oxygenate Lemon Difficult airway? King tube then Crich Not difficult? Versed 4mg/Etomidate .5mg/kg Max 40 Trismus gone? OTI(Max 2) King/Crich Trismus not gone? Succs 1mg per kg Max 100mg OTI/King/Crich |
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Post intubation after DAI we do what?
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keep sedation with Versed 2 - 10 mg. Check and confirm placement.
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How does Glucagon help in EFBO?
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decreases lower esophageal sphincter tone interfering with esopageal contractions (acts as a smooth muscle relaxer)
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Most common obstruction in children is?
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Coin (80%)
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Procedure for EFBO?
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Initial Care
Airway obstruction??? go to FBAO Control Airway Position of comfort Glucagon 1mg IVP q 5min Max 2 mg |
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How long do we continue abdominal or chest thrusts in an FBAO patient?
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Until item is dislodged or patient becomes unresponsive.
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Make sure when trying to dislodge items always?
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Alternate with attempts to ventilate
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If patient is physiologically difficult to intubate refer to ?
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DAI for difficult airways
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FBAO procedure?
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Initial Care
Partial? Encourage patient to cough...Do Not interfere with Patienst attempt to clear Complete? Conscious abdominal thrusts/Chest thrusts/Back blows&chest thrusts Unconscious: BVM with CPR/Laryngoscope and forceps/BVM/OTI if object not seen/Crich |
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FBAO Conscious pregnant patient we do what to clear item?
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Chest thrusts
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FBAO Conscious infants we do what to clear items?
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Back blows and Chest thrusts
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Albuterol/Atrovent are used when HR is?
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<120
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Albuterol/Atrovent are used when HR is?
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>120
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If patient presents with mild ventricular ectopy that is unresolved with aggressive oxygen treatment use what? If condition worsens after that we do what?
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Xopenex / Discontinue Updraft
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Atrovent is contraindiated in?
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Children less then 12 yrs old
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Xopenex is contraindicated in children?
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Less then 6 yrs old
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Albuterol is contraindicated for?
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No one when given by itself.
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PEEP size for COPD or asthma?
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7.5
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PEEP size for CHF patients?
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10.0
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How do we prepare Mag sulfate for asthma patients?
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mix in 10mg saline
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Procedure for Rales or signs of CHF?
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Initial Care, no activity
Patent Airway? NO? DAI Yes? CO? Refer CPAP 10.0 or 7.5 Nitro paste 1 inch Xopenex and atrovent for wheezing Intubation??? |
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Procedures for COPD?
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Initial care and rule out of patent airway
Rule out CO poisoning BVM if RR <10 or >30 Albuterol/Atrovent <120 HR or Xopenex/Atrovent >120 HR CPAP 7.5cm Intubation???? |
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Procedures for Asthma?
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Initial Care
Rule out patent Airway Rule out CO poisoning BVM if <10 or > 30 Albuterol/Atrovent <120 HR repeat as needed Xopenex/Atrovent >120 HR repeat X3 CPAP 7.5 Mag Sulfate slow IVP 1GM Intubation??? EPI 0.3 mg IVP first line if unstable |
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Abdominal pain in women should be treated as?
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Ectopic pregnancy until otherwise noted.
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Antacids should be avoided in patients with?
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Renal disease
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Flank pain radiating to the area of the groin may represent?
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Kidney stones
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Abdominla pain or flank pain in patients over 50 should be considered?
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abdominal anuerysm
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Describe how appendicitis presents in a patient?
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vague, periumbilical pain which migrates to the RLQ over time.
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After every bolus of fluid we repeat what?
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Vital signs
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Choice of pain meds for abdominal pain?
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Dilaudid over morphine
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Dose and use of pepcid?
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20 mg IVP slowly over 2 minutes, histamine h2-receptor antagonist. Inhibits stomach acid production.
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Procedure of abdominal pain with a GI bleed?
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Initial care, Pepcid 20 mg slow IVP over 2 minutes. 1 liter of fluid titrate to MAP >70. Medical consult for further treatment
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Procedure of abdominal pain with no GI bleed?
