Term
| responsibilities of base hospital in supervising the medical care by paramedics and MICNs. policy 304 |
|
Definition
implement and monitor the policies, procedures, protocols, and guidelines approved by laco ems agency. base hospital physician has the ultimate responsibility for treatment of the patient. report violations of prehospital care staff.
provide formal education programs for prehospital personnel.
-read the policy for actual verbage and addtl info |
|
|
Term
| discuss als unit staffing requirements for 911 and ift transport. policy ref 408 and 409 |
|
Definition
all units both public and private shall be staffed with at least to state licensed and county accredited or 2 MICNs.
If given permission by EMS agency. providers my staff 1 paramedic and 1 emt for the purpose of IFTs. (policy 517) |
|
|
Term
describe principles used to determine patient destination. policy 502 and 517
part 1 (covers just 502) |
|
Definition
patients go to MAR unless specialty center is needed, base hospital deems other destination necessary, or patient request if patient is somewhat stable and would not unreasonably put a unit out of service.
if base hospital request diversion it must be within 15minute drive time and the patient must not have an uncontrollable problem, ie. an unmanageable airway or an uncontrollable bleed. |
|
|
Term
| true or false... base hospital contact is not needed for routine ALS IFTs |
|
Definition
| true. if patient's condition deteriorates then begin prior to base contact treatment and then contact base to decide if destination must be changed. |
|
|
Term
| policy 517. true or false...paramedics may take standing orders from sending facilities in case patient deteriorates. |
|
Definition
| false. base contact must be made if anything besides what you are already monitoring (IV drip, etc.) is needed or a different complaint arrises. |
|
|
Term
as per policy 503 what are the 6 categories that hospitals can divert?
what is special to bls and diversion? |
|
Definition
1. closed due to ED sat
2. closed due to lack of CT scanner
3.trauma diversion request due to either lack of equipment, OR sat, or ED sat.
4.PMC lack of equipment diversion request.
5. being sent to a different stemi center because the closest is saturated.
6.Internal disaster.
bls can only be diverted if by internal disaster. |
|
|
Term
| identify the proper destination for trauma patients. policy 506 |
|
Definition
there are 5 steps to trauma triage policy 506
physiological assessment, anatomical injury, mechanism of injury, trauma guidelines assessment, special considerations.
we will go over each one in the next 5 cards. |
|
|
Term
| Step 1 trauma triage criteria |
|
Definition
-SBP less than 90
-SBP less than 70 infants less than 1 year
-greater than 29 breaths/minute sustained
-less than 10 breaths/minute
-less than 20 breaths/minute in infants less than 1 year or infants requiring ventilatory support
-cardiac arrest with penetrating torso trauma
step 1,2,or 3 require transport to designated trauma center. 14 and younger goes to PTC |
|
|
Term
|
Definition
Anatomical injury assessment
-all penetrating injuries to head, neck,torso, and extremities above the elbow or knee.
-blunt head injury associated with: suspected skull fracture, gcs less or equal to 14, seizures, unequal pupils, or a neuro defecit
-spinal injury with sensory or motor defecit
-blunt chest injury with unstable chest wall (flail chest)
-diffuse abdominal tenderness
-suspected pelvic fracture (excluding isolated hip fx from a ground level fall)
-extremity injuries with: neuro/vascular compromise and/or crushed, degloved, or mangled; amputation proximal to wrist or ankle; or fractures of 2 or more long bones (femur/humerus)
step 1,2,or 3 require transport to designated trauma center. 14 and younger goes to PTC |
|
|
Term
| step 3 trauma. What is the category and the encompassing criteria? |
|
Definition
Step 3 is the mechanism of injury
-Falls: Adult patients > 15 feet
Peds >10 feet or > 3 times the height of the child.
-PSI > 12 inches occupant side, >18 inches any other site.
-vehicle ejection whether partial or complete
-auto vs. ped/bike/motorcycle thrown, run over, or impact greater than 20mph
-unenclosed transport crash with significant impact (>20mph)
step 1,2,or 3 require transport to designated trauma center. 14 and younger goes to PTC |
|
|
Term
| Step 4 trauma. What is its criteria and what is the patient's destination? |
|
Definition
Trauma Guidelines.
-auto vs ped/bike/motorcycle (impact less than 20 mph)
-injured victims of a TC with a fatality in same vehicle
-patients requiring extrication
-vehicle telemetry data consistent with high risk of injury
-injured patients (excluding minor extremity injuries) on anticoagulation therapy other than aspirin-only or bleeding disorders.
