Recert Study Guide

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engmedic19
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Recert Study Guide
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2016-03-09 11:32:32
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Paramedic
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Paramedic Recert 2016
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  1. Paramedic Protocol 2015- What is the definition of Level I Treatments?***
    NO BASE CONTACT NEEDED
  2. Paramedic Protocol 2015- What are the requirements for Level II treatments? Pg.1***
    Make base contact. Continue if radio failure.
  3. Paramedic Protocol 2015- Level I Treatment pg.2***
    • Start IV and Administer fluids***
    • Saline lock
    • ET airway
    • CPAP
    • 12 lead ECG
    • Cardiac Defib
    • Cardioversion
    • Pacing
    • Valsalva procedure
    • Forceps (Foreign Body)
    • Administer 14 drugs
    • IO
    • glucometer, capnography, and capnometry
  4. Paramedic Protocol 2015- What are the 14 Level I drugs? Pg.2***
    • 10% Glucose solution
    • Adenosine
    • Albuterol (Proventil) Beta-2 Bronchodilator
    • Amiodarone
    • Aspirin
    • Atropine Sulfate
    • (Atrovent) Ipratropium Bromide
    • Epinephrine 
    • Fentanyl
    • Lidocaine HCL (Xylocaine)
    • Morphine Sulfate
    • Naloxone (Narcan)
    • Nitroglycerin
    • Ondansetron (Zofran)
  5. Paramedic Protocol 2015- What should you consider in all unresponsive patients? Pg.3***
    Narcan, blood glucose analysis and Dextrose (if hypoglycemic) in all unresponsive patients including cardiopulmonary arrest***
  6. Paramedic Protocol 2015- What are the Level II protocols? Pg.4***
    • Cricothyrotomy  
    • Thoracic decompression
    • Administer 9 additional drugs
  7. Paramedic Protocol 2015-What are the 9 Level II Drugs? Pg.4***
    • Activated Charcoal
    • Calcium Chloride
    • Diazepam (Valium)
    • Diphenhydramine
    • Dopamine
    • Glucagon
    • Magnesium Sulfate
    • Midazolam (Versed)
    • Sodium Bicarbonate
  8. Paramedic Protocol 2015- What are Paramedics authorized during interfacility patient transfers? Pg.4***
    • Give medications through pre-existing peripheral and central venous IV
    • Give doses greater than the max dose with doctors written orders
    • Monitor (only) arterial vascular access lines
    • Monitor pre-existing thoracostomy tubes
    • Monitor IV’s of Potassium Chloride with less than 40 mEq, per liter ***
    • Monitor naso-gastric infusions
    • Transfer of patients with whole blood or blood product infusions
    • Transfer of patients with heparin or nitroglycerin infusions
  9. Paramedic Protocol 2015- Adenosine Adult Dose ***
    6 mg IV/IO push, may repeat in 1-2 min. with 12 mg IV/IO push. May repeat 12 mg dose in 1-2 min. for a maximum dose of 30 mg. ***
  10. Paramedic Protocol 2015- Adenosine Pediatric Dose ***
    0.1 mg/kg IV/IO (Max dose 6 mg, may repeat x 2 in 3 min intervals with 0.2 mg/kg (Max dose 12 mg)
  11. Paramedic Protocol 2015- Amiodarone Adult Dose ***
    VF/VT (Pulseless) 300mg IV/IO Push (over 1-2 min) Followed in 5 minutes by 150mg.

    VT (with pulses) 150mg in 100ml NS over 10 minutes to max dose 450mg

    PVC's 150mg in 100ml NS over 10 minutes, repeat in 5 with 150mg in 100ml NS over 10 minutes to max dose of 450mg
  12. Paramedic Protocol 2015- Amiodarone Peds Dose ***
    Peds – 5 mg/kg to 15 mg/kg max
  13. Paramedic Protocol 2015- Aspirin Adult Dose***
    325 mg PO***
  14. Paramedic Protocol 2015- Atropine Adult Dose
    Bradycardia: 0.5mg IV/IO to max dose of 3mg.

    Organophosphate: 2mg every 5 minutes until symptoms clear.
  15. Paramedic Protocol 2015- Atropine Pediatric Dose
    Bradycardia: 0.02 mg/kg IV/IO, may repeat in 5 min for a max dose of 1 mg for children and a max dose of 2 mg for adolescents. Minimum dose to be given is 0.1 mg
  16. Paramedic Protocol 2015- Albuterol (Proventil) Adult Dose
    2.5 mg in 3 mL NS via nebulizer
  17. Paramedic Protocol 2015- Albuterol (Proventil) Pediatric Dose***
    2.5 mg in 3 mL NS via nebulizer ***
  18. Paramedic Protocol 2015- Atrovent Adult Dose (Ipratropium Bromide)
    • 500mcg premixed with 2.5mg Albuterol
    • Can give every 20 minutes.
    • Max dose of 3.
  19. Paramedic Protocol 2015- Atrovent Pediatric Dose (Ipratropium Bromide)
    • 500mcg premixed with 2.5mg Albuterol
    • Can give every 20 minutes.
    • Max dose of 3.