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Initial care. RULE OUT ACS or shock. NPO, assess distal and femoral pulses. Pain management protocol.
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If you push Epi on an allergic reaction, what must we always due after?
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12 lead ekg.
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The shorter the onset of an allergic reaction the?
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More severe the issue.
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Newborn is classified as what?
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First 30 days of life.
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What two drugs can we now push for allergic reactions?
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Pepcid 20 mg and benadryl 25 mg.
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Procedure for unstable allergic reactions in all 3 age groups?
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Adult: SQ 1:1,000 0.3 mg or IVP 1:10,000 0.3mg EPI
Pediatric SQ 1:1,000 0.01mg/kg or IVP 1:10,000 0.01mg/kg EPI Newborn: IVP 1:10,000 0.01 mg/kg Treat Shock Albuterol 2.5 mg Nebulizer Benadryl 25mg max of 25 mg Pepcid slow IVP of 20 mg Severe cases refer to DAI. |
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Procedure for stable allergic reactions?
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Initial care
Albuterol/Xopenex Max 3 doses (Wheezing) Benadryl 25mg Pepcid slow IVP of 20mg |
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During any AMS call always be aware of?
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Hazmat situations or environmental toxins
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Is it safer to assume hyperglycemia or hypoglycemia?
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Hypoglycemia
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Do not use oral glucose if the patient can not protect his own?
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Airway
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Only administer Narcan if there is?
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probable cause for opiate overdose with resp depression
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Procedure for patients with AMS?
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Initial Care including a stroke exam
Hypotension or shock protocol C-spine? Accucheck <60 Glycemic protocol 60-250? consider narcan 2mg IVP max of 8mg >250? Glycemic protocol. |
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Cincinnati pre hospital stroke screen?
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Arm drift
Slurred speech facial drooping |
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How do you determine a stroke alert off of the Cincinnati exam?
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Any one deficit at all
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Every stroke patient receives?
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Screening checklist
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With an onset of symptoms less than 2 hours, scene times with a stroke should be?
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Minimized with Ivs and procedures started en route
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Onset of symtoms is determined by?
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Last time seen normal
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Zofrab can be given IM?
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Yes
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Documenation and family members when dealing with a stroke should be?
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Very detailed documenation including missed Ivs and take a family member with you.
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Treatable high BP ranges?
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230/120... either one will qualify
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Treatment of high BP should be titrated to what workable range?
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185/90
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85% of a hemorrhagic stroke if the patient meets these three criteria?
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GCS <8
Seizures BP 220/120 |
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Procedure for patients with a possible CVA?
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Initial Care...confirm last time seen normal
O2 NC @2lpm...elev head 15-30 no trauma Cincinnati stroke exam Abnormal?? complete stroke exam decide on transport D50 12.5 (half) if needed Zofran 4mg Labetalol 10mg slow IVP q every tem minutes until BP of 185/90 is reached. Establish 2nd Iv. Good documenation |
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Do not rely on patient history of ingestion espicially in?
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Suicide attempts
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Do what with bottles, contents, and emesis from overdose patients?
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Bring to ER
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S/S of tricyclic overdose?
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seizures
tachy dysrhytmias hypotension decreased mental status or coma |
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S/S of acetaminophen overdose?
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initially normal or N&V
not treated can cause irrreversible liver damage |
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S/S of depressant overdose?
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decreased HR
decreased BP decreased temp decreased RR non-specific pupils |
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S/S of stimulant overdose?
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increased HR, BP, temp,
dilated pupils seizures |
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S/s of anticholinergic overdose?
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increased HR, increased temp
dilated pupils mental status changes |
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S/S of cardiac med overdose?
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dysrhytmias
mental status changes |
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S/S of insecticides overdose?
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increased or decreased HR
incresed secretions N&V diarrhea pinpoint pupils |
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Do not give beta blockers to?
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Cocaine overdose
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Poison control phone number?
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1800-222-1222
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Procedure for a patient dealing with an overdose?
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Initial Care
NC @2lpm Accucheck AMS protocol Narcan 2mg max of 8mg Poison control |
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After any does of D50 or Gulcagon, always?