Consult with trauma center/base hospital, transport to designated trauma center is advisable. |
|
|
Term
| step 5. Criteria and transport to where? |
|
Definition
Special considerations
-adults age greater than 55
-SBP less than 110 after age 65 (may represent shock)
-Pregnancy greater than 20 weeks
-Prehospital judgement |
|
|
Term
| identify the appropriate destination for a victim of sexual assault. policy 508 |
|
Definition
sexual assault patient who deny physical injuries and who do not meet base contact, may be released at scene to local law enforcement.
every effort should be made to transport sexual assault patient to the MAR with a SART center. If unreasonable transport time then head to regular MAR.
Notify law enforcement regardless of whether there are physical injuries and document whom the incident was reported to. |
|
|
Term
| state the age that determines when destination should be the pediatric care center. policy 510. |
|
Definition
ped patient is defined as 14 years of age or younger.
patients who meet requirements for pmc must go to pmc if transport is within 20minutes, if not then edap.
trauma patients must be sent to a PTC within 30 minutes if a PTC cannont be reched, then trauma center, if no trauma center avail, then EDAP. |
|
|
Term
| guidelines for identifying critically ill peds patients who require transport to a PMC (6) |
|
Definition
1.cardiac dysrhythmias
2. severe resp distress
3. cyanosis
4. persisten altered mental status
5. status epilepticus
6 ALTE and less than or equal to 12months in age. |
|
|
Term
| guidelines to establishing when a pediatric patient requires a PTC |
|
Definition
| if they meet trauma criteria, duh! just went over that few cards back |
|
|
Term
| identify 3 different destinations pediatric patients my be transported to |
|
Definition
|
|
Term
| what is perinatal qualify as? |
|
Definition
| perinatal is a patient who is at least 20weeks pregnant |
|
|
Term
| what type of patients should be transported to the most accessible perinatal? |
|
Definition
1. patients who appear to be in labor
2.patients whos chief complaint is related to pregnancy or is appearing to have perinatal complications
3. injured patient who do not meet trauma criteria |
|
|
Term
| perinatal patients meeting trauma criteria should be transported to? |
|
Definition
|
|
Term
| if transport for the perinatal patient is longer than 20minutes then... |
|
Definition
| transport to MAR that is an EDAP as well. Mayo makes our life somewhat easy. |
|
|
Term
the following perinatal patients should be transported where?
a. acute respiratory distress
b. patients in full arrest
c. those whos complaint is not clearly related to pregnancy |
|
Definition
|
|
Term
| remember to honor those requests to specific hospitals if they have already chosen an OB |
|
Definition
|
|
Term
| burn patients without trauma criteria go where? |
|
Definition
| to the MAR. It is their responsibility to stabilize the patient. |
|
|
Term
| burn patients with trauma criteria? |
|
Definition
| go to trauma center or PMC if PMC criteria is met and within 20minutes drive time. |
|
|
Term
policy 513. identify proper management of patients with a STEMI.
what if transport is farther than 30minutes?
what about requests to specific SRCs? |
|
Definition
patients will go to a stemi receiving center if it is within 30 minutes.
if over 30 minute ETA head to MAR.
you can honor patient requests if patient is stable and it is within 30minutes. |
|
|
Term
| identify appropriate destination for a cardiac arrest patient with rosc. policy 516 |
|
Definition
| policy 516 ststes that if over 14 and have rosc, if not meeting trauma guidelines, the patient will be taken to closest SRC. if transport over 30minutes long than MAR is acceptable. Read therapeutic hypothermia handout. |
|
|
Term
| discuss how patient destination is determined during a multi casualty incident. policy 519 |
|
Definition
| after patient is tagged (red,yellow,green) they are given destination. patients are reassessed once removed and sent to trauma center if indicated by trauma policy, PMC or PTC if indicated, or just edap or MAR based on bed availability and patient overall condition. |
|
|
Term
|
Definition
| approved stroke center.... |
|
|
Term
| la county mLAPSS or modified Los Angeles Prehospital Stroke Screen. What are the 6 criteria? |
|
Definition
1. symptom duration less than 2 hours
2. no history of seizures or epilepsy
3. age greater than 40
4. patient is not wheelchair bound or bedridden at baseline
5. blood glucose between 60 and 400mg/dl
6. motor exam: facial symmetry, grips, arm strength. (exam is positive if one or more of section 6 is present) |
|
|
Term
| if transport to ASC is more than 30 minutes |
|
Definition
|
|
Term
| just read policy 702 on controlled substances...hard to tell what might be test question |
|
Definition
|
|
Term
| how emt scope of practice impacts ALS field treatment procedures...policy 802 |
|
Definition
| only thing really outlined is that EMTs may setup procedures for medics if under supervision. Everything else is just emt scope of practice, including assisting with meds like nitro and epi pen |
|
|
Term
| on policy 803, paramedic scope of practice. It outlines what we can do per state and and what the county allows. Name some of the 12 adjustments LA county DHS has made |
|
Definition
1. PVAD access allowed on all above skin devices
2. state says we can administer glucose and ringers lactate solutions....county says only saline can be administered. Glucose and ringers solutions may be monitored
3. needle cricothyroidotomy not allowed in la county
4. needle T only allowed in 2nd intercostal space - mid clavicular.