  20. Paramedic Protocol 2015- Dextrose 10% Adult and peds Dose
    5ml/kg for Adults & Peds
  21. Paramedic Protocol 2015- Epinephrine 1:1,000 Adult Dose
    0.3 mg IM
  22. Paramedic Protocol 2015- Epinephrine 1:1,000 Pediatric Dose
    0.01 mg/kg IM
  23. Paramedic Protocol 2015- Epinephrine 1: 10,000 Adult Dose
    0.5-1 mg IV/IO, may repeat every 3-5 min. for non-perfusing cardiac rhythms
  24. Paramedic Protocol 2015- Epinephrine 1: 10,000 Pediatric Dose
    0.01 mg/kg IV/IO, may repeat every 3-5 min. for non-perfusing cardiac rhythms.
  25. Paramedic Protocol 2015- Epinephrine Drip Adult Dose
    2-8 mcg per minute
  26. Paramedic Protocol 2015- Epinephrine Drip Pediatric Dose
    0.1-– 1 mcg/kg/min IV/IO with Base Hospital Order
  27. Paramedic Protocol 2015- Lidocaine Bolus Adult Dose***
    • 1-1.5 mg/kg IV/IO/, see comments for repeat dose.
    • Repeat: 0.5-0.75 MG/KG
  28. Paramedic Protocol 2015- Lidocaine Bolus Pediatric Dose
    1 mg/kg IV/IO
  29. Paramedic Protocol 2015- Lidocaine Bolus Routes & Comments Perfusing rhythms
    Perfusing rhythms: Use lower end of dosing range, repeat every 7-10 min. with 0.5 mg/kg, to a max dose of 3 mg/kg.
  30. Paramedic Protocol 2015- Lidocaine Drip Adult Dose
    1-4 mg/min.
  31. Paramedic Protocol 2015- Lidocaine Drip Pediatric Dose
    • Base Hospital Order
    • 20-50 mcg/kg/min
  32. Paramedic Protocol 2015- Naloxone (Narcan) Adult Dose
    0.4 mg to– 2 mg IV/MADD/IM
  33. Paramedic Protocol 2015- Naloxone (Narcan) Pediatric Dose Less than 5 yr old or less than 20kg:
    0.1mg/kg IV/IO/MADD
  34. Paramedic Protocol 2015- Naloxone (Narcan) Pediatric Dose Greater than 5 yr old or greater than 20 kg: ***
    2mg IV/IO/MADD ***
  35. Paramedic Protocol 2015- Nitroglycerin Adult Dose***
    0.4 mg (gr 1/150) SL, may repeat every 3-5 min. as long as systolic BP remains above 90. ***
  36. Paramedic Protocol 2015- Nitroglycerin Pediatric Dose
    Not used.
  37. Paramedic Protocol 2015- Nitroglycerin Routes & Comments
    • Do not administer if systolic BP <90 or HR <50.
    • Do not administer if it is suspected or known that the patient has taken sildenafil (Viagra) or vardenafil (Levitra) within the previous 24 hours.
    • Or tadalafil (Cialis) within the previous 48 hours.
  38. Paramedic Protocol 2015- Ondanestron (Zofran) Adult Dose
    • 4 mg PO tablet-Preferred Method
    • Slow IV over 1-2 min /IM/IO. May repeat x 2 every 10 minutes to a max dose of 12mg.
  39. Paramedic Protocol 2015- Ondansetron (Zofran) Pediatric Dose children 4 years or younger.
    Not used
  40. Paramedic Protocol 2015- Ondansetron (Zofran) Pediatric Dose Children over 4 years of age:
    • 4 mg PO tablet-Preferred Method
    • Slow IV over 1-2 min/IM/IO. Do not repeat dose.
  41. Paramedic Protocol 2015-LEVEL II MEDICATIONS Activated Charcoal Adult Dose***
    50 grams PO/NG (No Lavage)
  42. Paramedic Protocol 2015-LEVEL II MEDICATIONS Activated Charcoal Pediatric Dose***
    25 grams PO/NG (No Lavage)
  43. Paramedic Protocol 2015-LEVEL II MEDICATIONS Calcium Chloride Adult Dose
    1 gram IV/IO push over 2 min.
  44. Paramedic Protocol 2015-LEVEL II MEDICATIONS Calcium Chloride Pediatric Dose
    20 mg/kg IV/IO push over 2 min.
  45. Paramedic Protocol 2015-LEVEL II MEDICATIONS Diazepam (Valium) Adult Dose***
    5mg IV/IO, may repeat dose with 5 mg every 10 minutes to a max dose of 30 mg***
  46. Paramedic Protocol 2015-LEVEL II MEDICATIONS Diazepam (Valium) Pediatric Dose
    0.3 mg/kg IV/IO, may repeat dose with 0.3 mg/kg every 25 minutes to a max dose of 5 mg. Rectal dose 0.5 mg/kg to a max dose of 10 mg
  47. Paramedic Protocol 2015-LEVEL II MEDICATIONS Diphenhydramine (Benadryl) Adult Dose
    • 50-100 mg IM
    • 25-50 mg IV over 2-3 1min.
  48. Paramedic Protocol 2015-LEVEL II MEDICATIONS Diphenhydramine (Benadryl) Pediatric Dose***
    12.5 IM only***
  49. Paramedic Protocol 2015-LEVEL II MEDICATIONS Dopamine HCL Adult Dose
    2-10 mcg/kg/min.