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recheck BGL
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Can a patient refuse after admin of D50?
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yes, criterai must be met.
>18 BGL acceptable No driving Food being eaten staying with an adult |
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patients that receive glucagon must be transported?
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yes
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Can we use D50 in an IO?
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no, use glucagon and transport
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Procedure for Glycemic emergencies?
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Initial care...stroke exam and accucheck
<60? Instant glucose if able to swallow, D50 25mg IVP, Glucagon if unable to obtain IV, No second dose of D50 is approved >250? NS 500 cc bolus, transport |
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Contraindications for Labetalol?
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hypotension, low HR, av blocks, Copd, heart failure, asthma
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Nitro for patients with high BP?
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No, only labetalol.
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How many sets of vital signs do we need to treat HTN?
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at least two
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All symptomatic patients with hypertension should be transported with their heads?
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elevated 15-30 degrees.
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Procedure for patients with a hypertensive crisis?
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Initial Care
NC @2lpm minimum Labetalol 10mg slow IVP over 5minutes Titrate until 185/90 Zofran 4mg IVP or IM |
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Hyperthermia is considered in what temp range?
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anything over 102 degrees
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Do not decrease temp below what number in hyperthermia patients?
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100 degrees
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Some main causes of hyperthermia?
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infectious disease, anesthesia, drug use
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Procedure for Hyperthermia Patients?
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Initial care
Infuse 1-2 liters cold NS 1 ice pack to head Poison control Other S/S? refer to appropriate protocol |
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Be sure to rule out all medical/trauma causes like???? before treating behavior problems
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AMS
BGL Stroke Alcohol Overdose Head Injury |
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All behavior calls use should contact ???
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LCSO
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If a patient receives physical or chemical restraints, what must the paramedic do?
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Stay with that patient the whole time
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When should chemical restraints be used?
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After all other efforts including physical
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Haldol can be given what two ways?
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IVP or IM
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Procedure for psychological and behavior emergencies?
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Scene safety
Consider all AMS possiblities Determine if patient will harm himself/others attempt to calm patient Consult with LSO for help Physicaly restrain check PMS before and after and every 5 minutes Initial Care and IV if possible Chemical restraint haldol 5mg, benadryl 25mg, Versed 2mg |
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Define status epilepticus?
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Two or more successive seizure without a period of consciousness or recovery. True emerency requiring rapid airway control, treatment, and transport
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Grand mal seizures are associated with?
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loss of consciousness, incontinence, and tongue trauma
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Focal seizures are associated with?
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only a part of the body and usually don't lose consciousness. (petit mal)
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Define Jacksonian seizures?
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petit mal that turn into Grand mal
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Seizures in pregnant patient we should always refer to ?
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OB emergencies
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Pediatric febrile seizures?
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Rectal Valium
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Always be prepared for airway assistance and breathing problems if you use ------ for seizures.
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Versed
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Procedure for a patient with seizures?
|
Initial care
Aspiration precautions Low BGL? hypoglcemic Actice seizure: Valium 5mg shlow IVP titrate to effect Max of 20mg Versed 2 mg max of 10mg refractory to Valium DAI if necessary Febrile? move to cool emvironment |
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Hypotension can be described as a systolic BP of less then?
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90
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In non trauma situations if suspected fluid or blood loss, check for?
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orthostatic vital signs
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Positive orthostatic changes include?
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increased HR by 10 and a decreased BP of 10.
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In neurogenic shock, what is needed to maintain bp?
|
Pressors
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Procedure for hemorrhagic or relative hypovolemia shock?
|
Initial care
2 large bore IVs Blood set with a macro rapid infusion of 500 cc bolus Reevaluate for a second 500cc MAP > 70mmHg Max 3 liters |
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Procedure for cardiogenic shock?
|
Initial care
Consider HR TCP with electrical and mechanical capture 500 cc bolus NS max of 2 liters No response?? Dopamine 5mcg/kg/min increase by 5mcg to get a MAP of 70. max of 20mcg/kg/min |
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Procedure for neurogenic shock?
|
Initial care
Dopamine 5mcg with progression max of 20mcg with a MAP goal of 70 1 Liter NS also titrate to MAP 70 |
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Sickle cell is more prevelant in?
