Emergency Medical Procedures, Exams of Advanced Education

Download Emergency Medical Procedures and more Exams Advanced Education in PDF only on Docsity! PBCFR PDC Study Guide Questions and Answers with Complete Solution 2024 6 rights of drug administration - Correct Answer-Right drug Right patient Right dose Right route Right time Right documentation True Allergy Findings - Correct Answer-rash, SOB, swellin of the toungue, face and/or throat IO Sites for Adults: - Correct Answer-1. Proximal Humerous 2. Proximal Tibia 3. Distal Tibia IO sites for Pediatrics - Correct Answer-1. Distal Femur 2. Promixal tibia 3. Distal Tibia 4. Proximal Humerous IM injection site - Correct Answer-Lateral Thigh IM injection size and volume for Adults - Correct Answer-21- 23g 1.5 in needle 4ml max per site IM injection size and volume for pediatrics - Correct Answer- 23 gauge 1 in needle Medications given in MAD device - Correct Answer-Versed Fentanyl Narcan Ketamine Dose for MAD device - Correct Answer-0.3 - 0.5ml per nostril Max 1ml AEIOU - TIPS - Correct Answer-Alcohol Epilepsy Insulin Transport Respiratory Arrest goes to where - Correct Answer- Closest ED Facility Trauma Alerts go by air if transport time is greater than - Correct Answer->25min Pregnant Trauma Alerts go to - Correct Answer-St. Marys Trauma Center If Trauma Hawk is not available during a Trauma Arrest and transport time is greater than.... where do we go - Correct Answer-40 minutes OB patients are defined as gestation - Correct Answer->20 weeks St. Marys Hyperbaric Chamber Transport Reasons - Correct Answer-Decompression Sickness (>40 transport time go by Air) Carbon Monoxide Exposure Hydrogen Sulfide Cyanide Exposure Trauma Hawk Should Not be Used If - Correct Answer- Bariatric of 500lb or Greater Patient unable to lay supine Patient is combative and cannot be restrained Hazmat Contaminated Patient Florida Poison Control Number - Correct Answer-1-800-222- 1222 What is the exception when splinting a fracture and how many attempts can be made to correct the fracture - Correct Answer-No Pulse present or patient cannot be transported due to extremities unsual position 2 attempts (Discontinue if severe pain or resistance is felt) Contraindications to Sager Splint - Correct Answer-Suspected Pelvic Fracture Open Femur Fracture Suspected Hip Fracture Avulsion/Amputation of ankle or foot Fracture distal to mid shaft femur Posterior Hip Dislocation Finding - Correct Answer-Leg flexed and internally rotated Anterior Hip Dislocation Finding - Correct Answer-External rotation and shortening What is a junctional Hemorrage - Correct Answer-Neck, Axillary, Pelvis, Groin Maintain pressure for atleast 1 minute How to Bag an Amputated Extremity - Correct Answer-Place into sealed bag with a second sealed bag with ice. Label with: Name Date Time of Amputation Which medications get diluted - Correct Answer-Benadryl Push Dose Pressure Epi Magnesium Sulfade Ketamine Rocephin Cyanokit What are the special considerations for Ketamine for excited deliriumWhat is the - Correct Answer-<50 kil Head Trauma Over 65 yo Taken another benzo / Alcohol What pain medication helps with BP - Correct Answer- Ketamine What number on the pain scale is used to use ketamine - Correct Answer-7 What paralytic do we use and what is the dose - Correct Answer-Rocuronium 100mg may repeat x1 What is indicated for Rocuronium Bromide - Correct Answer- Apneic Status Epilepticus Trismus EMS Capt or Trauma Hawk Discretion What are the contraindications for Rocuronium - Correct Answer-Allergy to medication Pre indicated difficult intubation Pt who cannot be assisted with a BVM What is an allergic reaction characterized by - Correct Answer- Generalized uticaria airway swelling, respiratory distress, bronchospasm, tongue and/or facial swelling, nausea, vomiting Loss of Radial Pulse <90 SBP What is considered Mild Allergic reaction and treatment - Correct Answer-Generalized Uticaria Benadryl 50mg diulted with 9ml What is considered a Moderate allergic reaction - Correct Answer-Airway Swelling/ Respiratory Distress/ Bronchospasm/ Swelling of tongue and face What is the treatment for Moderate Allergic reaction - Correct Answer-Epinephrine (1:10,000) 0.3 IM May Repeat 2x in 5min Intervals Benadryl 50mg over 2 min diluted with 9ml Albuterol 2.5mg via neb may repeat prn Solu-Medrol 125mg over 2 min What is considered a Severe Allergic Reaction - Correct Answer-Loss of a Radial Pulse or SBP <90 mm Pts with a brain injury that become hypotensive or hypoxic have a mortality rate of - Correct Answer-150% In the advanced airway algorithm for <3 