ECRN Test

"Appropriate procedures involving uninjured students from a category two bus accident include"

Category two or three bus accident/incident 1. Contact medical control - discharge uninjured children by the ER physician in charge 2. Injured children should be examined, treated, and transported. 3. Implement provided procedures for contacting school officials and parents. 4. And medical control a discharge, the uninsured students into the custody of the ambulance service who will transfer the students to the appropriate department, parents school officials. 5. Authorized school representatives will sign the log sheet, indicating acceptance of responsibility for the students after the medical clearance by EMS personnel finds know if evidence of injury school representative will then follow policies of informing parents of accident. 6. Any student age 18 or older, and any adult nonstudent present on the bus wanna show the log sheet adjacent to their name. 7. Complete one prehospital care report form in addition to the school bus incident form.

" patient, so serious trauma may need intervention that is not available in the prehospital, setting, making rapid transport a priority which of the following is considered a load and go situation"

Certain signs and symptoms require the trauma patient to be immediately loaded into a spine board and transferred to the Ambulance in transported rapidly with lights and sirens. Non life-saving procedure such a splinting and bandaging maybe needed, but should be done during transport life-saving procedures must not be delayed during transport. Examples of a load and go situation -Traumatic arrest -Obstructed airway -Altered mentation with GCS less than 10 -Respiratory compromise with a rate of 10 or greater than 29 or severe distress -Shock -Injuries that will rapidly lead to shocker respiratory difficulty. Examples: foil, chest open pneumothorax, tension, pneumothorax, tinder, abdomen unstable pelvis, bilateral femur fractures, and poorly controlled major bleeding.

" which of the following assessment findings would indicate decrease perfusion in the six month old pediatric patient"

Circulation: Heart rate Central and truncal pulses Distal, peripheral pulses Color Skin temp Blood pressure Hydration status

" which is an indication for an endotracheal intubation"

Comatose patient with an adequate airway Respiratory distress

" which of the following would be a contraindication for the administration of a chewable aspirin in a 70 year old with chest pain"

Contra indications of aspirin use: known hypersensitivity to the drug, bleeding disorders, active ulcer asthma

" according to protocols which patient can a paramedic attempt to place, and Io if peripheral line is unable to be obtained"

Contraindications -Fractured bone -pre-existing medical condition such as infection, cellulitis tumor, prosthetic, limb joint replacement osteogenesis -Inability to locate anatomical landmarks due to edema, obesity, joint replacement, other surgical intervention, or deformity

" approved site for ground crew EZ intraosseous insertion is

Currently only approve site is the proximal tibia How to insert IO -Put on PPE -Aseptic technique must be use -Identify landmarks at the proximal tibia site and choose a needle set appropriate to the patient wait -Attach needle to set driver -Clean area -Stabilize the extremity do not put your hands behind extremity -Position the needle at 90° angle to the bone and push the needle through the soft tissue until the tip of the needle touches a bone -Gently squeeze the trigger and apply light steady pressure until sudden decrease in resistance is felt -Stabilize the needles at her by removing the driver by pulling it straight off do not rock twist return the driver -Continue to stabilize. The needle set an unscrew. The stylet counterclockwise from the catheter, remove the silent and dispose in the sharps container. -Attach a primed extension set with a 10 mill syringe. Attach an attempt to aspirate bone marrow, then flush with 10 mils in NS. 2-5ml for peds -Verify placement needle should be firmly seated in the bone, able to flush and observe, bone marrow or blood when aspirating you should also be no evidence of excavation when palpating around the site during and after flush -Connect prime IV tubing, apply pressure bag and adjust to desired flow rate small children you say stopcock -Secure with dressing so that the site may continue to be observed monitor for any signs of excavation

" what is the correct Jewell setting for the second and third shock of a child in ventricular fibrillation"

Defibrillation 2J/kg After two minutes of CPR give one shock 4J/kg or utilize an AED resume CPR immediately for two minutes

" search for an IV site continues on a patient with a blood sugar of 38 which of the following is a possible treatment option for this patient"

EMT and paramedics are able to administer glucagon 1 mg IM or IN

" which has successfully completed a course that meets or exceeds the DOT national curriculum, except emergency calls from the public and provides pre-arrival medical instructions to the public?"

Emergency medical dispatcher: a person who has successfully completed a training course in emergency medical dispatching in accordance with this part who accepts calls from the public for emergency medical services and dispatches designated emergency, medical services, personnel, and vehicles EMD duties : -Except calls from the public for emergency medical services -Dispatches designated emergency, medical service personnel, and vehicles -Provides pre-arrival medical instructions to the collar in accordance with protocols approved by the EMS medical Director

" what would be considered a form of child neglect?

