Lake EMS Protocols
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What medication should be administered to control shivering in induced hypothermia patients? What is the dose? What is the max?
What are the signs and symptoms of Rhabdomyolysis?
- 1. Muscle pain/tenderness
- 2. Hypovolemia
- 3. Decreased urine output
- 4. Peaked T-waves
- ...following a crush injury with extended impingement
Cat bites may rapidly lead to infection specifically from which bacteria?
What is the indication for use of the crush sydrome protocol?
Extremity or torso impingement injury greater than 1 hour.
What is the condition that might result from a crush injury with extended impingement?
A fluid bolus of ____________ should be given if significant blood loss is noted following child birth. Repeat until systolic BP is greater than ____________.
250cc Normal saline
What two protocols call for the use of Lactated Ringers?
Heat related emergencies
If a newborn's HR is less than ___________ begin chest compressions.
If no response, give _________ at a dose of ________ until the HR is greater than __________. Give NS __________ as needed.
- 1. 60
- 2. EPI 1:10,000
- 3. 0.01mg/kg
- 4. 100 bpm
- 5. 20ml/kg
What are the classifications of burns?
- 1. Source
- 2. Degree
- 3. Severity
In a patient with hypothermia, when does shivering stop?
What kind of spider has a red hour glass on the belly?
Do/Do not apply ice or cold packs to snake bites and marine stings.
"Red on yellow ____________"
"Red on black______________"
"Kill a fellow"
What are crotolins? Give 3 examples.
- 1. Rattle Snakes
- 2. Water moccasins
- 3. Copperhead
Besides the analgesics, name 2 other medications associated with the pain management protocol. Include the dose and max dose.
Narcan 2mg max 8mg
Zofran 4mg max 4mg
What is hyphema?
Blood in the anterior chamber of the eye.
What are 5 differential diagnosis of syncope?
- 1. CVA/Stroke
- 2. Hypoglycemia
- 3. Shock
- 4. Cardiac Dysrhythmia
- 5. Vasovagal stimulation
Name the five main sections of the Guidelines for Pre-Hospital Care.
- 1. Administrative guidelines
- 2. Protocols
- 3. Procedures
- 4. Medications
- 5. Appendicies
Name 3 comprehensive stroke centers.
- 1. Florida Hospital Orlando
- 2. Tampa General
- 3. Shands
The START method is based on 3 observations, what are they?
If ST depression is seen in V1-V3, which other leads should be checked?
V7, V8, V9
List the medications in order that are used to chemically restrain a patient.
- 1. Haldol 5mg
- 2. Benadryl 25mg
- 3. Versed
What are the contraindications of Labetalol?
- 1. Asthma
- 2. COPD
- 3. Bradycardia
- 4. Hypotension
- 5. CHF
- 6. Cardiogenic Shock
- 7. Heart Block > 1st degree
How is the dopamine drip mixed?
400mg in 250ml D5W
Atropine should be administered per the bradycardia protocol when the HR is _____________.
less than 50 bpm
What are the criteria for induced hypothermia?
- 1. 18 yrs old or older
- 2. Advanced Airway in place (ET or King tube)
- 3. No purposeful response to pain (comatose)
- 4. Nontraumatic cardiac arrest
What is standby pacing?
Rate set at 60bpm and 0MA
BVM should be used on all patients with inadequate ventilations less than _________ or greater than __________.
Less than 10 or greater than 30
A COPD patient is having dyspnea and wheezing. Which up draft combo should be given?
HR less than 120______________
HR greater than 120____________
Albuterol + Atrovent
Atrovent + Xopenex
What does the acronym "LEMON" stand for?
- Look externally
- Evaluate 3-3-2 rule
- Mallampati score
- Neck mobility
Where are 2 hyperbaric chambers located?
Shands Hospital Gainesville
Florida Hospital Orlando
If a bolus of Amiodarone is given, does the patient require a maintenance drip?
You may administer an Amiodarone drip if you witness __________ or more wide complexs and the patient converts with AICD.
Delta waves and a shortened PR interval are indicative of what accessory pathway issue?
What are the initial synchonized cardioversion settings for each rhythm?
Aflutter & PSVT_______
Aflutter & PSVT 50j
Define adult, pediatric, infant.
Adult 8yrs old or older
Pediatric Less than 8 years old and less than 80lbs
Infant birth up to 1yr old
What 4 criteria are used to describe an "unstable patient?"
1. Pain or discomfort of a cardiac origin
3. Altered mental status
4. Hypotension with signs of hypoperfusion
What is the order of contacting medical control?
