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ICEMA PROTOCOLS | ALL QUESTIONS AND
CORRECT ANSWERS | GRADED A+ |
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Pediatric dose for midazolam for seizures? ---------CORRECT ANSWER---- -------------Midazolam, 0.1 mg/kg IV/IO with maximum dose 2.5 mg. May repeat Midazolam in five (5) minutes, or Midazolam, 0.2 mg/kg IM/IN with maximum dose of 5 mg. May repeat Midazolam in ten (10) minutes for continued seizure. IN dosage of Midazolam is doubled due to decreased surface area of nasal mucosa resulting in decreased absorption of medication. Maximum of three (3) doses using any combination of IV/IO/IM/IN may be administered for continued seizure activity. Contact base hospital for additional orders and to discuss further treatment options. Adult dosage for naloxone for suspected narcotic overdose? --------- CORRECT ANSWER-----------------Naloxone, 0.5 mg IV/IO/IM/IN, may repeat Naloxone 0.5 mg IV/IO/IM/IN every two (2) to three (3) minutes if needed. Do not exceed 10 mg of Naloxone total regardless of route administered. Pediatric dosage for naloxone for suspected narcotic overdose? --------- CORRECT ANSWER-----------------1 day to 8 years Naloxone, 0.1 mg/kg IV/IO 9 to 14 years Naloxone, 0.5 mg IV/IO May repeat every two (2) to three (3) minutes if needed. Do not exceed the adult dosage of 10 mg IV/IO/IM/IN.
Dosage for Nitroglycerine? ---------CORRECT ANSWER----------------- Nitroglycerin, 0.4 mg sublingual/transmucosal One (1) every three (3) minutes as needed. May be repeated as long as patient continues to have signs of adequate tissue perfusion. If a Right Ventricular Infarction is suspected, the use of nitrates requires base hospital contact. Nitroglycerin is contraindicated if there are signs of inadequate tissue perfusion or if sexual enhancement medications have been utilized within the past forty-eight (48) hours. Dosage for zofran? ---------CORRECT ANSWER-----------------Ondansetron, 4 mg slow IV/IO/ODT All patients four (4) to eight (8) years old: May administer a total of 4 mgs of Ondansetron prior to base hospital contact. All patients nine (9) and older: May administer Ondansetron 4 mg and may repeat twice, at ten (10) minute intervals, for a total of 12 mgs prior to base hospital contact. When do we administer oxygen? what about COPD patients? --------- CORRECT ANSWER-----------------General Administration (Hypoxia): Titrate Oxygen at lowest rate required to maintain SPO2 at 94%. Do not administer supplemental oxygen for SPO2 > 95% Chronic Obstructive Pulmonary Disease (COPD): Titrate Oxygen at lowest rate required to maintain SPO2 at 90% Do not administer supplemental oxygen for SPO2 > 91%
When can a stroke center divert a stroke patient to another facility? --------- CORRECT ANSWER-----------------Only when the hospital is under internal disaster How quickly must a on call stroke physician respond when they are called? ---------CORRECT ANSWER-----------------30 min 24/ Can a medic transport a patient with blood or blood products? --------- CORRECT ANSWER-----------------No Patients under what age can not receive ondasteron? ---------CORRECT ANSWER-----------------patients under 4 years old When should C-spine be placed? ---------CORRECT ANSWER----------------- Neuro defecits Spinal tenderness altered intoxication destracting injury How should C-pap be used. ---------CORRECT ANSWER----------------- Started at the lowest setting and increased untill relief is felt, not to exceed 15 cm h
Contraindications for cpap ---------CORRECT ANSWER-----------------apnea, unconscious, less than 15 years of age, suspected pneumothorax, vomiting, systolic blood pressure of less than 90 Indications for cpap ---------CORRECT ANSWER-----------------acute asthma/bronchospasm, COPD, acute pulmonary edema/CHF) Ej's are not indicated at what age? ---------CORRECT ANSWER--------------- --8 years and younger. What are two contraindications of placing an IO? ---------CORRECT ANSWER-----------------The site is fractured or there was a previous attempt at the site. Where should IO placement be for a patient 8 years and younger? --------- CORRECT ANSWER-----------------Anterior medial aspect of tibia, 2 cm below the tibial tuberosity What sites can be used for patients 9 and older? ---------CORRECT ANSWER------------------Anterior medial aspect of tibia, 2 cm below the tibial tuberosity.