yo what is the next medication after pre-oxygenation - Correct Answer-Atropine 0.02 / kg What is a contraindication of Asprin - Correct Answer-<16 yo What is the initial rate set to PACE an ADULT patient - Correct Answer-60 BPM What receptor for Histamine in the cell membrane modulates dilation of blood vessels and contraction of smooth muscles - Correct Answer-H1 Receptor What is an antiplatelet Aggregate - Correct Answer-Asprin Which medication is a non-depolarizing neuromuscular blocker or muscle relaxant used in Advanced Airway Procedures - Correct Answer-Rocuronium Bromide What is the initial joule setting of a pediatric patient in synchronised cardioversion - Correct Answer-0.5 j/kg What is the QRS width of an adult patient in SVT - Correct Answer-0.12 What type of facility should a pediatric patient with epiglottis or Croup should go to - Correct Answer-Comprehensive Facility What is the max dose of Atropine - Correct Answer-3mg What is the classificaition for Gentamicin - Correct Answer- Aminoglycoside Antibiotic Lidocaine has a duration of - Correct Answer-10-20 When treating a pt with asthma and albuterol or solu-medrol is not helping what is the dose for Magnesium Sulfate - Correct Answer-2g in a 50 bag Fentanyl is contraindicated for a preganant pt in how many weeks gestation and or what - Correct Answer-32 weeks or greater and/or active labor How many different FDA pregnancy catergories are there - Correct Answer-5 What is the half life of Cardizem (Dilatizem) - Correct Answer- 2 hours What is the max dose of Epi 1:1,000 with a moderate allergic reaction - Correct Answer-0.3mg What medication blocks serotonin receptors in the CTZ, Stomach and Small intestines - Correct Answer-Zofran What is the max dose of Etomidate when sedating a pediatric pt for Pacing - Correct Answer-6mg What is the dose for ketamine for an Adult Post Intubation - Correct Answer-200mg in a 50 Bag What are common beta blockers - Correct Answer-Atenolol Carvedilol Metropolol Propranolol What medication is given for CPR induced conciousness - Correct Answer-Ketamine What are the signs and symptoms of a calcium channel blocker - Correct Answer-Hyptotension Syncope Seizure AMS Non-Carido Pulmonary Edema Brady What is the max dose for a pedi patient with decompression sickness - Correct Answer-250ML What are the contraindications for performing a finger thoracotamy - Correct Answer-Devastating Head Trauma Unwitnessed cardiac arrest with blunt thoracic trauma Loss of Cardiac Output for greater than 10 min How many beats per minute is considered Asystole when looking at PEA - Correct Answer-20 BPM Dose for narcan IV/IO - Correct Answer-0.5mg What is a contraindication for giving Push Dose Epi 100,000 - Correct Answer-Hypotension due to Blood Loss What is the correct anatomical location when performing a Finger Thoracotamy - Correct Answer-4th/5th Intercoastal Space of the midaxillary line During a breach birth if the head does not deliver within how many minutes what do you do - Correct Answer-3 min Elevate Mothers Hips and insert gloved hand into vagina and push wall away from neonates nose and mouth What age is ketamine contraidicated - Correct Answer-<3 yo When transporting a pt with ICP from a head injury what degrees should the head be elevated - Correct Answer-30 degress What age does croup usually happen - Correct Answer-<3 yo What medication is given for a cocaine overdose and dose - Correct Answer-Versed 5mg When treating ICP from a head injury where should you keep the ETCO2 between - Correct Answer-30-35 mm When going IN what is the dose for Narcan - Correct Answer- 2mg Which drug in the myocardium increases the force of contraction and augments cardiac output - Correct Answer- Calcium Chloride Esmolol has the half life of what - Correct Answer-2-9 min What is the inital treatment for a patient with pulmonary edema secondary to a non fatal drowning that is normotensive - Correct Answer-CPAP What is the initital medication given for a tricyclic antidepressant overdose - Correct Answer-Sodium Bicarb What is the dose for Ketamine for advanced airway procedure - Correct Answer-200MG may repeat x1 When drawing up Push Dose Epi how many micro grams does it yield - Correct Answer-10 MCGs in 1 ML after Dilution What is the dose of D10 for a pediatric pt - Correct Answer- 5ML/K may repeat 1x What is considered a distonic reaction - Correct Answer- Intermittent spasmodic or involuntary contractions of the muscles in the Face Neck Trunk Pelvis Extremities Larynx What medications may be responsible for a dystonic reaction - Correct Answer-Antipsychotic (Haldol, Risperdol) Antiemetic (Campazine, Reglan, Phenergan) Antidepressant (Prozac, Paxil) What is the treatment for a dystonic reaction - Correct Answer-Benedryl 50 mg diluted What are signs and symptoms associated with Hyperkalemia with pts in renal failure/dialysis - Correct Answer-General Weakness Cardiac Arrythmias Peaked T-Waves Sine Wave Wide Complex Regular Really Wide Brady High Blocks What is the treatment for Hyperkalemia - Correct Answer- Calcium Chloride 1G over 2min Albuterol 2.5mg NEB Sodium Bicarb 100 meq over 2 How many times can you repeat a fluid challenge for a pediatric - Correct Answer-x2 appropriate for age What is the result of patients who have COPD &Asthma who have prolonged exhalation secondary to bronchospasm - Correct Answer-Hypercapnia / AUTO PEEP What SpO2 level should you keep a patient in Hypercapnia - Correct Answer-90% What happens during assisted ventilations when air goes in before the pt is allowed to fully exhale and causes expansion High Grade Fever Poor General Impression Drooling Tripod Position What should you consider for a seizure - Correct Answer- Meningitus Fever Head Trauma Hemorragic Stroke Drugs Alcohol Diabetic Poisoning What is the treatment if the patient is actively seizing - Correct Answer-Versed 5mg IV/IO/IN May Repeat 1 x What is a contraindication to Versed - Correct Answer- Hypotension If seizure does not respond to Versed what is the next line of Drug - Correct Answer-Ketamine with EMS Captain Approval 100mg in a 50 bag with a 60 drop set run wide open What is the treatment for a pediatric seizure - Correct Answer- Active Cooling by removing clothing DO NOT COVER PT WITH WET TOWEL OR SHEET DO NOT APPLY ICE OR COLD PACK TO PTS BODY Versed 0.1 IV/IO max of 5 mg Versed 0.2 IN/IM max of 5 mg What is the Sepsis Alert Criteria - Correct Answer-Adult and Not Pregnant AND Suspected or Documented Infection AND H - Hyptonsion (<100SBP) A- Altered Mental Status T - Tachypnea (>22 RR and/or ETCO2 <25) What are signs and symptoms for Sepsis - Correct Answer- Fever UTI Pneumonia (Productive cough with color sputum) Wounds or site that are red/swollen/puss Pt is on antibiotics and has ABP pain/Diarrhea Recent surgery/medical procedure (Foley, Central line) AMS or Poor oral intake in past 24-48hrs Bed Sores, Abscess, Cellulitus What is a warning when calling a sepsis alert - Correct Answer-Once sepsis is identified it is imperative that the pt is kept from becoming hypotensive as an episode of hypotension increases morbidity and mortality Does Pneumonia pts still REQUIRE fluids with rales? - Correct Answer-YES with monitoring EtCO2 and SpO2 during fluid administration What is the treatment for sepsis alert - Correct Answer- Normal Saline 1L MUST repeat 1x What should you do IMMEDIATELY when calling a Stroke Alert to the receiving hospital - Correct Answer-Stroke Alert notification with RACE PLUS score What is the max score of the RACE assessment - Correct Answer-11 What are the assessment you are looking for in RACE PLUS - Correct Answer-Facial Palsy Arm Motor Function Leg Motor Function Head and Eye Gaze Daviation Aphasia Agnosia What is Facial Palsy in the stroke exam and the score - Correct Answer-Ask the pt to show their teeth 0 - Absent 1 - Mild ( Slightly Symmetrical) 2 - moderate to severe ( completely symmetrical) What is the Arm Motor Function for the stroke exam and score - Correct Answer-Extend pts arms 90 degrees or Palms Up 45 degrees 0 - Normal (Limbs help up for >10 sec) 1 - Mild ( Limbs help up for <10 sec) 2 - Severe ( pt unable to hold up arm) What is the Leg motor function for the stroke exam and what is the score - Correct Answer-Extend the pt leg 30 degress one leg at a time 0 - Normal to mild ( limb held fro >5 sec) 1 - Moderate ( Limb held for <5 sec) 2 - Severe ( pt unable to hold up limb) What is the sign called when you add to the RACE score and what are the assessments - Correct Answer-Cortical Signs Head and Eye Gaze Deviation Aphasia Agnosia What is the assessment for Head and Eye Gaze Deviation - Correct Answer-Observe range of motion of eyes and head turning to one side 0 - Absent ( Normal Eye movement to both eyes and no head deviation) 1 - Present ( eyes and/or head deviation to 1 side) What is the assessment for aphasia - Correct Answer-Ask the pt to follow 2 verbal orders "close your eyes" and "Make a fist" 0 - Normal (performs both tasks correctly) 1 - Moderate ( performs 1 task correctly) 2 - Severe ( Fails both tasks) What is the assessment for Agnosia - Correct Answer-Ask the pt "whos arm is this" when showing the pt their weak arm or "can you