5.up to 40 meq/ml of potassium may be monitored.
6.no meds allowed to be given via ET
7. d25 may be diluted from d50
8. no activated charcoal
9.some stupid verbage on albuterol and nebulizer or fda approved delivery device
10. diazepam for disaster caches only
11.no lasix
12. no lidocaine |
|
|
Term
| discuss how 806 benefits timely initiation of patient care |
|
Definition
| 806 is prior to base contact....so you can start treating and not need base yet...dur |
|
|
Term
| identify procedures and treatments allowed prio to base...policy 806 |
|
Definition
| see other cards for full prior to base practice title APLO |
|
|
Term
808 defines when base contact must be initiated. in reference to pediatric patients, when must you contact base?
if parent refuses transport what must happen? |
|
Definition
-all children under 3 require base hospital contact and/or transport except isolated minor extremity injuries.
-infants shall be transported regardless of complaint or moi
-if parent or legal guardian refuse transport base contact is required prior to leaving the scene |
|
|
Term
| in accordance with policy 808, base contact is required for 16 specific patient complaints. attempt to name them all. |
|
Definition
1. signs or symptoms of shock
2. cardiac arrest unless 814,815, or 821 apply
3. chest pain or discomfort
4. SOB or tachypnea
5. PMC PTC criteria
6. 5 or more patients requiring transport
7. ALOC
8. suspected ingestion of poisonous substance
9. exposure to hazardous materials with a medical complaint
10. abd pain and pregnancy or suspected pregnant
11. childbirth or signs of labor
12. suspected pelvis or femur fracture
13. facial, neck, electrical, or extensive burns greater than 20% in adults, 15% in peds, and 10% in infants.
14. trauma criteria met
15. syncope, loss of conciousness, acute neurological symptoms
16. AMA and any of the previous 15 met. |
|
|
Term
| remember if base contact cannot be made you are able to treat patient if, in your judgement it is a life saving procedure. |
|
Definition
|
|
Term
| what is the difference between pronouncement and determination of death. |
|
Definition
| doctors pronounce, pre hospital determine. |
|
|
Term
| transporting patients without ROSC is |
|
Definition
|
|
Term
| ok, time for the 11 things per policy 814 that give paramedics the power to determine death and NOT contact base |
|
Definition
1. decapitation
2. massive crush injury
3. penetrating or blunt injury with evisceration of the heart, lung, or brain
4. decomposition
5. incineration
6. pulseless, non breathing victims with extrication time greater than fifteen minutes, and no resuscitative measures can be performed prior to extrication
7. blunt trauma patients who, based on a paramedic's thorough patient assessment, are found apneic, pulseless, and without organized ECG activity (narrow complex supraventricular rhythm) upon the arrival of ems personnel at the scene
8. pulseless, non breathing victims of a multiple victim incident without sufficient resources
9. drowning victims when it has been over an hour of submersion.
10. rigor mortins (requires continued assessment)
11. post-mortem lividity (requires assessment) |
|
|
Term
| rigor and lividity is not enough to determine death...must have assessment of respirations over 30 seconds, cardiac status, and neuro relexes. |
|
Definition
|
|
Term
| if you have a patient who is atraumatic and in cardiac arrest and it has been over 10 minutes without cpr and they are currently in asystole...what do you do? |
|
Definition
| discontinue cpr if started and determine dead. |
|
|
Term
if your patient is not able to be determined death and you must work it up, what do you do?
what are some exceptions to determination of death without ROSC after 20 minutes |
|
Definition
contact base. the base hospital physician my pronounce death when it is determined that further efforts are futile.
patient without ROSC after 20 minutes should be considered candidates for termination of resuscitation.
