Emergency Medical Procedures and Criteria, Exams of Advanced Education

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PBCFR Protocol Study Guide with

Complete Solution 2024

Who is PBCFR Chief Medical Director? - Correct Answer- Kenneth A. Scheppke, MD What are the 6 rights of drug administration? - Correct Answer-Right: Person, Drug, Dose, Time, Route & Documentation Who is given the authority to deviate from the ALS protocols as needed? - Correct Answer-EMS Captains & Trauma Hawk personnel Patient Assessment: List the base set of vital signs - Correct Answer-Pulse (rate, rhythm, quality) Respirations (rate & quality) Temperature Pulse Oximetry Blood Pressure (capillary refill) EtCO

BGL

Patient Assessment: Minimum vitals signs for priority 3 patients - Correct Answer- At least 2 sets of vitals Patient Assessment: Minimum vitals signs for priority 2 patients - Correct Answer- vitals every 5 minutes Per our protocol Hypotension for Adults is defined as? - Correct Answer-Systolic BP < 90 mmHg Pediatric Age Classification for : Neonates: Infants: Children: - Correct Answer-Neonates: Birth to 1 Month Infants: 1 Month to 1 Year Children: 1 Year to puberty

A BGL shall be documented for Patients with any of the following... - Correct Answer-* Hx of Diabetes

• AMS
• General Weakness
• Seizure
• Syncope/lightheadedness
• Dizziness
• Poisoning
• Stroke
• Cardiac Arrest Patients with Altered Mental Status consider... - Correct Answer-A.E.I.O.U/T.I.P.S
• Alcohol
• Epilepsy (Seizures)
• Insulin (Hyper/Hypo)
• Overdose/Oxygenation
• Uremia (Kidney Failure)
• Trauma
• Infection
• Psychiatric

• Stroke/Shock Per PBCFR protocol what is the proper airway positioning for a TRAUMA patient? - Correct Answer-Modified Jaw Thrust Per PBCFR protocol what is the proper airway positioning for a MEDICAL patient? - Correct Answer-External Auditory Meatus (a.k.a. "The Earhole") Note: Towel behind shoulders in line w/ears O2 Administration: What is the proper Spo2 levels for all Pt's? What are the EXCEPTIONS? - Correct Answer-Maintain 95% for all Pt's Except COPD & Asthma Pt's then 90% O2 Administration: We administer ______ LPM via NRB regardless of Spo2 levels for Pt's that..... - Correct Answer-15LPM for
• All 3rd trimester pregnancy w/trauma
• All head injury Pt's

• Decompression Sickness
• Carbon Monoxide exposure
• Cyanide exposure EtCO2 Monitoring shall be utilized for what sort of patients? - Correct Answer-* requiring ventilatory support
• in respiratory distress
• w/Altered Mental Status
• have been sedated
• received pain medication
• seizure patients Ventilatory rates for ADULT Patients; with & w/out pulse. Pt's w/ICP and/or herniation - Correct Answer-* w/pulse: 1 breath every 6 seconds
• w/out pulse: 1 breath every 10 seconds
• Pt's w/ICP & Herniation: Maintain Etco2 30-35% & SpO

90% Ventilatory rates for PED Patients; with & w/out pulse. Pt's w/ICP and/or herniation - Correct Answer-* w/pulse: 1 breath every 3 seconds

• w/out pulse: 1 breath every 6 seconds
• Pt's w/ICP & Herniation: Maintain Etco2 30-35% & SpO

90% Priority 1 Patients are: - Correct Answer-In Cardiac or Respiratory Arrest Priority 2 Patients are: - Correct Answer-Unstable w/immediate life-threatening conditions Priority 3 Patients are: - Correct Answer-Stable w/no immediate life-threatening conditions It is expected that the ________________________ will be in the patient care compartment during transport for all priority 1 and 2 patients. - Correct Answer-Lieutenant Transport criteria for Priority 1 patients: Primary/Cardiac Arrest - Correct Answer-(less) < 20 min. transport to nearest STEMI Facility (greater) > 20 min. transport to closest ED (excluding free standing ED)