move your arm?" 0 - Normal appropriate answer 1 - Moderate ( does not recognize limb OR move it) 2 - Severe (does not recognize limb AND cannot move it) Sick Sinus Syndrome Heart Block If rapid A-Fib / A-Flutter is hypotensive what is the treatment - Correct Answer-Normal Saline 1L May Repeat x1 If Remains Hypotensive after fluids give Push Dose Pressor Epinephrine may repeat 2x max 300mcg If pt becomes normotensive after fluid administration or Push Dose what do give - Correct Answer-Cardizem 10mg or if given already given 15mg If pt becomes Hypotensive after cardizem administration what is the treatment - Correct Answer-Fluid Challenge 1L Normal Saline Calcium Chloride 500mg over 2 min What is a warning when Cardioverting a pt that may cause an embolic stroke - Correct Answer-DO NOT CARDIOVERT A-FIB / A-FLUTTER What is Bradycardia defined as - Correct Answer-<50 BPM What do you do for stable Bradycardia - Correct Answer- Monitor and Transport What is considered to be unstable bradycardia and the treatment - Correct Answer-Hypotensive Atropine 0.5 IV/IO may repeat PRN in 3 INTERVALS max of 3mg What is a contraindication to Atropine - Correct Answer- Bradycardia in the presence of an MI What is the treatment if you have given 2 doses of Atropine and the pt deteriorates or hypotension persists - Correct Answer-Transcutaneous Pacing inital of 60 BPM and increase miliamps until capture (increase rate as needed to improve pt to be hemodynamically stable) What is the treatment to sedate a pt for tanscutaneous pacing and do you delay to establish IV acess - Correct Answer-NO Etomidate 6mg IV/IO may repeat 1x If the pt becomes normotensvie after pacing and no IV is established what is the treatment - Correct Answer-Versed 5mg IN/IM (Remember contraindication is HYPOTENSIVE) If the pt remains hypotensive after Atropine and Pacing what is the treatment - Correct Answer-Push Dose Pressor Epi What is the treatment for a PEDIATRIC PT in stable Bradycardia - Correct Answer-Adequate Oxygenation What is considered to be UNSTABLE BRADYCARDIA IN PEDIATRICS - Correct Answer-AMS and Age Appropriate Hypotension What is the treatment for Unstable Bradycardia in Pediatrics - Correct Answer-Oxygenation Ventilations Neonates: 1 Breath every 3 sec for 30 sec Infants/Children: 1 Breath every 3 sec for 1 min Pts in Cardiogenic shock with pulmonary edema what can you not administer to these pts - Correct Answer-Nitro Glycerine When a pt has Chest Pain what IV sites do you need to avoid - Correct Answer-Right Hand and Right Wrist What is the treatment for Chest Pain - Correct Answer-Aspirin 324mg Fentanyl 100mcg may repeat 2x in 5 min interval What are the contraindications to Aspirin - Correct Answer- <16 yo Active GI Bleed What are the Contrindications to Fentanyl - Correct Answer-<6 mo old Pregnancy Near Term 32 weeks or older and in Active Labor What are precautions when using fentanyl - Correct Answer- Drug Seekers Respiratory Depression If pt becomes drowsy Apnea Bradycardia Increased ICP Chest Wall rigidity Can you reverse Fentanyl with Narcan - Correct Answer-Yes What treatment is given if the pt has chest pain and you have given the maximum dose of Fentanyl or is a Drug Seeker - Correct Answer-Nitro 0.4 mg Sublingual may repeat 2x in 5 min What are the Contraindications to Nitro and any Nitro Drg Product - Correct Answer-SBP <90 mm Heart Rate <50 BPM or >100 BPM EDD Viagra & Levitra in 24hrs, Cialies 48hrs V4R Positive STEMI When transporting a Chest Pain pt what SHALL pts have have when transporting - Correct Answer-Multiple 12 and 15 lead ECGs What are STEMI symptoms - Correct Answer-Discomfort of chest, arm, neck, beck, shoulder or jaw Syncope General Weakness Unexplained Diaphoretic SOB Nausea/ Vomiting What is the STEMI alert Criteria - Correct Answer-ST Stegment Elevation in 2 or more Continuous Leads In the STEMI alert criteria what is a Convex - Correct Answer- Frowny Face or Straight Morphology in 2mm or greater in V2 and V3 1mm or greater in ALL leads Conv(ex) = Your ex :( Rales Pedal Edema What is the treatment for CHF - Correct Answer-12 lead & 15 lead Nitro 0.8 mg SL 2 TABLETS (May repeat with 0.4 1 Tablet) 2x every 5 min CPAP 10cm Nitro-Paste Apply 1" to anterior Upper Chest When giving Nitro Medications WITH a CPAP what should be a warning and have medications withheld from which type of PT!? - Correct Answer-Febrile pts or from a nursing home and has pneumonia What is the criteria for SVT for Adults - Correct Answer-SVT will generally have no P waves or there may be P waves just after the QRS Complex QRS <0.12 >150 BPM What is