Term
| 606 criteria for patients who are obviously dead |
|
Definition
| decapitation, incineration, hemicorporectomy, or decomposistion |
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|
Term
| 606 respiratory assessment porcedure |
|
Definition
| open the patients airway, auscultate lungs or feel breaths while observing the chest for movement for a minimum of 30 seconds. dead if no response. |
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Term
| 606 cardiac assessment for field determination of death |
|
Definition
| palpate carotid artery (brachial for infant) for a minimum of 1 minute. or monitor cardiac rhythm for minimum of 1 minute. check asystole in 2 leads. obtain a 6 second strip to be retained with the ems provider documentation. dead if no response |
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Term
| 606 neurological assessment procedure for determination of death in the field |
|
Definition
| check for pupil response to light. check for response to painful stimuli. no response = ded |
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Term
| 606 what to do if patients appear to be dead without rigor or dependent lividity. |
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Definition
| see what etiology it is. if medical, resuscitation measures shall take place. if traumatic etiology, check resp,cardiac, and neuro. if under 18....resuscitate. |
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Term
| 606 trauma with no signs obvious death. you shall consider? |
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Definition
| if its within 20 minutes to a trauma center, if yes apply cardiac monitor and check rhythm. if narrow or wide complex pea greater than 30bpm, vf, vt.....resuscitate and transport. |
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Term
| 606 trauma with no obvious signs of death and its not pea,vf,vt at rate greater than 30bpm and it is less than 20 minutes to the trauma center from initial determination of pulessness and apnea |
|
Definition
| rhythm must be asystole or wide complex pea at less than 30bpm.....determination of death will be made. |
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Term
| 606 if initial determination of pulselessness and apnea until trauma center arrival is greater than 20 minutes |
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Definition
| the patient may be determined to be dead, regardless of cardiac rhythm |
|
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Term
| 606 if resuscitation measures have been initiated the you must what? |
|
Definition
| base contact should be attempted before resuscitation is terminated a determination of death. |
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Term
| 606 in cases of full arrest as a result of lightning strike, electrocution or suspected hypothermia.... |
|
Definition
| cpr shall be performed for a minimum of one hour. |
|
|
Term
| 606 what must be done for the body after determination of death. |
|
Definition
| if in hospital, snf, or on hospice, dont call law enforcement and the body may be left at scene. all other situations must be reported to law enforcement and the body must be left in their custody. |
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|
Term
| 606 at any time your patient is under 18.... |
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Definition
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Term
| 613-DNR dont forget to make sure that you positively match the person on the dnr. |
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Definition
| generally by witness or id band |
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Term
| 613 DNR and pertaining to patients taking high doses of opioid medications and has decreased respiratory drive. |
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Definition
| early base contact should be made before administering naloxone. use narcan sparingly in doses no more than 0.1mg ever 2-3 minutes. |
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Term
| 613 a DNR shall be considered null and void if any of 3 circumstances |
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Definition
| patient is conscious and states he wishes resuscitation, unusual cases where the validity of the request is in question...temporarily disregard request and contact base while resuscitating, validity of DNR start resuscitating immediately. |
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|
Term
| 613 - living wills or written instructions without california durable power of attorney you must |
|
Definition
| commence resuscitation and contact base asap |
|
|
Term
| 613 DNR in a public place happens |
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Definition
| if an operative DNR order, should not transport. Medical examiner and law enforcement should be notified. |
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|
Term
| 613 what following information must be documented in the AVCDS (approved ventura county documentation system)? |
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Definition
| name of patients physician on the dnr, type of dnr (medallion, dnr form, polst form, natural death act declaration), if made by an emt his cert number and name |
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|
Term
|
Definition
| gcs less than 14, sbp less than 90, respiratory rate greater than 29 or less than 10 and less than 20 in infant younger than 1 years old |
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|
Term
|
Definition
1. Penetrating wounds to the head, neck, torso, or extremities proximal to the elbow or knee
2. Flail chest
3. Two or more proximal long bone fractures (femur or humerus)
4. Crushed, degloved, or mangled extremity
5. Amputations proximal to wrist or ankle
6. Pelvic fractures
7. Open or depressed skull fracture
8. Paralysis |
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|
Term
|
Definition
1. Adults: > 20 feet (one story is equal to 10 feet)
Children < 15 years old: > 10 feet, or two times the height of the child