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African Americans
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|
|
Procedure for treating sickle cell anemia?
|
Initial Care
HIGH FLOW NRB 100% oxygen No activity Infuse 500 cc NS Pain mangement protocol |
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|
In syncope patients always assess for what first?
|
S/S of trauma
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|
|
Consider all causes for syncope but look at these the most?
|
dysrythmias
ectopic pregnancy seizures GI bleed |
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|
More than 25% of geriatric syncope is ?
|
cardiac dysrythmias
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Syncope patients should transported or no?
|
Yes
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Syncope patients should always have what checked?
|
orthostatic vitals
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|
|
Procedure for syncope patients?
|
Initial care
C-spine? Orthostatic vitals IV Accucheck Anginal equivalents and ACS |
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|
Human bites are much worse then animal bites because?
|
Normal mouth bacteria
|
|
|
Carniovore bites are much more likely to become infected and develop?
|
Rabies
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|
|
Cat bites can progress quickly to?
|
Infection from bacteria (Pasteurella multicoda)
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|
|
Procedure for bite from a Human?
|
Initial care
Position patient supine and immobilize the area Consider allergic reaction Recover avulsed tissue Rinse with sterile solution Consider abuse and LCSO Pain mangement protocol |
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Procedure for bite from an animal?
|
Initial care
Contact animal control Position patient supine Allergic reaction? Consider trauma alert if indicated Rinse with sterile solution Pain mangement protocol |
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|
Pain management for second or thirs degree burns, what med?
|
Morphine 2-5mg max of 5mg call Doc for more
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|
|
Classify and evaluate the burn in what three ways?
|
source
degree severity |
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|
Describe "source" for burns?
|
Never assume the agent or source
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|
|
Describe degree for burns?
|
1st superificial
2nd Partial thickness 3rd Full thickness |
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Estimate extent of burns by doing what?
|
Rule of nines
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|
Treatment for burns
|
Sterile burn sheet on stretcher
Cover burns with sterile dressings cover patient with blanket Remove all jewelry |
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|
Parkland Formula?
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4ml X kg x % of burn / 2
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|
|
S/S of lighting or electrical burns??
|
Cardiorespiratory
Respiratory arrest due to paralysis of the medullary center Shock (neurogenic and hypovolemic) Ruptured tympanic membrane featherlike burns Corneal lesions Hyphema Retinal detachment |
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Procedure for Thermal/Inhalation Burns?
|
Assist with BVM
Initial trauma care Dry sterile dressings LR IV fluids Early intubation or DAI Pain management |
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Procedure for electrical burns?
|
Turn off source
Initial truama care assess for exit and entry wounds Assess PMS for affected extremity Cover with dry sterile dressings IV LR fluids 12 lead EKG Pain management protocol |
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Procedure for chemical burns?
|
Brush away powdered chemical
remove clothing and place in biohazard bag Irrigate with saline immediately and enroute Initial truma care IV fuids LR Pain manegment protocol |
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|
How do we assess for Pericardial Tamponade?
|
Beck's Triade:
Narrowing pulse pressures JVD Muffled heart tones |
|
|
Pneumo or Hemothorax we?
|
Pleural Decompression
|
|
|
With chest injuries reassess what a lot?
|
Lung sounds
|
|
|
With chest injures always obtain ----- to rule out medical?
|
12 lead ekg
|
|
|
Always watch for symmetrical schest rise to rule out?
|
Flail segment
|
|
|
Signs and symptoms of a tension Pneumo?
|
Anxiety, apprehension, agitation
Diminished or absent breat sounds Dyspnea with cyanosis Rapid shallow breathing JVD Hpotension due to loss of radial pulse cool clammy skin decreased AVPU Visible deterioration Loss of consciousness Tracheal deviation (late sign) |
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|
How dow we treat a tension pneumothorax?
|
Pleural decompression
Intubation |
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|
How dowe treat an open pneumothorax?
|
4 sided occlusive dressing
Tension? Intubation |
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|
Treatment for a flail segment?