the criteria for Sinus Tachycardia - Correct Answer- History that favors Sinus Tachycardia such as Dehydration, Fever, Pain, Anxiety, Physical Activity What will affect Sinus Tachycardia but will not affect nor abruptly break SVT - Correct Answer-Vagal Manuvers What is the criteria for SVT in pediatrics - Correct Answer-QRS <0.09 SVT in Pediatrics >180 BPM SVT in Infants >220 BPM What is considered to be unstable in SVT - Correct Answer- Altered Mental Status What is the treatment for SVT - Correct Answer-Vagal Manuvers Adenosine 12 mg with a 20ml Flush Print ECG during Administration What are the contraindications for Adenosine - Correct Answer-Heart Transplant Patients taking Tegretol Pts with a history of High Blocks Sick Sinus Syndrome (J wave) without pacemaker Active Bronchospasm What classification is Adenosine - Correct Answer-Class V What pregnancy Category is Adenosine - Correct Answer-C What is the onset, peak effects and duration of Adenosine - Correct Answer-Onset 20-30 sex Peak Effects 20-30 sec Duration 30 sec Half life 10 sec What is the treatment is SVT fails to convert or Adenosine is contraindicated or pt has a history of Atrial Dysrythmias - Correct Answer-Cardizem 10mg over 2 min If no response to first dose give 15 mg over 2 min 2nd and 3rd degree Hear block Hypotension QTc >500 What class drug is Amiodarone - Correct Answer-Class III antiarrhythmic What Pregnancy Category is Amiodarone - Correct Answer- Class D What is the Onset, Peak, Duration and Half life of Amiodarone - Correct Answer-2-3 min 3-7 hours varies 40-55 days What is the treatment for Unstable Wide Complez Tachycardia or if Amiodarone is Contraindicated - Correct Answer-Etomidate 6mg may repeat 1x Synchronized Cadioversion 100j, 200j, 300j, and 360j repeat 360 until conversion (If WCT returns after Cardioversion refer back to last setting used to convert) What is the contraindication to Cardioverting WCT - Correct Answer-WCT that is irregularly Irregular What is the treatment for pts who convert after cardioversion - Correct Answer-Immediate 12 lead to rule out for Amiodarone 150 into a 50 2 or more shocks by Fire Rescue or 2 or more shocks by their own implant defibrilator What is considered Wide Complex Tachycardia in Pediatrics - Correct Answer-QRS >0.09 (2.25m boxes) What is the treatment for Pediatric Stable Wide Complex Tachycardia - Correct Answer-Amiodarone 5mg/k into a 50 bag may repeat 1x adminster over 25 min using 15 drop set, 30 gtts/min (1 gtts/ 2 sec) What is the treatment for unstable Wide Complex Tachycardia that is Unstable - Correct Answer-Etomidate 0.1 mg/k over 30 sec may repeat 1x Synchronized Cardioversion 0.5j/k if no respnse 2j/k Amiodarone after conversion 5mg/k in a 50 bag with a 15 drop set run over 25 min 30gtts (1 gtts/ 2 sec) What are the ECG features that show a diagnosis of Regular Really Wide Complex Tachycardia - Correct Answer-Adult and Pedi pts with >0.20 (5small boxes or 1 large) Rate usually >120 What is the treatment for Regular Really Wide Complex Tachycardia - Correct Answer-Calcium Chloride 1G over 2 min Sodium Bicarb 100mEq over 2 min What is considered Unstable for Regular Really Wide Tachycardia - Correct Answer-Hypotension If Polymorphic Magnesium Sulfate converts after defibrillation what medication do you give if not given already - Correct Answer-Magnesium sulfate 2g into a 50 with a 16 drop 75 drops/min (1.25 gtts) What effort should be made when regarding an LVAD - Correct Answer-To contact the pts primary caretaker What should you locate when regarding an LVAD - Correct Answer-Pts emergency bag What equipment should you take to the hospital when regarding an LVAD - Correct Answer-All Equipment associated with the LVAD What treatment can you do dealing with a pt that has an LVAD but is not dealing with the device - Correct Answer-Treat pts conditions with appropriate protocol When ausculating the pt what should you take note of and hear - Correct Answer-Type of device, alarms, pump sounds Where on the pts body should you ausculate a pt with an LVAD - Correct Answer-Chest and Upper Abdominal Quadrants for a humming sound Will a person with an LVAD have a detectable pulse and is it okay if they do not - Correct Answer-Pts may not have a detectable pulse and is normal for them What should you locate on a Pts body with an LVAD and where is it located - Correct Answer-Driveline on the abdomen If a pt with an LVAD has Hypo-Perfusion what treatment can you render - Correct Answer-Normal Saline 1L What treatment do you give with an LVAD pt Unresponsive - Correct Answer-Perform Chest Compressions