Transport criteria for Priority 1 patients: Secondary/Respiratory Arrest - Correct Answer-Transport to closest ED (excluding free standing ED) Transport criteria for Priority 2 patients: - Correct Answer- Shall be transported to the closest appropriate ED Transport criteria for Trauma Alert (Priority 2) - Correct Answer-Shall be transported to the closest Trauma center. On-scene time for Trauma Alert Patients should be... - Correct Answer-(less) < 10 min. on scene. What must you do if your on-scene time for a trauma alert is (greater) > 10 min... - Correct Answer-Document the delay in your ePCR report Trauma Alert (Priority 2): If ground transport is >______ min you must transport by _______. - Correct Answer-(greater) >25 min transport by AIR

Pregnant Trauma Alert (Priority 2): Pregnant Pt's meeting trauma alert criteria should be transported to _____________________ by __________________. - Correct Answer-St. Marys Trauma Center by Air whenever possible Trauma Arrest : If Trauma Hawk is unavailable & ground transport exceeds ____________ min. it is acceptable to transport to the _________________________. - Correct Answer-(greater) > min / nearest ED STEMI Alert (Priority 2): Transport to... - Correct Answer-Closest STEMI facility Allergic Reaction are characterized by any of the following: - Correct Answer-* Generalized Urticaria (hives)

• Airway, tongue, or facial swelling, respiratory distress, bronchospasm, nausea, vomiting or diarrhea
• Loss of radial pulse or SBP < 90 mmHg Altered Mental Status:

If BGL is ____________ and Pt is able to protect airway/swallow you can administer ___________________ - Correct Answer-(less) < 60 & 15g Oral Glucose Contraindications for Oral Glucose - Correct Answer-* Pt's who are no conscious enough to swallow

• Pt's (less) < 2 years old Allergic Reaction: Assist Pt w/prescribed Epi-Pen when... - Correct Answer-Pt. presents with Airway, tongue, or facial swelling, respiratory distress, bronchospasm or loss of radial pulse or SBP < 90 mmHg Helmets should be... - Correct Answer-Removed from all Patients

Helmet Removal: Spinal motion restriction should be _________________ performed during the removal process - Correct Answer- Manually Closed Fractures: Fractures should be... - Correct Answer-Splinted in the position found EXCEPTION: No pulse present or Pt cannot be transported due to extremities positioning Closed Fractures: _______________ attempts can be made to place the injured extremity in a normal anatomical position - Correct Answer- Closed Fractures: What must you do before/after repositioning a Pt's extremity

• Correct Answer-Assess/Reassess their neurovascular status Hip Dislocations:

What are the differences between a POSTERIOR (back) and ANTERIOR (front) hip dislocations? - Correct Answer- Posterior-Leg flexed and internally rotated Anterior-external rotation & shortening of leg Bleeding Control: When would you use Celox Rapid? - Correct Answer-Extremity injury after 2nd Combat Application Tourniquet (C.A.T.) failed to control bleeding & Junctional Hemorrhage (e.g. Neck, Axillary, Pelvis & Groin) What is the procedure for using Celox Rapid on an extremity injury or junctional hemorrhage? - Correct Answer-1. Pack wound w/Celox Rapid

2. Maintain pressure for minimum of 1 minute
3. Apply a pressure dressing Snake bites: DO NOT...... - Correct Answer-Apply ice packs, tourniquets or constrictive bands

Snake Bites: You must.. - Correct Answer-1. Mark area of edema w/pen

2. Remove constrictive jewelry & clothing
3. Splint extremity. Ensure remains below heart
4. Take picture of DEAD "snake head & eyes" if possible w/ePCR device How do we clean All Bites & Stings? Whats the Exception? - Correct Answer-Clean the wound w/soap and water or sterile water. **Exception: Marine Animal Stings Insect Stings: What is the procedure for Stinger Removal? - Correct Answer- Remove stinger by scraping Pt's skin w/edge of flat surface. DO NOT attempt to pull stinger out as this may release more venom. Marine Animal Stings: How are large tentacle fragments removed with Marine Animal Stings? - Correct Answer-Use forceps with proper PPE & stay upwind

Marine Animal Stings: How are Marine Animal Stings cleaned? - Correct Answer-* Rinse skin w/sea water (if available)

• Apply white vinegar (if available) Respiratory Distress: COPD & Asthma Pt's (Adults & PED's) who develop poor bag compliance or Hypotension should have positive pressure ventilation discontinued, to allow full exhaltion for how long?