2.High-risk auto crash:
a.Intrusion: interior measurement > 12 inches patient site; > 18 inches any occupant site
b.Ejection: partial or complete from automobile
c.Death in same passenger compartment
3.Auto-pedestrian / auto-bicyclist thrown, run over, or with > 20 mph impact
4.Motorcycle crash > 20 mph |
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|
Term
|
Definition
1.Age > 65 years old
2.Head injury with loss of consciousness AND on warfarin (Coumadin)
3.Burns with trauma mechanism
4.Time sensitive extremity injury (open fracture, neurovascular compromise)
5.Pregnancy > 20 weeks with known or suspected abdominal trauma
6.Prehospital care provider or MICN judgment |
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|
Term
| policy 705 general. what defines an adult and what defines a pediatric? |
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Definition
| adult is 12 or greater pediatric is everything below up to 12th birthday |
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Term
| what are the 4 listed exceptions (including policy number) to the rule for pediatric ages....cpap is not one |
|
Definition
1. policy 606, withholding or termination of resuscitation and determination of death
2. policy 710 endotracheal intubation
3.policy 717 intraosseous infusion
4. policy 805 emt-d medical cardiac arrest protocols - saed |
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|
Term
|
Definition
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|
Term
| according to policy 710 the resqpod must be utilized how? |
|
Definition
| with 2 providers maintaining face mask seal throughout compressions |
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|
Term
| according to policy 710, intubation is indicated what 3 times? |
|
Definition
1.cardiac arrest - according to policy 705
2. respiratory arrest or severe respiratory compromise AND unable to maintain adequate airway and ventilate with bvm
3. after base hospital contact and the base physician orders intubation in other situations. |
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|
Term
| according to policy 710, intubation contraindications (2) |
|
Definition
1. traumatic brain injury - unless unable to maintain adequate airway
2. intact gag reflex |
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|
Term
| according to policy 710 there shall be no more than how many attempts to perform intubation lasting no longer than how long each? |
|
Definition
| 2 attempts lasting no longer than 40 seconds each. |
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Term
| according to policy 710 if patient is in cardiac arrest each intubation attempt shall interrupt chest compressions for no longer than how long? how long will you ventilate the patient by bvm with 100% O2 for prior to an attempt? |
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Definition
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|
Term
| according to policy 710 when using a resqpod if the patient has rosc you shall? |
|
Definition
| immediately remove resqpod from advanced airway and continue to assist ventilations every 5-6 seconds |
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|
Term
| according to policy 710 for airway management. in the special considerations on a patient with a tracheal stoma...you will pass the ett until the cuff is just past? |
|
Definition
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|
Term
| according to policy 710 for advancing the et tube. at heights 5', 5'-6'6", and over 6'6". what depth for each? |
|
Definition
| less than 5ft...balloon 2cm past the vocal cords. 5'-6'6"....22cm at the teeth. over 6'6" tall...24cm at the teeth or 2cm past the vocal cords. |
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|
Term
| according to policy 710 for documentation what does the acronym SADCASES used for |
|
Definition
| Size of the ett, attempts in number, depth of the ett at the patients teeth, confirmation devices used and results, auscultatation results, secured by what means, etco2 initial value, support of the head or immobilization of the cervical spine. |
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Term
|
Definition
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Term
| according to policy 715 what are the 3 indications required for needle T? |
|
Definition
a. clinical suspicion of pneumothorax
b. sbp less than 90
c. absent or significantly decreased breath sounds on the affected side |
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|
Term
| according to policy 715 needle T contraindications |
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Definition
|
|
Term
| according to policy 715 on placement. where are the 2 places you can place a needle T? |
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Definition
| the 2nd intercostal space in the mid-clavicular line. If unable to place anteriorly, lateral placement is in the fourth intercostal space in the mid-axillary line. |
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Term
|
Definition
| use of pre-existing vascular device (pvad). |
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|
Term
| according to policy 716 what 3 things can you access? |
|
Definition
| peripheral vein heparin/saline lock. Central vein indwelling catheter/device. Hemodialysis fistula |
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Term
|
Definition
| policy for intraosseous infusion |
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|
Term
| according to policy 717 IO what is the indications |
|
Definition
| patient with aloc or in extremis and an urgent need to administer IV fluids or medications and venous access is not available. |
|
|
Term
| according to policy 717 using the manual IO is for patients aged? what about the ez IO |
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Definition
| Manual IO is for ages 8 or less. Ez IO is for all ages. |
|
|
Term
| according to policy 717 IO what are the 5 contraindications? |
|
Definition
-recent fracture within 6weeks of selected bone.
-congenital deformities of selected bone.