    400 mg in 500 ml NS ran at 2-10 mcg/kg/min. with a micro drip

    • 200 mcg/min = 15 gtts/min
    • 400 mcg/min = 30 gtts/min
    • 600 mcg/min = 45 gtts/min
    • 800 mcg/min = 60 gtts/min
  50. Paramedic Protocol 2015-LEVEL II MEDICATIONS Dopamine HCL Pediatric Dose***
    2-20 mcg/kg/min.***
  51. Paramedic Protocol 2015-LEVEL II MEDICATIONS Fentanyl Adult Dose***
    50 mcg slow IV/IM/IO/Atomized, may repeat in 50 mcg increments to a max dose of 200 mcg***
  52. Paramedic Protocol 2015-LEVEL II MEDICATIONS Fentanyl Pediatric Dose
    1 mcg/kg slow IV/IM/IO/Atomized, a max of 50 mcg/dose. Max dose 3 mcg/kg
  53. Paramedic Protocol 2015-LEVEL II MEDICATIONS Glucagon Adult Dose***
    1 mg IM***
  54. Paramedic Protocol 2015-LEVEL II MEDICATIONS Glucagon Pediatric Dose
    Less than or equal to 8 years old: 0.5mg IM/ greater than 8 years old: 1mg IM
  55. Paramedic Protocol 2015-LEVEL II MEDICATIONS Magnesium Sulfate Adult Dose Cardiac/Respiratory***
    1-2 grams IV/IO infused over 5 min.***
  56. Paramedic Protocol 2015-LEVEL II MEDICATIONS Magnesium Sulfate Pediatric Dose Cardiac
    25-50 mg/kg IV/IO over 10-20 minutes. Max dose 2g for torsades de pointes.
  57. Paramedic Protocol 2015-LEVEL II MEDICATIONS Magnesium Sulfate Adult Dose Eclampsia:
    2-4 grams IV/IO bolus over 2-3 min.
  58. Paramedic Protocol 2015-LEVEL II MEDICATIONS Magnesium Sulfate Pediatric Dose Respiratory***
    40 mg/kg MAX 2g/ 30 min***
  59. Paramedic Protocol 2015-LEVEL II MEDICATIONS Morphine Sulfate Adult Dose***
    5 mg IV/IM/IO, may increase in 5 mg increments to a max dose of 20 mg.***
  60. Paramedic Protocol 2015-LEVEL II MEDICATIONS Morphine Sulfate Pediatric Dose
    0.1-0.2 mg/kg IV/IM/IO, may increase in 0.1mg/kg increments to a max dose of 10 mg
  61. Paramedic Protocol 2015-LEVEL II MEDICATIONS Midazolam (Versed) Adult Dose***
    1mg IV/MAD/IO, may repeat in 2 min to a max dose of 5 mg.***
  62. Paramedic Protocol 2015-LEVEL II MEDICATIONS Midazolam (Versed) Pediatric Dose
    0.2 mg/kg IM, may repeat after 15 min IV/IO/MAD to a max dose of 6mg
  63. Paramedic Protocol 2015-LEVEL II MEDICATIONS Sodium Bicarbonate Adult Dose***
    1 mEq/kg IV/IO, may repeat with 0.5 mEq/kg every 10 minutes during cardiac arrest.***
  64. Paramedic Protocol 2015-LEVEL II MEDICATIONS Sodium Bicarbonate Pediatric Dose
    1 mEq/kg IV/IO, may repeat with 0.5 mEq/kg every 10 minutes during cardiac arrest.
  65. Paramedic Protocol 2015- LEVEL II PARAMEDIC PROCEDURES - Cricothyrotomy Comments***
    May only be utilized if ventilation attempts by all other means are unsuccessful. Division approved device is a 10g IV catheter.
  66. Paramedic Protocol 2015- DESTINATION DECISION - What is the hospital destination decision shall be based on?
    • Patient choice
    • Closest, most appropriate hospital criteria.
  67. Paramedic Protocol 2015- DESTINATION DECISION - What is considered a significant ED OVERLOAD SCORE?***
    5 or greater
  68. Paramedic Protocol 2015- DESTINATION DECISION Trauma - Step 1 or 2*
    KMC
  69. Paramedic Protocol 2015- DESTINATION DECISION Orthopedic
    • BMH
    • KMC
    • Mercy
    • MSW
    • SJCH
  70. Paramedic Protocol 2015- DESTINATION DECISION Cardiac
    • BMH
    • Heart
    • SJCH
  71. Paramedic Protocol 2015- DESTINATION DECISION STEMI***
    • BMH
    • Heart
    • SJCH
  72. Paramedic Protocol 2015- DESTINATION DECISION Pediatric Emergent Medical, less than 30 minute ground time? pg 10
    Patients that are fourteen (14) years and younger with an emergent medical complaint shall be transported to a Level I or Level II PedRC if ground transport time is thirty (30) minutes or less.
  73. Paramedic Protocol 2015- DESTINATION DECISION Pediatric Emergent Medical, more than 30 minute ground time? pg 16
    Ground transport times that are greater than thirty (30) minutes may be transported to the closest, most appropriate receiving hospital.
  74. Paramedic Protocol 2015- DESTINATION DECISION Sexual Assault***
    SJCH***
  75. Paramedic Protocol 2015- DESTINATION DECISION Psychiatric w/out other medical condition ruled out
    ALL
  76. Paramedic Protocol 2015- DESTINATION DECISION Psychiatric with other medical condition ruled out.
    KMC
  77. Paramedic Protocol 2015- DESTINATION DECISION Medical extremis
    Closest open hospital
  78. Paramedic Protocol 2015- DESTINATION DECISION Traumatic Arrest
    • KMC
    • DRMC
    • KVH
    • TH
    • RRH
  79. Paramedic Protocol 2015- DESTINATION DECISION Traumatic unmanageable airway or inability to ventilate
    Closest open hospital
  80. Paramedic Protocol 2015- DESTINATION DECISION Conscious Patients
    Conscious, alert, and oriented patients shall have a choice in destination, so long as the requested hospital is a Kern County EMS approved receiving center. (See above table) In the event that a conscious patient is adamant and insists on being transported to a hospital contrary to a case specific hospital which is most appropriate, the attendant shall attempt to obtain a signed AMA and continue appropriate care and transport to the requested hospital. At no time will an ambulance crew advise a patient that they have no choice in their destination hospital
  81. Paramedic Protocol 2015- DESTINATION DECISION Med-Alert/Multi-Casualty (MCI) Destination: Who assigns which hospital the patients go to?