Examples of neglect: -Environment is dangerous (weapons within reach, playing near open windows without screens are guards unsanitary conditions) -caretaker has not provided or refuses to permit medical treatment of child, acute or chronic life-threatening illnesses or fails to seek necessary and timely medical care for child -Child under the age of 10 has been left unattended or unsupervised - even if child was not endangered while being left alone, EMS cannot make that determination, and it should still be reported -abandonment -caretaker appears to be incapacitated. I cannot meet the child needs. -Child appears in adequately fed -Child is found to be intoxicated, or under the influence of illicit substances

" which treatment is indicated for the unconscious patient of unknown ideology"

Fingerstick glucose Narcan Oxygen Iv normal saline

"Which is the first step in treating a child with suspected hypovolemic shock"

First steps: -Assess ABC's -Secure airway -Administer 100% oxygen -Initial assessment -Cardiac monitor -Supine position Secondary steps : -establish vascular access -Fluid bolus 20ml/kg -Repeat fluid bolus if needed

Contra indications for IV lidocaine used "Which of the following is correct regarding lidocaine Iv"

Hypersensitivity to the drug Hi degree heart block Malignant PVCs

"Which patient would you consider administering external transcutaneous pacing?"

Indications for pacing: -symptomatic and hemodynamically unstable bradycardia Sinus or junctional Second-degree type one block Second-degree type to block Third-degree block Contra indications of transcutaneous pacing : Non-symptomatic patient

" which patient would benefit from CPAP therapy in route to the hospital"

Indications for use a CPAP: -awake and able to follow commands -Over 12-years old and able to fit the CPAP mask -Has ability to maintain an open air way And Exhibit 2 or more of the following: -Respiratory rate greater than 25 -SPO2 less than 94% at any time -Use of accessory muscles during respirations Contraindications for use of a CPAP: -Respiratory arrest apneic -Suspected pneumothorax or trauma to chest -Tracheostomy -vomiting, upper G.I. bleed -Decreased cardiac output, questionable ability to protect, airway, chest trauma, gastric, distention, severe facial injury, uncontrolled vomiting, and hypotension secondary to hypovolemia

"Which statement is not true regarding adult endotracheal intubation"

Indications: Comatose patient with inadequate airway Respiratory arrest Contraindications : Patient able to maintain their own airway Comatose patient ventilating adequately Complications : Hypoxemia Equipment malfunction Damage to teeth and soft tissue Esophageal intubation Endobronchial intubation Aspiration Elevated intracranial pressure Precautions : Avoid hypoxemia drink, intubation limit each attempt to know more than 20 seconds before we oxygenating the patient Consider the use of apneic oxygenation to help prevent hypoxia during intubation apply nasal cannula 5 to 6 L per minute and leave on under the BVM to increase physiological reserve of oxygen

"Which is a complication of IV therapy"

Infection catheter, sheer arterial, puncture, thrombophlebitis, air embolism, allergic reaction, pyrogenic reaction, circulatory overload

" which patient would require spinal motion restriction using a long spine board"

Blunt trauma with altered mental status, spine, pain, tenderness, or deformity neurological deficits High energy mechanism, and any of the following : drug or alcohol intoxication, in ability to communicate distracting injury Penetrating trauma to the head, neck or torso with evidence of spinal injury

" dopamine Ivy is a drug used in the prehospital setting to treat"

Cardiogenic shock Dosing 5 to 20 MCG/KG/minute

" what is not indicated in care of a patient with anaphylactic shock"

Care of a person and anaphylactic shock: -Epinephrine 1:1,000 adults, 0.3 mils subq for mild reaction. -Benadryl 25 mg slow IVP -If patient is conscious, albuterol, 2.5 mg neb use an extreme caution if epi was already given. -Solu-Medrol 125 mg IVP

"Which of the following statements is true about nitroglycerin tablets?"

Precautions for use of nitro: -Monitor blood pressure before and after administration of each dose -Do not administer a systolic BP is less than 90 -Protect from light

" preferred site for needle, chess decompression"

Preferred site is fifth intercostal space interior axillary line (5th ICS AAL) Secondary site a second intercostal space mid clavicular line

"Which of the following statements regarding the care of an amputated part is not true"

Prehospital protocol for amputated parts: -Any gross contaminants on the part should be removed by renting the part and sterile saline solution -no attempt should be made to debris or otherwise clean up the amputated -The part should be rinsed, wrapped in a moist but not wet, sterile dressing placed in a plastic bag and tightly sealed to prevent direct contact with liquid substance is the sealed bag should then be placed in an iced Celine or sterile water -Cover the stump with a sterile dressing -Patient transport should not be delayed by searching for the amputated part. Search can be contained by other person while patient is transported.

