Paramedic Study Guide 2017 Part 1

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  1. Paramedic Protocol 2017- What is the definition of Level I Treatments?pg 1***
    NO BASE CONTACT NEEDED
  2. Paramedic Protocol 2017- What are the requirements for Level II treatments? Pg.1***
    Make base contact. Continue if radio failure.
  3. Paramedic Protocol 2017- 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 2017- 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 2017- 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 2017- What are the Level II protocols? Pg.4***
    • Cricothyrotomy  
    • Thoracic decompression
    • Administer 9 additional drugs
  7. Paramedic Protocol 2017-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 2017- 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 2017- LEVEL II PARAMEDIC PROCEDURES - Cricothyrotomy Comments*** pg 4
    May only be utilized if ventilation attempts by all other means are unsuccessful. Division approved device is a 10g IV catheter.
  10. Paramedic Protocol 2017- DESTINATION DECISION - What is the hospital destination decision shall be based on? pg 6
    • Patient choice
    • Closest, most appropriate hospital criteria.
  11. Paramedic Protocol 2017- DESTINATION DECISION - What is considered a significant ED OVERLOAD SCORE?*** pg 6
    5 or greater
  12. Paramedic Protocol 2017- DESTINATION DECISION Trauma - Step 1 or 2* pg 7
    KMC
  13. Paramedic Protocol 2017 - DESTINATION DECISION Orthopedic pg 7
    • BMH
    • KMC
    • Mercy
    • MSW
    • SJCH
  14. Paramedic Protocol 2017- DESTINATION DECISION Cardiac pg 7
    • BMH
    • Heart
    • SJCH
  15. Paramedic Protocol 2015- DESTINATION DECISION STEMI*** pg 7
    • BMH
    • Heart
    • SJCH
  16. Paramedic Protocol 2017- 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.
  17. Paramedic Protocol 2017- DESTINATION DECISION Pediatric Emergent Medical, more than 30 minute ground time? pg 10
    Ground transport times that are greater than thirty (30) minutes may be transported to the closest, most appropriate receiving hospital.
  18. Paramedic Protocol 2017- DESTINATION DECISION Sexual Assault***pg 7
    SJCH***
  19. Paramedic Protocol 2017- DESTINATION DECISION Psychiatric w/out other medical condition ruled out pg 7
    ALL
  20. Paramedic Protocol 2017- DESTINATION DECISION Psychiatric with other medical condition ruled out. pg 7
    KMC
  21. Paramedic Protocol 2017- DESTINATION DECISION Medical extremis pg 7
    Closest open hospital
  22. Paramedic Protocol 2017- DESTINATION DECISION Traumatic Arrest pg 7
    • KMC
    • DRMC
    • KVH
    • TH
    • RRH
  23. Paramedic Protocol 2017- DESTINATION DECISION Traumatic unmanageable airway or inability to ventilate pg 7
    Closest open hospital
  24. Paramedic Protocol 2017- DESTINATION DECISION Conscious Patients? pg 9
    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
  25. Paramedic Protocol 2017- DESTINATION DECISION Med-Alert/Multi-Casualty (MCI) Destination: Who assigns which hospital the patients go to? pg 10
    Transportation coordinator at scene.