Exceptions include hypothermia, patients who remain in, or whose rhythm changes to, vfib or pulseless vtach. |
|
|
Term
| discuss procedures as per policy 814 that must be performed and documented for determination or pronouncement in field when ROSC has not occured. |
|
Definition
the time and criteria utilized to determine death. location and position of body, and any care provided.
if deceased moved explain why
time of pronouncement and name of pronouncing physician. |
|
|
Term
| explain the procedure that allows a physician at scene to assume responsibly of patient care. policy 816 |
|
Definition
paramedics shall obtain proper identification, consisting of a california physicians and surgeons license. note the physician's name, license number and license expiration date on ems report form.
contact base and notify them of the presence of a physician on scene.
if physician chooses to assume or retain responsibility for medical care, paramedics shall instruct that they must take total care and accompany patient to hospital. |
|
|
Term
| identify specific abusive situations that must be reported by paramedics |
|
Definition
all non accdidental injuries, sexual abuse, or neglect to children.
elder abuse and dependent adult abuse. |
|
|
Term
| policy 832, discuss the proper disposition of minors when no treatment or transport is required. |
|
Definition
minor child who is evaluated by ems personnel and determined not to be injured or to have sustained only minor injuries or illnesses not requiring immediate treatment or transport may be released to:
parent
self - given the age a maturity
responsible adult at the scene
designated care giver
law enforcement
children less than 36 months require base contact |
|
|
Term
| compare and contrast released at scene to those who are left via ama. policy 832 and 834 |
|
Definition
released at scene is a patient who does not meet any policy 808 criteria (chest pain, sob, aloc, etc...)
ama is for those who meet policy 808 |
|
|
Term
| describe how competence is determined for purposes of treatment and transport. policy 834 |
|
Definition
| a patient who alert and oriented and has the capacity to understand the circumstances surrounding their illness/injury and the risks associated with refusal of treatment. |
|
|
Term
| describe the procedure to be followed when a patient declines treatment or transport |
|
Definition
ems report must be completed including:
1. patient hx and assessment
2. patient mental status
3. what the patient is refusing
4. why the patient is refusing
5. risk and consequences of refusing
6. statement that the patient understands risks and consequences
7. signature of patient or legal guardian
8. patient's plan for follow up |
|
|
Term
| compare and contrast the types of restraints that are approved and those that are not. policy 838 |
|
Definition
restraints must be padded hard or soft and must be able to released quickly.
restraints may not be hard plastic ties, be behind the back and feet, sandwiching patient with boards is not allowed, and any type of materials that can cause neuro or respiratory damage. |
|
|
Term
| describe the procedure for maintaining continuous accreditation for paramedics/micns in la county. |
|
Definition
1. maintain continuous california paramedic state licensure
2. be currently employed and sponsored by an approved paramedic provider agency
3. complete current mandatory EMS agency programs. |
|
|
Term
| describe field presentation of an ALTE as per handout |
|
Definition
alte in a infant (12months and under) is described as an episode that is frightening to the observer and characterized by some combination of:
1. transient apnea
2. color change (usually pale or cyanotic, but sometimes red)
3. marked changes in muscle tone
4. choking
5. gagging |
|
|
Term
| state assessment and reporting requirements for peds weights in la county |
|
Definition
peds tape. paramedics should obtain only the patient's weight and treatment color from the tape and then utilize the color drug doses/la county kids chart for the drug doses
ped age is defined as 14 or younger. |
|
|
Term
| give the indications and benefits of using cpap for a patient in respiratory distress. |
|
Definition
cpap is approved for patients greater than 14 with moderate to severe respiratory distress.
