EMS Protocols

Card Set Information

Author:
jessjohnson0617
ID:
205891
Filename:
EMS Protocols
Updated:
2013-04-05 17:52:34
Tags:
Thurston County
Folders:

Description:
EMS Protocols for Thurston County EMTs
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user jessjohnson0617 on FreezingBlue Flashcards. What would you like to do?


  1. 11 universal ALS upgrades
    • signs/symptoms of shock or hemodynamic compromise
    • any blood/fluid loss with auscultated systolic BP less than 90 or absent radial pulse
    • pulse is less than 50 or greater than 130
    • unconscious
    • status epilepticus (prolonged seizure)
    • step 1 or 2 trauma pt
    • SOB with RR<10 or >36 or noisy or absent lung sounds
    • airway compromise
    • uncontrollable bleeding
    • prolonged extrication
    • intoxicated step 3 or 4 trauma pt
  2. General pt care procedures for ground transport
    • in general, take pt to hospital of their choice.
    • if BLS becomes ALS, request upgrade in order to transport to rendezvous point or go directly to hospital if faster
  3. general pt care procedure for air transport
    • ALS upgrade required
    • any field providor may request transport via TCOMM
    • destination determined by ALS provider  w/ medical control
    • primary provider is Airlift NW
    • use of air transport should be coordinated with IC
    • field personnel must provide receiving hospital w/ report
  4. obvious signs of death
    • rigor mortis
    • livor mortis
    • decapitation
    • incineration
    • decomposition
    • body position incompatible with life
    • evisceration of brain or heart
  5. EMTS and Paramedics may withhold or terminate resuscitation only if...
    • there are obvious signs of death
    • pt has a POLST/DNR form
    • if pt has been diagnosed with terminal illness and there is a reasonable indication the pt/family does not want CPR
    • MCIs - apneic patient who doesn't start breathing with airway positioning
    • traumatic cardiac arrest
  6. Healthcare workers, subject to title 18, RCW, are required to report when...
    • there is reasonable cause to believe that abandonment, abuse, financial exploitations, neglect of vulnerable adult - report 866-END-HARM
    • there is reason to suspect sexual or physical assault - report to law enforcement and 866-END-HARM
  7. definition of a vulnerable adult
    • someone over the age of 60 who is unable to care for themselves
    • an adult living in a nursing. board, or adult family home
    • adult with developmental disabilty
    • adult with legal guardian
    • adult receiving personal care services in their/their family's home
  8. signs of physical abuse in adults
    • unexplained bruises, welts, black eyes, wounds or fractures
    • multiple injuries in various stages of healing
    • sudden changes in behavior (fearful, depressed, self-destructive)
    • caregiver refuses to allow visitors
    • person is in restraints or locked in room
    • missing patches of hair or hemorrhage below scalp
    • person reports abuse
  9. signs of mental abuse in adults
    • person is emotionally upset, agitated, withdrawn, noncommunicative, depressed, or nonresponsive
    • caregiver refuses to allow visitors or does not let pt participate in family/community events
    • person reports abuse
  10. signs of sexual abuse in adults
    • bruising around breasts and/or genetalia
    • unexplained VD
    • soiled underclothing or bedding
    • sudden change in behavior
    • person reports sexual abuse
  11. signs of abuse in young children
    • clinginess
    • bedwetting
    • inappropriate sexual knowledge
    • aggressive behavior
    • nightmares
  12. signs of abuse in older children
    • inability to concentrate in school
    • drop in grades
    • promiscuity
    • self-destructive behavior
    • comments about suicide
    • poor relations with peers
    • depression
    • eating disorders
  13. When responding to an unexpected death or serious injury to a child, what 8 things should you do and/or know?
    • Insure safety and provide medical aid as needed to save or assist the child
    • if the child is clearly dead, do not move the body
    • make sure to notify law enforcement
    • document all adults and children present
    • document all demeanor and statements of speakers
    • document all observations of the environment ASAP
    • consider and record child's developmental lvl
    • know signs of abuse and neglect
  14. SAMPLE
    • signs and symptoms
    • allergies
    • medications
    • pertinent past history
    • last oral intake
    • events leading to 911 call
  15. OPQRST
    • onset
    • provokers
    • quality
    • radiation
    • severity
    • time
  16. SOAP
    • subjective - what they said
    • objective - what you found
    • assessment - what you think the problem is
    • plan- treatment written out and how it worked
  17. Prerequisites for refusal of care
    • must be fluent in english
    • must be over 18
    • must be oriented to person, place and time and not show any obvious signs of cognitive deficit
    • bee free of the influence of alcohol, drugs or any mind altering substances
    • not have any injury or medical condition affecting their judgement
    • not have threated or attempted suicide during this episode