- lower end of tibia, 2cm above the malleolus
- proximal humerus What IO site needs a BHO? ---------CORRECT ANSWER-----------------Distal femur, 2cm above the patella
What medication do we ALWAYS administer before attempting nasotracheal intubation? ---------CORRECT ANSWER----------------- phenylrphrine HCL 0.5 mg What is your landmark for a needle cricothyrotomy? ---------CORRECT ANSWER-----------------Between the thyroid and cricoid membranes What is your landmark for a needle thorcostomy? ---------CORRECT ANSWER-----------------2nd intercostal space superior to the third rib, midclavicular line. What is an alternative needle thorocostomy site and what patients must we take special consideration for before doing it? ---------CORRECT ANSWER- ----------------between 4th and 5th rib mid auxiliary. take special consideration in 3rd trimester of pregnancy due to displacement of the liver and spleen After ___ failed attempts to intubate, base hospital must be contacted. ------ ---CORRECT ANSWER----------------- 3 Containdications for ETT placement? ---------CORRECT ANSWER------------ -----ALOC due to narcotic overdose or hypoglycemia Stop attempting ET tube placement how many seconds before we need to start ventalations? ---------CORRECT ANSWER-----------------20 seconds
Patients under 8 years old and intubated should also have what in place? -- -------CORRECT ANSWER-----------------c-collar to prevent dislodgment of tube. What should we put in place after every intubation? ---------CORRECT ANSWER-----------------NG/OG tube
- use lidocaine to assist with insertion What energy levels do we cardiovert at? ---------CORRECT ANSWER-------- ---------100J, 200J, 300J, and 360J At what age can we not perform TCP? ---------CORRECT ANSWER---------- -------8 years and younger How do we perform TCP? ---------CORRECT ANSWER-----------------set at 60 bpm and start at the lowest setting and increase until we find capture. What is the maximum time you should have somebody use a vagul maneuver? ---------CORRECT ANSWER-----------------no more than 10 seconds If an adult patient in a respiratory emergency is showing signs of poor tissue perfusion, how much fluids can we administer? ---------CORRECT ANSWER-----------------300 ml bolus and repeat until improvement is seen
What are the four criteria is that a multi casualty incident can be declared? - --------CORRECT ANSWER-----------------1.Incident requires five or more ambulances
- Incident involves 10 or more patients
- Requires utilization of triage tags
- May require patient distribution to more than one hospital. Adults shall be triaged in an MCI using what system? ---------CORRECT ANSWER-----------------The START system Pediatric patients shall be triaged in an MCI using what system? --------- CORRECT ANSWER-----------------The JumpSTART system The first arriving resource should do what on an MCI? ---------CORRECT ANSWER-----------------Declare in MCI; establish command, name the incident, and request hospital bed availability through the coordinated communication center. How can the coordinated communication center (CCC) be reached on the radio? ---------CORRECT ANSWER-----------------On the med COM talk group. Medcom shall notify the CCC with the following information for all patients the part in the scene.... ---------CORRECT ANSWER-----------------1. Transport method (Air, ground, bus)
- Transport agency and unit
- Number of patients 4.classification of patient ( immediate, delayed, minor)
- Destination Transporting units show make attempts to contact the receiving hospital in route to provide patient information. What information should be provided? ---------CORRECT ANSWER-----------------1. Incident name
- Transporting agency and unit number
- Age/sex
- Mechanism of injury
- chief complaint and related injuries that may need special services
- GCS score 7.ETA The patient transportation unit leader may decide to transport "minor" patients with what type of vehicles? ---------CORRECT ANSWER-------------- ---Non-emergency vehicles If nonemergency vehicles are used for transport during a multi casualty incident who must accompany them? ---------CORRECT ANSWER------------ -----At least one paramedic and one EMT (1 ALS team) An ALS team should never exceed what patient ratio? ---------CORRECT ANSWER-----------------15 patients: 1 ALS team What system in hospitals is in place to review hospital bed availability? ----- ----CORRECT ANSWER-----------------The ReddiNet system At what age should the jumpstart system be used to triage children? --------- CORRECT ANSWER-----------------Under the age of nine
What is the dosage for albuterol in pediatrics? ---------CORRECT ANSWER-----------------2.5mg nebulized. May repeat two times. What is the dosage for Asprin? ---------CORRECT ANSWER----------------- 325 mg (4 chewable 81mg tablets) The paramedics are on scene and need to access an external jugular vein. In which patient is Base Hospital contact not required? ---------CORRECT ANSWER-----------------EJ's are indicated in any patient over 8 years old where peripheral IV access is needed but cannot be established elsewhere.. Contraindicated in patients under 8. What is an indication for transcutaneous pacing? ---------CORRECT ANSWER-----------------Symptomatic bradycardia What is an indication for oral endotracheal intubation? ---------CORRECT ANSWER-----------------1. Non-responsive patient with failing respirations and no gag reflex.
