Advanced Airway Management Quiz
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Questions and Answers

What is the primary indication for using a Bag-Valve-Mask (BVM)?

  • To assist ventilation when oxygen saturation is below 94%. (correct)
  • To provide positive end-expiratory pressure (PEEP).
  • To administer aerosolized medications.
  • To clear a complete airway obstruction.
  • What does the mnemonic 'RODS' stand for in the context of difficult extraglottic device placement?

  • Restricted mouth opening; Obstruction / Obese or late pregnancy; Distorted or disrupted airway; Stiff or increased airway pressures. (correct)
  • Respiratory Obstruction, Double Seal, Stiff Lungs.
  • Rapid Oxygen Desaturation, Obstruction, Dislodged Airway, Stridor.
  • Return of spontaneous circulation, Oxygenation, Defibrillation, Sedation.
  • In which of the following scenarios is nasotracheal intubation contraindicated?

  • In patients with increased intracranial pressure. (correct)
  • In patients with severe asthma exacerbation.
  • In patients with spontaneous breathing.
  • In patients who require immediate airway control due to apnea.
  • What is the recommended preparation for the nostrils prior to nasotracheal intubation?

    <p>Spraying each nostril with PHENYLEPHRINE 1-2 sprays . (D)</p> Signup and view all the answers

    In the context of preoxygenation prior to intubation, what is the purpose of lung denitrogenation?

    <p>To maximize the patient's oxygen saturation and reserve. (D)</p> Signup and view all the answers

    What is the significance of an SBP ≤94% in the context of a trauma patient?

    <p>It suggests the patient may be experiencing severe hypotension and requires immediate intervention. (B)</p> Signup and view all the answers

    According to the information provided, what is the pediatric defibrillation dosage progression?

    <p>4 J/kg to 10 J/kg until conversion occurs. (B)</p> Signup and view all the answers

    A patient with a suspected basal skull fracture requires definitive airway management. Considering the contraindications, which approach is LEAST suitable for securing the airway?

    <p>Nasotracheal intubation. (B)</p> Signup and view all the answers

    Which of the following is the MOST appropriate insertion site for needle decompression?

    <p>4th intercostal space, mid-axillary line within the 'triangle of safety' (C)</p> Signup and view all the answers

    Hypotension with signs of shock, persistent hypoxia, and jugular venous distention indicate what?

    <p>The patient requires immediate intervention. (D)</p> Signup and view all the answers

    If a female patient's breast tissue displaces the nipple inferiorly, how should the insertion site for needle decompression be adjusted?

    <p>The insertion site must be above the nipple line. (A)</p> Signup and view all the answers

    Why is tracheal deviation considered a 'late sign'?

    <p>It only occurs after other compensations have failed. (C)</p> Signup and view all the answers

    Which of the following conditions necessitates bilateral needle thoracostomy during resuscitation?

    <p>Traumatic cardiac arrest with suspected chest or abdominal trauma. (A)</p> Signup and view all the answers

    In the context of needle decompression, what is the relevance of the 'triangle of safety'?

    <p>It minimizes the risk of damaging vital neurovascular structures. (C)</p> Signup and view all the answers

    Which of the following is an inclusion criterion for first response evaluation/release, according to the provided guidelines?

    <p>Patient has normal vital signs including SpO2. (C)</p> Signup and view all the answers

    What is the significance of consistently documenting VS, SpO2, and ETCO2 (if available) BEFORE applying oxygen to a patient?

    <p>To facilitate accurate assessment of the patient's baseline physiological status. (B)</p> Signup and view all the answers

    What is the first step in managing extremity hemorrhage, according to the guidelines?

    <p>Apply a tourniquet proximal to the bleeding site. (D)</p> Signup and view all the answers

    A patient presents with a respiratory rate of 30, SpO2 of 90% on room air, and obvious retractions. Supplemental oxygen is administered, but the SpO2 remains at 92%. Which of the following interventions is MOST critical at this stage, considering all possible underlying causes?

    <p>Immediately prepare for advanced airway management. (B)</p> Signup and view all the answers

    What is an absolute contraindication for tourniquet application as per the protocol?

    <p>Bleeding has stopped (B)</p> Signup and view all the answers

    What defines a Junctional Hemorrhage, according to the provided information?

    <p>Hemorrhage occurring at the junction of an extremity with the torso, and/or the base of the neck. (C)</p> Signup and view all the answers

    In which scenario should you consider tightening the first tourniquet or applying a second one?

    <p>When bleeding is not controlled with the first tourniquet. (B)</p> Signup and view all the answers

    In the context of the provided guidelines, what implies the need for direct intervention for a first responder?

    <p>A minor (&lt;18 years) trauma patient found pulseless and apneic following a motor vehicle accident. (B)</p> Signup and view all the answers

    Consider a scenario where a patient with a junctional hemorrhage also has a mid-shaft femur fracture. How should the wounds be treated?

    <p>Address the junctional hemorrhage first with wound packing, then apply a traction splint to the femur fracture if possible. (B)</p> Signup and view all the answers

    A 25-year-old patient with a complete traumatic amputation at the mid-thigh is actively hemorrhaging bright red blood. Bystanders have already applied a commercially manufactured tourniquet, but bleeding persists. What is the MOST appropriate next step?

    <p>Apply a second tourniquet side-by-side and proximal to the first tourniquet, ensuring it is tightened until bleeding ceases. (C)</p> Signup and view all the answers

    According to the provided protocols, what documentation-related task must be completed within a specific timeframe after a call?

    <p>Completing the EMS patient care record. (C)</p> Signup and view all the answers

    In which situation is a Field Response Low-Risk Alpha Evaluate and Release Form required?