    • demonstrate the ability to explain the decision they are making and the possible negative outcomes including death & disabilty
  18. What should be included in a BLS short report to incoming ALS unit?
    • unit ID
    • age and sex of pt
    • chief complaint
    • very brief pertinent medical history (1-2 sentences)
    • vitals
    • pertinent treatment rendered
  19. What makes a BLS short report to incoming ALS unit different from a BLS short report to hospital?
    also include pt's primary care physician and ETA
  20. What should be included in a verbal report given to RN or MD upon handing the pt off?
    • name, age, sex and pt's physician
    • chief complain or injury
    • if trauma, describe MOI
    • if ACS, provide 12-lead ECG
    • pertinent medical history
    • allergies to meds
    • physical exam findings
    • treatment provided and response
    • accompany with initial written report
  21. Criteria for Step 1 Patient in Trauma Triage Tool
    • glasgow coma scale less than 14 or
    • systolic BP less than 90 in adult
    • signs and symptoms of shock
    • respiratory rate less than 10 or greater than 29 per minute (less than 20 in infants under one year)
  22. Criteria for Step 2 Patient in Trauma Triage Tool
    • all penetrating injuries to head, neck, torso, and extremities proximal to elbow and knee
    • flail chest
    • two or more proximal long-bone fractures
    • crushed, degloved, or mangled extremity
    • amputation proximal to wrist and ankle
    • pelvic fractures
    • open or depressed skull fracture
    • paralysis
  23. Criteria for Step 3 Patients in Trauma Triage Tool
    • Falls: adults greater than 20ft (2 stories) or children 10 ft or 2-3 times the height of the child
    • high risk auto crash: intrusion greater than 12in. in occupant side or 18 in. on any side, ejection (partial or complete) from vehicle, death in same passenger compartment, or if the vehicle telemetry consistent with high risk injury
    • auto vs pedestrian/bicycle thrown, or with significant impact (greater than 20mps)
    • motorcycle crash greater than 20 mph
  24. Criteria for Step 4 Patients in Trauma Triage Tool
    • Assess special patient or system considerations
    • Age: older adults/children
    • Anti coagulation and bleeding disorders
    • Burns: without other trauma mechanism: triage to burn facility; with trauma mechanism: triage to trauma center
    • Time sensitive extremity injury
    • end-stage renal disease requiring dialysis
    • pregnancy greater than 20 weeks
    • EMS Provider judgement
  25. pertinent subjective findings in a bleeding, non-traumatic patient
    • prolonged vomitting/diarrhea
    • "coffee grounds" emesis
    • bloody or tarry stools
    • pregnancy
    • trauma
    • medications: coumadin, NSAIDs
    • history: cancer, ulcer, alcoholism, recent surgery
  26. pertinent objective findings in a bleeding, non-traumatic patient
    • diaphoresis (excessive sweating)
    • weak or absent radial pulse
    • rapid pulse
    • hypotension
    • obvious bleeding
    • rigid abdomen
    • pallor
  27. steps to control bleeding
    • apply direct pressure on wound until bleeding is controlled
    • if bleeding is not controlled with direct pressure, use an escalating treatment plan of elevation above the heart lvl, and pressure points
    • after bleeding is controlled, apply dressing and bandage
    • AS LAST RESORT TO CONTROL LIFE-THREATENING BLEEDING FROM AN EXTREMITY, apply BP cuff proximal to the wound and inflate until bleeding stops
  28. what are the 4 ways to remove a foreign body airway obstruction?
    • suctioning
    • finger sweep (no blind finger sweep for children and infants)
    • abdominal thrusts (chest thrusts for infants)
    • black blows (infants)
  29. in what order should you attempt to maintain the airway?
    • positioning
    • OPA
    • NPA
  30. breathing shall be enhanced, assisted or maintained using these two pieces of equipment at what lpms?
    • nasal cannula at 2-4lpm
    • non-rebreather mask at 8-15lpm
  31. what are the 3 non-pharmacologic measures an EMT can take for pain relief?
    • place pt in position of comfort
    • ice or cold packs
    • immobilizing and splinting painful areas
  32. Pt should receive an ALS evl for pain management if they...
    • have received all non-pharacolgical interventions and
    • show physical or physiological signs of pain and
    • rate their discomfort at a 7 or greater and
    • state they would like an IV injection for pain relief
  33. What are the general pt care procedures for foreign airway obstruction removal?
    • suctioning
    • finger sweep (no blind finger sweeps for infants or children)
    • abdominal thrust (chest thrusts for infants)
    • back blows  (for infants)
  34. When possible, pts should be transported in this position
    sitting up
  35. What are pertinent subjective findings in a bleeding, non-traumatic patient?
    • prolonged vomiting/diarrhea
    • "coffee grounds" emesis
    • bloody or tarry stools
    • pregnancy
    • trauma
    • medications: coumadin, NSAIDs
    • history: cancer, ulcers, alcoholism, recent surgery
  36. What are pertinent objective findings in a bleeding, non-traumatic patient?