- 1. Medical Director
- 2. ER physician at the receiving facility
- 3. EMS 3
What is the max dose of benadryl in the adult allergic reaction protocol?
How should EPI be given in the unstable adult allergic reaction protocol?
SQ - Epi 1:1000 0.3mg
IV - Epi 1:10,000 0.3mg
For hypertensive crisis not related to CVA, what is the end point blood pressure goal?
What does the acronym FAST stand for?
- Facial Droop
- Arm drift
- Slurred speech
- Time of onset
What does the acronym LAMS stand for?
Adult hypoglycemic patients who are symptomatic with a BGL of less than ___________ should be given __________ at a dose of ___________.
- 1. 60mg/dl
- 2. D50 or instant glucose
- 3. 25 g (D50) or 30 g (instant glucose)
Hyperglycemic patients that are symptomatic should be given _________ cc bolus of normal saline if BGL is greater than _____________.
500cc NS bolus
What is the phone number for poison control?
Treatment for hypertensive crisis should begin when BP is over _________ and continue until the BP is under___________.
What is the dose of Dilaudid in the adult abdominal pain protocol?
.5mg every 5 min
Max 1.0 mg
What type of seizures start off as focal and become generalized?
_________ is defined as 2 or more seizures without a period of consciousness or recovery.
What is the first line medication for an adult seizure patient? Dose? Max Dose?
If seizures are refractory to the first line medication, what is the second choice medication? Dose? Max dose?
What are the signs and symptoms of pregnancy induced hypertension?
- Weight gain
- Peripheral edema
List 5 Non-MI reasons for ST-elevation.
- Left ventricular hypertrophy
- Left bundle branch block
- Early repolarization
What are the ECG changes often seen with pulmonary embolism?
- Sinus tachycardia
- Inverted Twave (lead III)
- Swave (lead I)
List the 12 "Red" classifications for adult trauma alert.
- Active airway assistance
- Lack of radial pulse with HR >120bpm
- BP < 90 mmHg systolic
- GCS < 12
- BMR < 4
- Suspicion of spinal cord injury
- Loss of sensation
- 2nd or 3rd degree burns to > 15% TBSA
- Amputation proximal to wrist or ankle
- Penetrating injury to Head, neck, or torso
- Fracture of 2 or more long bones
List the 6 Hs and 5 Ts.
- Hydrogen ions
- Tension Pneumothorax
List 5 contraindications for succinylcholine.
- Penetrating eye injury
- Burns < 24 hrs
- Larynx fracture
When should air transport be used for a stroke patient?
When the time of onset is between 5 and 7 hours.
List five signs of tension pneumothorax.
- Dyspnea with cyanosis and tachypnea
- Diminished lung sounds
- Tracheal deviation
When do you start CPR for a pediatric patient with bradycardia?
HR < 60bpm with poor perfusion
What opiate narcotic is indicated for abdominal pain?
Dose and max dose?
Dilaudid 0.5mg, max 1.0mg
Capnography values > 45mmHg indicate ____________ .
Capnography values < 35mmHg indicate _____________.
What is the procedure if a new born presents with the umbilical cord around the neck?
First attempt to slip it over the head. If this is unsuccessful clamp and cut the cord immediately.
What is the 1st, 2nd, and 3rd shock joule setting for a pediatric patient that needs defibrilation?
1st - 2 joule/kg
2nd - 4 joule/kg
3rd - 4 joule/kg
On the MTP pump, what do the switches on the right control? What do the switches on the left control?
- Right - flow rate
- Left - total volume
Describe how selective beta agonist differ from nonselective beta agonists. Include medications that fit each category.
Selective beta agonist stimulate only the beta 2 receptors. This is useful in patients with respiratory problems because you can stimulate brochodialation without stimulating the heart (increased HR and tachycardia). Albuterol and Xopenex are examples we use. Epinephrine is an example of non selective beta agonist and useful in patient's who also need beta 1 receptors stimulated to increase HR, BP, etc...
At what HR should a pediatric patient be cardioverted?
At what HR should an infant be cardioverted?
- Pediatric > 180bpm
- Infant > 220
List 6 contraindications of the CPAP.
- Penetrating chest trauma
- Severe hypotension
- Persistent nausea and vomiting
- Respiratory and/or cardiac arrest
- Unable to protect their own airway
What is the action of Adenocard and where in the heart does it work?
Adenocard slows the conduction through the AV node and interrupts the reentry pathways through the AV node to restore sinus rhythm in patients with PSVT.
What are the generic names for Labetalol?
List 3 contraindications of the King Airway Device.