" a key side effect to assess for a patient receiving an IIb/HIa inhibitor (aggrastat, integrilin, or reopro) IV drip while being transferred is"

Procedure for transfer: Obtain patient report from the nurse caring for the patient in the transferring facility with special attention to the following - patient condition, vital signs, all drugs, being infused know right of the infusion for each transfer orders, including measures to be taken, if bleeding occurs which cannot be controlled with direct pressure Assess the patient for any signs of bleeding

Indications for CPAP therapy "which pt would be a candidate for a CPAP"

Pt is in respiratory distress with s/s of asthma, COPD, pulmonary edema, CHF, of pneumonia who is: - awake, alert, and can follow commands -Over 12 years old and can fit a CPAP mask -Can protect their own airway AND has two or more of the following: -reps rate greater than 25 breaths per min -spo2 of less than 94% at any time -Use of accessory muscles

" which statement about glucagon is correct"

Purpose: Glucagon causes breakdown of glycogen stored in the liver to glucose Inhibits glycogen synthesis Elevates blood glucose

" of the following conditions, which would not indicate the emergent use of a central venous access device in the prehospital setting"

Purpose: -Previously established central lines, and other access. Port may be utilized during an emergency in the event that a peripheral IV line cannot be establish. Emergency situations include : Cardiac arrest Major trauma Life-threatening situation requiring immediate need for medication or fluid therapy

" appropriate application, assessment, an indication for use of a tourniquet"

Purpose: control hemorrhage Indications: -Control. Potentially fatal hemorrhage from wound or traumatic amputation. So insignificant extremity bleeding cannot be stopped using direct pressure. -Turn, the kids may be indicated if tactical or safety situation those involving prolong extraction, remote locations or multiple casualties -Turn the kids may be considered when treating patients who have had prolonged compression of an trapped extremity, in order to decrease a life-threatening release of potassium and assets from the ischemic limb Contraindications : -Venus, Bonnie, and small vessel bleeding -Tourniquet application is greatly unnecessary. 11 bleeding is adequately controlled using direct pressure. -non-extremity hemorrhage

"The disaster tag system uses the QAEMS system in the event of a major EMS incident is called the"

QAEMS systems use: smart tag

" according to the Illinois law as a mandated reporter of child abuse, ECR ends in paramedics must"

Report suspected abuse to ED physician ED charge nurse and DCFS

"The minimum ED staffing criteria for a resource and/or associate hospital is?"

Resource: 1 ECRN & 1 EMS dr in house 24hrs Associate: 1 ECRN & 1 EMS dr in house 24hrs

" the start program is used to triage patient involved a mass casualty incident. It consist of assessing for three basic components, which include."

STEP 1: respirations / breathing -None > open airway > still no breathing: BLACK tag deceased -respirations greater than 30 per minute or less than 10 per minute: RED IMMEDIATE -respirations between 10 to 30 (go to step 2) STEP 2: perfusion check (radial pulse) -If no radial pulse tag RED immediate -if radial pulse present go to step 3 STEP 3: mental status -if unable to follow, simple, commands or unconscious tag immediate RED -If you're able to follow commands tag delayed YELLOW

Valium (diazepam) " Valium is a benzodiazepine that is commonly used to treat seizures and provide sedation prior to emergency cardioversion. However, the patient must be monitored for potentially serious side effects, which is considered a potential side effect after administering Valium 5 to 10 mg IV."

Side effects: -CNS depression / drowsiness -respiratory depression -Hypotension -Phlebitis / venous thrombosis Route: -Iv administer no faster than 1 mg/min. -IM onset of action 15 to 30 minutes -Rectal Does: -Seizures 5 to 10 mg Slow IV push at 1 mg/min. max dose of 10 mg -sedation prior to electrical therapy: 5 to 10 mg slow IV push at 1 mg/min. max dose of 10 mg -Acute anxiety: 2 to 5 mg IM or slow IV push

"Which medication may be administered for a patient with overdose of tricycle, anti-depressants, exhibiting ventricular, tachycardia, or other dysrhythmia?"

Sodium bicarbonate: Used for severe acidosis, cardiac arrest with prolonged downtime and tricycle anti-depressant overdose

Emergency deliver with prolapsed cord " in the case of a prolapsed umbilical cord you should:"

prolapsed cord occurs when the umbilical cord is compressed between the fetus in the pelvis If the umbilical cord is noted to be protruding from the vagina : -Administer oxygen at 15 LPM nonrebreather -Place mother and knees, chest or Trendelenburg -insert two fingers of a gloved hand into vagina to raise the presenting part off of the cord. This position will need to be maintained until instructed otherwise. Also check for pulsation of the cord. -Cover expose cord with moist sterile dressing do not compress, palpate or handle the cord more than necessary

" during cardiac arrest it is often easier to get an IV access via IO approach, which is a contraindication for this type of IV insertion"

purpose of IO: provides an alternative means to gain, rapid, vascular access and cardiac arrest Indications: adults over 40 kg Contraindications: -Fracture of the tibia or femur (consider alternate tibia) -previous orthopedic procedure (IO placement within 24 hours or a knee replacement) -pre-existing medical condition (tumor, near site or peripheral vascular disease) -Infection insertion site -inability to locate landmarks (edema) -Excessive to shoot at insertion site (obesity)

"Which of the following is a duty of the emergency communications registered nurse?"