-grossly contaminated skin,skin injury, burn, or infection at the insertions site.
-excessive adipose tissue at the insertions site with absence of anatomical landmarks.
-IO in same bone within previous 48 hours. |
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|
Term
| according to policy 717 IO. for responsive patients needing pain management. |
|
Definition
| infuse 2% cardiac lidocaine prior to fluid/medication administration for pain management; 1mg/kg max of 4mg slow IVP over 60seconds. |
|
|
Term
| according to policy 717 flush the IO with? |
|
Definition
| 5ml ns. but only after aspirating and giving lidocaine if indicated. |
|
|
Term
| according to policy 717 IO. dont forget to document distal pulses and skin color to extremity utilized for IO insertion before and after procedure. |
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Definition
|
|
Term
| according to policy 717 IO. there are 3 different needle sizes for EZ IO. explain them |
|
Definition
15mm needle set (pink) 3-39kg
25mm needle set (blue) greater than 40kg
45mm needle set (yellow) for patients with excessive adipose tissue at insertion site. |
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|
Term
| according to policy 717 IO. when giving IV fluids through ezIO what weights give what amount of fluid? |
|
Definition
| 3-39kg - 500ml ns. greater than 40kg - 1 liter ns |
|
|
Term
| according to policy 717 IO. what weights get how much 2% lidocaine? |
|
Definition
| 3-39kg get 1mg/kg. greater than 40kg get 40mg. with 10ml flush ns afterwards. |
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|
Term
|
Definition
| guidelines for limited base contact |
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|
Term
| according to policy 720. paramedics shall make limited bh contact for uncomplicated cases, which respond positively to initial treatment and require no further intervention or where symptoms have resolved. what are the first 5 criteria? |
|
Definition
1.hypoglycemia
2.narcotic overdose
3.chest pain-acute coronary syndrome no arrhythmia or associated SOB.
4. SOB - wheezes/other
5.altered neurological function chemstick greater than 60 |
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|
Term
| according to policy 720 what are the criteria for lbc 6-9 |
|
Definition
6. seizure with no drug ingestion,no dysrhythmias, chemstick greater than 60 (no longer seizing, not status epilepticus, not pregnant)
7. syncope or near-syncope (stable vs. no dysrhythmia, chemstick greater than 60.)
8.pain
9. nausea and vomiting |
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|
Term
|
Definition
| interfacility transport of patients with iv heparin and nitroglycerin |
|
|
Term
| according to policy 722 what concentrations of nitro are allowed? |
|
Definition
|
|
Term
| according to policy 722 heparin infusions will have medication concentration of? drip rates will not exceed? vitals documented every? |
|
Definition
| 100units/ml of iv fluid. drip rate will not exceed 1600 units/hour. documented every 10minutes. |
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|
Term
|
Definition
|
|
Term
| according to policy 723 what is the minimum age limit and what are the situations, aka indications for cpap? |
|
Definition
min age of 8.
1. chf with acute pulmonary edema
2. near drowning
3. any cause of respiratory failure. |
|
|
Term
| according to policy 723 cpap. what are the 6 absolute contraindications to cpap? |
|
Definition
1. respiratory or cardiac arrest.
2.agonal respirations
3. unconsciousness
4. pneumothorax
5. inability to maintain airway patency
6. head injury with increased ICP |
|
|
Term
| according to policy 723 what are the relative contraindications (4) |
|
Definition
1. decreased loc
2. unable to tolerate mask
3. systolic bp less than 90
4. vomiting |
|
|
Term
| according to policy 723 cpap. vital signs and spO2 must be documented every? |
|
Definition
|
|
Term
|
Definition
| alte also know as apparent life threatening event. |
|
|
Term
| according to policy 724 ALTE usually involves any combination of the 5 following symptoms |
|
Definition
1.marked change or loss in muscle tone
2. color change
3. apnea
4. loss of consciousness
5. choking or gagging |
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|
Term
|
Definition
|
|
Term
| according to policy 725 taser policy. taser probes may only be removed if? |
|
Definition
| if they interfere with the safe transportation of the patient. |
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|
Term
| according to policy 725 if the taser is in a dangerous area you may not remove. and must transport the patient in an appropriate position. what are considered dangerous areas? 9 of them. |
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Definition
| face,neck,hand,bone,groin,spinal column,eye, blood vessels, nerves. |
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|
Term
|
Definition
|
|
Term
| what are the 3 indications for a 12 lead if past 12 hours... |
|
Definition
| trick question. it has to be within 12hours |
|
|
Term
| so now 12lead ecg indications |
|
Definition
1. chest, upper back or upper abdominal discomfort.