    Transportation coordinator at scene.
  82. Paramedic Protocol 2015- CPR - The pause in chest compressions to check the rhythm and pulse should not exceed?***
    10 seconds
  83. Paramedic Protocol 2015- CPR - For a cardiac arrest patient in VF/VT who has a body temperature of (<86oF), How many defibrillation(s) attempt are appropriate?***
    One***
  84. Paramedic Protocol 2015- CPR -What hospital(s) would you transport to for therapeutic hypothermia treatment?***
    Bakersfield Memorial or San Joaquin Community Hospital
  85. Paramedic Protocol 2015- CPR -For therapeutic hypothermia what is the inclusion criteria?
    • Age 18-75
    • There is restoration of spontaneous circulation (ROSC)
    • Comatose after ROSC: Unresponsive to verbal stimuli and no purposeful movement to pain
    • CPR initiated within 15 minutes of collapse
    • An interval not exceeding 60 minutes from collapse to ROSC
  86. Paramedic Protocol 2015- CPR PEA-Patients with PEA have poor outcomes. The most common and easily reversible causes of PEA?
    hypovolemia and hypoxia
  87. Paramedic Protocol 2015- CPR PEA What are the H’s and T’s in PEA?***
    • Hypovolemia(most common)***
    • Hypoxia
    • Hydrogen ion (acidosis)
    • Hyper/hypokalemia
    • Hypoglycemia
    • Hypothermia
    • Toxins
    • Tamponade (cardiac)
    • Tension Pneumothorax
    • Thrombosis (coronary and pulmonary)
    • Trauma
  88. Paramedic Protocol 2015- TACHYCARDIA WITH A PULSE - What is the treatment sequence for a stable patient with a wide QRS and a regular rate?***
    GIVE AMIODARONE 150 MG IN 100 ML OF NS IV/IO OVER 10 MIN, MAX DOSE 450MG***
  89. Paramedic Protocol 2015- TACHYCARDIA WITH A PULSE - What is the treatment sequence for a stable patient with a narrow QRS ***
    Adenosine 6mg, 12mg,12mg
  90. Paramedic Protocol 2015- TACHYCARDIA WITH A PULSE - What should you do if the patient is unstable and conscious and you need to cardiovert?***
    Provide sedation to a conscious patient if possible, but do not delay cardioversion if the patient is unstable.***
  91. Paramedic Protocol 2015- BRADYCARDIA - What dose of Atropine should you give?***
    0.5MG IV. MAY REPEAT TO A TOTAL DOSE OF 3 MG
  92. Paramedic Protocol 2015- BRADYCARDIA - When should you start TCP immediately?***
    • No response to atropine***
    • Atropine unlikely to be effective (second degree block-type II or third degree block)
    • IV access cannot be quickly established
    • Patient is severely symptomatic
  93. Paramedic Protocol 2015- BRADYCARDIA -What should the starting pace rate be?***
    80***
  94. Paramedic Protocol 2015- CHEST PAIN/ACUTE CORONARY SYNDROME - What is the maximum time to obtain a 12-lead ECG?***
    Do not delay treatment or transport beyond 2-3 minutes to obtain 12-lead ECG***
  95. Paramedic Protocol 2015- CHEST PAIN/ACUTE CORONARY SYNDROME - If the patient has not taken aspirin?
    If the patient has not taken aspirin and has no history of aspirin allergy or evidence of recent GI bleeding, administer ASPIRIN (325mg) to chew.
  96. Paramedic Protocol 2015- CHEST PAIN/ACUTE CORONARY SYNDROME - If the patient has taken there own aspirin and still are having Chest Pain, can you give them aspirin?**
    Yes (325mg) to chew.
  97. Paramedic Protocol 2015- CHEST PAIN/ACUTE CORONARY SYNDROME - Sublingual nitroglycerin contraindications?
    • Suspected or known that the patient has taken sildenafil (Viagra) or vardenafil (Levitra) within the previous 24 hours or tadalafil (Cialis) within the previous 48 hours.
    • Systolic blood pressure less than 90 mm Hg or heart rate less than 50 beats per minute.
  98. Paramedic Protocol 2015- CHEST PAIN/ACUTE CORONARY SYNDROME - What do you administer if unresponsive to nitroglycerin?
    • Fentanyl 50mcg slow IV/IM/IO/atomized, repeat 50mcg increments to max dose of 200mcg unless contraindicated by B/P or HR
    • 5 mg of morphine, slow IV push, to relieve persistent chest pain/discomfort.