when LVAD is not working Evaluate AEIOU TIPS Hs & TS BGL When giving compression to an LVAD pt what is your hand placement and contrindication - Correct Answer-Right of the sternum to avoid LVAD dislodgement What is a contraindication to use when on an LVAD pt and you need to do CPR - Correct Answer-LUCAS Device When a pt has an LVAD but is not complaining of any LVAD chief complaints where does the pt need to go for transport - Correct Answer-Protocol according to Transport Destinations If a pt has an LVAD and is having an LVAD issue where should the pt go - Correct Answer-JFK When loading a pt with an LVAD and he/she has all the wires hanging out how should you dress the stretcher - Correct Answer-Place stretcher straps under the LVAD cables to not create torque All witnessed cardiac arrest must be transported unless what exception - Correct Answer-Hospice/DNR pts What are the contraindications to the ResQpod and when should it be applied - Correct Answer-Should be used on all Pts <1 yo Trauma Arrest Pt has a Pulse Durring Passive Oxygenation For an Adult pt what the reasons that you can Terminate a Cardiac Arrest - Correct Answer-Persistent Asystole for 15 min EtCO2 of <10 mm Pt is Normothermic (Not Cold) 500ml of Saline 1 Defibrillation 360 joules All Reversible Causes have been Discussed All ALS interventions done Social Support group in place What are the Hs - Correct Answer-Hyperkalemia Hyper/Hypothermia Hypoxia Hypovolemia Hydrogen Ions Hyporglycemia What are the Ts - Correct Answer-Toxins or Tablets Tension Pneumothorax When should an intubation take place on a cardiac arrest - Correct Answer-If you are unable to successfully manage the pts airway with an IGel When working a cardiac arrest there should be no more PULSE checks until when - Correct Answer-A spike in EtCO2 or signs of life When the compressor announces 200 what should be done or every 2 min - Correct Answer-Monitor Should be charged With a FBAO and you cannot remove the object what should be done - Correct Answer-Cricothyrotomy After you have established a Primary Cardiac arrest what do you do after you inserted the IGel - Correct Answer-Apply EtCO2 line 8LPM for 6 min DO NOT USE RESQPOD What do you do after 6 min are done after passive oxygenation on a Primary Cardiac Arrest - Correct Answer- Apply RESQPOD Ventilate 1 breath every 10 sec What are the drugs of choice for Asystole/PEA - Correct Answer-EPI (1:10,000) 1mg every 5 min max of 4mg Saline max of 2 What are the drugs of choice for V-Fib/V-Tach - Correct Answer-Defibrillate every 2 min 360j Amiodarone 1st dose 300mg 2nd dose 150mg If it is torsades 2g in a 15 drop set What is the treatment for excited delirium - Correct Answer- Sodium Bicarb 100mEq Cold Saline 1L may repeat 1x What is the treatment of a pregnant pt in her third trimester pregnancy and in Cardiac Arrest - Correct Answer-Manually displace uterus to the left All these Arrest are to be Secondary Arrest Transport to Closest OB Hospital exception is a Trauma Alert What typr of Arrest of all Drug Overdoses - Correct Answer- Secondary except a cocaine overdose What is CPR induced Conciousness - Correct Answer-Pts who gain a spontaneous heart while recieving CPR What is the treatment for a pt with CPR induced conciousness - Correct Answer-Ketamine 200mg may repeat 1x What is refractory V-Fib defined as - Correct Answer-Persient V-Fib/V-Tach after 3 defibrillations When should Double Sequential Defibrillation be considered - Correct Answer-5 or more shocks have been administered Correctable causes have been addressed 450 of Amio is on Board After double sequential defibrillation has been administered what drug follows the treatment - Correct Answer-Esmolol 40mg over 1 min After an Esmolol infusion has been administered for refractory V-Fib/V-Tach what is the treatment - Correct Answer-Esmolol 60mg in a 50 bag using a 15 drop set over 10 min 75 drops (1.25 gtts) What is the classification of Esmolol - Correct Answer-Class II Beta Blocker Antiarrythmic What pregnancy category is Esmolol - Correct Answer- Category C What is the contraindication to esmolol - Correct Answer- none What is the onet, peak, duration and half life of esmolol - Correct Answer-<5min 10-20 min 10-30min 2-9min If a firefighter is in cardiac arrest after a fire incident due to cyanide exposure how many hours after is it still considered - Correct Answer-6 hours and treat as Secondary Arrest What should you consider with a Electrocution and Lighting Strike arrest - Correct Answer-Trauma Alert Spinal Immobalization Immediate Defibrillation For a drowning cardiac arrest can