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Newborn Stabilization/Resuscitation
What size blanket roll do you position under the shoulders?
1"
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Newborn Stabilization/Resuscitation
What does the negative pressure need to be less than when using a bulb syringe or mechanical suction?
less than 100cm H2O
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Newborn Stabilization/Resuscitation
How many chest compressions do you administer per minute when the HR is less than 60?
120 per minute
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Newborn Stabilization/Resuscitation
How many breaths/minute do you ventilate with 100% O2 when HR is less than 100 or when encountering Persistent Central Cyanosis/Apnea?
40-60 breaths/min
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Pediatric Guidelines
At what age do you routinely assess BPs in children?
children older than 3 yrs
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Pediatric Guidelines
What is the definition of neonate?
birth to 1 month
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Pediatric Guidelines
what is the definition of infant?
greater than 1 month to 1 yr of age
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Pediatric Guidelines
what is the definition of child?
greater than 1 yr to 12 yrs of age
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Pediatric Guidelines
What is the definition of adolescent?
greater than 12 yrs to 15 yrs of age
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Pediatric Guidelines
what is the definition of adult?
greater than 15 yrs of age
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Pediatric Cardiac Arrest
At what age can you apply AED?
over 1 year of age
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Abandoned Neonate
what florida statute allows for new parents to anonymously leave a neonate at a fire station or hospital?
Florida Statute 383.50
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Consent and Competency Guidelines
what determines if a patient is mentally competent?
A+O x4
awake, alert and fully oriented to person, place, time and situation
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Consent and Competency Guidelines
What do you need to obtain and record per JFRD Refusal Protocol?
- follow EMT assessment
- at least 1 set of vital signs
- any improvement from initial complaint
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Consent and Competency Guidelines
Under JFRD Refusal Protocol, when you record that patient is A+O x4, what do you assess for?
- trauma or medical illness (hypoxia, hypoglycemia, stroke)
- psychiatric illness (suicidal/homicidal, hallucinations, delusions)
- presence of a toxic ingestion or exposure
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Consent and Competency Guidelines
When is a documented refusal valid?
with an appropriate witness signature
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Cooperation with Law Enforcement
Who handles discrepancies between JFRD transport protocol and law enforcement's destination decision?
Rescue District/Battalion Chief
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Dealing with Behavioral Emergencies
What position should restrained patients be placed in?
supine, Fowler's or semi-Fowler's position
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Dealing with Behavioral Emergencies
When restraints are in use, how often should circulation to the extremities be evaluated?
at least every 10 min
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Patient Care Report
When are patient care reports completed?
as soon as the call is over
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Patient Care Report
When are transport units patient care report completed?
by the end of the shift
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Patient Care Report
How often do completed refusals get forwarded to the Quality Improvement Office at HQ?
every 6 months
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Reporting Abuse/Neglect of Children and the Elderly
An employee who fails to report or prevents another employee from reporting abuse or discloses information relating to abuse cases or who makes a false report may be charged with what?
2nd degree misdemeanor
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Resuscitation Protocol
When will an Emergency-Pro Report be completed?
when the rescue crew is on scene and is not canceled prior to patient contact.
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Transport and Destination Policy
Who can elect to deviate from existing guidelines in determining destination of patients during situations where extraordinary circumstances exist (MCI, multiple pt, other environmental situations)?
Incident Commander
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Transport and Destination Policy
With the exception of which trauma center, patients will not be transported to facilities out of the county without the approval of the appropriate District/Battalion Rescue Chief?
Orange Park Level II Trauma Center
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Transport and Destination Policy
When can obstetric patients be taken directly to labor and delivery from the ED?
- when accompanied by an:
- RN
- PA
- Physician
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Transport and Destination Policy
Who do you need to consult with by radio to be able to take OB patients directly to Baptist Pavilion, Baptist Beaches OB or St Lukes Women's Ctr?
ED
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Transport and Destination Policy
Who can authorize inter-facility transfers?
Rescue District/Battalion Chief
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Transport and Destination Policy
When can STEMI alerts be taken directly to the cardiac catheterization lab?
- when accompanied by
- RN
- PA
- Physician
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Transport and Destination Policy
Consult the Charge Nurse or Nurse Mgr if a pt is not assessed within how many min?
