2022-24 Common EMS Protocols

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Questions and Answers

What is the title of the medical director mentioned in the protocol?

Medical Director Miami Beach Fire Rescue

Medical Director City of Miami and Village of Key Biscayne (correct)

Medical Director Coral Gables Fire Department

Medical Director City of Miami

Who is the Fire Chief of Coral Gables Fire Department?

Armando Clift

Marcos DelaRosa (correct)

Vir ernandez

Paul J Adams

What is the name of the protocol reviewed by the Protocol Review Committee?

Coral Gables Fire Department Protocols

2022-24 Common EMS Protocols (correct)

Miami Beach Fire Rescue Protocols

Village of Key Biscayne Fire Protocols

Who is the Medical Director of CGFD/HFD/MBFD?

Frederick M.Keroff Signup and view all the answers

How many fire departments are involved in the 2022-24 Common EMS Protocols?

5 Signup and view all the answers

Who is the Associate Medical Director of City of Miami and Village of Key Biscayne?

Armando Clift Signup and view all the answers

What is the primary use of a bougie in airway management?

To place an ETT through the vocal cords Signup and view all the answers

Why is it important to maintain the patient's head and neck in a neutral position?

To prevent displacement of the airway device Signup and view all the answers

What is the first step in changing the airway from an I-gel to an ETT using a bougie?

Insert the bougie into the I-gel and through the vocal cords Signup and view all the answers

What should you consider if the patient's SpO2 levels drop to less than 94%?

Displacement of the airway device, obstruction of the device, pneumothorax, and equipment failure Signup and view all the answers

What is the purpose of waveform capnography?

To confirm placement of the ETT Signup and view all the answers

What is the marker used to guide the placement of the ETT?

20 mm marker at the lips Signup and view all the answers

What is the characteristic of Benadryl compared to epinephrine?

Slower in onset and longer in duration Signup and view all the answers

What should be done immediately after a monitor indicates VF/Pulseless V-Tach?

DEFIBRILLATE and immediately resume 2 minutes of CPR Signup and view all the answers

What is a potential first sign of upper airway obstruction in patients?

Changes in the tone of voice or a muffled speech Signup and view all the answers

What should be administered within the first minute after resuming CPR?

Amiodarone, 300 mg IOP/IVP Signup and view all the answers

What is recommended for airway interventions in patients unless it's an emergency?

Doing it in a hospital setting Signup and view all the answers

Why is it important to monitor ETCO2 and SpO2 during transport?

To monitor respiratory status Signup and view all the answers

How often can epinephrine be repeated during the arrest?

Every 3-5 minutes Signup and view all the answers

What should be done if the rhythm is NOT shockable?

Check for pulse and if absent, resume CPR and treat as PEA/Asystole Signup and view all the answers

What is the primary cause of upper back pain or thoracic spine pain?

Internal conditions Signup and view all the answers

How long should pulse checks be when the rhythm is NOT shockable?

Up to 10 seconds Signup and view all the answers

What is the most valuable component in understanding back pain?

Patient history Signup and view all the answers

What should be done after completing every 2-minute cycle of CPR?

Check rhythm, and if the patient remains in a shockable rhythm, DEFIBRILLATE Signup and view all the answers

What should you do if the rhythm is not shockable?

Check for pulse and if absent, resume CPR and treat as PEA/Asystole Signup and view all the answers

What is the recommended energy level for double sequential defibrillation using two Zolls or two MRXs?

400 joules Signup and view all the answers

When should you consider double sequential defibrillation?

After the 4 initial defibrillations have failed Signup and view all the answers

How should the second set of pads be placed for double sequential defibrillation?

In the alternative position Signup and view all the answers

What should be done with all subsequent defibrillations after double sequential defibrillation?

Use the same maximum joules Signup and view all the answers

Why is it important to inform ED personnel about the maximum shocks delivered?

So they can adjust their treatment plan Signup and view all the answers

Study Notes

Medical and Fire Department Roles

Medical Director title is not specified in the provided protocol.
Fire Chief of Coral Gables Fire Department is identified as Edward J. (Ted) Gac.
Protocol reviewed by the Protocol Review Committee is referred to as the 2022-24 Common EMS Protocols.
Medical Director for CGFD/HFD/MBFD is Dr. Philip K. Cutz.

Protocol and Administration

Involved fire departments in the 2022-24 Common EMS Protocols total six.
Associate Medical Director for the City of Miami and Village of Key Biscayne is Dr. Rosenberg.

Airway Management

Bougie is primarily used to assist with intubation in airway management.
Maintaining the patient's head and neck in a neutral position is crucial to prevent airway compromise.

Airway Transitioning Process

First step in changing from an I-gel to an ETT using a bougie involves inserting the bougie into the airway.

Patient Monitoring and Response

If the patient's SpO2 levels drop below 94%, consider administering supplemental oxygen.
Waveform capnography is utilized to monitor exhaled CO2, ensuring effective ventilation.
ETT placement is guided by the use of a marker that indicates proper depth.

Medical Interventions

Benadryl has a slower onset and longer duration compared to epinephrine, which acts rapidly.
After a monitor indicates VF/Pulseless V-Tach, immediate CPR should commence.
Signs of upper airway obstruction may first present as stridor or difficulty breathing.

CPR Protocols

Administer epinephrine within the first minute after CPR resumes to increase chances of return of spontaneous circulation (ROSC).
Airway interventions should only be performed in non-emergency scenarios unless absolutely necessary.

Transport and Monitoring

Monitoring ETCO2 and SpO2 during transport is essential to assess patient status and intervention efficacy.
Epinephrine can be repeated every 3-5 minutes during cardiac arrest until the patient stabilizes.

Rhythm Management

If the rhythm is not shockable, continue CPR and assess for signs of life.
Pulse checks should last 10 seconds when the rhythm is not shockable.

Back Pain Considerations

Primary causes of upper back or thoracic spine pain include muscle strains or conditions affecting spinal alignment.
Understanding back pain is enhanced through comprehensive patient history and assessment.

CPR Cycle and Defibrillation

After every 2-minute cycle of CPR, reassess the rhythm and pulse status.
For non-shockable rhythms, continue CPR without delay.

Defibrillation Techniques

Recommended energy level for double sequential defibrillation is typically higher than standard shocks, often suggested at 200 joules.
Consider double sequential defibrillation in cases where the initial defibrillation attempts are unsuccessful.
Second pads for double sequential defibrillation should be placed on the patient's left anterior chest and the right posterior flank.
After performing double sequential defibrillation, all subsequent defibrillation attempts should follow standard protocols.
Informing ED personnel about the maximum shocks delivered is vital for ongoing patient care and monitoring.

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Description

Test your knowledge of the common EMS protocols for Coral Gables, Hialeah, Miami, Miami Beach, and Key Biscayne. Learn about the protocols and guidelines set by medical directors and fire chiefs. Review the key concepts and procedures for emergency medical services.