  26. Paramedic Protocol 2017- CPR - The pause in chest compressions to check the rhythm and pulse should not exceed?*** pg 18
    10 seconds
  27. Paramedic Protocol 2017- CPR - For a cardiac arrest patient in VF/VT who has a body temperature of (<86oF), How many defibrillation(s) attempt are appropriate?*** pg 18
    One***
  28. Paramedic Protocol 2017- CPR -What hospital(s) would you transport to for therapeutic hypothermia treatment?*** pg 18
    Bakersfield Memorial or San Joaquin Community Hospital
  29. Paramedic Protocol 2017- CPR -For therapeutic hypothermia what is the inclusion criteria? pg 18
    • 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
  30. Paramedic Protocol 2017- CPR PEA-Patients with PEA have poor outcomes. The most common and easily reversible causes of PEA? pg 18
    hypovolemia and hypoxia
  31. Paramedic Protocol 2017- CPR PEA What are the H’s and T’s in PEA?*** pg 20
    • Hypovolemia(most common)***
    • Hypoxia
    • Hydrogen ion (acidosis)
    • Hyper/hypokalemia
    • Hypoglycemia
    • Hypothermia
    • Toxins
    • Tamponade (cardiac)
    • Tension Pneumothorax
    • Thrombosis (coronary and pulmonary)
    • Trauma
  32. Paramedic Protocol 2017- TACHYCARDIA WITH A PULSE - What is the treatment sequence for a stable patient with a wide QRS and a regular rate?*** pg 21
    GIVE AMIODARONE 150 MG IN 100 ML OF NS IV/IO OVER 10 MIN, repeat to a MAX DOSE 450MG***
  33. Paramedic Protocol 2017- TACHYCARDIA WITH A PULSE - What is the treatment sequence for a stable patient with a narrow QRS *** pg 21
    Vagal maneuver then Adenosine 6mg, 12mg,12mg max of 30mg
  34. Paramedic Protocol 2017- TACHYCARDIA WITH A PULSE - What should you do if the patient is unstable and conscious and you need to cardiovert?*** pg 21
    Provide sedation to a conscious patient if possible, but do not delay cardioversion if the patient is unstable.***
  35. Paramedic Protocol 2017- BRADYCARDIA - What dose of Atropine should you give?*** pg 23
    0.5MG IV. MAY REPEAT TO A TOTAL DOSE OF 3 MG
  36. Paramedic Protocol 2017- BRADYCARDIA - What medications should you consider if you are going to pace a patient? pg 24
    • Versed 1mg slow IV push and
    • Fentanyl 50 mcg IV or Morphine 5 mg IV, titrated to patient comfort.
    • Contact base hospital for further orders if additional sedation/pain relief is required.
  37. Paramedic Protocol 2017- BRADYCARDIA - What should you do after TCP? pg 24
    • Assess electrical and mechanical capture
    • Reassess patient perfusion
    • Give analgesics and sedatives for pain control if not done before TCP
  38. Paramedic Protocol 2017- BRADYCARDIA - What should you do if the patient fails to respond to TCP or Atropine? pg 24
    • EPINEPHRINE infusion 2-8 mcg/ min, titrated to patient response, or
    • DOPAMINE infusion 2-10 mcg/kg/min, titrated to patient response
  39. Paramedic Protocol 2017- BRADYCARDIA - When should you start TCP immediately?*** pg 24
    • 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
  40. Paramedic Protocol 2017- BRADYCARDIA -What should the starting pace rate be?*** pg 24
    80***
  41. Paramedic Protocol 2017- CHEST PAIN/ACUTE CORONARY SYNDROME - What is the maximum time to obtain a 12-lead ECG?*** pg 26
    Do not delay treatment or transport beyond 2-3 minutes to obtain 12-lead ECG***
  42. Paramedic Protocol 2017- CHEST PAIN/ACUTE CORONARY SYNDROME - If the patient has not taken aspirin? pg 26
    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.
  43. Paramedic Protocol 2017- CHEST PAIN/ACUTE CORONARY SYNDROME (could no longer find in protocol) - If the patient has taken there own aspirin and still are having Chest Pain, can you give them aspirin?**
    Yes (325mg) to chew.
  44. Paramedic Protocol 2017 - CHEST PAIN/ACUTE CORONARY SYNDROME - Sublingual nitroglycerin contraindications? pg 26
    • 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.
    • ST Elevations in lead II, III, or AVF
  45. Paramedic Protocol 2017- CHEST PAIN/ACUTE CORONARY SYNDROME - What do you administer if unresponsive to nitroglycerin? pg 26
    • 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
    • (Max doses no longer stated in the part of protocols)

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Author:
sdrake99
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330757
Filename:
Paramedic Study Guide 2017 Part 1
Updated:
2017-04-25 21:12:22
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KCEMS Protocols
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