• Correct Answer-Adult: 20-40 seconds PED's: 10-20 seconds Moderate or Severe Respiratory Distress: CPAP Contraindictations: - Correct Answer-* SBP (less) < 90 mmHg

• Spontaneous respirations
• Decreased LOC (lethargic)
• Pt's (less) < 30Kg Respiratory Distress:

(Adult) What is administered to severe Asthma Pt not responding to Albuterol & Solu-Medrol treatment? - Correct Answer-Epinephrine (1:1,000, 1mg/ml) Seizure (Pediatric): Febrile Seizure treatment for Pediatric? And DONT's? - Correct Answer-1. Active Cooling: Remove clothing DO NOT: cover patient w/wet towel or sheet or apply ice/cold packs to the patients body Sepsis: What is the SEPSIS Alert Criteria? - Correct Answer-1. Adult & NOT pregnant

2. Suspected or Documented Infection
3. At Least TWO (2) points of the H.A.T Criteria: H-Hypotension (SBP <100 mmHg) = 1 point A-Altered Mental Status or GCS < 14 = 1 point T-Tachypnea (respiratory rate < 22) and/or EtCO2 <25 = 1 point Sepsis:

What is the H.A.T acronym & criteria? - Correct Answer-H.A.T (Hypotension, AMS, Tachypnea) Criteria: H-Hypotension (SBP <100 mmHg) = 1 point *Not to be confused w/NORMAl Hypotension (<90) A-Altered Mental Status or GCS < 14 = 1 point T-Tachypnea (respiratory rate > 22) and/or EtCO2 <25 = 1 point Stroke: What initial stroke assessment is used? If stroke is suspected what assessment shall Patient receive? - Correct Answer-1. Cincinnati Stroke Scale

2. (if suspected) R.A.C.E -Rapid Arterial oCclusion Evaluation assessment (max score 11) At what age can a Patient determine whether they want to be transported without parent/guardian permission? - Correct Answer- Puberty in Females is determined by.. - Correct Answer-Breast Development

Puberty in Males is determined by... - Correct Answer-Body Hair True or False: A 15 lead is required anytime you do a 12 lead - Correct Answer-True What "position" and "why" are Patients positioned for strokes? - Correct Answer-Supine because it allows for easier blood flow to the brain Lightening strikes for Adults are always considered what type of arrest? - Correct Answer-Secondary What does the acronym PEEP stand for? - Correct Answer- Positive end-expiratory Pressure What is the CPAT setting no matter the indication? - Correct Answer-10 PEEP

All witnessed cardiac arrest patients must be transported. Exceptions are... - Correct Answer-Hospice/DNR Patients In what cases should you NOT consider starting resuscitation efforts? - Correct Answer-Unwitnessed, Asystolic patients who have succumbed to the dying process by terminal illness The Paramedic may determine that the patient is dead/non- salvageable and decide not to resuscitate if At LEAST ONE (1) of the following conditions is present: - Correct Answer-R.A.T.L

• Rigor Mortis
• A valid DNRO is presented or discovered
• Tissue Decomposition
• Lividity The Paramedic may determine that the patient is dead/non- salvageable and decide not to resuscitate if ALL of the following are present: - Correct Answer-K.A.P.A.W *Known down time of > 30 minutes
• Asystole
• Pupils fixed and Dilated

• Apneic
• Without hypothermic mechanism for arrest Name the PRIMARY Cardiac Arrest criteria: - Correct Answer- A.C.E.O.U.
• AMI
• Cardiac Arrhythmias
• Electrocution (Alternating Current)
• Overdose (By Cocaine)
• Unknown Origin Name the SECONDARY Cardiac Arrest criteria: - Correct Answer-C.C.A.T.D.L.
• CHF
• Cyanide Exposure
• Asystole
• Trauma
• Drowning
• Lightning (Direct)
• 3rd Trimester Pregnancy

What does MICCR stand for? - Correct Answer-Minimally Interrupted Cardio-Cerebral Resuscitation During Minimally Interrupted Cardio-Cerebral Resuscitation (MICCR) emphasis is placed on minimizing interruptions on compressions for no more than... - Correct Answer-5-seconds During Minimally Interrupted Cardio-Cerebral Resuscitation (MICCR) you must make all efforts to obtain ________________ prior to leaving scene? - Correct Answer- ROSC-Return of Spontaneous Circulation When possible during Minimally Interrupted Cardio-Cerebral Resuscitation (MICCR) the patients head should be... - Correct Answer-Elevated by 15 degrees or utilize Head-Up CPR Device TRUE/FALSE: You must turn off the LUCAS compression device during MICCR for defibrillations or advanced airway procedures? - Correct Answer-FALSE-You DO NOT turn off the LUCAS compression device Follow all IVP medication administration with... - Correct Answer-Normal Saline 10ml flush

