1
Q
If aspirin was given/taken since the onset of symptoms and prior to your arrival, you may give up to _____ mg of aspirin
A
Up to 324mg of aspirin
2
Q
Patients should only recieve ____ aspirin and not ______ aspirin
A
Chewable, enteric coated aspirin
3
Q
If a patient took enteric coated aspirin you may give how much chewable aspirin?
A
324 mg
4
Q
What are the two contraindications for aspirin?
A
NSAID allergy
Viral infections in children and teens
5
Q
List five situations where aspirin may create an adverse reaction
A
Fever
Hypothermia
GI Bleed
Dysrhythmias
Hypotension
6
Q
When obtaining HPI for a burn injury what four informational items should be obtained?
A
Type of exposure causing the burn (heat, gas, chemical)
Time of burn
Mechanism of injury
Location (indoor/outdoor, confined area)
7
Q
If a burn surface area (BSA) is <10% what is the correct treatment for the burn
A
Apply a cool, moist dressing and prevent hypothermia
8
Q
If burn surface area is >10% what is the correct treatment for the burn?
A
Use a dry burn sheet or dry sterile dressing
9
Q
Provide the body surface area percentages for adults per burn guidelines
A
Head: 9%
Arms: 9% each
Chest & Back: 18% each
Groin: 1%
Legs: 18% each
10
Q
Provide the body surface area percentages for pediatrics per burn guidelines
A
Head: 18%
Arms: 9% each
Chest & Back: 18% each
Groin: 1%
Legs: 13.5% each
11
Q
Per the burn guideline, list the criteria identifying major burns
A
Partial thickness burns >25% BSA
Full thickness burns >10% BSA
Any full thickness burn to hands, face, eyes, ears, feet and perineum
Burns compromising circulation
Burns with evidence of respiratory involvement
Any burns involving high voltage electricity
Burns involving hydrofluoric acid
Burns associated with multi-system trauma
12
Q
Per the burn guideline, list the criteria identifying moderate burns
A
Partial thickness burns 15-25% in adults
Partial thickness burns 10-20% in pediatrics
Full thickness burns <10% BSA
13
Q
T/F with penetrating eye injuries or protruding foreign object eye injuries is examination of the eyes indicated
A
False this is contraindicated
14
Q
With penetrating eye injuries what is the correct treatment?
A
Protect injured eye with a moist dressing and bulky padding without putting pressure on the injured eye
15
Q
For protruding foreign body eye injuries what is the correct treatment?
A
Stabilize foreign body, cover with bulky padding and cover unaffected eye to prevent eye movement
16
Q
For chemical eye injuries what is the correct treatment
A
Brush off any dry powders
Initiate copious irrigation and continue treatment while enroute to the hospital
17
Q
When should mace/pepper spray patients be transported to the hospital?
A
Shortness of breath
Prolonged visual impairment
18
Q
T/F for a patient to be eligible for ECMO they must meet ALL inclusion criteria and NONE of the exclusion criteria
A
True
19
Q
What is the inclusion criteria for ECMO
A
18-75 years old
Bystander CPR
Capno >10
Initial rhythm anything but asystole
Current rhythm VT / VF or PEA with cardiac activity on ultrasound
20
Q
What is the exclusion criteria for ECMO
A
Suspected significant co-morbidities
Likely respiratory arrest leading to cardiac arrest (hanging, strangulation, OD, trauma)
21
Q
When considering to transport an ECMO patient the time from collapse to arrival at hospital should be _____ minutes or less
A
30
22
Q
ECMO may be activated by AFR if the total patient downtime to the time of ECMO dispatch is less than _____ mins
A
15
23
Q
Where can ECMO patients be transported to?
A
UNMH or PRES DT
24
Q
Who is contacted to issue an “ECMO Alert”
A
AAS Base
25
The incidence of re-arrest after ROSC is estimated at _____ %
40%
26
T/F if your ECMO patient has ROSC it is appropriate to cancel ECMO-1 response
False, keep ECMO-1 coming because the incidence of re-arrest after ROSC is 40%
27
Generally the goal for determining an ECMO candidate is within _____ mins of arriving on-scene
5 minutes
28
T/F Hypothermic cardiac arrest has excellent outcomes with ECMO
True
29
For provider ECMO activation the time from patient collapse to time of ECMO dispatch must be less than ____ minutes
15 minutes
30
When on-scene of a cardiac arrest, patient eligibility for ECMO must be determined less than _____ minutes from patient contact
5 minutes
31
When a patient is an ECMO candidate an ECMO Alert is issued when the patient is less than _____ minutes from the time of collapse to hospital arrival at which two hospitals?
Max 30min time from collapse to hospital arrival
UNMH or PDT
32
How should an eviseration be dressed?
Cover with clean sterile dressing
33
T/F an impailed object in the abdomen should be removed
False, impailed objects should be stabilized with bulky dressings
34
A crush injury is defined as a limb or body being pinned for >____ mins
30 minutes
35
For a crush injury what metabolic abnormality should be considered?