- Non-responsive and apneic patient
- When prolonged ventilation is required and adequate ventilation cannot be achieved otherwise. Prior to an intubation attempt in an adult patient with a head injury, what is the prophylactic dose of lidocaine? ---------CORRECT ANSWER--------------- --1.5mg/kg
According to the pediatric A neonate intubation protocol, which of the following statements is correcf? ---------CORRECT ANSWER----------------- After two intubation attempts, Base Hospital contact is required. is it true or false.according to the "Axial Spinal Immobilization"LS personnel may remove axial spinal immobilization placed on a patient by BLS personnel, if the patient isn't exhibiting any of the criteria for placement of axial spinal immobilization and after a complete assessment and documentation have been done ---------CORRECT ANSWER-----------------true What medications can be given down the et tube ---------CORRECT ANSWER-----------------no meds down the ET tube when is Nasotracheal intubation contraindicated and when should BH contact be made? ---------CORRECT ANSWER-----------------Apnea. BHO needed in pt with facial trauma, anticoagulant therapy, failed CPAP and burns to airway. Blunt chest trauma with increasing signs of respiratory distress and hypotension may be an indicator to perform? ---------CORRECT ANSWER-- ---------------a needle thoracostomy a patient that cannot be ventilated after failed BLS and ALS maneuvers would be a candidate for what? ---------CORRECT ANSWER-----------------a needle cricothyrotomy
What is the initial system used to rapidly triage and transport patients ------- --CORRECT ANSWER-----------------START Simple triage and rapid transport What are the requirements for the application of restraints in the prehospital setting ---------CORRECT ANSWER------------------restraints must be padded or soft with a method for quick release
- restraints placed by law enforcement officers require law enforcement officers to accompany the patient during transport
- patients must be transported while supine and shall avoid obstruction airway or vascular comprimise.
- PMSC's shall be evaluated every 15 minutes The paramedics are called to an alley where they find a 36-year-old male. He has obvious signs of rigormortis. The BIS providers who arrived first have started CPR. What shouldthe paramedic's next action be? --------- CORRECT ANSWER-----------------Stop CPR, determine death, and contact the coroner or proper authorities The paramedicsare at the apartment of a 56-year-old female with a history of cancer and diabetes. The patient is unresponsive with stable vitals and a blood sugar of 50. The family provides a valid DNR. What action should the paramedics take? ---------CORRECT ANSWER-----------------Educate the family that this is reversible state, establish an IV, and administer dextrose Which of the following situations require a paramedic to continue treatment and make Base Hospital contact before determining death andterminating further treatment? ---------CORRECT ANSWER-----------------When Asystole has been confirmed in 2 leads and there is no response after an initial cycle of ACLS drugs.
The paramedics are on scene with a suspected sudden infant death syndrome incident. What actions should they take? ---------CORRECT ANSWER------------------Providethe parent/caregiver with the number of the California SIDS Information Line.
- Assure the parent/caregiver that your activities are standard procedure for the investigation al all death incidents.