15 min
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Transport and Destination Policy
When transferring a pt to a hospital stretcher, how long of a delay should there be before you notify FRCC?
more than 30 min
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Trauma Transport Protocols
Where is the Trauma Scorecard Methodology outlined in for adults ?
64 J-2.004 F.A.C.
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Trauma Transport Protocols
Where is the Trauma Scorecard Methodology outlined in for pediatrics?
64 J-2.005 FAC
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Trauma Transport Protocols
Who are the only people authorized to change the trauma alert status?
The Medical Director of the EMS provider that issues the trauma alert
The Physician at the receiving trauma center/hospital
(64 J-2.005 FAC)
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Abdominal Trauma
What is the best treatment for the pt with severe abdominal trauma?
rapid transport
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Traumatic Injury of the Pregnant Patient
Immobilizing a pregnant pt in what trimester elicits Supine Hypotensive Syndrome?
3rd trimester
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Crush Syndrome
What is the most consistent clinical finding?
loss of 2-point discrimination
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Acute Compartment Syndrome
What kind of injury is acute compartment syndrome?
localized
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Acute Compartment Syndrome
What finding is the least reliable and rarely occurs?
pulselessness
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Acute Compartment Syndrome
Why do you not want to elevate or apply cold packs?
Because ice increases vasoconstriction
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Burns
Do not use water for chemical burns due to what?
LCsss
- lime
- carbolic acid
- sulfuric acid
- solid potassium
- sodium metals
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Burns
What kind of burns are spinal immobilization for?
electrical
(430.3010)
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Burns
For chemical burns, what do you irrigate eye exposures with?
lukewarm NS or sterile water
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Electrical Injuries
What type of triage shall be applied during a lightning strike scene with multiple patients?
reverse triage
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Electrical Injuries
During a lightning strike scene when there are multiple patients, what type of pt shall be worked first?
patients in cardiac arrest
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Electrical Injuries
When you administer supplemental O2, saturation needs to be maintained between what percentages?
95-100%
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Eye Emergencies
If blood is noted in anterior chamber, what angle do you elevate head of the patient's bed?
40 degrees
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Eye Emergencies
When would you elevate LSB to 40 degrees?
if spinal immobilization is indicated
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Eye Emergencies
What position do you place the pt in when being transported for treatment of diagnosed central retinal artery occlusion?
shock position
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Chest Pain/Discomfort
If SpO2 is less than 95%, administer O2 via nasal cannula at what lpm?
2-4 lpm
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Acute Stroke
The head of the bed should be elevated to what angle?
30 degrees
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Acute Stroke
What blood pressure is considered a stroke mimic and a Stroke Alert should not be issued?
systolic less than 90 mmHG
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Acute Stroke
When would you consider taking a pt to a Comprehensive Stroke Center?
if time of onset is greater than 2 hours
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Acute Stroke
When would you consider taking a pt to a Primary Stroke Center?
if time of onset is 2 hours or less
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Acute Stroke
When would you consider taking a pt to ATU?
only if time will be saved
- -distance + travel exceeds 25 min
- -helicopter can be launched prior to rescue arrival
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CHF/Pulmonary Edema
What position should you place the pt in?
full Fowler's position
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Hypertensive Urgency
What should systolic BP be greater than?
220 mmHG
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Hypertensive Urgency
What should diastolic BP be greater than?
120 mmHG
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Hypertensive Urgency
What position do you place the pt in?
semi-Fowler's position
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Cardiac Arrest
What percentage of O2 do you ventilate with?
100%
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Cardiac Arrest
How many minutes of CPR do you perform for an unwitnessed arrest?
- Unwitnessed Arrest
- Perform 2min of CPR prior to any other intervention
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430 EMS
What position are "Restrained Patients" transported in?
Supine, Fowlers or Semi-Fowlers
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430 EMS
What position is a "Shock/Trauma" patient transported in?
Shock position (Trendelenburg position)
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430 EMS
What position is an "Immobilized Pregnant Patient" transported in?
LSB elevated on right side approx. 15° or (6")
If LSB cannot be elevated, manually displace uterus to the left as much as possible without causing spinal movement and maintain this throughout transport.
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430 EMS
What position is a "Crush Syndrome" patient transported in?