An emergency communications registered nurse is a registered professional nurse who has been approved by the EMS medical Director to participate in the Quincy area. EMS system and perform the following duties and responsibilities: -Give voice orders and direction to system, participants via radio or phone in accordance with system approved protocols -Document prehospital patient condition, interventions and orders on the emergency department radio log -Monitor supervisor and assist personnel for filling educational requirements in the clinical setting -Monitor conformance to system, policies and procedures

" pediatric burns that would be appropriate. Transfer to a burn center include."

Any patient with life-threatening condition should be treated until stable at the nearest appropriate facility before being transferred to a burn center Criteria for pediatric transport to burn center : -Second and 3rddegree burns greater than 10% of the body surface area and child is less than 10 years old -Second and 3rddegree burns greater than 20% body surface area and any other age group -Second and thirddegree burns that involve the face hands feet, genitalia, perineum and major joints -3rd degree burns greater than 5% of the body surface area in any age group

" for the normal spontaneous emergency delivery infield and Apgar score should be done"

Apgar: appearance pulse grimace, activity, respirations Note score 1 minute after delivery and five minutes after delivery

Contraindications to CPAP therapy "which pt would be a candidate for a CPAP"

-Hypotension (below 90 systolic) -AMS/ Can't follow commands -Resp arrest/ Apenic -Suspect pneumothorax/ chest trauma -Tracheostomy -N/V -GI bleed - Gastric distension

ACLS rhythm identification "You are transferring a 55 y/o male pt with an anterior MI. Your pt has a rhythm change (Vtach) Pt is now restless and confused. Skin ashen and feels cool and clammy. BP 68/p. Next action is:

-If ventricle rate is > 150 with serious s/s related to tachycardia prepare for cardioversion -S/S : Chest pain, dyspnea, LOC change, low BP, pulmonary congestion, AMS.

"Atropine is an antidote for organophosphate poisoning, including malathion and diazinon. The correct dose for treatment is."

Atropine 2 to 5 mg every 10 to 15 minutes Organophosphate poisoning - insecticides -parathion -malathion -diazinon -TEEP

" when caring for renal dialysis patients in the prehospital setting when may a shunt fistula or graph be utilized"

Utilization of a dialysis access only if IV and I owe is unsuccessful in the patient is in cardiac arrest or near cardiac arrest

Who can refuse care? "Which statement regarding patient refusal is correct"

- An Adult 18+ -Under 18 who meets at least one of the following: emancipated, pregnant, a parent -POA for a person unable to make their own decision at the time -Legal guardian of a minor

Tourniquet procedure "Application of a tourniquet is an effective means to control severe bleeding when other methods have failed. Of the following patients with uncontrolled hemorrhage, which treatment follows the procedure for tourniquet application and/or monitoring of patients with a tourniquet?"

- CAT tourniquet is preferred -Blood pressure cuffs can be used if needed -Apply device apx 3 in proximal to wound. If wound is on a joint or distal to joint apply tourniquet to the joint -Tighten until bleeding stops (venous oozing is okay) / distal pulse is absent -Can apply 2nd tourniquet if needed. Should be proximal to the 1st -Do NOT cover tourniquet with a. dressing -Do not remove or loosen unless ordered by ERP -Note time of application and tell ED

Nitro & Hypotension "While transferring a pt with a nitro drip the pt becomes hypotensive. Pt has a HX of ACS without pulmonary edema. You should first:"

- Lower HOB. Give 200ml fluid bolus if not contraindicated. (pulmonary edema) -If BP does not return to minimum systolic (90 if none listed) contact MC.

Board make up "Who would be a candidate to serve as a member of a local system review board?"

- One emergency department dr with knowledge of EMS -Two EMTS -Two persons of the same professional category as the suspended individual, or person requesting the hearing

" routine, cardiac care for patients with chest pain include"

-02 -Iv ; fluids -Cardiac rhythm check -Nitro 0.4 mg sublingual if BP is appropriate. -Morphine 2 mg IV push - four 81mg aspirin tablets

" what is the correct administration and initial dose of adenosine?"