Hyperkalemia
36
For crush injuries, besides usual trauma stuff what else should an AFR crew do as part of patient treatment
12-lead
37
What medication is needed to treat hyperkalemia in the context of crush injuries
Sodium bicarbonate
38
This airway device is the most important airway device but also the one that is the most difficult to use correctly is?
THE BVM
39
When positioning a BVM mask on a patient’s face, do we push the mask into their face or pull their face to the mask
pull face to mask
40
The optimum position for a patient receiving BVM is?
The sniffing position
41
When using a BVM, ventilations should be delivered over _____ seconds to avoid inflating the stomach
1-2 seconds
42
When bagging with an adult BVM we bag until we see _____
subtle chest rise
43
To limit over ventilation with a BVM what are two things we can do?
Use a pediatric BVM
Squeeze an adult BVM with two fingers
44
To limit over ventilation with a BVM what are two things we can do?
Use a pediatric BVM
Squeeze an adult BVM with two fingers
45
What is the preferred airway device for pre-hospital cardiac arrest?
EGD (i.e. LMAs)
46
During adult CPR ventilations should not exceed ______ bpm or one breath every _______ seconds
8-10
6 seconds
47
reactive airway disease is best managed with what two interventions?
BVM and CPAP
48
When responding to a trach tube emergency and the patient’s breathing is adequate but exhibits signs of respiratory distress what intervention is most appropriate
high flow O2 with NRB over the trach tube or blow by
49
T/F: Basics may suction a trach tube
true
50
when responding to a trach tube emergency your first intervention is?
ask caregivers for assistance and look for easily correctable solutions like disconnected oxygen
51
during a trach tube emergency if the patients breathing is inadequate what is your intervention
attach BVM to tube and assist with ventilations
52
When are trach tubes are most likely to cause problems within the first _______ weeks of installation
within the first two weeks
53
During a trach tube emergency all priority should be given to?
basic suctioning and BVM
54
Adult cardiac arrest compressions should be delivered at ______ per min with a desired capno value of >= ______
100-120
10
55
pulse checks should be <=_____
10 seconds
56
under what conditions can you terminate a code without an MCEP call?
unknown/unwitnessed arrest with unknown downtime and rhythm is only asystole for 20mins despite ACLS
57
When are codes worked for at least 40mins?
Vfib
Vtach
PEA >=40
58
codes are worked for at least 30mins when?
downtime is established
terminal rhythm is asystole
arrest not caused by hypothermia
59
what two basic skills are not done while a patient is in cardiac arrest?
BGLs and nalaxone
these may be done after ROSC
60
At a suspected hypothermic cardiac arrest, pulse is checked for ______ seconds
60
61
hypothermia is defined as a tympanic temperature less than ______
90F
62
If a cardiac patient is not SOB or hypoxic should you give oxygen as a precaution?
guidelines states that this is not reccomended
63
What is the preferred position for a cardiac patient in shock
supine
64
The position of comfort for most cardiac patients who are not in shock is what?
fowlers
65
What two rhythms are a priority for defibrillation?
VFib & VTac
66
When can you terminate a code without MCEP approval? How long is this type of code worked?
unwitnessed or unknown downtime with persistent asystole despite ALS interventions
20mins
67
At the scene of a call involving chest pain, the first 12-lead should be completed within _____mins
10
68
When responding to a cardiac call if a STEMI is confirmed the time from first medical contact to transport should be ________
<10mins
69
When responding with an all basic crew and the EKG strip says *Acute MI Suspected*, what is an immediate priority?
Transmit a STEMI alert
70
During a cardiac call with a STEMI alert, O2 is given to maintain a saturation of >=_____%
95%
71
What are the elements of a STEMI alert?
pt age
pt gender
Cardiology group or cardiologist if known
hospital destination
72
Who do you contact to initiate a STEMI alert?
AAS Base
73
CPR is given at a rate of 100-120bpm and the quality of compressions is evaluated with capno. Capno should be >= ______ during compressions
10
74
Paramedics get ______ attempts at an ETT tube during a cardiac arrest
2
75
In moderate to severe CHF what do we expect HR and BP to be (elevated, within normal range, below normal range)?
Both elevated
76
During a CHF episode O2 saturation should be maintained >=____%
94%
77
If a patient is in severe respiratory distress the primary intervention before any other intervention is?
CPAP
78
Our protocols for tachycardia conditions identify these serious tachycardia conditions as a HR >=_____bpm. This is in contrast to our regular cutoffs for tachycardia which are HR between ______bpm
150bpm
100-120bpm
79
If you encounter a patient in tachycardia (>=150bpm), the 12-lead should be acquired within ____mins
5mins
80
Bradycardia is considered a HR <=____bpm
50
81
If a patient presents with a HR <=50bpm the 12-lead should be obtained within the first ____min
5
82
During a call involving bradycardia, how should the pads be placed?
Anterior & posterior
83
You get ROSC at a cardiac arrest, what are four things that need to happen?
Vitals to include BGL and temp
12-lead with transmission to destination hospital
raise head of bed 30-degrees
if patient is unconscious, consider permissive hypothermia with cold packs
84
During ROSC care, if you initiate hypothermia, what is the target body temp?