Shock position- use caution with trauma PT, potential respiratory compromise.
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430 EMS
What position do you transport an "Eye Trauma" patient?
If blood noted in anterior chamber elevate head or LSB to 40°
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430 EMS
What do position do you transport an "Atraumatic, diagnosed central retinal artery occlusion" patient?
Place them in the shock position
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430 EMS
What position do you transport the "Acute Stroke" patient?
Place them in the position of comfort, with head of bed elevated to 30° if tolerated.
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430 EMS
What position do you transport the "CHF/Pulmonary Edema" patient?
Full Fowlers position
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430 EMS
What position do you transport the "Hypertensive Urgency" patient?
Semi-Fowlers or position of comfort
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430 EMS
What position do you transport the "Coma/Altered Consciousness" patient?
Recovery position
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430 EMS
What position is the "Epistaxis" patient transported in?
sitting position with head leaning forward
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430 EMS
What position do you transport the "Shock/Medical" patient in?
Shock position
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430 EMS
What position should a "Heat Stroke" patient be transported in?
Semi-Fowlers with the head elevated 30°
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430 EMS
What position do you transport "Vaginal Bleeding"?
1st or 2nd trimester- position of comfort
3rd trimester- recover position (left side)
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430 EMS
What position should you transport patients having "Complications of Deliver"?
Breech Delivery - Knee-Chest position
Limb or Brow presentation- Knee-Chest
Prolapsed Cord- Knee-Chest or supine with hips elevated
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430 EMS
What position should the stretcher be in if you are transporting a patient while using the "Pediatric Stretcher Restraint Device" with the caregiver sitting on the stretcher?
Head of the stretcher should be at least at a 45° angle
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430 EMS
What does APGAR stand for?
- Apearance
- Pulse
- Grimmace
- Activity
- Respirations
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430 EMS
In APGAR what are you assessing and the score under "Appearance"?
- Appearance
- 0 Blue all over
- 1 Acrocyanosis
- 2 Pink all over
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430 EMS
When using the APGAR chart what are you assessing and the score under the "P"?
- Pulse
- 0 Absent
- 1 Less than 100
- 2 Greater or equal to 100
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430 EMS
When using the APGAR chart what are you assessing and the score under "G"?
- Grimmace
- 0 No Response
- 1 Grimmace/Weak Cry
- 2 Sneeze/Cough Vigorous Cry
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430 EMS
When using the APGAR chart what are you assessing and the score under "Activity"?
- Activity/Muscle Tone
- 0 Limp/Flacid
- 1 Some Motion/Flexion
- 2 Active Motion
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430 EMS
When using the APGAR chart what are you assessing and the score under "R"?
- Respirations
- 0 Absent
- 1 Slow/irregulat
- 2 Vigorous Cry/Normal Respirations
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430 EMS
On the GCS scale what is listed under EYE Opening and the scores?
- EYE Opening
- 4 Spontaneous
- 3 To Speach
- 2 To Pain
- 1 None
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430 EMS
On the GCS scale what is listed under Best Verbal Response and the score?
- Verbal Response
- 5 Oriented
- 4 Confused
- 3 Inappropriate Words
- 2 Incomprehensible sounds
- 1 None
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430 EMS
On the GCS scale what is listed under Best Motor Response and the score?
- Best Motor Response
- 6 Obeys
- 5 Localizes
- 4 Withdraws
- 3 Flexion
- 2 Extension
- 1 None
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430.1013 Reporting Abuse
JFRD personnel shall report abuse to?
- Statewide #, obtain name and ID from contact person
- Notify Rescue District/Batt Chief
- Notify Division Chief of Rescue in writing within 24hrs that you've reported to Florida Abuse Regisry
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430.1015 Risk Management
What is the most common form of contamination to the health care provider?
Sharps
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430.1017 Adult Trauma Scorecard
Under the one condition criteria for trauma alert, what is the airway condition?
Active airway assistance beyond beyond administration of oxygen
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430.1017 Adult Trauma Scorecard
Under the one condition criteria for trauma alert, what is the circulation criteria?
- Patient lacks a radial pulse with HR >120
- or
- Has systolic <90
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430.1017 Adult Trauma Scorecard
Under the one condition criteria for trauma alert, what is the cutaneous criteria?