-6mg fast & hard 1st dose -12mg 2nd dose 1-2 mins after first dose -A syringe of adenosine and a second syringe of 10 to 20 NS should be prepared. Adenosine is given rapid IV push followed immediately by the NS - if the tachycardia persist after 1 to 2 minutes and the rhythm is still thought to be. PSVT THEN CONSIDER 12 MG RAPID IV PUSH

Morphine "What medications may be given in the pre-hospital setting to control pain prior to contact with ERP

-Adult: 1st dose 2mg IVP may repeat x1. Call MC for more doses -Peds: Must call MC before giving. The dose is 0.1mg/kg IVP -Make sure to do VS and pain before and after. VS Q10 mins. Let ED know of meds given

N/V prehospital "Ground EMS is transporting someone with N/V. What meds can they give?"

-Adults: Zofran 4mg IV push -Peds: Must call medical director before giving -Notify ER so they can prepare NG if necessary

Stable wide complex tachycardia "You are transporting a 60 year old, female patient who was diagnosed with AMI. minutes after transport began, your patient has a rhythm change what you identify as wide complex ventricular tachycardia. She is alert and oriented and her color is pale. She denies dyspnea or chest pain BP is 100/58, pulse 140 which would be an appropriate. Initial treatment of this patient."

-Assure airway is patient -02 at high flow, cardiac monitor -IV -lidocaine 1-1.5 mg per kilogram IV push

ACLS skills " you are transporting a cardiac patient. Suddenly the monitor shows a systole, and no pulse is detected your initial steps and caring for the patient would include"

-Begin CPR - give epi ASAP -Epi every 3-5 mins after 1st -bag/ advanced airway -pulse check every 2 mins & change compressor

Request for inactive status "Prior to expiration of current license, a provider may request to be placed on inactive status if all relicensure requirements have been met at that time. During inactive status: "

-During inactive status an EMT shall not function as an EMT at all

EMS Medical Director " the final designated medical authority in the EMS system is the:"

-EMS medical Director is the designated final medical authority -the first arriving EMS team on the scene is responsible under the direct authority of the EMS medical Director and will assume responsibility for caring out appropriate. Patient care at the scene. -Responsibility and authority for patient care management will be transferred to the team, providing the highest level of care at the scene upon their arrival

Low risk refusals (NO call to MC) "You respond to a call regarding a patient with history of diabetes and decreased level of consciousness. Upon arrival you find a 55-year-old male, conscious, responsive with skin, moist and cool to the touch you quickly obtain a blood sugar reading reading is 36 after giving dexterous 30% the patient is alert and oriented and feeling better the patient and spouse. Thank you for your treatment but do not feel they need to go to the hospital in this case you realize you. "

-Low speed, MVC without significant injury -isolated injuries, not related to high risk mechanism -third-party calls were no injury or illness is present -non-injury call for assistance -A patient with no other concerns and complaints who is mental status is not normal but it's confirmed to be usual for the patient by family or friends who remain on scene with the patient after EMS -A patient with hypoglycemia due to insulin use, which was corrected by administration of oral glucose or Ivy dextrose and his family or friend who remain on scene after EMS -A patient with a respiratory complaint that requires only one albuterol nebulizer treatment to correct -A patient with heat related muscle cramps that requires only IV fluids to correct

" resource hospitals can be asked to intervene or override orders from an associate hospital when"

-No radio response by the receiving hospital after three attempts by the prehospital unit -Deviation from Quincy system, define treatment, protocols, disposition, or communication protocols -When the associate hospital request the intervention -When an ALS crew request the intervention

" for the patient and the signs and symptoms of acute pulmonary edema in a heart rate of 90 prehospital treatment may include"

-Oxygen spo2 > 94% ; 92% if COPD -Nitro sublingual, 0.4 mg. -Morphine 2 mg IV push

Contraindications to aspirin " a reason for withholding, baby aspirin to a patient with chest pain would include"

-active ulcer disease -Asthma -No one hypersensitivity to the drug or a bleeding disorder

" appropriate prehospital care for OB/GYN patient exhibiting a prolapsed umbilical cord would include"

-administer oxygen 15 L per minute nonrebreather -Put mom in the chest position or transdelenberg -insert two fingers of a gloved hand into the vagina to raise the presenting part off of the cord-this position needs to be maintained until instructed otherwise, check cord for pulsation at this time -Cover the expose cord of a moist sterile dressing do not compress, palpate or handle the cord more than necessary

"Prior to accepting a refusal from patient you must"

-assess the patient and obtain vital signs if the patient refuses assessment document this on the patient care report form -Explain to the patient or guardian, the risks associated with their decision to refuse treatment and or transport -Medical control must be contacted via radio or phone to verify acceptance of the refusal for all high-risk refusals