96.8F
85
During ROSC care, the head of the bed should be elevated ______ degrees
30 degrees
86
During ROSC care, the target RR is ______ with a capno of ______
10-12rpm with capno 35-45
87
Approx. ____% of patients with ROSC will rearrest prior to arriving at the hospital
40%
88
The only VAD capable hospital in Albuquerque is?
Heart Hospital
89
T/F: All VAD patients in cardiac arrest should be transported
true
90
What is a unique factor regarding VAD patients that can really throw off AFR?
patients with VADs will not have a pulse and you cannot get a BP.
91
T/F: We may use the LUCAS device on a VAD patient in cardiac arrest with an non-functioning VAD
False
92
When treating a VAD patient in cardiac arrest with a functional VAD do we perform chest compressions?
No
93
you are on scene of a VAD patient in cardiac arrest and the pipemen go to remove the patient’s shirt. What specific consideration should we call out?
power cord for VAD will likely exit at abdomen and all care should be made to not cut the power cord!!!
94
When treating a VAD patient that is unresponsive with a non-functional VAD, CPR is initiated only when Capno is <_____
20
95
When treating a VAD patient what are two phone calls you make right away
patient’s VAD coordinator and MCEP
96
A top priority at a call involving a VAD patient is to?
Call patient’s VAD coordinator ASAP!
97
How can you check to see if a VAD is functioning?
listen to patient’s chest, VAD should make a whirring sound
98
What specific patient belongings should go to the hospital with a VAD patient?
Emergency travel bag
all batteries, chargers, monitors and cables associated with the VAD
99
T/F: Only certain patients with a VADs are anti-coagulated
false, all VAD patients are
100
What is a special action you should take with a suspected or confirmed meseals exposure?
Early notification to receiving hospital and have them meet you in ambulance bay
101
Acute abdomen is potentially a surgical emergency and is characterized by what Sx?
rigid with guarding, distention, and diffuse tenderness
102
When is a 12-lead indicated for abdominal pain
patients >=30 years with upper abdominal pain or epigastric/heartburn pain (nose to naval)
103
per our protocols, childbearing age is considered?
12-50 years old
104
abdominal pain may be present with an MI in what two patient populations?
elderly and diabetics
105
For anaphylaxis, what is considered a front line treatment
Epi
106
EMT-Bs can only administer Epi in what two ways?
3ml syringe
auto-injector
107
The ratio of Epi used when given in a 3ml syringe for allergic reactions is?
1:1000
108
Moderate and severe allergic reactions involve a minimum how many body systems?
2
109
Severe allergic reactions involve how many body systems and what other criteria?
2+ systems and airway compromise
110
In addition to epi what is another primary intervention for moderate and severe allergic reactions?
DuoNeb
111
What are the Sx of CO poisoning?
headache, nausea, vomiting, weakness, chest pain, changes is LOC
112
What is a consideration for pregnant women exposed to CO?
they should be transported because fetus hemoglobin has higher affinity to CO. Mom may feel fine but fetus may be in danger
113
post-ictal seizure patients should be positioned how?
On their left side
114
Status Elipticus is present when what two conditions are met?
Single seizure longer than 5mins
two or more seizures without an intervening ludic period
115
Per protocols a low BGL is <______ and a high BGL is>_____
60
250
116
What criteria must be met for a diabetic patient experiencing a diabetic emergency refuse transport?
All refusal criteria met
will be monitored for 2-3 hours and witness to eat food prior to departure of EMS
normalizing BGL and mentation
117
What two drugs taken by diabetics have long half-lives and will often require hospital admission despite corrected hypoglycemia?
The G’s:
glyburide, glipizide
118
If an unconscious diabetic has an insulin pump who should turn off pump?
family
119
T/F; When treating an opiate OD, narcan is titrated to reverse respiratory depression only
true
120
Hyperkalemia should be strongly considered in what two clinical contexts?
Crush injuries
renal failure with missed dialysis
121
what is a specific consideration for the patient in hypothermia?
avoid rough handling as this may precipitate v-fib
122
what is a specific consideration for the patient in hypothermia?
avoid rough handling as this may precipitate v-fib
123
T-F: for hypothermic patients, if ANY pulse is detected, no mater how slow, no CPR
true
124
How long is a pulse check on a hypothermic patient ?
60s
125
Severe hyperthermia is a body temp of >______
104F
126
For hyperthermic patients when is active cooling initiated (mild, moderate, severe)
severe
127
For patients in septic shock the time from first medical contact to transport is _____
10mins
128
What is the SIRS criteria for IDing sepsis?
Temp >100.4 or <96.8
HR>90
RR>20
Capno<25
129
What triggers a Septic Shock alert?
2+ SIRS CRITERIA
SBP<100
130
What criteria defines a stroke alert?
Any failure of cinci with onset of symptoms within 24 hours
131
For stroke alert patients, scene time should be kept to less than _____mins
15mins
132
If the cinci is positive for a suspected stroke patient you will evaluate the LAMS criteria. What are the three components of LAMS
Facial droop
grip strength
arm drift
133
A LAMS score of >=____ indicates a possible LVO. Where are these patients transported too?