- Pt. has 2nd or 3rd degree burns to 15% or more of the total body surface area
- or
- Amputation proximal to wrist/ankle
- or
- Penetrating injury to the head, neck or torso
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430.1017 Adult Trauma Scorecard
Under the one condition criteria for trauma alert, what is the Best Motor Response criteria?
- The PT exihibits a score or 4 or less on the GCS
- or
- exhibits the presence of paralysis
- or
- there is suspicion of spinal cord injury
- or
- the loss of sensation
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430.1017 Adult Trauma Scorecard
Under the one condition criteria for trauma alert, what is the criteria under Long Bone Fracture?
Pt reveals signs or symptoms of two or more long bone fracture sites
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430.1017 Adult Trauma Scorecard
Under the two condition criteria for trauma alert, what is the criteria for airway?
The patient as a resp rate of 30 or greater
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430.1017 Adult Trauma Scorecard
Under the two condition criteria for trauma alert, what is the criteria under circulation?
patient has a sustained HR of 120 or greater
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430.1017 Adult Trauma Scorecard
Under the two condition criteria for trauma alert, what is the criteria under BMR?
BMR of 5 on GCS
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430.1017 Adult Trauma Scorecard
Under the two condition criteria for trauma alert, what is the criteria under cutaneous?
Pt has soft tissue loss from either major degloving or a major flap avulsion 5" or greater.
GSW to extremities
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430.1017 Adult Trauma Scorecard
Under the two condition criteria for trauma alert, what is the criteria under long bone fracture?
Pt reveals signs or symptoms of a single longbone fracture from a MVC or a fall from 10' or greater
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430.1017 Adult Trauma Scorecard
Under the two condition criteria for trauma alert, what is the criteria under age?
Pt is 55yrs or older
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430.1017 Adult Trauma Scorecard
Under the two condition criteria for trauma alert, what is the criteria under mechanism of injury?
Pt has been ejected from a motor vehicle or driver of vehicle impacted with the steering wheel causing steering wheel deformity
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430 Trauma transport protocol
Who is authorized to change the trauma alert status?
- Medical director of the EMS provider
- or
- Physician at the the receiving trauma center or hospital
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430 Hyperthermia
At what temp is heat stroke?
Greater than 104°
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430 Hypothermia
What temp does Shivering occur?
89.6°F to 98.6°F
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430 Hypothermia
What temp is a significant finding?
Rectal temp below 95°F
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430 Pediatric Fever
What temp should you apply cooling measures?
- Oral or rectal temp is greater than 105°F
- (tympanic greater than 104°F)
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430 Respiratory Insufficiency
What is one of the first signs of hypoxia?
Pt anxiety
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430 Consent and Competency
What 4 conditions must be met for Implied Consent?
Pt intoxicated or under influence or otherwise incapable of providing informed consent
Pt experiencing an emergency medical condition
The competent pt would normally give consent
Unreasonable force shall not be used
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430 Consent and Competency
A Pt is considered to give informed consent when?
Pt gives verbal permission to treat
Pt gives written permission to treat
Pt does not object as you begin assessment
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430 Consent and Competency
To give informed consent a pt must be mentally competent. This means the pt must be?
A&Ox4
No significant mental impairment
Not suicidal or homicidal and does not want to hurt themselves
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430 Dealing with Behavioral Emergencies
What needs to be documented when restraints are used?
Pt behavior that necessitated restraints
Type of restraint used
Status of circulation distal to restraints
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430 Consent and Competency
Documented refusals are only valid with an appropriate witness signature. In order of preference who are the appropriate witnesses?
- 1.Spouses
- 2.Relatives
- 3.Law Enforcement
- 4.Friends
- 5.Other Fire/Rescue Personnel
JFRD officer documenting may not sign as a witness
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430 Risk Management
How should all re-usable equipment be thoroughly disinfected after use?
Wash with soap and water
Cleanse with appropriate disinfecting agent
Dry thoroughly before returning to storage
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430 PED Trauma Transport
What age pt is the PED Trauma criteria used for?
Trauma pt with the anatomical and physical characteristics of a person 15yrs of age or less.
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the single criteria under Airway?