. "Your patient is experiencing chest pain, dyspnea, confusion, hypertension you attach the monitor and identify sinus Brady with a rate of 40 proper treatment would include"

-atropine 0.5 mg IV. Push every 3 to 5 minutes up to a max of 0.0 3 to 0.04 mg per kg -Transcutaneous pacing If low blood pressure after rate increases: -Dopamine IV at 5 to 20 µg per kilogram per minute -Epinephrine IV drip at 2 to 10 mcg per minute

Criteria to request a scene response by helicopter air ambulance would include

-category one trauma or seriously ill patient and remote or off-road locations not easily accessible to ground ambulances or who's location because delay and transport time -NBC or incident with prolong extraction time anticipated typically greater than 20 minutes -Special environmental condition, such as extreme heat or cold that prohibits ground transportation -no available trauma center within 20 minutes by ground transportation -Reduction and transport time to trauma center compared to ground transportation for the seriously injured patient -Ground transportation resources are exhausted or exceed ability

Treatment of V Tach and V Fib " what is the initial energy does for defibrillation of a peds patient"

-defib 2J / kg -may repeat at 4J / kg

" examples of possible systemwide crisis that might necessitate activation of the system wide crisis plan includes all of the following"

-heat emergency -Communicable disease -Influenza epidemic -terrorist act involving nuclear biological or chemical agent

"Paramedics and EC RNs are mandatory reporters when a patient is a victim of child abuse or neglect, which patient with potentially be reported to the child abuse hotline"

-obvious or suspected fractures and children under two -Injuries in various stages of healing, especially burns or bruises -Injury scattered over many body parts -Bruises or burns in a pattern that suggest intentional infliction -Injuries which do not match the history -Vague, inconsistent, or changing history -delay and seeking treatment -Inappropriate clothing, signs of poor nutrition or poor care -abandonment of an elderly person, or child unable to care for themselves

Severe postpartum hemorrhage " after normal delivery of an infant in Placentia, you know if the mother is bleeding heavily from the vagina, your initial steps and caring for the patient would include"

-oxygen 12 to 15 LPM nonrebreather -Iv normal saline fluid bolus (SBP > 100) -oxytocin 10 units ( in 500-1000 ml NS) infuse slowly at indicated rate by medical control. You must be certain that the placenta was delivered, and there is no other fetus present. -Consider use of PASG leg sections only (BLS must call MC before inflating)

" medication's indicated for prehospital treatment of asthma include"

-oxygen to achieve targeted saturation of 94% or greater (92% if COPD) -solu medrol 125 mg IV -2.5 mg of albuterol / 3ml Neb

"Treatment goals for the patient of pulmonary edema includes preventing hypoxemia and subsequent respiratory failure medication's to be considered in the treatment regimen include"

-oxygenation: intubate if needed -Nitroglycerin sublingual -Morphine 2 mg IV push

" prehospital orders for adults insulin-dependent diabetic patient may include"

if blood glucose levels less than 60: -IV NORMAL SALINE -50 mils of 50% dextrose IV push -1 mg glucagon IM if IV is not able to be obtained, and patient is unresponsive or unable to swallow

" which of the following drugs is used for suspected or no narcotic overdose"

naloxone Adult: 1 to 2 mg IN 2 mg IV,IO, IM, IN

"Detective a physical restraint for a patient demonstrating a behavioral emergency is to"

-physical restraints may be necessary when EMS personnel have a reasonable belief that the patient may be a harm to themselves or others -Safety is a priority only attempt restraints with adequate assistance, request additional resources, EMS, law-enforcement and fire as needed. Consider the need to clear bystanders from the immediate area. -The objective of physical restraints is to restrict movement without endangering the patient. -Appropriate restraining devices examples include soft restraints, leather restraints, wide, roller, bandages, triangular, bandages (only use leather restraint of the caregiver in the patient compartment has the restraint key) -Patient monitoring includes positioning of the patient to enable immediate access to the airway and visualization of breathing and chest rise circulation, and all them should be checked at least every 15 minutes during transport -Request law enforcement accompany the patient in the ambulance at the patient is handcuffs or if there is a safety concern

"Appropriate treatment for an unstable patient experiencing supraventricular tachycardia would include"

-vagal maneuvers (have patient cough or bear down) -adenosine 6 mg rapid IV. Push over one to three seconds. -If no change in 1 to 2 minutes of giving adenosine, give 12 mg rapid IV push followed by normal Celine and elevating the extremity -If at any time, patient becomes unstable, consider synchronized cardioversion

" you arrive at a chest pain call to find a 60 year old female lying on the kitchen floor. Your patient is unresponsive pale diaphoretic. It has a St. carotid pulse of 60 bpm your partner quickly applies patches and begins to look for an IV site. Monitor shows a rhythm resembling ventricular fibrillation you should.