4
UNMH
134
For stroke patients with symptoms >_____ hours a code 1 transport should be considered
6
135
If you issue a stroke alert and the patient’s symptoms resolve should you cancel the stroke alert?
No
136
What are the three elements of a stroke alert?
Patient age/gender
Last seen normal
Failing point of Cinci/LAMS
137
For alcoholics, withdrawal symptoms usually start within _____ hours after last drink and DTs kick in at _____ hours after last drink
6-24
48-72
138
For snake bites what four things should you NOT do?
elevate above heart
apply ice
apply TQ
Make incisions
139
For spider bites, ants, flying insects, etc the bite should be kept at the level of the heart, above or below?
at the level of the heart
140
For snake bites should the bite be kept at the level of the heart, above or below?
below
141
Can you apply ice packs to bites that are not a snake bite?
Yes
142
For fevers or hyperthermia aggressive cooling should be initiated at body temps >_____F
105F
143
per our protocols a fever is defined as a body temp >_____F
100.4F
144
For syncope calls a 12-lead should occur within ___mins of first medical contact
10mins
145
Entrapment or crush injuries should be considered anytime a body part is crushed or trapped for >=_____mins
30
146
Can you use the traction splint of a person with a suspected pelvic fracture
No
147
for TBIs what increases mortality?
The hypos:
hypoxia
hypothermia
hypoglycamia
hypoxapnia
hypotension
148
What is considered mandatory as part of TQ application
document the time of TQ application and must be part of patient handoff
149
Your partner mentions wanting to remove a TQ during transport to check for bleeding. Is this OK?
No, once applied, TQs should not be removed
150
How often should a TQ be re-assessed? What do we look for?
Every 5 mins
After patient movement
has the TQ loosened
151
For a given voltage is alternating current or direct current more dangerous?
AC more dangerous
152
during an electrical emergency with mass casualties we should initiate “reverse triage”, what is this?
treat cardiac arrests first
153
what are the two radio benchmarks for an MCI event?
Triage Report
All Immediates transported
154
What additional action should you take at an MCI event where 5+ Reds/Yellows need transport
banner the event
155
An MCI is bannered when what criteria is met?
5+ reds/yellows need to be transported
156
During an MCI what is considered the four major life saving interventions?
Control major hemmorage (i.e. TQs)
Open airway (consider 2 rescue breaths for children)
Chest decompression
Administer antidote
157
Explain the patient distribution guidelines for an MCI event
1st 4 reds : UNHM
Next reds : 2x each for PDT & LDT
Next Reds: 1x each for Rust LWestside, Womens, Heart, Kaseman and SRMC
158
In ABQ what are the Tier 1 hospitals(s)
UNMH only
159
In ABQ what are the Tier 2 hospitals(s)
PDT and LDT
160
In ABQ what are the Tier 3 hospitals(s)
Rust, Kaseman, LWomrns, LHeart, LWestside, SRMC
161
During an MCI if the transport of reds reaches a second or more waves, how many reds go to Tier 1, Tier 2 and Tier 3 hospitals?
2x to UNMH, PDT and LDT (T1 & T2)
1x to all tier 3 hospitals
162
During an MCI scenario what is the distribution criteria for yellow and green patients?
Transport to an ED but should be evenly distributed to EDs that have not received a red patient if possible
163
What is the main objective during an MCI scenario?
Transport of all red patients without delay
164
Will the VA accept non-veterans during an MCI?
yes
165
What types of patients will the VA accept during an MCI?
Greens and yellows
166
How are patients categorized as a red during an MCI?
must be breathing
No to any of the following:
obeys commands and makes purposeful movements
peripheral pulses
not in respiratory distress
Major hemorrhage controlled
167
With burn injuries what four things do we need to obtain during patient assessment?
type of exposure
mechanism of injury
time
location (indoor/outdoor,confined space)
168
for burns <10% BSA what is the primary treatment?
Apply a cool moist dressing and avoid hypothermia
169
for burns >10% BSA what is the primary treatment?
Use dry burn sheet or dry sterile dressing and prevent hypothermia
170
What types of burns are particularly dangerous and pose a potential for vascular compromise?
circumferential burns
171
What are high risk taser probe strikes that require removal at a hospital?
Anything above the clavicle
Tasers embedded in bone, joints, genitals, blood vessels and breasts
172
Taser probes may embed themselves up to ____mm in the skin
13mm
173
Are hangings treated as a trauma arrest or a medical arrest?
Medical arrest
174
Is commotio cordis treated as a traumatic or medical arrest
treat as medical cardiac arrest
175
In what situation would you transport a trauma patient that does not have ROSC after needle decompression?
penetrating trauma where PEA >40 AND transport time to UNMH is <10min
176
A traumatic arrest patient with a blunt trauma MOI does not have ROSC after bi-lateral needle decompression. What is your course of action?
Discontinue resuscitation
177
T/F: Any helmet outside of football helmets must be removed to maintain spinal alignment
true
178
In the context of helmet removal for football helmets, what are the indications for football helmet removal?