- Follow individual department/agencies policiesat all times According to protocol "Organ Donor Information," what should occur when attempting to locate an organ donor card. ---------CORRECT ANSWER------ -----------patient must be at least 18 years old and a brief attempt to locate a card in a wallet or purse may take place. this attempt to locate shall not interfere with patient care. albuterol is indicated in what conditions? ---------CORRECT ANSWER------- -----------Acute allergic reactions with dyspnea and wheezing.
- Chronic obstructive pulmonary disease with increased dyspnea and wheezing.
- Dyspnea and wheezing present in a burn patient The paramedics are on scene with a 9-year-old male who is complaining of difficulty breathing. His mother tells you "he has had asthma since he was five years old." Wheezes are present throughout all lung fields. The paramedics have given him two doses of nebulized albuterol 2.5 mg with Atrovent 0.5 mg without improvement. They make Base Hospital contact, what orders might they receive? ---------CORRECT ANSWER----------------- Epinephrine 0.01 mg/ kg of 1:1,000 IM The paramedics are on scene with a 65-year-old male that is experiencing a severe asthma attack. The patient has a history of asthma and cardiac
The paramedics are called to a restaurant where they find a 26-year-old female in severe anaphylactic shock. She has no palpable radial pulse and has a decreased level of consciousness. Her friends te ll the paramedics she waseating shrimp andstarted having trouble breathing. Prior to contact the paramedics mayadminister which of the following? ---------CORRECT ANSWER------------------ Obtain vascular access, for signs of inadequate tissue perfusion initiate IV bolus of SOOcc NS.
- Epinephrine O.Smg SC if no response to albuterol.
- Diphenhydramine 25mg IVP. The paramedics are on scene with an 11 year-old with an acute allergic reaction. He is alert stating, "I can't breathe and I think I am going to throw- up." His vitals are: radial pulse, 100 strong/regular, respirations32 and B/P 100/P. The paramedics have placed the patient on oxygen and established an IV. They have administered two nebulized albuterol with atrovent treatments. There has been no improvement or changes in the patient's condition. What further field care treatment should they do prior to Base Hospital Contact? ---------CORRECT ANSWER------------------ Epinephrine (1:1000) O.O1mg/kg IM not to exceed the adult dose of O.3mg
- 300cc fluid challenge
- Diphenhydramine 25mg IV The protocol for "Chest Pain" states that during radio communication failure, nitroglycerine and morphine may be repeated as long as... --------- CORRECT ANSWER-----------------As long as signs of adequate tissue perf usion are present the paramedics have identified a patient with MI symptomology. What treatments should be utilized? ---------CORRECT ANSWER----------------- 324mg ASA Nitro 0.4mg repeated every 3-5 min
Fentanyl 50mcg IV Consider obtaining 2nd IV site Under the chest pain protocol, how much fentanyl can be given during radio communication failure? ---------CORRECT ANSWER-----------------an additional 100mcg in 50mcg increments What should a paramedics treatment be for a hypertensive patient with a complaint of a headache and dizziness? ---------CORRECT ANSWER-------- ---------perform a strokes scale. position of comfort with the head elevated. Establish an IV with a saline lock The paramedics are at the home of a 52-year-old male with a C/C of "a slight fluttering sensation, but no chest pain." These sensations started while he was watching TV. His skins are normal, warm and dry, B/P 140/90, pulse 180, and respirations 20. Lung sounds are clear. Capillary refill is immediate. He is oriented x4. The paramedics have placed him on 6L of 02/nasal cannula. The monitor shows an SVT. The patient has no previous medical history and no known allergies. They have established an IV of NS @ a TKO rate. Vagal maneuvers have been attempted without success.What should the paramedic'snext step be? ---------CORRECT ANSWER-----------------administer adenosine 6 mg rapid IVP. The paramedics are called to the home of a 62-year-old male. When they arrive they find a man who is unconscious. He is pale, cool and profusely diaphoretic. Vital signs are B/P 70/P, radial pulse is weak and rapid, respirations 12. Lungs clear. Level of consciousness is eye-none verbal- incomprehensible and motor-withdrawal. The monitor shows ventricular tachycardia at 140. The paramedics place the patient on 02 @ 15 liters by mask. IV access has been established.Prior to Base Hospital contact what