-when you are assessment a monitor readings do not match always re-check the patient and the equipment

"A participant in the EMS system may be suspended by EMS medical director for"

1. Failure to meet the educational and or training requirements of the state or by the EMS medical Director 2. Violation of the EMS act or any rules promulgated under it 3. Failure to maintain proficiency in the provision of basic or advanced life support services. 4. Failure to comply with system, policies, and procedures. 5. Intoxication or personal miss use of any drugs 6. Falsification of any reports or orders. 7. Abandoning or neglecting a patient. 8. An authorized use, or removal of narcotics drugs, or supplies from the ambulance or healthcare facility. 9. Performing or attempting emergency, care, procedures, or techniques, without permission, training, or certification. 10. Discrimination in rendering care. 11. Medical misconduct or incompetence. 12. Physical impairment. 13. Mental impairment. 14. EMS medical Director believes that person is immediate danger to the public 15. Felony act on or off duty.

" prehospital care of an unconscious patient of undetermined cause would include"

1. Fingerstick glucose test - treat hypoglycemia 2. Naloxone for suspected narcotic overdose - 1 to 2 mg IVIOIMIN May repeat Every 2-3 minutes for 2 to 3 doses if no response 3. Monitor vital signs level of consciousness in cardiac rhythm.

The Cincinnati stroke scale includes the following parameters

1. facial droop 2. Speech 3. Arm drift

" approve 10 codes used for medical communications in the queue AEMS system include:"

10-33 run emergent HOT 10-44 run nonemergent COLD 10-56 intoxicated 10-79 dead body 10-96 psychiatric patient

" supine, hypotension syndrome can occur in the pregnant trauma patient over _______ weeks gestation when the enlarged uterus compresses the ________

20 weeks gestation Vena cava

" when delivering medication's for bronchospasms with wheezing, the nebulizer in the prehospital, setting the oxygen flow rate to the medication, Reservoir chamber should be set to"

6-10LPM

Which of the following statements is true regarding the prehospital treatment of serious Burns

Airway management: be alert for the possibility of associated pulmonary injuries if the burn occurred in an enclosed space or during an explosion know any toxic fumes -ensure patent airway -Suction -Utilize oral or nasal airway -Endotracheal intubation Oxygen ventilation -Oxygen -Monitor SPO2 should be greater than 94% Pain Morphine 2 to 4 mg IVP or fentanyl 25 to 50 mcg IVP

" your patient is refusing treatment and transport after an MVC under what circumstances would you be able to accept the refusal at the scene without calling report a medical control"

Low risk refusals require no call to medical control Examples : -Low speed, MVC without significant injury -Isolated injuries, not relate to a high risk mechanism -third-party calls were no injury or illness is present -non-injury call for assistance -Patient with no other concerning complaints. His mental status is not normal but it's confirmed to be usual for the patient by family. Someone will also stay with patient after EMS leaves. -Patient with hypoglycemia due to insulin use that was corrected by room, administering oral glucose or Ivy dextrose and his family will stay on scene with them after EMS leaves -Respiratory patient requiring only one albuterol nebulizer to correct -Patient with the heat related muscle cramp that requires only IV fluids

" which of the following measures should be taken in a neonatal resuscitation, with no signs of meconium present"

Meconium absent: Warm, dry stimulate Respirations low, and or gasping : Position airway support ventilation with BVM 100% O2 at 40 to 60 per minute for 15 to 30 seconds

" prehospital treatment of isolated frostbite includes"

Move patient to warm environment remove wet and restrictive clothing cover affected areas with dry, sterile dressings, prevent thawing and refreezing of the affected areas rewarming a frostbite tissue is best performed in a controlled setting of the emergency department

" on a snow-covered road you arrive to find a driver involved in an MVC car versus electric pole with estimated speed of 30 mph driver was seatbelted in airbags didn't deploy. Patient is ambulating on the scene and reports neck pain three out of 10 and questioned no signs of intoxication or present due to road conditions transport time to receiving hospital is 50 minutes the most appropriate steps would be to:"

PEARLS: -if patient meets assessment criteria, but is ambulatory at the scene, or if a prolong transport of greater than 45 minutes is anticipated, placed a cervical collar on the patient position on a firm stretcher, and instruct the patient to limit spine movement -EMS provider discretion in medical practice should be a guide when determining the need for end circumstances when spinal motion restriction should be employed examples uncooperative patient fighting the application of a spinal motion restriction is not in the patient's best interest a patient with an airway issue that requires patient to be position other than supine will take precedence over immobilization -Spine boards should be removed in the emergency department at the discretion of the ED physician at the earliest appropriate time -If in doubt follow spinal motion or striction guidelines