    • Repeat in 2-3 minutes until pain relieved or to a total of 20 mg
  99. Paramedic Protocol 2015- PREMATURE VENTRICULAR CONTRACTIONS - PVC’s in bradycardia or heart blocks?***
    PVC’s should not be suppressed in bradycardic rhythms***
  100. Paramedic Protocol 2015- (CVA) AND ACUTE STROKE- What type of flow oxygen unless hypoxia is present?***
    Use low flow***
  101. Paramedic Protocol 2015- (CVA) AND ACUTE STROKE- What position should you transport a stroke patient?***
    Semi-Fowler’s position with no more than 30 degrees head elevation***
  102. Paramedic Protocol 2015- PEDIATRIC PULSELESS ARREST/ENTRY ALGORHITHM - Should you allow the family to remain present during resuscitation?***
    Consider allowing the family to remain present during resuscitation. Studies show that family members who were present believe their presence was beneficial to the patient. Studies also suggest that family members present during resuscitations have less anxiety and depression and more constructive grieving behavior.***
  103. Paramedic Protocol 2015-Comments Synchronized Cardioversion***
    50-100 J, 200 J, 300 J, 360 J or equivalent bi-phasic delivered (Do Not Use Quick-Look Paddles).***
  104. Paramedic Protocol 2015-Comments Defibrillation***
    Adult: 360 J or equivalent bi-phasic delivered***Pediatric: 2 J/kg or equivalent bi-phasic delivered, repeat at 4 J/kg or equivalent bi-phasic
  105. Paramedic Protocol 2015- PEDIATRIC VF/PULSELESS VT-The pause in chest compressions to check the rhythm and pulse should not exceed how many seconds?***
    10 seconds***
  106. Paramedic Protocol 2015- PEDIATRIC VF/PULSELESS VT- What should you do for a cardiac arrest patient in VF/VT who has a body temperature of <30oC (<86oF)?***
    A single defibrillation attempt is appropriate. If the patient fails to respond to the initial defibrillation attempt, defer subsequent attempts and drug therapy until the core temperature rises above 30oC (86oF).***
  107. Paramedic Protocol 2015- NEONATAL RESUSCITATION - What is the most common cause of bradycardia and cardiac arrest in neonates?
    Hypoxia
  108. Paramedic Protocol 2015- NEONATAL RESUSCITATION - What is the recommended ratio for compressions to ventilations?***
    3:1 with 90 compressions and 30 breaths to achieve 120 events per minute***
  109. Paramedic Protocol 2015- ALTERED MENTAL STATUS - When should 10% dextrose be administered?***
    When blood glucose is below 60***
  110. Paramedic Protocol 2015- ALTERED MENTAL STATUS - Can Narcan be withheld if respiratory depression is not present?
    Yes
  111. Paramedic Protocol 2015- ALTERED MENTAL STATUS - When is Hyperventilation advocated?
    • It is only indicated in the patient who is rapidly deteriorating and manifesting signs of impending herniation, such as:
    • Rapidly deteriorating mental status
    • Contralateral weakness/paralysis
    • Unilateral dilated pupil
    • Decerebrate or decorticate posturing
  112. Paramedic Protocol 2015- BURNS - How do you treat burns to large body surface areas?***
    They should be cooled initially to stop burning process and then wrapped in dry, sterile dressing to prevent hypothermia***
  113. Paramedic Protocol 2015- PATIENT RESTRAINT - How should Restraints should be secured?***
    To a non- moving part of a gurney and tied in a fashion that will allow for quick release***
  114. Paramedic Protocol 2015- POSTPARTUM HEMORRHAGE - Postpartum hemorrhage is characterized by? ***
    Acute blood loss of (Greater than) >500 mL after delivery of the newborn***
  115. Paramedic Protocol 2015- RESPIRATORY COMPROMISE-ADULT - What is indicated with minor to moderate cases of bronchospasm not responsive to albuterol?***
    Epinephrine 1:1000 0.3 MG, IM
  116. Paramedic Protocol 2015- RESPIRATORY COMPROMISE-ADULT - What can be administered to reduce myocardial workload and oxygen consumption in cases of pulmonary edema?***
    nitroglycerin 0.4 MG SL
  117. Paramedic Protocol 2015- SEIZURE ACTIVITY - What is the FIRST LINE THERAPY FOR SEIZURE in Peds ?***
    PEDS: VERSED 0.2MG/KG IM MAY REPEAT AFTER 15 MIN IV/IO/ATOMIZED TO MAX DOSE 6MG
  118. Paramedic Protocol 2015- HEAD TRAUMA - When is Hyperventilation indicated?
    patients with rapid deterioration and signs of impending herniation
  119. Paramedic Protocol 2015- HEAD TRAUMA - What are the signs of Cushing’s Triad?***
    • Decreased heart rate
    • Increased blood pressure
    • Increased respiratory rate.
  120. Paramedic Protocol 2015- HEAD TRAUMA - What is the goal for blood pressure?***
    80-90 systolic.***
  121. Paramedic Protocol 2015- 12-LEAD EKG - What should you do if the monitor indicates "ACUTE MI”***
    CONTACT A STEMI RECEIVING CENTER AND ADVISE “STEMI ALERT”***
  122. Paramedic Protocol 2015- 12-LEAD EKG - What shall be the trigger for the notification of a “STEMI Alert?
    The monitor’s interpretation, on the printed 12 Lead EKG
  123. Paramedic Protocol 2015- 12-LEAD EKG - Who receives a copy of the 12 lead EKG?
    • The hospital ED for inclusion in the patient chart
    • A copy made available to EMS upon request
    • The 12 lead EKG print-out shall be presented to hospital staff at the time the patient is delivered.
  124. Paramedic Protocol 2015-Comments Airway: CPAP***
    CPAP is approved for use on adults and children eight (8) and older. CPAP is indicated for patients who are alert, oriented, and able to follow commands. Patient must have the ability to maintain an open airway (GCS>10). BP must be above 90 systolic. Additionally two (2) of the following must exist: Respirations above 25/min; retractions or accessory muscle use; pulse ox <94%; abnormal or diminished lung sounds.