Indications:
Wearing helmet and not pads
presence of head/facial trauma
removal of facemask not adequate for airway management
helmet is loose on head
9E
179
You run a 9E at a football game. The player is wearing pads and a helmet. Shat equipment is removed?
Both helmet and pads
180
In the context of injuries with patients in football gear, what combination of helmet, pads and other gear keeps the spine in a neutral allignment
Helmet and pads together
181
Unstable vital signs are listed under the SANE assessment protocol. List these criteria
HR>110
RR>24
SPO2<90%
SBP<90 or >180
182
What is the preferred way to get a patient to the SANE nurse?
POV or LE
183
If you end up transporting a patient to the SANE nurse, what specific considerations should you tell the patient?
wear or bring clothing worn at the time of the assault
advise against eating, drinking, bathing, smoking and urinating if possible
184
What is the age criteria for a SANE patient to be accompanied by an adult?
16 or under
185
What are the four Sx of compensated shock in adults?
Anxiety
Tachycardia
Tachypnea
Diaphoresis with pallor
186
What are the Sx of compensated shock in children?
Delayed cap refill
palpable central pulse with decreased or bounding distal pulses
cool extremities
Altered mental status
Mild tachypnea
187
If a suspected traumatic brain injury is present, elevate the head of gurney to _____ degrees
30
188
for patient’s aged >______ , a c-collar is placed regardless of spinal assessment outcome when a neck/spine MOI exists
65
189
A positive spinal assessment is declared when what five conditions exist?
pain, tenderness or deformity in posterior mid-line over any vertebra
abnormal motor function or strength in any extremity
Paresthesia
Sensation is not intact and symetrical
Neck movement elicits midline spinal pain
190
What is the one exception to never transporting a patient with a rigid extrication device in place? (This is a type of rigid extrication device commonly used in mountain rescue)
Vaccusplint
191
At a vehicle crash if intrusion is >_____inches on occupant side or >_____ inches at any impact site, consider transporting to UNM
12
18
192
Falls greater than ______ are considered high risk and should be transported to UNM
10ft/one story
193
When considering transport to UNM for a trauma patient, what three risk factors favor transport to UNM even in grey zone situations?
older adults with significant head impact
>65 years old even with moderate mechanism
anticoagulant use
194
What is the two situation where you may insert fingers into a patient’s vagina?
prolapsed cord and breech deliveries
195
Explain management of a prolapsed cord (abnormal birth emergency)
Transport mom in trendelenburg position
discourage pushing
insert two fingers to elevate presenting part (preserves blood flow and prevents descent)
cover cord with sterile saline dressing
196
For the abnormal birth emergency shoulder dystocia (jammed shoulder) what position should the mom be placed in?
McRobert’s position
(hips elevated and knees to chest)
197
explain the treatment for the abnormal birth emergency, shoulder dystocia
Transport in McRobert’s position (hips elevated and knees to chest)
place pressure above symphysis pubis
support babies head and suction oral/nasal passages if able
DO NOT pull on head
198
What two actions happen immediately during a breech delivery
Transport ASAP
Do not encourage mom to push
199
At what point do more invasive EMT-B skills happen in a breech delivery?
Baby delivered to level of umbilicus
200
Explain what the provider does during a breech delivery when the providers hand is placed in the vagina
trying to form a “V” around infants nose with index and middle fingers to gently push vaginal wall away from infants face while applying gentle traction
201
If a mom is in labor at <20weeks gestation what hospitals can she go to?
nearest ED based on presentation rather than OB capabilities
202
If a mom is in labor at 20-29 weeks gestation what hospitals should mom be transported to?
NICU facility
PDT, UNMH and womens
203
If a mom is in labor at >30 weeks gestation what hospitals can she go to?
Without complications: any OB capable facility
With Complications: NICU facility
204
During a pregnancy call when should you suspect that delivery is imminent (Sx?)
crowning
urgent desire to push/move bowels
continuous intense contractions
membrane rupture
bloody show
205
After a normal field delivery clamps should be placed _____ inches from infants abdomen to cut the cord
6-8inches
206
What are the guidelines for when you cut the cord after a field deliver?
Preferred 1-2mins after delivery but do not delay if infant is in distress
207
What is Eclampsia?
An active, life-threatening seizure in a pregnant or post-partum patient
208
you run on a pregnant woman at 25 weeks complaining of Involuntary muscle contractions (clonus), abdominal pain and spots in her vision. what do you suspect?
pre-eclampsia
209
What are the two criteria identifying pre-eclampsia?
SBP>160 and/or DBP>110
OR
SBP>140 and/or DBP >90
AND any two of the following Sx
Headache
vision change
AMS
Abdominal pain
210
Pregnancy induced hypertension, pre-eclampsia and eclampsia can occur _____ weeks postpartum
6 weeks
211
A pregnant patient who is seizing is presumed to have what condition? what medication is the priority in this situation?
eclampsia
magnesium administration
212
T/F: some vaginal bleeding during pregnancy is normal
false
213
During what trimester is vaginal bleeding considered an emergency?
third trimester
214
T/F: For vaginal bleeding, the amount of blood loss visible is a reliable indicator of the total ammount of blood lost
False
215
For vaginal bleeding calls is visual examination of the perineum indicated?