Airway-
- pt is intubated
- or
- pt is assisted through such measures as jaw thrust
- or
- continuous suctioning
- or
- the use of adjuncts to assist vent efforts
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the single criteria under Circulation?
Circulation
- Pt has a faint or non palpable
- carotid or femoral
- or
- systolic <50
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the single criteria under Consciousness?
Consciousness
- Pt exhibits altered mental status
- or
- there is presence of paralysis, the suspicion of spinal cord injury
- or
- loss of sensation
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the single criteria under Fracture?
Fracture
- Evidence of open long bone fracture
- or
- multiple fracture sites (except isolated wrist/ankle)or
- multiple dislocations (except isolated wrist/ankle)
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the single criteria under Cutaneous?
Cutaneous
- Pt has a major soft tissue disruption including major flap avulsion
- or
- 2nd or 3rd degree burns to 10% or more of the total body surface area.
- or
- Amputation proximal to wrist or ankle
- or
- Any penetrating injury to head, neck, torso
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the criteria listed under "any two" for Consciousness?
Consciousness
- Pt has symptoms of amnesia
- or
- there is a loss of consciousness
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the criteria listed under "any two" for Circulation?
Circulation
- Carotid or femoral is palpable but radial or pedal are not.
- or
- systolic blood pressure is >90
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the criteria listed under "any two" for Fracture?
Fracture
Pt reveals signs or symptoms of single closed long bone fracture
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430 PED Trauma Transport
When assessing a PED for a trauma alert with the PED Trauma Scorecard, what is the criteria listed under "any two" for Size?
Size
- PED trauma pt weighing 11kilos or less
- or
- body length is equivalent to this weight on a PED length and weight emergency tape (33" or less)
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430 Chest Trauma
What is the best treatment for the Pt with severe chest trauma?
Rapid transport
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430 Abdominal Trauma
What is the most important indicator of abdominal trauma?
Mechanism of Injury
The best treatment is rapid transport
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430 Traumatic Injury of the Pregnant Pt
Why might the onset of signs and symptoms of shock be delayed in a pregnant pt?
Due to the increased maternal blood volume
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430 Extremity Injuries
When would you apply axial traction for open or closed dislocations or fractures?
Asense of distal pulses
Proper immobilization
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430 Crush Syndrome
What can cause a decrease in the fibrillatory threshold of the heart which makes ventricular fibrillation more likely in the crush syndrome pt?
Severe metabolic acidosis
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430 Crush Syndrome
What can contribute directly and indirectly to kidney failure in a crush syndrome pt?
the release of myoglobin, uric acid and other toxins into the blood
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430 Crush Syndrome
What is the primary cause of death from crush syndrome?
- Hypvolemia
- Dysrhythmia
- Renal Failure
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430 Crush Syndrome
What is the most consistent clinical finding in a crush syndrome pt?
Loss of two-point discrimination
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430 Acute Compartment Syndrome
What are the 5 "P's" (signs and symptoms) associated with acute compartment syndrome?
- Pain
- Paresthesia
- Pressure
- Passive Stretching
- Pulselessness
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430 Acute Compartment Syndrome
During the treatment of Acute Compartment Syndrome, what do you not want to do?
- Do Not
- Elevate
- Apply cold packs (ice increases vasoconstriction)
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430 Head Trauma
What is Diploplia?
Double or blurred Vision
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430 Head Trauma
Why would a head trauma pt. present with shock?
Look elsewhere for the cause
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430 Extremity Injuries
What is Ecchymosis?
a bruise
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430.2110
What is Ecchymosis a sign and symptom of?
An extremity injury
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430.2116
What is Hyphema?
Blood in the anterior chamber of the eye
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430 Eye Emergencies
When treating Direct eye trauma what should you elevate the head of the pt's bed or LSB?
40 degrees
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430 Airway Protocol
Comi-Tube- what do you fill the #1 and #2 cuff to?
Cuff #1- 100mL of air
Cuff #2- 15mL of air
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430 Airway Protocol
What is perhaps the most critical as well as the most basic of interventions practiced in emergency medicine?
Management of the pt's airway
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430 Airway Protocol
What should you not use to determine if a pt should receive oxygen therapy?
Oxygen Saturation Levels
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430 Airway Protocol
What is Homan's sign?