cpap is a non invasive mechanically assisted oxygen delivery system designed to decrease the work of breathing and allowing time for patients to respond to medical therapies. |
|
|
Term
|
Definition
| uncooperative patient or an inability to follow instructions, resp or cardiac arrest, suspected pneumothorax, tracheostomy, facial, head or chest trauma, vomiting, moderate or severe epistaxis, and hypotension. |
|
|
Term
|
Definition
|
|
Term
| what is the difference between crush injury and crush syndrome |
|
Definition
| easy. crush injury is one quick high weight crush. crush syndrome occurs from prolonged crush allowing acids and tissue breakdown to occur in affected limb or body. |
|
|
Term
| field management of crush injury |
|
Definition
1.airways
2. spinal immobilization
3. oxygen/pulse oximetry
4. advanced airway prn
5. cardiac monitor
6. IV acces
7. prior to base pain management
8. contact base
9. NS to dilute cellular toxins, 20ml/kg iv bolus (adult and peds) then 500ml/hr for adults...peds is confusing lol
10. morphine after base contact if given
11. if it becomes true crush syndrome, albuterol, calcium chloride 1gm slow ivp over 60 seconds, and sodium bicarb 1meq/kg added to first liter of saline both adults and peds but only administer 20ml/kg to peds. |
|
|
Term
| describe methods to increase success of first attempt intubation. six things |
|
Definition
1. position the patient - increase head elevation when not in c-spine
2. oxygenate with bvm and oral airway
3. macintosh #4, cricoid pressure by assistant
4. release cricoid - bimanual laryngoscopy
5. straight to cuff styletted tube or bougie
6. suctioning |
|
|
Term
| indications and contraindications to ET tube introducer |
|
Definition
indicated: inability to visualize the vocal chords, inability to intubate using standard techniques
contraindications: not to be used in patients under 14 years of age |
|
|
Term
| placement of ET tube must be verified after what 5 things? |
|
Definition
-immediately after placement
-after major movement of patient
-after manipulation of neck
-after any unexpected color change in EtCO2 detector
-when waveform capnography is not continually present |
|
|
Term
| describe methods to verify successful intubation |
|
Definition
-EDD
-EtCO2
-colormetric device
-auscultate LS
-direct visualization |
|
|
Term
zofran doses (requires base contact)
indicated when? contraindicated? |
|
Definition
indicated for nausea and vomiting, regardless of mechanism. contra if under 4 or parkinsons patient receiving apomorphine(my cause hypotension and ALOC).
adult: 4mg slow ivp, 4mg IM or ODT
peds: 4mg IV, IM or ODT - for patients under 40kg use only ODT route
NO REPEAT DOSES FOR ADULT OR PEDS. |
|
|
Term
| describe the field management of nerve agent exposure including 2pam |
|
Definition
based on mild, moderate, or severe.
mild gives one dose of duo dote or mark 1 kit (atropine 2.1mg pralidoxime 600mg), or atropine 2mgim or iv every 5 minutes until symptoms improve. peds 0.0.5mg/kg of atropine IV or IM |
|
|
Term
| moderate exposure: miosis, rhinorrhea, sob, and or vomiting and diarrhea. adult and peds dose |
|
Definition
adult: 2 doses of mark 1/duodote, or atropine 2mg IM/IV every 5 minutes until symptoms improve. after 6mg IM give all repeat doses IV only.
peds: 0.05mg/kg |
|
|
Term
| severe exposure: SLUDGE, and SOB/Resp arrest, cyanosis, seizures, unconsciousness. Adult and peds doses |
|
Definition
adult: 3 doses of duodote/mark 1 one after another, midazolam 2-5mg IV titrated to seizure control. max of 10mg versed. diazepam 10mg IM or 5-10mg IV if available. If symptoms persist atropine 2mg IM or IV every 5 minutes
peds: 0.1mg/kg IV, 5mg IM if no IV access. if symptoms persist u can use atropine 0.05mg/kg IM/IV |
|
|
Term
| compare CHF, COPD, and Pneumonia |
|
Definition
chf: rales, nitro based off bp max of 9 doses, cpap
copd: o2 prn, albuterol for wheezes 2.5mg if under 1, 5mg if over 1. if respiratory worsens....contact base for 0.3mg epi IM for adult, 0.01mg/kg to a max of 0.3mg for peds
pneumonia - 02 prn, albuterol for wheezes. watch for sepsis |
|
|
Term
what are some non invasive pain management techniques
pain management adult and peds doses |
|
Definition
splint injured extremity and elevate, reposition, ice pack, distracting measures, reassurance.
adult: 2-12mg IVP titrated to relief, 4-12mg IM if no IV access may repeat every 5minutes to a max of 20mg all routes
peds:0.1mg/kg slow IVP/IM see color code and do not repeat dose, max 4mg all routes |
|
|