|
Restrict flail segment with saline bags
assess for pnuemo Intubate as needed |
|
|
Procedure for treating a chest injury?
|
Initial Care
Penetrating Injury? Occlusive dressing and possible burps Stabilize objects in place |
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|
Indications for use of the CRUSH protocol?
|
Any extremity or torso impingement over an hour
|
|
|
Complications of Rhabdomyolsis?
|
Muscle pain, tenderness, and swelling
Hypovolemic state Decreased urine output dark urine Peaked T waves (hyperkalemia) |
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|
Procedure for crush syndrome?
|
Initial medical care
12 lead ekg q 15min 2 large bore IV's Keep patient warm NS wide open Max of 2 liters Sodium Bi-carb 50 mEq Pain management protocol |
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|
With cold water drowning keep????
|
CPR going at all times
|
|
|
Drowning is the major cause of death among?
|
Would be rescuers
|
|
|
Hyperbaric chambers at what two hospitals?
|
Shands
Florida Hospital South |
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|
Define Near Drowning?
|
A submersion event with loss of pulse or RR and ROSC after
|
|
|
Define drowning?
|
a submersion event when no ROSC and should be transported to IRF
|
|
|
Procedure for Drowning or near drowning?
|
Initial medical care
Care should begin in water Remove wet clothing and protect from environment cardiac dysrythmias Hpypothermia Adults near drowning is a medical, pediatrics near drowning is a trauma center |
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|
S/S of decompression sickness or dysbarism?
|
Severe throbbing pain
Itching Mottling CNS or resp issues N/V Cough Ear Pain |
|
|
Procedure for decompression sickness?
|
Initial care
NRB or BVM only 100% Transport Left lateral head down position Zofran 4mg Hyperbaric chamber?? Significan injury refer to trauma alert criteria |
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|
Most important part of amputations?
|
Time is critical... transport immediately
|
|
|
Injured areas with high incidence of vascular compromise?
|
Hip, knee, elbow
|
|
|
Severe bleeding not rapidly controlled may require a ??
|
Tourniquet
|
|
|
Procedure for suspected fracture?
|
Initial truma care
Consider cold packs distal pulses present, immoblize as found Closed with absent or diminsihed, attempt to realign once then splint Never manipulate open fractures Pain management protocol |
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|
Procedure for Traumatic amputation?
|
Initial Trauma Care
Incomplete? Stabilize with bulky dressing Splint in line with extremity Uncontrolled bleeding? Tourniquet Clean amputated part, wrap in sterile soaked dressing, place in plastic bag, attempt to cool with ice pack |
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|
In the absence of capnography, we can do what for head injuries?
|
Mildly hyperventilate with S/S of blown pupils, decorticate/decerbrate posture, bradycardia
|
|
|
Cushings response??
|
ICP
elevated BP low HR Irregular RR |
|
|
Hypotension in a head injury patient may indicate?
|
severe shock somewhere else and should be treated aggresively.
|
|
|
Most important item to document in head injury patients?
|
Change in LOC or GCS
|
|
|
Define a concussion?
|
Periods of confusion or loss of consciousness... any prolonged S/S should see a doctor
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|
|
Procedure for Head Injuries
|
Initial care
C-spine precautions Treat shock No shock? restrict fluids and elevate head Combative patient 2-10mg Versed q 3min Zofran 4mg RR <10 >30 Dai or BVM Consult Doc for Pain management |
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|
Hyphema?
|
blood in the anterior chamber of the eye
|
|
|
Amarosis Fugax?
|
Curtains across the eyes
|
|
|
Pseudotumor Cerebri?
|
Increases CSF in the brain causing headaches
|
|
|
Procedure for eye injuries with chemical involvement?
|
Initial trauma care
Use continuous NS through IV tubing as soon ass possible and throughout transport |
|
|
Procedure for eye injuries with penetrating injury?
|
Initial care
Do not remove object Cover both eyes with cup or bandage No bending or straining Pain management protocol |
|
|
Procedure for eye injury with blunt trauma?
|
Initial care
Hyphema? Elevate head at least 60 degree Dim lights to help patient Apply paper cup as necessary Pain management protocol |
|
|
Always be aware of patient's ----- before administering ?