  125. Paramedic Protocol 2015- CONTINUOUS POSITIVE AIRWAY PRESSURE - What criteria must be met?***
    • AGE >8 YEARS OLD
    • PATIENT ALERT, ORIENTED, AND ABLE TO FOLLOW COMMANDS
    • PATIENT HAS THE ABILITY TO MAINTAIN AN OPEN AIRWAY (GCS>10)
    • SYSTOLIC BP > 90MMHG
  126. Paramedic Protocol 2015- CONTINUOUS POSITIVE AIRWAY PRESSURE - What are the four signs and symptoms that two must be present?***
    • RESPIRATORY RATE > 25 BREATHS PER MIN
    • RETRACTIONS OR ACCESSORY MUSCLE USE
    • PULSE OXIMETRY <94%
    • ADVENITIOUS (ABNORMAL) OR DIMINISHED LUNG SOUNDS
  127. Paramedic Protocol 2015- CONTINUOUS POSITIVE AIRWAY PRESSURE - What are the five signs and symptoms that must be absent?***
    • AGONAL OR ABSENT RESPIRATIONS
    • SUSPECTED PNEUMOTHROAX OR PENETRATING CHEST TRAUMA
    • PATIENT HAS TRACHEOSTOMY
    • SYSTOLIC BP OF <90 mmhg
    • RISK FOR ASPIRATION (VOMITING, EPISTAXIS, FACIAL TRAUMA)
  128. Paramedic Protocol 2015- CONTINUOUS POSITIVE AIRWAY PRESSURE - What is a more important factor than the age in determining eligibility for CPAP?
    The size and anatomy of the patient
  129. Paramedic Protocol 2015- CONTINUOUS POSITIVE AIRWAY PRESSURE - How often must vital signs must be recorded?***
    Every 5 minutes
  130. Paramedic Protocol 2015- CONTINUOUS POSITIVE AIRWAY PRESSURE - What vital signs must be recorded?
    • Respiratory rate
    • Heart rate
    • Blood pressure
    • Sp02
  131. Paramedic Protocol 2015- CONTINUOUS POSITIVE AIRWAY PRESSURE - Can a CPAP patient be transferred to a Paramedic that has not been trained on the use of CPAP?
    NO
  132. Paramedic Protocol 2015- SPINAL IMMOBILIZATION - Who recieves spinal immobilzation?***
    • SECTION 1
    • Posterior midline spinal pain or tenderness with a history of or suspicion of trauma.
    • Numbness or weakness in any extremity after trauma.
    • Injuries distracting patient from distinguishing spinal pain (e.g., pelvic fracture, multi-system trauma, crush injury to hands or feet, long bone fracture proximal to the knee/elbow, or to the humerus/femur.)
    • Altered Mental Status GCS <15.
    • Intoxication.
    • Language Barrier, unless reliable translation is available.
    • Age less than 3 or greater than 65.
  133. Paramedic Protocol 2015- SPINAL IMMOBILIZATION - Does mechanism of injury alone determine spinal immobilization?***
    No***
  134. Paramedic Protocol 2015- SPINAL IMMOBILIZATION - May a paramedic remove spinal immobilization precautions previously placed on patients?***
    Yes, after a patient assessment using the standards stated in Section 1 of the Spinal Immobilization protocol
  135. Paramedic Protocol 2015- BLOOD PRODUCT TRANSFER - May paramedics transfer patients that are recieving blood products?***
    Yes
  136. Paramedic Protocol 2015- BLOOD PRODUCT TRANSFER - What are the sign and symptoms of Anaphylaxis?***
    • Coughing
    • Bronchospasm
    • Respiratory distress
    • Vascular instability
    • Nausea
    • Abdominal cramps
    • Vomiting
    • Diarrhea
    • Shock
    • Loss of consciousness.
  137. Paramedic Protocol 2015- BLOOD PRODUCT TRANSFER - What are the sign and symptoms of a Volume Overload?
    • Dyspnea
    • Headache
    • Peripheral edema
    • Coughing
    • Frothy sputum or other signs of congestive heart failure occurring during or soon after transfusion
  138. Paramedic Protocol 2015- BLOOD PRODUCT TRANSFER - How often must vital signs be documented?
    every 10 minutes
  139. Paramedic Protocol 2015- HEPARIN & NITROGLYCERIN TRANSFER - How often do you record vital signs?
    Every 5 minutes
  140. Paramedic Protocol 2015- HEPARIN & NITROGLYCERIN TRANSFER - What type of blood pressure monitor will be used?***
    A non-invasive blood pressure monitor device that will record and print out blood pressure readings every five (5) minutes
  141. Paramedic Protocol 2015- HEPARIN & NITROGLYCERIN TRANSFER - What monitors must the patients be on?***
    • Non-invasive blood pressure monitor
    • Cardiac
    • Pulse oximetry
  142. Paramedic Protocol 2015- HEPARIN & NITROGLYCERIN TRANSFER - May the Paramedic restart the nitroglycerin administration if interrupted?***
    Yes
  143. Paramedic Protocol 2015- HEPARIN & NITROGLYCERIN TRANSFER - How long do you have to communicate significant complications to the EMS agency?