you pronounce the pt on scene if hypothermia exsits and what should you remove - Correct Answer-No you cannot pronounce the pt dead with What are signs and symptoms of a calcium channel blocker overdose - Correct Answer-Hypotension Syncope Seizure AMS Non-Cardiogenic Pulmonary Edema Bradycardia What is the treatment for a Calcium Channel Blocker Overdose - Correct Answer-Calcium Chloride 1g over 2 min Normal Saline 1L may repeat 1x What is the classification for Calcium Chloride - Correct Answer-Calcium Supplement What is the pregnancy category for Calcium Chloride - Correct Answer-C With a calcium channel blocker overdose with hypotension and bradycardia or not responding to calcium chloride and normal saline what do you do - Correct Answer-refer to bradycardia protocol What are the signs and symptoms for a cocaine overdose - Correct Answer-Tachycardia SVT Chest Pain / STEMI HTN Seizures Excited Delirium Hyperthermia What is the treatment for a pt in a cocaine overdose presenting with SVT, WCT, Chest Pain, HTN or Seizures - Correct Answer-Versed 5mg may repeat 1x What is Narcan to be appropriately used for - Correct Answer- Improving the intrinsic airway patency, ventilation and oxygenation What is the goal of using Narcan on pts - Correct Answer-To restore spontaneous respiration not wake up the pt What are common narcotics - Correct Answer-Fentanyl Codeine Dilaudid Heroin Methadone Lorcet Vicodin Oxycontin Lortab When in an overdose what are the vital sign parameters you follow - Correct Answer-Respiration >10 mm SpO2% >92% EtCO2 <45 mm When giving Narcan IV what is the dose - Correct Answer- 0.5mg max of 8mg When giving Narcan IN what is the dose - Correct Answer-2mg max of 8mg Head Injury <50kg Already taken another sedative (Benzos, Alcohol etc) What is the treatment for sedation for pts in the Special Population - Correct Answer-Ketamine 200mg may repeat 3x in 5 min interval What is the treatment for Chemical Sedation without Special Considerations - Correct Answer-Ketamine 400mg may reapeat 1x What is the treatment for a Ketmine induced Laryngospasm - Correct Answer-High Flow O2 Assist Ventalations via BVM (Almost always resolves with high flow O2 or bried BVM ventilation) Consider Advanced Ariway What is the treatment for hypersalivation from Ketamine - Correct Answer-Atropine .5mg May repeat PRN in 3 min intervals Max 3mg After Ketamine administration if the patient begins to wake up what is the next drug of choice and procedure - Correct Answer-Versed 5mg May Repeat 1x in 5min Obtain a temp At what temperature should you begin to rapid cool a pt in excited delirium - Correct Answer->103 degrees What is the treatment when treating a pt with a temperature >103 - Correct Answer-Ice packs to groin and axillary areas Cold Saline 1L of saline May repeat 1x Sodium Bicarb 100mEq over 2 min What is the front line medication for Pain Management - Correct Answer-Fentanyl What medication for pain management is given for patient who are Hypotensive or who have opiate contraindications ( Allergy, History of Abuse) - Correct Answer-Ketamine What pain Medication may be given if the pt has severe pain that is >7 on the pain scale - Correct Answer-Ketamine What is the treatment for pain management <7 - Correct Answer-Fentanyl 100mcg May repeat x2 in 5min Contraindications: Pregnancy near term (32 weeks or greater) or active labor What are precautions when using Fentanyl - Correct Answer- History of Opiate use Monitor pt for Respiratory depression Discontinue if pt becomes drowsy Can be reversed with using Narcan What is the treatment for Pain Management >7 - Correct Answer-Ketamine 25mg in a 50 bag with a 60 drop Reassess pain scale after half the bag is administered 3. Atropine 0.02/kg 4. Etomidate 0.3mg over 30-60 sec May repeat 1x max of 30mg 5. Paralyze (ROC) 1mg/kg May repeat 1x 6. Placement of Tube 7. Post Intubation Sedation Versed 0.1mg/kg May repeat 1x max of 10mg What are the signs and symptoms of Decompression Sickness - Correct Answer-Stroke Like Symptoms Visual Disturbances AMS Paralysis or weakness Numbness / Tingling Bowel / Bladder Dysfunction What is the time period of a pt who went SCUBA diving that should be considered a decompression sickness pt - Correct Answer-48 hours What is the Hospital that the pt should be transported to when suspected Decompression sickness - Correct Answer-St. Marys Hyperbaric Chamber What does DAN stand for - Correct Answer-Diver Alert Network What is the DAN phone number - Correct Answer-919-684- 4326 When contacting the DAN what should be done for the pt - Correct Answer-Treatment