Only if pre-term labor is suspected
216
After a field delivery what is your first action?
Dry/stimulate baby
217
After a field delivery when is suction indicated?
mouth and nose only and only if there a signs of obstructions by secretions
218
After a field delivery the baby should have spontaneous respirations after _____ seconds
15
219
APGAR scores are calculated at _____min and ______min
1min & 5min
220
After a field delivery, neonate resuscitation is initiated when HR Is <______
100
221
You deliver a baby in 5s to a junkie mom who is high on fentanyl. Can you give naloxone to the baby? why or why not?
No, this may cause seizures or pulmonary edema
222
For neonatal resuscitation, when the baby requires a BVM, what is the initial flow rate?
At room air
223
what BVM flow rate (lpm) is provided during neonatal resuscitation if the baby is refractory to basic maneuvers and initial BVM
20L
224
When is CPR initiated on a neonate during neonatal resuscitation?
HR<60
225
When delivering neonate CPR what is the compression to ventilation ratio and what technique is used to deliver compressions?
3:1 compress to ventilation
two thumbs encircling technique
226
What is the age cutoff for using Lifepak AED mode?
<1 month
227
Should you consider checking a sugar on a neonate?
Yes, this may be a reason the neonate is refractory to resuscitation
228
A BGL <_______ is considered hypoglycemia in a neonate
40
229
What three conditions usually cause a neonate to be refractory to resuscitation?
hypovolemia, pneumothorax and hypoglycemia
230
What are the contraindications for giving NSAIDS?
Pregnancy, renal disease/dialysis, severe liver disease, GI bleed, shock or major hemorrhage, headaches
231
What are the contraindications for tylenol?
severe liver disease
232
The first does of an analgesic should be given by what route(s)?
IM or IN
233
What is the age cutoff for an ET tube?
12 years and younger
234
For pediatric complete airway obstruction if the patient is 1-8years we perform _____ to relieve the obstruction and if the patient is <1yr we perform _____ to relieve the obstruction
abdominal thrusts
alternating 5 back blows and 5 chest thrusts
235
for pediatric choking we perform 5 back blows and 5 chest thrusts at what age range?
<1yr
236
For pediatric choking we perform abdominal thrusts at what age range?
1-8yrs
237
For pediatric reactive airway disease that progresses to the need for a BVM, what is the BPM rate?
20-30 bpm
238
What is the most common diagnosis in children <2yrs with wheezing?
Broncholitis (RSV)
239
What is very important to assess in pediatric trouble breathing?
patient’s work of breathing
240
For pediatrics what are three signs of increased work of breathing?
nasal flaring
chest wall retractions
see-saw breathing and grunting
241
For pediatric patients experiencing Bronchoilitis, what are the two most important interventions?
supplemental oxygen
suction secretions
242
Drooling is a common sign in what pediatric illness?
epiglotitis
243
barking cough is a common sign in what pediatric illness?
croup
244
What is the most common cause of stridor in children?
croup
245
Croup is most often seen in children <_____ yrs old
9
246
What is one of the first things you do for a pediatric croup patient?
keep pt comfortable and quiet with parent
247
A child presents with stridor, barky cough and URI symptoms of sudden, often nocturnal onset. what do you suspect?
croup
248
What is the age cutoff for using pediatric pads?
has the child reached puberty?
249
Can an adult AED be used for children and infants?
only if no pediatric AED is availble
250
The age cutoff for Lifepak AED mode is?
<1 month
251
What is the age cutoff for pediatric versus neonatal cardiac arrest guidelines?
30 days old (1 month)
252
for chest compressions at a peds code, we compress 1/3 the diameter of the chest or ____inch in infants and ____inch in children
1.5in infants
2 inch children
253
T/F: For infants 30 days to 1 year if HR is <60 we start compressions
True
254
The ventilation rate for a pediatric code once an advanced airway is in place is _____
20-30 bpm or a breath every 2-3 seconds
255
What is the most common cause of symptomatic bradycardia in children?
hypoxia
256
If you get a pediatric ROSC what hospitals can you transport too?
PDT and UNM
257
For altered mental status in children what two things should you consider?
accidental drug OD (give narcan)
non-accidental trauma
258
What is the TEN-4 rule?
Unexplained bruising or injuries:
Torso
Ears
Neck
In children under 4-years old
259
In what context should the pediatric TEN-4 rule be utilized
pediatric AMS to look for non-accidental trauma
260
Can you take a refusal on a BRUE?
No all BRUEs should be transported
261
BRUEs tend to last _____min(s) or less and are very frightening to caregivers
1 min
262
BRUEs are characterized by what 4 Sx
abnormal breathing
cyanotic or pallid
marked change in tone
AMS
263
What is one explanation you should strongly consider in a pediatric seizure
Signs of physical abuse
264
What are the “One Pill Kills” medications for children (i.e. pediatric drug overdose)
calcium channel blockers
beta-blockers
Clonidine
Long acting anti-hyperglycemics
Opiates
265
When a patient is restrained how many EMTs must ride in the back of the ambulance?