|
Pain meds
|
|
|
RR is important with pain medication and always use?
|
Capnography to watch for depression
|
|
|
Narcan should be ready for signs of over sedation... they are?
|
RR depression
AMS Unresponsive Low Sao2 saturation |
|
|
Procedure for pain management??
|
Initial Care
Morphine 2-5mg max 5mg Dilaudid .5 to 1 mg max 1mg Zofran 4mg Narcan as needed 2 -8mg Max 8mg Call doc for more |
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|
Indications for the Autopulse?
|
Non traumatic cardiac arrest
18> or older less then 300lbs |
|
|
Who don't we use the autopulse on?
|
Trauma patients
Pediatric patients, unless they fall into the specs |
|
|
Procedure fopr Autopulse
|
Align armpits on yellow line on platform
keep bands at 90 degrees power on autopulse close chest bands Press continue then start |
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|
Indications for capnography
|
verifying tube
continuous monitoring for displacement monitoring cpr |
|
|
Indications for cardioversion
|
SVT protocol
Vtach protocol A-fib or A flutter with RVR |
|
|
Procedure for cardioverting
|
Verfify upright QRS on the monitor with a small dot on each "r" point, you can turn up gain
Confirm the rhythm turn on Sync select starting energy level Press and hold energy button to sync look for rhytym change and check for pulse |
|
|
Procedure for childbirth?
|
Controlled delivery
support the infant's head umbilical; cord present? slip over head otherwise clamp and cut suction airway gently pull on the head to facilitate shoulder delivery cut the cord two inches from the abdomen with 2 clamps and cut record APGAR 1 and 5 minutes |
|
|
Indications for CPAP
|
Hypoxemia secondary to COPD or Pulmonary Edema
|
|
|
Contraindications for CPap?
|
penetrating chest trauma
sever hypotension N&V Obtundation Resp/cardiac arrest unable to protect their own airway |
|
|
Procedure for CPAP?
|
choose peep valve size
valve to face / filter to O2 tank Turn the device on and then apply the mask If patient's issues don't improve then prepare to intubate |
|
|
Equipment for Needle Crich?
|
14 gauge over the needle catheter
3.0 mm endotracheal adapter antisseptic swabs 12 cc syringe tape occlusive dressing BVM |
|
|
Procedure for needle crich?
|
Antiseptic swab
palpate cricothyroid membrane, anteriorly between the thyroid cartilage and cricoid cartilage Puncture the skin midline with the needle attached to the syringe direct the neddle at a 45 degree angle aspiration of air signifies that the needle is in the right place Remove the syring and withdraw the needle, attache 3.0 ET adapter to hub and connect BVM Observe for breath sounds |
|
|
Contraindications for Surgical Crich
|
kids under 16
known bleeding disorder unable to locate the landmarks |
|
|
Equipment for surgical crich?
|
#11 scalpel blade
needle nose hemostats 5.0 to 7.0 ET tube cut above pilot balloon antiseptic swabs tape BVM |
|
|
Procedure for surgical Crich?
|
Palapte the thyroid notch
prepare site with antiseptic swabs Go to adams apple and slide your finger twards the feet look for the V notch stabilize with your non dominate hand Make a vertical incision Then make a horizontal incision protect yourself against blood. Rotate the scalpel 90 degrees and insert the hemostats. Slide the ET into the hole. Inflate the cuff and attach a BVM Observe for chest rise and fall |
|
|
Indications for DAI?
|
GCS of 8< with a gag reflex
Trauma patients with sig facial trauma closed head injuury or stroke Severe asthma, CHF, COPD Overdoses with AMS where airway loss is inevitable Status epileptic Carbon monoxide poisoning |
|
|
Weight cut offs for IO needles?
|
Pediatric 3-39 KG
Adult >40 |
|
|
Procedure for IO insertion?
|
Find your insertion site
Position the needle ver the insertion site, 90 degree angle with firm pressure. Unscrew the stylet Connect the IV extension set flush 1-2 cc of fluid and look for return of blood Then after confirmation flush with 10 cc Lidocaine can be pushed at 40 mg after insertion for pain. |
|
|
Procedure for Induced hypothermia?
|
Assure Capno of 94% or better
Ice packs to head and axilla Versed for shivering 2mg 1 gram Mag Sulfate Cold aline bolus 30ml/kg max 2 liters Dopamine 5mcg/kg/min Do not hyperventilate ETOC 40mmHg Goal to drop temp 1 degree |
|
|
Gravida?