Calf Pain
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430 Airway Protocol
When the mechanism of injury indicates possible spinal involvement, what is integral to proper airway management and must be given appropriate attention?
Cervical Spine Considerations
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430 Airway Protocol
What do you set the flow at for a Nebulizer?
- at least 6lpm (typically 8lpm)
- Adjust flow to maintain a mist of the med
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430.2401
What is Melena and what is it a sign and symptom of?
Melena- bloody, tarry stools
Abdominal/Flank Pain
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430.2403
What is Uticaria and what is it a sign and symptom of?
Urticaria- hives
Allergic Reaction/Anaphylaxis
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430.2404
What is Nuchal Rigidity and what is it a sign and symptom of?
Nuchal Rigidity- Stiff neck
Coma/Altered Consciousness
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430.2702
What is oliguria and what is it a sign and symptom?
Oliguria- diminished/infrequent urination
Mild Pre-Eclampsia
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430.2204
What are the Neurologic Signs and Symptoms of Hypertensive Urgency?
- Decreased LOC
- Impaired Movement
- Asymmetry of face and extremities
- Seizures
- Unequal pupils
-
430 Hypertensive Urgency
What are the treatments for hypertensive urgency?
Administer Oxygen as indicated
- Pt in Semi-Fowlers
- or
- Position of comfort
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430 CHF/Pulmonary Edema
What is the treatment for CHF/Pulmonary Edema?
Administer 100% oxygen
Pt in Full-Fowlers position
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430.2501
What is Pleuritic chest pain and what is it a sign and symptom of?
Pleuritic Chest Pain- chest pain exacerbated by forceful breathing
Drowning/Near-Drowning Submersion
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430 Decompression Sickness/Dysbarism
What is the Etiology of Decompression Sickness/Dysbarism?
- Dysbarism
- Barotrauma
- Decompression Sickness
-
430 Decompression Sickness/Dysbarism
What are the skin signs and symptoms?
- Tenderness
- Mottling
- Rash from bubble emboli
- Subcutaneous Emphysema
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430 Acute Stroke
What is the treatment for Acute Stroke?
Admin. Oxygen as indicated- SAT. below 95% admin 2-4lpm nasal canula
Room air SAT. above 95%, no oxygen administered
Pt in position of comfort with head of bed elevated 30°
Obtain BP in both arms
Florida Bureau of EMS Stroke Alert Checklist
Dont administer any oral meds
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430 Symptomatic Bradycardia
What is the treatment for Symptomatic Bradycardia?
Admin. 100% oxygen
Assess for reversible causes
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430 Respiratory Insufficiency
What is a sign of Severe hypoxia/anoxia?
Obtundation
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430 Respiratory Insufficiency
What is the treatment for Respiratory Insufficiency?
Admin. supplemental oxygen, maintain saturation between 95 and 100%
-
430 Respiratory Arrest
What should be performed to prevent arrest?
Aggressive airway procedures and supplemental ventilation should be performed.
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430 Respiratory Arrest
If a pt has a foreign body airway obstruction and is unconscious, what should be done before beginning CPR?
Reposition Airway
Before vent and after opening airway, look for obstruction and remove if visible.
Then begin CPR
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430 Airway Protocol
What determines Oxygen administration?
Pathology of the complaint, differential (field) diagnosis and this protocol
-
430 Airway Protocol
What technique should be used with a BVM?
Use the E-C technique
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430 Airway Protocol
What is the flow set for a NRB mask?
at least 10lpm
adjust liter flow to maintain oxygen in the reservoir bag
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430 Airway Protocol
How do you size a NPA?
Distance from the tip of the nose to the angle of the jaw
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430 Airway Protocol
What are the indications for Combi-Tube?
Cardia, respiratory or traumatic arrest
-
430 Airway Protocol
What are the contra-indications for a Combi-tube?
- Less than 5' tall, Greater than 7'
- Less than 16yrs old
- Pt has esophageal disease
- Ingested caustic substance
- Foreign Body Airway Obstruction
- Responsive or has gag reflex
-
430 Airway Protocol
Where should you Auscultate to confirm Combi-tube placement?
The epigastrum in the mid-line slightly inferior to the xiphoid process
Then lungs while ventilating pt
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430 EMS
For Pt exhibiting signs and symptoms of hypoglycemia, conscious and able to swallow, when do you administer Dextrose Past or sugar orally?