2 minimum
266
What are the two criteria indicating patient restraint?
patient is significantly impaired and lacks decisional capacity AND/OR is violent/combative/uncooperative and does not respond to verbal de-escalation
267
The only two approved patient restraint systems used by all providers in bernalillo county are?
Gurney soft velcro restraints
Chemical sedation: Versed (all providers) or ketamine (AAS only)
268
T/F: AFR may chemically sedate a patient to help out law enforcement executing a Certificate for Evaluation
False, we never do this based solely on a CFE
269
You respond to a law enforcement CFE call and the patient has a medical complaint. What take prescience, the CFE (transport to behavior health facility) or transport for the medical complaint?
transport for the medical complaint
270
At Certificate for Evaluation (CFE) events with EMS involvement, who has the final decision making authority
On-duty EMS supervisor (i.e. 78)
271
For autistic patients how can lain symptoms manifest? (very different than non-autistic ppl)
laughing
humming
singing
removal of clothing
272
Can AFR restrain or sedate a patient for law enforcement purposes alone?
No
273
For autistic patients how can pain symptoms manifest? (very different than non-autistic ppl)
laughing
humming
singing
removal of clothing
274
Radio reports when transporting should be limited to ____seconds or less for the majority of patients
30
275
transport radio reports are REQUIRED in what 5 situations?
Any Code 3 return
Hospital Alert events (STEMI, Stroke, etc)
Bannered events
Patients requiring addition staff (hostile, SI/HI, etc)
Active labor
276
Advanced resuscitation efforts may be withheld in the expected death of a DNR patient but will require_____
MCEP contact
277
What is your course of action if a DNR Patient is in cardiac arrest and family/providers can’t find the DNR form
continue basic life support measures while obtaining consensus from family and contact MCEP
278
How does AFR handle situations involving alternative DNRs, advanced directives and living wills?
The specifics of the document will be followed as judged appropriate by the paramedic
279
What is your course of action for hospice/palliative care patients requesting transport to the hospital?
honor the request, these patients may request transport at any time
280
Can law enforcement sign a patient refusal form for someone in custody?
No
281
A patient is handcuffed and requires transport and LE offers to follow your ambulance in a squad car. What is your course of action?
Request that LE rides in the back of your ambulance. At no time will a handcuffed patient be transported without LE attending in your ambulance
282
For a patient transported in handcuffs, what is the proper positioning of the handcuffs
In front of the patient for proper seatbelt usage
283
What are two unusual reasons for acquiring a 12-lead?
age >65 with nausea/vomiting
abdominal pain above umbilicus
284
When using a BVM the starting O2 flow is _____lpm
15
285
when using a BVM, we create a mask seal with the patient in the ______ position
sniffing
286
When using a BVM, ventilations should be delivered gently over ____ seconds to avoid air in the stomach
1-2seconds
287
Adult BVMs are actually oversized in relation to the typical adult breath. To avoid over-ventilating the patient what are two things you should do
squeeze BVM with two fingers
only bag to chest rise
288
When using the BVM on an adult patient the appropriate rate is _____ breaths per minute or one breath every ______ seconds
8-10
6 seconds
289
What are the two indications for CPAP?
correct hypoxia that is refractory to oxygenation with NRB/NC
Decrease work of breathing to improve ventilation
290
What are the four contraindications for CPAP?
Unconscious
active vomiting or GI bleed
head trauma, increased ICP, facial fractures
pneumothorax
291
CPAP should be used cautiously in what two circumstances and why
SBP<90 because this may reduce cardiac pre-load making hypotension worse
Asthma/COPD avoid too much CPAP, (>10cmH2O) can impair exhalation. Target is 5cmH2O
292
The starting PEEP value for CPAP is?
5cmH2O
293
Capno is identified as MANDATORY in what three situations
confirmation of ET tube
Confirmation of extraglottic airway (i.e. LMA)
Administration of opiates or sedatives
294
many accidental needle sticks occur during what two scenarios?
recapping a syringe
handing off a syringe
295
What is the preferred airway device for prehospital cardiac arrest?
Extraglottic airway devices
296
When using an LMA, generally where should the patient’s teeth end up in relation to the tube?
There are two black lines near the end of the tube and patient’s teeth should rest between the two horizontal lines
297
When placing an LMA tube, the cuff is inflated after tube placement. How much is the LMA cuff inflated?
half way
298
What are indications for pelvic binder use? What are contraindications?
Indications:
Pelvic binder placed on ALL patients with blunt multi-trauma that are clinically unstable
Consider routine placement on patients with high MOI, especially motorcycle accidents and Ped vs vehicle
Contraindications:
stable patients sustaining a ground level fall
Do not use with traction splints
298
Do not remove taser darts from what 4 locations?
genitals, face, eyes and neck
299
For infection control purposes, taser darts are considered?
A contaminated sharp
300
T/F: Once a pelvic binder is applied it must remain tensioned for the duration of the transport
true
301
If a pelvic binder is not available, what is an alternative that you can use to bind the pelvis?
bedsheet wrapped around the patient and twisted anteriorly to bind the pelvis
302
Oropharyngeal and tracheal suctioning should not be performed longer than _____ seconds
10
303
How long may gastric suctioning be performed for?