Para? |
# of times that a woman has been pregnant
# of viable births >20 weeks |
|
|
Procedure for Breech Presentation?
|
Do not pull infant from vagina
support infant in towel when it delivers If infant is face down after shoulders deliver gently raise the trunk to facilitate delivery of the head If head does not deliver within 30 seconds enter two fingers into the vagina, locate the infant's mouth and create an airway. Apply gentle pressure to the fundus, If the head doesn't deliver in 2 minutes keep fingers inserted to maintain airway. ***Transport ASAP*** |
|
|
Procedure for prolapsed cord??
|
Elevate the mother's hips
Place gloved hand into the vagina between the pubic bone and presenting part, have cord between fingers to monitor cord pulsations and exert counter pressure on presenting parts. Cover exposed cord with moist dressings and keep warm ***Transport ASAP*** |
|
|
S/S for pre-eclampsia?
|
Severe headache, vision changes, RUQ pain may indicate this issue
|
|
|
HTN in pregnancy is described as?
|
140/90 or 30/20 increase in patient's normal blood pressure
|
|
|
What position helps treat supine hypotensive syndrome?
|
Left lateral
|
|
|
Ask any patient having a baby to quantify bleeding by how?
|
Number of pads used by hour 30cc per pad
|
|
|
Full procedure for Childbirth emergency...
|
Patent airway?? Hyperventilating?? help coach
Hypotensive or lightheaded? 250 cc NS titrated to SBP >100 Place mother supine Prepare OB kit Delivery: Baby's head first, apply suction mouth then nose, feel for umbilical cord around neck; if present attempt to remove. Double clamp and cut. Next: guide head downward to facilitate shoulder delivery, keep newborn level until cord is cut, if able let mother hold infant. Go to newborn care |
|
|
Procedure for Newborn care??
|
Apgar at 1 and 5 minutes, Meconium stained? Yes - Suction mouth first and then nose. DO NOT STIMULATE BABY until suction has occurred. After delivery intubate baby and apply suction to the lumen while withdrawing from trachea. Start assessing Resp rate. Assist with BVM as needed. Can move to NRB when adequate. Assess heart rate, <60 CPR and EPI ( 0.01 mg/kg 1:10,000 IVP) HR 60-100 BVM, HR >100 Reassess and transport
|
|
|
Procedure for post-partum care?
|
Initial Care, Placenta should deliver in 20-30 minutes. If delivered collect in a plastic bag. Transport ASAP, even without placenta. Apply direct pressure if perineum is torn and bleeding, Signs of hypotension? 250 cc boluses and gently massage abdomen above uterus until firm. Treat shock and AMS as needed.
|
|
|
Procedure for pregnancy induced HTN?
|
IV fluids NS. Gentle handling, minimal CNS stimulation, Patient on left side with backboard raised 30 degrees, Labetalol 10 mg slow IVP over 5 minutes. 160/110 treat to 140/90
|
|
|
Procedure for Pre-eclampsia?
|
IV fluids, Closley watch for seizures, Mag Sulfate Drip (5grams in 250 D5W infused over 30 minutes 500ml/hour.) Labetalol 10 mg slow IVP over 5 minutes. 160/110 treat to 140/90.
|
|
|
Procedure for Eclampsia?
|
IV fluids NS, Mag Sulfate 4 Grams IVP over 2 minutes. Valium 5mg every 2min IVP Max 20 mg. If refractory to Mag. Labetalol 10 mg over 5min 160/110 treat to 140/90.
|
|
|
Pregnant patients involved in trauma should always?
|
Be transported and seen b a physician.
|
|
|
Most common cause of fetal death is?