recommendations should be followed Document the treatment and name of representative on the ePCR report What does DANI stand for - Correct Answer-Depth of dives Air Mixture in the Tanks Number of dives Intervals between dives When suspected Decompression Sickness and the pt is being transported to the hospital what should you bring with you - Correct Answer-All of the Dive Equipment When suspected Decompression Sickness how should you transport the pt - Correct Answer-Supine What is the treatment for suspected Decompression Sickness - Correct Answer-Oxygen 15 lpm via NRB Saline 500 ml True or False: All non Fatal Drowining pts MUST be transported to the hospital - Correct Answer-True When is CPAP indicated for a pt from a non fatal Drowning - Correct Answer-Pulmonary Edema secondary to near drowning WITHOUT Hypotension A pt from a Non Fatal Drowning that is Hypotensive WITH CLEAR LUNG SOUNDS. What is the treatment - Correct Answer-Adult: Saline 1L (May Repeat 1x) Pediatric: 20ml/kg (May repeat 2x) Colorless Odorless Tasteless Slightly less dense than air Toxic to Humans when above 35 parts per million Lower doses may be harmful due to cumulative effect How should you examine a pt that has been exposed to Carbon Monoxide - Correct Answer-Full Head to Toe exam with SPCO monitoring What shall the rescuing crew members wear if the pt is inside the hazardous enviornment - Correct Answer-SCBA When suspected Carbon Monoxide exposure what should you apply in the pt to obtain the SPCO readings and the treatment - Correct Answer-Rainbow Sensor Oxygen 15LPM via NRB What are the symptoms and the finding you may find on a Carbon Monoxide Exposure that dictates to transport the pt to the St. Marys Hyperbaric Chamber - Correct Answer-SPCO >20 Headache Nausea / Vomiting Dizziness AMS Chest Pain Dyspnea Visual Disturbances Seizures Syncope What may be normal when assessing a Carbon Monoxide Exposure - Correct Answer-Normal Pulse Oxymetry What is a strong consideration you must have for which type of patients when dealing with Carbon Moxonide Exposure - Correct Answer-Pediatric and Obsterical pts What are the signs and symptoms of Cyanide Exposure - Correct Answer-AMS Pupil Dilation General Weakness Confusion Bizarre Behavior Excessive Sleepiness Coma SOB Headache Dizziness Seizure How can you be exposed to Cyanide and which routes - Correct Answer-Inhalation Ingestion Absorption Fire or Smoke in an enclosed space When should it be a considered a Hazardous Material Incident - Correct Answer-Direct Cyanide Exposure Done in Prompt Fashion and Do Not Delay What is the Max score on the GCS scale - Correct Answer-15 For the GCS scale what does each branch stand for and each score for each branch - Correct Answer-Eyes - 4 Verbal - 5 Motion - 6 When determining Death on a pt for Trauma Arrest when should Resuscitation not be done - Correct Answer-Apneic Asystole Fixed or Dilated Pupils or Injuries incompatible with life What is considered to be PEA - Correct Answer-An organzied rhythm greater than 20 bpm and anything less should be considered to be Asystole A pt who has Penetrating Chest Trauma. What should be done for the pt and when do you determine death - Correct Answer-Bilateral Needle Decompression After Needle decompression is done and pt did not regain pulses immediately stop resuscitation efforts When doing an Ultrasound to determine death on a Trauma Pt what are you looking for and when should you continue resuscitation and when do you not continue - Correct Answer- To Confirm any observation of motion in PEA - If motion is present continue resuscitation - If no motion do not continue resuscitation When performing a Finger Thoracostomy what is the placement and indications - Correct Answer-Known or suspected injury to the chest and/or abdomen 4th / 5th intercoastal space of the midaxillary line What are the contraindications of performing a Finger Thoracostomy - Correct Answer-Devastating Head Injury Unwitnessed Cardiac Arrest after Blunt Force Trauma Loss of Cardiac Output for greater than 10min What are the Greens in START Triage - Correct Answer-Move Walking Wounded What are the Blacks in START Triage - Correct Answer-No Respirations after Head Tilt What are the REDS in Start Triage - Correct Answer- Respirations >30 Perfusion (no radial pulse / CAP >2) Control Bleeding Mental Status (unable to follow simple commands) What is the Yellow in START Triage - Correct Answer- Otherwise What is the Goal of START Triage - Correct Answer-"Greatest Good for the Greatest Number of Patients" What are the BLUES in START Triage - Correct Answer- Contaminated