For a BGL less than 70mg/dl
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430 Epistaxis
What position should you sit the pt in if other injuries do not exist?
Prevent aspiration of blood by placing the pt in a sitting position with their head leaning forward.
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430 Epistaxis
How can you control the hemorrhage in an Epistaxis pt?
Pinch nostrils and pack gauze between upper lif and gum to provide pressure.
Tell pt not to sniff, blow or manipulate nasal passages
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430 Headache
What position should you place a pt with a decreased level of consciousness?
Place pt in the recovery position to maintain aspiration prophylaxis
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430 Shock/Medical
What is the most important goal in the prehospital management of shock?
Diagnosis and immediate treatment of Underlying Cause
-
430 Hyperthermia
Under signs and symptoms of Heat Stroke what might the pt temp be and describe the pt skin.
Greater than 104°
Moist or dry skin (may be sweating)
-
430 Hyperthermia
What position should you transport a Heat Stroke pt in?
Semi-Fowlers with head elevated 30°
-
430 Hyperthermia
What position should you transport a Heat Exhaustion pt in?
Position of comfort
-
430 Hypothermia
When does shivering occur?
-
430 EMS
What two resources should be used to properly identify the agents involved for a Exposure to Specific Hazardous Materials Pt?
NIOSH Pocket Guide to Hazardous Chems
ERG
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430 Carbon Monoxide
What is not a reliable sign of CO poisoning?
Cherry-red skin
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430 Vaginal Bleeding
What position do you transport a Vaginal Bleeding pt in?
1st or 2nd trimester or unknown preg status- allow pt to assume position of comfort
3rd trimester- pt in recover position
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430 Hypertensive state of Pregnancy
What are the BP findings during the assessment of Mild Pre-Eclampsia?
- Systolic Greater than 140
- Diastolic greater than 90
Systolic- greater than 30mmHg increase above baseline
Diastolic-greater than 15mmHg increase above baseline
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430 Hypertensive State of Pregnancy
In the assessment portion of Mild Pre-Eclampsia, what is the weight gain?
Greater than 2lb per wk
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430 Hypertensive State of Pregnancy
In the assessment portion of Severe Pre-Eclampsia what are the BP finding?
Systolic greater than 160
Diastolic greater than 110
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430 Hypertensive state of Pregnancy
What is the weight gain for Severe Pre-Eclampsia in the assessment?
Greater than 6lb per wk
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430 Hypertensive State of Pregnancy
What indicates Eclampsia in the Pre-Eclampsia pt?
Seizure activity
Can occur postpartum (up to 6wks)
Pt Hyperventilates after tonic/clonic seizure
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430 Imminent Deliver
What is the second stage of labor?
Fetal head entering vaginal canal to expulsion of the fetus
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430 Imminent Delivery
As soon as the head delivers what do you suction first?
Oropharynx first before nostrils
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430 Imminent Deliver
Where do you cut the cord?
Clamp (2 to 3 inches apart) 7 to 10 inches from abdomen of the neonate
Cut between clamps
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430 Complications of Delivery
During a Breech Deliver how long do you wait for the head to deliver before making an airway for the neonate and how?
Does not deliver within 3min
gloved hand to make an airway for neonate, using fingers to make airspace
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430 Complications of Delivery
What position do you place the mother in if there is a Prolapsed Cord?
- Knee-chest position
- or
- Supine with hips elevated
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430 Newborn Stabilization
When suctioning with a bulb syringe or mechanical suction what should the negative pressure be?
Less than 100cmH2O
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430 Newborn Stabilization
If amniotic fluid is meconium stained and after delivery of the head but before delivery of the rest of the body you should suction?
Hypopharynx and then the nostils
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430 Newborn Stabilization
What are the ventilation requirements with Persistent Central Cyanosis, Apnea or HR less than 100?
Vent 100% oxygen at 40-60 breaths a min
vent pressure may exceed 30 to 40 cmH2O, occlude the pop-off valve
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430 Newborn Stabilization
What do you do if the HR is less than 60?
Admin chest compressions- 120 per min
Re-assess every 30sec
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430 Pediatric Cardia Arrest
What are the most common PED rhythm disturbances?
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