    • diaphoresis (excessive sweating)
    • weal or absent radial pulse
    • rapid pulse
    • hypotension
    • obvious bleeding
    • rigid abdomen
    • pallor
  37. Assessment/Differential diagnosis for bleeding, non-traumatic patient
    • upper GI bleed
    • lower GI bleed
    • nose bleed
    • esophageal varices (extremely dilated sub-mucosal veins in lower third of esophagus)
    • vaginal bleed
    • trauma
  38. Plan/treatment for a bleeding, non-traumatic patient?
    • general BLS patient care procedures
    • position of comfort
    • nothing by mouth
  39. In a choking patient, an ALS upgrade is required for...
    • inability to speak/cough/cry
    • signs or symptoms of anaphylaxis
  40. What are the ALS upgrades for abdominal trauma?
    • altered or decreased lvl of conciousness
    • impaled object
    • evisceration of abdominal organs
    • pelvic fracture
  41. What are the ALS upgrades for burns?
    • partial/full thickness or chemical burns to the face or suspicion of airway involvement
    • partial or full thickness or chemical burns greater than 10% BSA
    • partial/full thickness burns or chemical burns if pt is less than 5 y/o
    • electrical burns
    • hydrofluoric acid burns
  42. What are the ALS upgrades for chest trauma?
    • penetrating chest injury
    • flail chest
    • unilateral decreased lung sounds
  43. What is the ALS upgrade for extremity trauma?
    no distal pulse
  44. What are the ALS upgrades for head and neck trauma?
    • repetitive speech
    • severe or multiple episodes of vomiting
  45. What does START stand for?
    Simple triage and rapid transport
  46. What are the three components of START triage?
    • respirations
    • pulse
    • mentation
  47. In order to refuse care (AMA), a pt with decision making capacity must...
    • have fluency in english
    • be over the age of 18
    • be oriented to person, place and time and not show any obvious cognitive deficit
    • be free of alcohol, drugs, or any mind altering substance
    • not have any injury or medical condition affecting their judgement
    • not have threatened or attempted suicide during this episode
    • demonstrate the ability to explain the decision they are making and the possible negative outcomes including death and devastating disability
  48. What are the indications for an NPA?
    patient with a decreased LOC and sonorous respirations who will not accept an OPA
  49. What are the contraidications for an NPA?
    • patient with maxillary trauma or nasal trauma or suspected skull fracture
    • OPA provided adequate airway control
    • resistance encountered during insertion
  50. What are the indications for OPA?
    unconscious patient without a gag reflex
  51. What are the contraindications for an OPA?
    patient with a gag reflex
  52. What the contraindication for long bone immobilization?
    if it would delay transport of a critical patient
  53. What are the procedures for long bone immobilization?
    • check distal PMS
    • apply gentle tension realign bone into gross anatomical position prior to applying splinting material unless this causes severe discomfort (if the fracture cannot be reduced secondary to severe discomfort or remains in a position incompatible with transport, upgrade to ALS, consider rendezvous and delay further manipulation of fracture until procedural sedation. manually immobilize fracture until ALS arrives)
    • apply appropriately sized splint and pad as needed
    • reassess the distal PMS after splint is secured (if absent, expedite transport), apply cold pack as needed, and always splint hands and feet in position of function
  54. What are the procedures for joint immobilization?
    • check distal PMS
    • if no pulse, attempt realignment. if unable to realign, consider rendezvous with ALS and delay further manipulation or joint until procedural sedation.
    • apply the appropriately sized splint and pad as needed
    • after splint is secured, reassess PMS and apply cold pack as needed, and always splint hands and feet in position of use
  55. What are the indications for helmet removal?
    patient wearing a helmet who requires airway preservation, stabilization of head to backboard, in-line stabilization for transfer
  56. What are the contraindications for helmet removal?
    do not remove football helmets unless airway is compromised. if you must remove football helmet, ensure that the shoulder pads are removed.
  57. What does APGAR stand for?
    • appearance
    • pulse
    • grimace
    • activity
    • respiratory
  58. Rules of nine for adults
    • 9 - head and neck
    • 9 - entire arm, each
    • 9 - chest
    • 9 - abdomen
    • 9 - upper back
    • 9 - lower back and buttocks
    • 9 - front of leg, each
    • 9 - back of leg, each
    • 1 - genitalia
  59. Rules of nine for child
    • 18 - head and neck
    • 9 - entire arm, each
    • 9 - chest
    • 9 - abdomen
    • 18 - entire back
    • 14 - each entire leg
    • 1 - genitalia
  60. What are the indications for the administration of O2?
    patients with symptoms of shock, respiratory distress, respiratory arrest
  61. What are the contraindications for the administration of O2?
    there are none

What would you like to do?

Home > Flashcards > Print Preview