    Within 48 hours
  144. Ambulance Destination Decision Policies and Procedures 2015 - Who shall be informed of destinations decisions and ambulance assignments on an MED-ALERT?***
    The incident commander (IC)
  145. The four categories of trauma activation are –
    • PAM-Co
    • 1. Physiological
    • 2. Anatomical
    • 3. Mechanism of injury
    • 4. Co-morbidity (age, preg, illness, etc.)
  146. What are examples of Level 1 –physiological
    • (Vital Signs)
    • GCS <14,
    • BP <90,
    • RR <10 or >29 ( <20 for infant less than 1 year)
  147. What are examples of Level 2 – injury site -
    • Penetrating injury to head, neck, torso, or extremity proximal to knee
    • Flail chest
    • Trauma with burns
    • 2 or more proximal long bone fractures,
    • Suspected pelvic fx
    • Open or depressed skull fx
    • Amputation proximal to wrist or ankle,
    • Time sensitive extremity injury with vascular compromise
  148. What are examples of Level 3 – Mechanism
    • Ejection, fall > 20’ adult or 2-3 x height of child
    • Death in same compartment
    • Extrication > 20 min
    • High speed MVA
    • Auto deformity > 20"”
    • Pass. Compartment intrusion > 12” near pt. or
    • 18” anywhere
    • Auto vs. ped > 20 mph
    • Pedestrian thrown or run over.
  149. What are examples of Level 4 – determining factors?
    • Age >55
    • Renal failure pt
    • EMS personnel judgment
    • OB pt. >20 weeks
    • Bleeding disorder pt.
  150. Who can deactivate the Trauma Care System?
    ALS or BLS transport personnel, trauma center physician, KCEMS Division.
  151. Who cannot deactivate the Trauma Care System?
    Fire based EMT’s and Paramedic first responders
  152. When can a paramedic clear C-Spine?
    • Technically never, but a medic can elect to not do c-spine based on criteria. C-spine immobilization is based on criteria and NOT mechanism of injury. C-spine the following in the setting of significant trauma:
    • Posterior midline spinal pain or tenderness with hx. of or suspected trauma.
    • Hx. of blunt trauma and Step 1 or 2 trauma activation.
    • Injury distracting from spinal pain (pelvic fx, multi-system trauma, crush inj. To hands or feet, long bone fx., )
    • Severe head or facial trauma
    • Numbness or weakness in any extremity after trauma
    • LOC secondary to trauma
    • If there’s ALOC and (w/ drugs, alcohol, and trauma)
    • No hx available
    • Found in setting of poss. Trauma
    • Near drowning w/ poss. Diving inj.
  153. What is a questionable mechanism of injury?
    A patient with an ALOC and in a setting of possible trauma (lying at the bottom of stairs, or in the street), a near drowning with poss. Diving injury, etc.
  154. Paramedic Protocol 2015-Comments Transcutaneous Cardiac Pacing (TCP)***
    For symptomatic bradycardia****
  155. What patients can receive transcutaneous cardiac pacing?
    Symptomatic brady-dysrhythmias
  156. What is the rate for external cardiac pacing?
    • Rate = 80
    • Ma= 50-90 adjust until capture
  157. What can’t a paramedic transport on an interfacility transfer?
    • Any med outside of our scope of practice.
    • A medic can transfer patients with blood products, potassium, NTG drips, and heparin drips.
    • Heparin = Not to exceed 100 u/ml or 1600 u/hr
    • NTG not to exceed 5 mcg/min. can make 2 rate changes enroute then base contact required
    • Potassium not more than 40 mEq
  158. What do you do if the patient has an allergic reaction to blood?
    Discontinue blood product infusion, admin fluid challenge, make base station contact.
  159. When can you discontinue CPR in a cardiac arrest pt.?
    • When information comes available that would have prevented you from starting CPR (DNR found, etc.), after 10 minutes of failure to respond to ALS procedures (ET, defib, appropriate meds), successful chest decompression of trauma pts. If indicated. In trauma pts. If transport To ED or Trauma Center is greater than 15 minutes.
    • Pt. is to be left at scene w/ ET, IV, electrodes etc. left in place.
  160. You are working up a cardiac arrest patient in the back of the ambulance at the scene and have not began transport, base physician advises to discontinue resuscitation, what do you do?
    Discontinue CPR, remain at scene with patient in your ambulance until released by law enforcement agency with investigative authority or coroner.
  161. You receive base orders to discontinue CPR while enroute to the hospital, what do you do?
    Stop CPR, continue Code 2 to the closest most appropriate receiving hospital or base hospital.
  162. You’re in the East Kern and receive orders from a base hospital in the Bakersfield area to discontinue CPR, what do you do?
    Discontinue CPR, proceed Code 2 to the closest most appropriate receiving facility. Make contact with that facility ASAP and inform the ED of the situation. In this situation you’re going to transport to either, AVH, RCH or KVH and contact them with the situation.
  163. Where do you transport a pediatric extremis patient?
    The closest hospital ED not on closure status.
  164. What is an Extremis ALS?
    • unmanageable airway or resp. arrest
    • Uncontrolled hemorrhage with signs of hypovolemic shock
    • Cardiopulmonary arrest
  165. What must the paramedic do before leaving the hospital after delivering a patient to the ED?
    The paramedic must leave a completed patient care report with the facility before leaving, either hand written on the county form or printed from their digital PCR device
  166. How long do you have to complete a (digital) PCR?
    A medic has 15 hours from call time to complete digital PCR’s
  167. When can a patient be transported to a closed hospital ED?
    When the patient is in extremis status and the ED is not on internal disaster closure.