TRUE/FALSE: ResQPOD should be used for all cardiac arrest patients? - Correct Answer-TRUE What are the ResQPOD Contraindications? - Correct Answer-* Patient is <1 years old

• Traumatic Arrest
• Patient has a pulse
• During passive oxygenation List the "H's" and their remedies: - Correct Answer-* Hydrogen Ion (Acidosis) --> Ventilation
• Hyperkalemia (Renal Failure) --> Calcium Chloride, Sodium Bicarb, Albuterol
• Hypoglycemia --> Glucose
• Hypovolemia --> Fluid Bolus
• Hypothermia --> Warming List the "T's" and their remedies: - Correct Answer-* Toxins or Tablets (OD)
• Tension Pneumothorax

(Adults) Consider termination of efforts when an EMS Captain is on scene and... - Correct Answer-* Persistent Asystole for 15 minutes

• EtCo2 of <10 mmHg
• Patient is normothermic
• Normal Saline/500 ml has been administered
• 1-Defibrillation (360 joules)
• All reversible causes have been addressed
• All ALS interventions have been completed
• Social support group is in place for the family if needed Medications should be delivered ASAP after the ___________________ and circulated for _________________? - Correct Answer-Rhythm Check & 2 minutes When do you remove ResQPOD from ETT or I-gel? - Correct Answer-Upon ROSC

During post arrest what 2 things are immediately done upon ROSC? - Correct Answer-1. ResQPOD is removed from ETT or i- gel

2. 12 & 15 Lead is obtained (leave cables connected) During post arrest what intervention is used for "UNSTABLE BRADYCARDIA (Hypotensive)"? - Correct Answer- Transcutaneous Pacing Rate for Transcutaneous Pacing? - Correct Answer-* Initial rate of 60 beats per min. Increase milliamps until capture is gained

• Increase rate as needed until the PT is Hemodynamically stable Post arrest Blood Pressure goal? - Correct Answer-Maintain a SBP of 100 mm Hg Post Arrest Hypotensive Interventions? - Correct Answer-* Normal Saline: 1-Liter IV/IO titrate to desired effect (Assess Lung Sounds & BP frequently. May repeat 1x prn) If Patient remains Hypotensive:
• Push-Dose Pressor EPI (1:100,000):

Discard 9ml, Draw up 9ml Saline to create 1:100,000 (yields 10mcg/ml. May repeat 2 x prn) List the Medication Dilution Instructions for:

1. Push-Dose Pressor Epinephrine (1:100,000)
2. Benadryl
3. Ketamine - Correct Answer-1. Discard 9ml of EPI 1:10,000 & draw up 9ml saline to create --> Push Dose EPI of 1:100,000 (10mcg/ml yield)
4. Dilute w/9ml saline for IV/IO administration
5. Ensure Ketamine is diluted per specific protocol Female puberty is defined as... - Correct Answer-Breast Development Male puberty is defined as... - Correct Answer-underarm, chest or facial hair Acronym used for determining mental status - Correct Answer-A.V.P.U. Alert: to person, place, time, event Verbal: responds only to verbal stimuli

Pain: responds only to painful stimuli Unresponsive List our base set of vital signs - Correct Answer-Pulse (rate, rhythm & quality) Respirations (Rate & Quality) Temperature Pulse Oximetry Blood Pressure EtCo2 BGL Vitals signs for priority 2 & 3 patients - Correct Answer-Priority 2 receive vitals every 5 minutes Priority 3 receive at least 2 sets of vitals Hypotension for Adults is defined as... - Correct Answer- Systolic BP of < 90 mmHg EtCo2 Monitoring shall be used for the following patients... - Correct Answer-Patients..

Requiring Ventilatory Support In Respiratory Distress Altered Mental Status (AMS) Who have been sedated Received pain medication Seizure Patients A BGL shall be documented for patients with any of the following... - Correct Answer-Hx of Diabetes Altered Mental Status General Weakness Seizure Syncope Stroke Dizziness Cardiac Arrest Poisoning All ALS patients shall be continuously monitored in... - Correct Answer-Lead II