As long as needed
304
What are the preferred devices for oropharyngeal and tracheal suctioning
Oro: rigid yankauer suction catheter
Tracheal: flexible french suction cath
305
For gastric suctioning what size french cath should you select?
the largest size that will fit in the gastric tube
306
When applying direct pressure to a serious hemorage, apply manual pressure for a minimum of ___min before re-evaluating bleeding
3min
307
It is OK to remove a TQ that is placed by an untrained/lay person in what three situations?
Ineffective
Clearly not required
Not placed correctly such as over clothing or a joint
308
TQs should be re-assessed every ___mins
5mins
309
What are the elements of the DOPE acronym for trouble shooting 78’s ventilator?
D: dislodgment of tube
O: Obstruction of right main stem intubation
P: Pneumothorax
E: Equipment Failure
310
What is the “Red Rule” of medication administration?
NEVER give the contents of a syringe that is not labeled or without visualizing the vial from which it was drawn
311
Per our medication administration rules, who is the provider that will give the medication?
The provider drawing up the meds
312
T/F: EMT-B and EMT-I can verify paramedic scope meds even if the med is not in their scope
True
313
What is the adult dose of tylenol?
1 gram PO
314
What is the pediatric dose of tylenol?
15mg/kg not to exceed 50mg/kg in 24 hours
315
What is the adult dose of albuterol
5mg nebulized, repeated as VS permit
316
What is the age cutoff for administering albuterol to pediatrics and what is the pediatric dose?
age: >2 y/o
Dose: 5mg nebulized, repeat as VS permit
317
What is the adult dose of aspirin?
324mg PO
318
What is the pediatric dose of aspirin?
Aspirin is not indicated in pediatrics
319
What type of aspirin should be given to patients (chewable or enteric coated)?
chewable ASA
320
If a patient received enteric coated ASA prior to your arrival, how much of AFR’s aspirin can you give (chewable ASA)?
up to 324mg chewable
321
When can pregnant patient patients receive ASA?
ONLY with confirmed STEMI
322
What are the two ways an EMT-B may administer Epi?
assist with patient’s auto/injector
0.3ml limited dose syringe
323
What is the adult dose of epi for allergic reactions?
0.3mg IM may repeat every 5mins
(0.3ml of 1:1000 epi)
324
What is the epi concentration given for both adult and pediatric allergic reactions?
1:1000
325
What is the preferred injection site for epi in pediatric allergic reactions?
lateral thigh
326
What is the weight cutoff for the pediatric dose of epi?
25kg
327
If a pediatric patient is <25kg what is the dose of epi for allergic reactions?
0.15mg (i.e. 0.15ml of 1:1000 epi)
328
If a pediatric patient is >25kg what is the dose of epi for allergic reactions?
0.3mg IM
(0.3ml of 1:1000 epi)
329
How often can you repeat doses of epi in both adult and pediatric allergic reactions
every 5 mins
330
What are the three types of patients who SHOULD NOT receive NSAIDs?
Pregnant
renal disease
>65 years old
331
What is the adult dose of ibuprofen?
400-600mg PO
332
What is the age cutoff for administering ibuprofen to pediatrics?
>6mo
333
What is the pediatric dose of ibuprofen?
10mg/kg PO (pill or liquid)
334
What is the adult dose of ipratropium?
0.5mg nebulized
335
What is the pediatric weight cutoff for administering ipatropium and what is the dose?
>8kg
Same as adult dose (0.5mg)
336
What is the adult dose of narcan when administered IM?
0.4mg repeat every 2-4mins up to 10mg
337
What is the adult dose of narcan when administered IN?
2mg , 1mg per nare
An additional 1mg dose may be administered for a max dose of 3mg
338
When administering narcan how far is the MAD device placed into thr nostril?
1.5cm
339
What is the adult dose of Zofran?
4 mg disintegrating tablet
May repeat dose once after 10min if needed
340
What is the pediatric dose of zofran?
0.15mg/kg disintegrating tablet to a max of 4mg for nausea only if no active vomiting
may repeat once after 10min if needed
341
What is the adult and pediatric dose of oral glucose?
15 grams PO
342
Per the neonatal resuscitation guideline, if the neonate initially requires BVM, at what rate are breaths given?
40-60bpm
343
For pediatrics, in general, is BLS or ALS airway the preferred approach?
BLS airway is preferred
(All Caps in protocols)
344
For a prolapsed cord birth emergency, the mother should be transported in what position?
Trendellenberg
LT Exam
flashcards
Decks in class (17)
# Cards
-
Test Deck0
-
EMS Guidelines345
-
AFR Policies357
-
Volume 3108
-
5-3 Equipment Specific Guidelines93
-
4-1 Fire Investigation30
-
5-8 Intrragency Operations17
-
5-2 Incident Specific Guidelines304
-
5-4 Wildland61
-
5-1 Fireground Operations319
-
Volume 7 Professional Development28
-
5-6 Hazmat101
-
5-5 Technical Rescue151
-
Volume 6 Driving Policies47
-
City Policies55
-
CBA64
-
Leadership Book10