  168. What is the purpose on an MCI activation?
    Proper management of incidents involving more than 5 patients, an incident involving a hazardous materials exposure regardless of the number of patients, and a serious or unusual overload of the EMS system as determined by the EMS Division.
  169. Who can activate the trauma system?
    Fire based EMT and paramedic first responders can activate step 1 and 2 trauma activations. BLS transport EMTs can activate step 1 and 2 trauma activations. ALS and BLS transport personnel can activate step 1,2,3,4 activation but should consider consult with the trauma center before activating step 3 and 4 activations.
  170. Where do you decompress the chest for patients with a tension pneumothorax?
    Mid-clavicular between the 2-3rd rib (2nd intercostal space) or Mid-axilliary between the 4-5th rib (4th intercostal space).
  171. When is it OK to use Versed for conscious intubation?
    Patients with head trauma (paramedic protocols-head trauma)
  172. Is it Ok to stay on-scene with a patient with a suspected MI to obtain a 12-lead?
    The Chest Pain protocol states, “do not delay treatment or transport beyond 2-3 minutes to obtain a 12-lead ECG.
  173. When is it Ok to hyperventilate a patient with head trauma?
    • Hyperventilation IS indicated for patients with rapid deterioration and signs of impending herniation, such as-
    • Rapidly deteriorating mental status
    • Contralateral paralysis/weakness
    • Unilateral dilated pupils
    • Decerebrate or decorticate posturing
  174. What are the approved drugs for MADD
    • Narcan
    • Versed
    • Fentanyl
  175. What are the contraindications of MS?
    • Hypotension
    • Head trauma
    • Acute asthma
    • known hypersensitivity to MS
  176. What are the precautions of MS administration?
    • Elderly patients
    • Children
    • Debilitated patients
    • Have narcan readily available
  177. Where do you perform a cricothrotomy?
    The cricothyroid membrane.
  178. Where do you start an IO?
    • The tibial-tuberosity 2’’ below the medial malleolus.
    • For associated pain admin. Lidocaine prior to saline flush.
    • 40 mg for adults
    • 0.5 mg/kg peds to 40 mg max.
  179. What are KCEMS approved patient restraints?
    Commercially manufactured devices intended for patient restraint.
  180. How much time savings is required for a patient to meet air transport criteria?
    10 minutes transport time savings. (Trick question, add up flight time + onload & offload times)
  181. What is the age cutoff for pediatric patients?
    • In medical: – infant =<1, child = 1-8
    • Trauma: a pedi pt = birth to age 14
    • Adult: is 14 + 1 day –
  182. What are the contraindications of saline lock use?
    If patient has a risk for hypoperfusion, (cardiac arrest, burn patients, trauma, shock)
  183. What are the indications for saline lock?
    Pts. That require IV access but don’t require fluid administration, blood draw, med admin, etc.
  184. Can you administer Versed with CPAP?
    No, IV/IO/MAD
  185. What are the contraindications of CPAP?
    Agonal or absent breath sounds, suspected pneumothorax or penetrating chest injury, pt. w/ tracheostomy, BP <90, aspiration risk (N/V, epistaxis, facial trauma).
  186. What meds can a paramedic transport during an interfacility transfer?
    Any meds within the paramedic scope of practice, even at higher doses with a physician order. Arterial lines, pre-existing thoracostomy tubes, Potassium Chloride = to or < 40 mEq, NG tubes, whole blood or blood products, heparin and NTG drips. This question is written as a negative, watch the wording. What can’t a paramedic transport on an interfacility transfer?
  187. Where can sexual assault patients be transported in the Bakersfield area?
    Memorial ED
  188. What are the STEMI Receiving Centers in the Bakersfield area?
    Bakersfield Heart, SJH, Bakersfield Memorial
  189. What are the Stroke Centers in the Bakersfield area?
    Bakersfield Heart, SJH, Bakersfield Memorial, Mercy, Mercy SW
  190. Once you stop a NTG drip can you restart it?
    Yes you can, if drip is interrupted you can restart the line and restart the drip
  191. You have a trauma patient that’s 25-30 minutes from the trauma center via ground, the air ambulance is 15 minutes out. By what means do you transport them?
    By ground, there’s no 10 min time savings
  192. What is the Bradycardic treatment protocol sequence?
    • Atropine
    • TCP
    • Epinephrine Drip
    • Dopamine Drip
  193. For a level 3 activation what should the medic not do?
    Utilize helicopter to transport to highest trauma facility
  194. If a doctor on scene, become primary pt care authority do they need to accopmany the patient to the hospital?
    Yes
  195. What classes are required by KCEMS?
    • ACLS
    • PHTLS
    • PALS
    • CPR
    • Skills Verification
  196. Who is the KCEMS medical director?
    Kristopher Lyons
  197. Ped volume resuscitation protocol for NS?
    • Fluid resuscitation for hypovolemic shock begins with a rapid infusion of 20 ml/kg of NS
    • Fluid boluses may be repeated in 20 mL/kg increments up to 60 mL/kg.
    • Make base station contact for further direction if child remains hypotensive after 60 mL/kg fluid challenge without response.
  198. What is the Lasix dosage in KC?
    Not used any longer (trick question)
  199. Ped/Infant cardiac asystole treatment sequence?
    • CPR IMMEDIATELY FOR 5 CYCLES
    • EPINEPHRINE 0.01 MG/KG IV/IO REPEAT EVERY 3-5 MINUTES
    • Look for reversible causes
  200. Intubation covered under what level of protocol?
    Level I

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