- Responsive patients with gag reflex intact
- Known esophageal disease
- Caustic substance ingestion
What is the weight range and alternate site for the EZ IO for adult and pediatric patients?
- Adult > 40kg distal tibia or proximal humerus
- Pediatric 3-39kg distal tibia only
How much glucagon would you administer to a hypoglycemic 3 year old patient?
0.1mg/kg, max 1mg
What is the action of vasopressin?
Directly stimulates smooth muscle V1 receptors resulting in vasoconstriction.
List the criteria that must be met for a previously hypoglycemic patient to refuse transport.
- Documented hypoglycemia that has been corrected.
- Patient is fully awake and alert and oriented x4 (understands current situation).
- The patient will not operate a moving vehicle or equipment immediately following the episode.
- There is a copentent adult who agrees to stay with the patient for 1-2 hours.
- There are no underlying medical or trauma conditions that require treatment at the time of service.
Define unstable angina.
Chest pain (1)that occurs at rest or minimal exertion and usually lasts >20 minutes (if nitroglycerin is not administered); (2) being severe and described as frank pain, and of new onset (i.e., within 1 month); (3) occurs with a crescendo pattern (more severe, prolonged, or increased frequency than previously).
Using the S.T.A.R.T. method of triage, how would a patient with 30 resp/min be classified?
List 5 pieces of equipment needed to perform a surgical cricothyrotomy.
- #11 scalpel blade with handle
- Needle nose hemostats
- 5.0-7.0 ET tube cut above the pilot balloon
- Antiseptic swabs
When sizing a traction splint, how many inches beyond the foot should the splint be set?
10-12 inches beyond the foot
A CVA patient who is perminently bed or wheel chair confined who normally has GCS < 14 should be transported to which type of hospital?
Primary stroke center
List the contraindications of the Autovent.
- Trauma patients
- Pediatric patients
Explain how dopamine works in LOW, MODERATE, and HIGH doses.
Low dose: (1-5 mcg/kg/min) Dilates renal and mesenteric arteries by stimulating dopaminergic receptors. May decrease BP due to vasodilation.
- Moderate dose: (5-10mcg/kg/min)
- Increases inotropy (force) without increasing chronotropy (heart rate). Increased BP by stimulating beta1 receptors.
High dose: (over 10-20mcg/kg/min) Causes vasoconstriction, increases inotropy and chronotropy. Increases BP by stimulating alpha and beta1 receptors.
After childbirth, what may facilitate delivery of the placenta and decrease bleeding by facilitating uterine contractions?
Massaging the uterus
How much IV fluid can be given to a patient with ROSC?
30ml/kg bolus max of 2L (cold saline)
How many times can a patient be defibrilated who is in V-Fib and suffering an enviromental cold emergency?
3 defibrilations max until rewarmed
TRUE/FALSE An EMT can assist a patient with their prescription inhaler.
Give 6 examples of a CODE 3 transport.
- Inability to establish or maintain a patent airway or effective ventilations.
- Complicated obstetrical.
- Respiratory arrest.
- Cardiac Arrest, if patient may significantly benefit from rapid transport.
- Massive internal / external hemorrhage with shock.
- Unstable pediatric
What is the adult and pediatric dosage of Lidocaine when used for pain at the IO insertion site?
What is the maximum oxygen percentage that can be achieved with these devices?
- Nasal Canula 25-40%
- NRBM nearly 100%
- BVMR nearly 100%
Give the formula for calculating the mean arterial pressure (MAP) and explain what it actually measures.
MAP=Diastolic + 1/3 (Systolic - Diastolic)
MAP is the average arterial pressure during a single cardiac cycle. It is the perfusion pressure seen by the organs in the body. Normal range is 70-100 and below 60 is significant hypoperfusion.
Per the protocol, can Dopamine be administered to a pediatric shock patient?
If so, how much can you give?
Dopamine can be given after 3 fluid bolus 20ml/kg.
Dose is 2-20mcq/kg/min titrated until SP is >90mmHg
What do Gravida and Para mean?
Gravida - number of pregnancies
Para - number of viable births (gestation > 20 weeks)
For patients experiencing environmental exposure, at what core body temperature does shivering generally cease?
What is the name of the mathematical equation that can be used to determine how much fluid a burn patient should receive?
Parkland Formula: 4 ml x kg x % of burn divided by 2
List 3 important factors that should be determined for a patient that has been recently
- Date of Last Tetanus
- Any Cardiac History
- Any ingestion of a mind altering stimulant(Phencyclidine (PCP), Cocaine, etc.)
The traction splint’s windless devise should be tightened until 2 things
occur, what are they?