" you're having difficulty placing an endotracheal tube in a patient with respiratory distress. You quickly recall the contraindications of a combitube airway, which patient would be appropriate to use this on

Patient with an intact gag reflex Patient under the age of 16 or under 5 feet tall Known esophageal, disease, or cirrhosis Ingestion of poison History of esophageal trauma Tracheostomy or laryngectomy Respiratory distress or arrest due to suspected narcotic overdose or hypoglycemia prior to administration of Narcan or dextrose

" the pediatric dosage for epi-in cardiac arrest is"

Pediatric cardiac arrest guidelines: -Secure airway -establish vascular access - epi 0.01mg/kg - et 0.1mg/kg repeat every 3-5 mins

"Which situation does not require an EMS physician to present at the medical control radio or phone?"

Physician to Phone scenarios: -A decision regarding wear a patient is to be transported needs to be made by the resource hospital -Intervention by the resource hospital is indicated -A major EMS incident is declared -When a Quincy ALS unit is requesting permission to respond to a request for assistance outside their normal response area -When an ALS crew is requesting an infield service level downgrade

"Stroke patients require immediate transportation and treatment to produce the best outcomes assessment and treatment of the stroke. Patient includes"

Stroke should be considered an emergency actuation, depending upon the type of stroke patients may be candidates for thrombolytic therapy in the emergency department. Time is critical in on same time, should be kept to a minimum for all patients with signs and symptoms of a stroke. ASSESSMENT: 1. Level of consciousness: AVPU, GCS 2. Cincinnati stroke scale: facial droop, speech, arm drift Facial droop: ask the patient to smile -Normal: both sides of face move equally -Abnormal: one side of face does not move Speech: ask the patient to repeat a simple sentence -Normal: patient uses correct words with no slurring -Abnormal: slurred, or inappropriate words, or unable to speak Arm drift: ask the patient to close eyes and hold arms straight out in front of them -Normal: both arms move equally or not at all -Abnormal: one arm drifts compared to the other 3. Fingerstick glucose 4. Determine time of last known well. 5. Obtain simple history. MEDS*

" your patient is complaining of severe chest pain and dyspnea during your assessment. The patient becomes semi conscious and diaphoretic. The monitor is showing tachycardic rhythm with a rate greater than 150 bpm you should:"

Synchronized cardioversion Start with 50 to 100 J Can increased to 200 J if unsuccessful

" you respond to a one vehicle car, crash and remote area upon assessment of the driver. You know if the patient to be an acute respiratory distress with absent breast sounds on the right side jugular vein, distention hyperresonance to percussion on the right chest wall normal heart tones and tracheal deviation to the left you suspect. "

Tension pneumothorax This is when air enters the pleural space without an exit or release, leading to increased intrathoracic pressure as enter thoracic pressure rises, ventilation is compromised venous, return to the heart decreases resulting in shock Needle decompression should be done only when the following three things are present : 1. Evidence of worsening respiratory distress or difficulty ventilating with a bag mask device. 2. Unilateral, decreased, or absent rest sounds. 3. Decompensated shock systolic blood pressure less than 90 for adults. Other findings associated with the tension, pneumothorax maybe subtle and difficult to identify in the field. These include. -Distended neck veins -Subcutaneous emphysema -Tracheal deviation (late sign)

" unless delayed by extraction or other mitigating circumstances the goal is to have an on screen time of 10 minutes or less when the patient is seriously injured, which procedure should be initiated while in route to the hospital"

The following procedures are appropriate, provide on scene in a load and go situation: -Airway management -Oxygen and ventilation -Seal open pneumothorax -Needle decompression -Stabilization of impaled object's -Spinal motion restriction -Hemorrhage control All other procedures, including IV therapy, splints managing should be performed in route unless the patient is in trapped in the procedures can be done during extraction

" prior to dispatching ALS assistance to an incoming ambulance, transporting a patient with a serious injury, medical control, or the receiving facility should"

The receiving Hospital should wear the benefits of the ALS assistance to patient against the ETA to the hospital and subsequent delay in transport that would occur

" what is the purpose of a local system review board?"

The resource hospital shall designate a local system review board for the purpose of reviewing a decision of the EMS medical Director, to suspend an individual individual provider or participant from participation in the Quincy area. EMS system.

" treatment for the victim of a heat related emergency may include"

Treatment: Move patient to cool environment remove excess of clothing If hypotensive or unconscious : maintain open airway apply oxygen initiate IV. Give normal Celine fluid bolus of 500 mls repeat bolus repeat bolus, if necessary, cardiac monitor, 12 lead EKG, initiate cooling of heat, stroke victim with cool packs and cool soaks to the neck, axillary and groin