1
Q
Who is given the authority to deviate from the EMS protocols as needed?
A
EMS captains
2
Q
Patient should arrive at the most appropriate receiving facility with a?
A
- Patent airway
- Oxygenated
- Ventilated
- A perfusing blood pressure
3
Q
What are the six rights of drug administration?
A
- Person
- Drug
- Dose
- Time
- Route
- Documentation
4
Q
IM injections: shall be administered in the lateral thigh, or deltoid:
A
adult: 21–23, gauge 1.5 inch needle with a max of four ML per site.
Pediatric : 23 gauge 1 inch needle with a max of one ML per site.
- More than 1 ML needs to be administered split the dose between two sites
5
Q
MAD
A
Adult and pediatric: 0.1, ML – 0.5 ML with a max of 1 ML IN per nostril.
6
Q
What medication’s can be administered via MAD?
A
- Narcan
- Versed
- Fentanyl
- Ketamine
7
Q
Patients who have not reached puberty, are considered?
A
Pediatric patients
8
Q
Patients who have reached puberty shall be treated as?
A
Adults
9
Q
What is the preferred method of vascular access during pediatric cardiac arrest?
A
IO
10
Q
Pediatric trauma alerts shall be?
A
15 years or younger
11
Q
When using the Handtevy system, the child’s ________ should be used as a primary reference point for determining the appropriate patient care?
A
Age
12
Q
Pediatric age classifications
A
- Neonates: birth to 1 month
- Infants: 1 month to 1 year
- Children: 1 year to puberty
13
Q
Puberty in a female is defined as?
A
Breast development
14
Q
Puberty in a male is defined as?
A
Under arm, chest or facial hair
15
Q
Adult and pediatric IO sites
A
- Proximal humerus
- Proximal tibia
- Distal tibia
16
Q
What are the two classifications of a vulnerable adult?
A
- A person 60 years of age or older with functional physical or mental and ability care for self
- and adult 18 years of age or older, who has a developmental disability, has a guardian lives in a nursing facility receives in-home services through a license, healthcare agency
17
Q
Possible causes of AMS
A
AEIOUTIPS
- Alcohol
- Epilepsy
- Insulin
- Overdose
- Uremia
- Trauma
- Infection
- Psychiatric
- Stroke/Shock
18
Q
GCS
A
- Max score is 15, min score is 3
- GCS 8 or less consider intubation
19
Q
Vital signs
A
- priority 3 patients shall receive at least two sets of vitals
- priority 2 patients shall receive vitals every 5 minutes
20
Q
Hypo/Hyper
A
- hypo systolic less than 90
- hyper diastolic greater than 160
21
Q
ROSC
A
- upon ROSC
- remove rescue pod
- 12 lead immediately and repeated every 10 minutes
22
Q
OPQRSTA
A
- Onset
- Pallation *
- Provocation *
- Previous *
- Quality
- Radiation
- Severity
- Time
- Association *
23
Q
ET CO2
A
- ideal ranges are 35-45 and Spo2 greater then 90%
24
Q
Ventilatory Rates Adult and Pediatric
A
Adult-
- PULSE: 1 every 6 secs
- NO PULSE: 1 every 10 secs
Peds-
- PULSE: 1 every 3 secs
- NO PULSE: 1 every 6 secs
25
When are high levels of ET CO2 acceptable?
- Cardiac arrest
- Broncospasm
26
Trauma Hawk Considerations
- ground transport for a trauma alert is greater than 25 minutes
- extrication time greater than 15 minutes
- pregnant trauma alert with a gestation
greater than 20 weeks
- Prehospital ground response time to scene is greater than 10 minutes.
- Decompression sickness when ground transport is greater than 40 minutes
*** it shall not be used if the patient is estimated to be 500 pounds or greater
27
Hyperbaric chamber uses
- Decompression sickness
- Carbon monoxide exposure
- Hydrogen sulfide exposure
- Cyanide exposure
28
Stroke facilities
- BHE: primary
- DMC/Boca: comprehensive
- St. Mary’s for PEDS
29
Pediatric trauma alerts
Shall be 15 years or less
30
K-9 suspected overdose
4 mg IN
31
Hypo/hyper glycemia
- less than 60
- greater than 300
32
Minimum age appropriate systolic blood pressures
- neonates: 60
- infants: 70
- children 1-10 yrs 70 + (age in yrs x2)
- children over 10 yrs old: 90
33
Contraindications to CPAP
- systolic BP less than 90
- Upper airway obstruction , oral secretions, aspiration risk
- Acute MI or unstable cardiac arrhythmia
- Pneumothorax
- AMS/ decreased level of consciousness
34
Croup vs. epiglottitis
Croup:
- Less than three years old
- Sick for a few days
- Low-grade fever
Epiglottis:
- Between 3 to 6 years old
- Sudden onset
- High-grade fever
35
Sepsis alerts
Must have at least two points on the HAT criteria max score is three points.