- Patient feels relief from the pain.
- Injured foot is aligned with the uninjured foot.
True or False: Glucagon should be immediately administered after reconstitution
What straps should be released when using a KED once a patient is positioned on the
When performing a cricothyrotomy, where should you cut the endotracheal tube?
Cut above the pilot balloon.
Hypothermia is defined as a core temperature of less than how many degrees Celsius?
The following respiratory complications generally occur in children of what age?
- Croup < 2yrs old
- Epiglotitis > 2yrs old
More than 25% of geriatric syncopal episodes are attributed to what medical
Specifically, what type of non-rebreather should a patient exposed to carbon monoxide
If an AICD fires and complexes are not witnessed can you administer an Amiodarone
At what temperature does sweating generally cease?
What percentage of pregnant patients progress from Pre-Eclampsia to Eclampsia?
A non-environmental hyperthermia patient should not have their body temperature
decreased below what temperature?
List 4 Level 2 Trauma Centers.
- Bayfront Medical Center
- Halifax Medical Center
- Lakeland Regional Medical Center
- St. Joseph's Hospital
What specific type of injury are you treating when you cover a site with dry sterile
dressings and a blanket to maintain body temperature?
What is Ptosis and what protocol might you see this symptom in?
Neurotoxic symptom related to snake bite with envenomation
What two things occur when someone has positive orthostatic changes? Please give the
numerical values of those changes
- Decrease in systolic blood pressure by 10 mmHg
- Increase in pulse rate by 10 beats per minute.
What indication must be met in order to utilize the Crush Injury protocol?
Any Extremity or Torso impingement injury > 1 hour
You and your partner have been called to a possible chlorine leak, what is the name of the book that will assist you in maintaining a safe distance (zone)?
Maintain safe zone using Emergency Response Guide Book (Guide 111).
You arrive on scene of a pregnant patient in her third trimester. She appears to be in
labor with complaints of pain, she also notes that there is dark red blood coming out.
What is her condition called?
Explain the difference between RSI and DAI.
Also include which one we use and why we choose to use it.
How should you care for an incomplete amputation?
Attempt to stabilize with tight bulky pressure dressings and splint inline with the associated extremity.
If a patient is bitten by a snake, wash the area with copious amounts of what?
About how long should it take for the placenta to deliver in a normal delivery?
How should you care for a patient experiencing a partial obstruction in their airway?
- Encourage patient to continue coughing and breathing. DO NOT interfere with patient’s
- attempts to expel foreign body.
- Continue to monitor patient
True or False: An EMT may assist with a patient’s prescribed NTG
At what core temperature (in Celsius) is hypothermia defined?
What is the minimum dose of Atropine in a bradycardic pediatric patient
Your patient is experiencing pain in the upper right quadrant of the abdomen, give 5
differentials diagnosis that may be the cause of his complaint.
- Bowel obstruction
- Peptic Ulcer
- Bowel Obstruction
What should you use to clean an area once a taser probe is removed?
Cleanse puncture site with Betadine and bandage
Explain how Glucagon works when administered to a patient with an
Esophageal Foreign Body Obstruction. Also include how Glucagon works in patients
who are experiencing a hypoglycemic emergency.
Name the medication: This drug inhibits the influx of calcium ions during membrane
depolarization of cardiac and vascular smooth muscle.
How can Magnesium Sulfate help a patient with hyperkalemia?
Magnesium Sulfate increases the movement of potassium into the cells.
True or False - IF THE STATEMENT IS FALSE, MAKE IT TRUE:
“When using CPAP the flow adjustment valve should be opened completely and the oxygen adjustment valve is in the highest flow position”.
“When using CPAP the flow adjustment valve should be opened completely and the oxygen adjustment valve is in the LOWEST flow position”.
Name the four positions where you would secure the Velcro straps when utilizing the
Hare Traction Splint. (Hint – two are placed near the same location)
2 are positioned mid thigh, 1 above the knee, and 1 above the ankle.
Prior to inserting an orogastric tube, how should you determine the proper length of the device?
Using the OG tube as a measuring device determine the length of the OG tube to be passed by measuring the length from
- a. nose to earlobe
- b. earlobe to midpoint between xiphoid process and stomach
How should a patient be transported to a Comprehensive Stroke Center if
the time last seen normal is greater than 5 hours but less than 7 hours?
There are two knobs on the AutoVent, what do they control? What are the ranges for
The two knobs control respirations/min and tidal volume.
If you respond to a sexual abuse call you are required to contact SAFE-T. What is the phone number?
What would you like to do?
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