|
Maternal Death
|
|
|
Procedure for trauma in pregnancy?
|
Initial care, Check for uterine contractions, vaginal bleeding, or leaking amniotic fluid. Place pt in left lateral with a 30 degree raise on the right. 500 ml NS up to 2 L. Treat HTN per protocol. Treat ACS and pain management as needed.
|
|
|
Describe Placenta previa?
|
bright red blood, no pain
|
|
|
Describe abruptio placenta?
|
dark red blood, pain present
|
|
|
Describe a uterine rupture?
|
possible bleeding, pain present and usually associated with sudden onset N/V.
|
|
|
Procedure for vaginal bleeding 1st/2nd Trimester?
|
Initial Care, determine date of LMP (note passage of clots or tissue) Shock protocol, Active labor? refer to that protocol
|
|
|
Procedure for 3rd trimester vaginal bleeding?
|
Initial Care, check for amniotic fluid, place patient in left lateral recumbent, Establish 2 large bore IVs, treat for Shock, Active labor go to that protocol. Pain management for above also.
|
|
|
I weight of the infant is available, always go to?
|
Broselow Tape and going directly to the weight and dosage block.
|
|
|
CPR should be administered in a linear approach....meaning?
|
Oxygen.....BVM.....CPR, if no or limited response.
|
|
|
Atropine dosages for pediatric patients?
|
Minimum .1 mg Maximum 1 mg
|
|
|
Procedure for bradycardia in a pediatric patient?
|
Initial care LBT
HR<80 Hi flow NRB BVM 20 per minute HR< 60 CPR Correct H and T's Hypovolemia 20ml/kg Epi .01 mg/kg every 3-5 Atropine .02 mg/kg every 3-5 minutes Max 1mg |
|
|
Procedure for V-Fib/V-Tach in a pediatric patient?
|
Initial Cardiac arrest care,
End of life guidelines. >4 minutes begin CPR, <4 minutes assess rhythm Defib 2j/kg CPR 2minutes reassess Defib 4j/kg Vascular access. IV/IO Epi 1:10,000 .01 mg/kg Amiodarone 5mg/kg IVP repeat once Mag Sulfate 50 mg/kg IVP max 2 grams for Torsades Intubate ROSC?????? |
|
|
Procedure for asystole/PEA in pediatric patients?
|
Initial CPR care
End of life guidelines Arrest > 4 minutes CPR < 4minutes assess rhythm Vascular access IV/IO Epi 1:10,000 .01 mg/kg every 3-5 minutes Intubate ROSC?????? |
|
|
ROSC after V-fib/V-tach in a pediatric patient?
|
Amiodarone drip 5mg/kg over 20 minutes if rhythm converts prior to drug
Versed 0.1 mg/kg every 3-5 minutes Max of 4mg |
|
|
ROSC after Asystole/PEA in a peditric patient?
|
Versed 0.1 mg/kg every 3-5 minutes Max 4mg
|
|
|
If time permits in peditric patient with tachycardia try and apply?
|
Capnography
|
|
|
SVT HR's in infants and children?
|
Infants = >220
Children = >180 |
|
|
Procedure for tachycardia in pediatric patients via unstable?
|
Initial Care
Versed 0.1 mg/kg max of 4mg Cardioversion 1J/kg Cardioversion 2j/kg Amiodarone 5mg/kg IV drip over 20 minutes Max 300 mg Medical direction for further treatment |
|
|
Procedure for tachycardia in pediatric patients via stable?
|
Initial Care
Vagal maneuvers Adenosine 0.1 mg/kg Rapid IV push with a second dose of 0.2 mg/kg Amiodarone 5mg/kg IV drip over 20 minutes Max 300 mg Monitor patient for Unstableness LBT!!!!!! |
|
|
Pediatric tachycardia will usually respond to ???
|
aggressive BLS measures and fluid.
|
|
|
Appendicitis presents with???
|
vague, periumbilical pain which migrates to the RLQ over time.
|
|
|
Procedure for pediatric patient with abdominal pain???
|
Initial medical care
Cardiac or shock protocol??? NPO Assess distal and femoral pulses Pediatric pain management |