- H: hypotension
- A: AMS or GCS less or equal to 14 (new onset)
- T: Tachypnea respiratory rate is greater than 22 or ETCO2 is less than 25
36
What does RACE stand for?
- Rapid
- Arterial
- Cerebral Occlusion
- Evaluation
37
Patient positioning for oxygenation
- cardiac arrest: 15°
- stroke: 30°
- narcotic overdose: 45°
38
What are cortical signs?
- Head and eye gaze deviation
- Aphasia
- Agnosia
** any patients exhibiting cortical signs will receive a plus to their RACE score
39
Stroke scores
- Max score is 11
- score over 0 is a stroke alert
- Any score over 5 is likely an LVO (large vessel occlusion)
40
Bradycardia is defined as
Less than 50 bpm
41
Contraindications for nitro
- SBP less than 90
- Viagra and Levitra within 24 hours
- Cialis within 48 hours
- positive V4R
42
Synchronized cardioversion
Adult:
- 70j
-120j
-150j
-200j
**max of 200j
Peds:
- 0.5j/kg
- 1j/kg
- 2j/kg
** Max of 2j/kg
43
Contraindications to amiodarone
- marked sinus bradycardia
- Cardiogenic Shock
- 2nd and third-degree heart blocks
- Hypotension
- ** QTC greater than 460
44
LVAD
- May not be able to detect pulse, blood pressure, or SPO2
- perform chest compressions to right side of the sternum
- do not utilize mechanical CPR device
- ** Shall be transported to JFK Medical Center
45
H’s & T’s
H: hydrogen ion, hyperkalemia, hypoglycemia, hypoxia, hypovolemia, hypothermia
T: Toxins, tablets, tension pneumothorax
46
Determination of death
Anyone of the following present:
- Lividity
- Rigor mortis
- Tissue decomposition
- A valid DNR order
Or all of the following are present :
- Downtime greater than 30 minutes
- Asystole confirmed in 2 or more leads
- Pupils fixed and dilated
- Apneic
-
47
Field termination requirements
- Asystole for at least 15 minutes
- Normothermic
- Failed adequate resuscitation, including:
- Airway management
- CPR
- ETOC02 less than 10
- Three rounds of medication
- Fluid replacement of at least 500 MLs
- Trial defibrillation at 200 J
48
DNR orders
- Must be signed and dated by the patient’s physician, be signed and dated by the patients surrogate or proxy, state that it is a DNR
- A DNR order may be withdrawn by any immediate family member, the patients attending physician, or the patient’s healthcare surrogate or proxy
49
Electrocution
Lightning strike patients have a 9 in 10 chance of surviving
Conduct triage and reverse manner from what you would normally do in an MCI , lightning, strike patients who are apneic, and in cardiac arrest, should receive priority
50
Refractory V-Fib/V-tach
If ALL 3 of the below treatments have failed to convert:
- five or more standard defibrillation have been delivered
- Hs & Ts have been addressed
- 450 mg of amiodarone has been a ministered
51
Cyanide exposure
Any firefighter who suffers cardiac arrest during or within 24 hours of a fire incident shall be treated for cyanide exposure
52
Pain management:
Exception: do not administer to pregnant patients near term 32 weeks or greater as fentanyl can cause respiratory distress in newborns.
Fentanyl be given IV/IO/IM
And rare occasions fentanyl may cause hypertension. Additionally, fentanyl may cause chest wall, rigidity if administered too quickly.
53
Delayed sequence intubation DSI
- EMS Capt. is responsible for ensuring the airway is secured
- For patients greater than 65 years old or suspected closed head injury: ketamine 100mg (pre-sedation)
- Rocuronium: 1mg/kg max dose 100mg (paralytic)
- Zofran 4mg (prophylaxis for nausea)
54
If DSI has failed, how many attempts are there?
- 1
** if second attempt is unsuccessful place SGA and ventilate with BVM
55
Decompression sickness
Any patient with the following signs and symptoms who has used SCUBA gear or compressed air within a 48 hour period shall be considered decompression sickness patient.
- Strokelike symptoms
- Visual disturbances
- Joint pain
- AMS
- Paralysis or weakness
- Numbness and tingling
- Bowel and bladder dysfunction
- SOB
Lt Exam
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