2. generalized weakness.
3. dyspnea |
|
|
Term
| 12 lead contraindications (2) |
|
Definition
1. trauma
2. cardiac arrest unless rosc |
|
|
Term
| how many total times are you allowed to repeat the 12lead |
|
Definition
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|
Term
| if interpretation is acute mi suspected verify what with the patient? |
|
Definition
| make sure the patient doesnt have a pacemaker or ICD. |
|
|
Term
| when acute mi is suspected you must tell the MICN.... what 3 mandatory things? |
|
Definition
| the patients cardiologist, if the underlying rhythm is atrial flutter so the cath lab wont be activated, if the pacemaker or the ecg is of poor quality report that to the micn. |
|
|
Term
| if acute MI suspected what should you tell the patient? |
|
Definition
| according to the ecg you may be having a heart attack. |
|
|
Term
| false positive ecgs not recognized and called in as such to the BH will be reported as an? |
|
Definition
| unusual occurrence (policy 150) |
|
|
Term
|
Definition
| transcutaneous cardiac pacing |
|
|
Term
| what are the indications for tcp? (3) |
|
Definition
1. signs of poor perfusion, evidenced by: decreased levels of conciousness
2. chest pain
3. CHF |
|
|
Term
| 1 absolute and 1 relative contraindication for TCP |
|
Definition
absolute - asystole
relative - hypothermia, patient warming measures have precedence. |
|
|
Term
| for TCP what is the heart rate and mA you start with? |
|
Definition
| heart rate of 70 with 40mA |
|
|
Term
| what mA should you increase until capture? |
|
Definition
|
|
Term
| patients with second degree type 2 or 3rd degree block who dont have symptoms do or dont require TCP? |
|
Definition
| dont, but be prepared to pace if necessary |
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|
Term
|
Definition
|
|
Term
| what is the indication for king airway? |
|
Definition
| patients who require assisted ventilation and meet criteria for an advanced airway. may be used as a primary airway or after one or more unsuccessful intubation attempts. |
|
|
Term
| king airway contraindications (3) |
|
Definition
1. its use will be restricted only to unconscious patients patients without a gag reflex.
2. it is not to be used on patients under 4 feet tall
3. it is not to be used on suspected cases esophageal diseases or of ingestion of caustic substances. |
|
|
Term
| what 3 sizes are there for king airway and what heights and ml of air does it use. |
|
Definition
size 3 - patient between 4 and 5 ft (55ml air)
size 4 - patients between 5 and 6 ft (70 ml air)
size 5- over 6ft (80ml air) |
|
|
Term
| verify king tube place with all of the following: (4) |
|
Definition
1. rise and fall of the chest
2. bilateral breath sounds
3. absent epigastric sounds
4. co2 measurement (colormetric capnography) |
|
|
Term
| after you have advanced the king airway and began bagging what should you do next? |
|
Definition
| withdraw the airway until ventilation is easy and free flowing. |
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|
Term
|
Definition
|
|
Term
|
Definition
| life threatening extremity hemorrhage that can not be controlled by other means |
|
|
Term
| tourniquet contraindications |
|
Definition
1. non-extremity hemorrhage.
2. proximal extremity location where tourniquet application is not practical |
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|
Term
|
Definition
| documentation of prehospital care |
|
|
Term
| helicopter transport should be considered potentially contraindicated in the following 6 circumstances |
|
Definition
1. asystole not responding to appropriate therapy and not meeting any criteria of an exceptional situation
2.patients contaminated with hazardous material
3. potentially violent patients or those with behavior emergencies.
4. potentially violent patients or those with behavior emergencies
5. when ground transport time is equal to or shorter than air transport time
6. other safety conditions as determined by pilot and/or crew. |
|
|
Term
| according to policy 1203; criteria for patient emergency transport by helicopter. what are the absolute contraindications? (4) |
|
Definition
1. patients contaminated with hazardous materials.
2. potentially violent patients or those with behavioral emergencies
3. stable patients (except in back country areas inaccessible to ground units)
4. when ground transport time is equal to or shorter than air transport time. |
|
|
Term
| by policy 1203, transport by helicopter. what are the 4 relative contraindications to transport |
|
Definition
1. patients in cardiac arrest.
2. transports from heavily populated areas
3. transports for which, prio to departing the scene, conditions exist such that helicopter arrival at the intended destination is uncertain.
4. other safety conditons as determined by pilot and/or crew. |
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