    <p>When a patient is evaluated and released at the scene with no further medical intervention needed. (C)</p> Signup and view all the answers

    What is the most critical action to perform immediately prior to administering any medication, regardless of provider level?

    <p>Checking the medication's clarity and expiration date. (D)</p> Signup and view all the answers

    Under what circumstances is needle cricothyroidotomy indicated, according to the provided protocol?

    <p>When a patient has total airway obstruction or cannot be adequately ventilated by other means. (B)</p> Signup and view all the answers

    Which of the following scenarios would NOT be a valid indication for performing a needle cricothyroidotomy?

    <p>A patient experiencing bronchospasm unresponsive to medication. (D)</p> Signup and view all the answers

    A paramedic is preparing to administer medication. They note the patient has a documented allergy to a similar drug in the same class. Following the 'Rights' of medication administration, what should the paramedic's next action be?

    <p>Contact medical control for further orders and guidance regarding the allergy. (D)</p> Signup and view all the answers

    A patient involved in a motor vehicle collision presents with signs of impending airway compromise, but the paramedic is unable to visualize or palpate the cricothyroid membrane due to significant swelling and distortion of the neck anatomy. According to the protocol, what is the most appropriate course of action?

    <p>Contact medical control for authorization to perform a surgical cricothyroidotomy, given the inability to identify landmarks for the needle approach. (C)</p> Signup and view all the answers

    Consider a scenario where a mass casualty incident overwhelms available resources. Multiple patients require immediate hemorrhage control, but the number of available tourniquets is limited. How should a first responder triage tourniquet application based solely on the documentation provided?

    <p>The document does not offer specific recommendations for triage of hemorrhage control in mass casualty situations. (D)</p> Signup and view all the answers

    According to the table of contents, which of the following conditions has a specific treatment protocol outlined for both adult and pediatric patients?

    <p>Allergic Reaction (C)</p> Signup and view all the answers

    If an EMS provider needs to review the protocol for managing a pediatric patient experiencing a behavioral emergency, on which page would they likely find this information, according to the table of contents?

    <p>Page 80 (B)</p> Signup and view all the answers

    Which of the following protocols are listed under the Adult Treatment Protocols section?

    <p>Smoke Inhalation (A)</p> Signup and view all the answers

    An EMS provider is called to the scene of a cardiac arrest involving an adult. According to the table of contents, on which page would they find the relevant non-traumatic cardiac arrest protocol?

    <p>Page 27 (D)</p> Signup and view all the answers

    Which of the following resources is located at the end of the protocol manual, according to the table of contents?

    <p>Formulary (D)</p> Signup and view all the answers

    According to the document, what is the effective date of the protocols listed?

    <p>January 6, 2025 (C)</p> Signup and view all the answers

    An ambulance crew is dispatched for a pediatric patient experiencing nausea and vomiting. Which page range would be MOST appropriate to consult for guidance?

    <p>Pages 74-75 (B)</p> Signup and view all the answers

    Which of the following topics is covered in both the Adult and Pediatric Treatment Protocols?

    <p>Sepsis (B)</p> Signup and view all the answers

    Where can a user find information about 'Vascular Access' according to the table of contents?

    <p>Procedures Protocols (B)</p> Signup and view all the answers

    If a patient presents with a nosebleed, which section of the manual would MOST likely provide guidance?

    <p>Epistaxis (D)</p> Signup and view all the answers

    Which of the following protocols is MOST likely to be used in conjunction with the 'Chest Pain (Non-Traumatic)' protocol in an adult patient?

    <p>STEMI (Suspected) (D)</p> Signup and view all the answers

    An EMS provider is preparing to administer medication to a patient. According to the table of contents, The medication information would MOST likely obtained from?

    <p>Formulary (A)</p> Signup and view all the answers

    Where would you find the Clark County EMS system address?

    <p>Bottom of each page (C)</p> Signup and view all the answers

    A paramedic is dispatched to a call for a pregnant patient experiencing complications. Considering the organization of this document, which section would be MOST relevant?

    <p>Both A and B depending on the specific situation (A)</p> Signup and view all the answers

    A seasoned paramedic, reflecting on the evolution of prehospital care, notes a subtle yet critical distinction in the treatment algorithms between the 2024 and 2025 versions of the protocols. Considering the document's structure and stated effective date, what inference can be definitively drawn regarding this change?

    <p>The difference signifies an adaptation informed by contemporary medical evidence or local system needs, necessitating a thorough review by practitioners to ensure continued alignment with best practices. (B)</p> Signup and view all the answers

    When should synchronized cardioversion be considered for a patient experiencing tachycardia?

    <p>If the patient is unstable, showing signs of mental status changes or lack of a palpable radial pulse. (A)</p> Signup and view all the answers

    What is the recommended initial medication and dosage to consider for sedation and analgesia before synchronized cardioversion?

    <p>Etomidate 0.15 mg/kg IV/IO (B)</p> Signup and view all the answers

    What should be done if a patient with tachycardia is stable?

    <p>Continue with a general adult assessment. (B)</p> Signup and view all the answers

    What is the initial dose of adenosine for a patient in tachycardia?

    <p>12 mg (C)</p> Signup and view all the answers

    For which type of tachycardia is amiodarone indicated?

    <p>Wide complex tachycardia (C)</p> Signup and view all the answers

    What is an important differential diagnosis to consider when assessing a patient with tachycardia?

    <p>Electrolyte imbalance (B)</p> Signup and view all the answers

    What historical information is relevant when assessing a patient with tachycardia?

    <p>Medications and diet (C)</p> Signup and view all the answers

    In the context of tachycardia assessment, what does 'CP' stand for?

    <p>Chest Pain (D)</p> Signup and view all the answers

    What defines a 'narrow complex' tachycardia?

    <p>QRS interval ≤ 0.11 seconds (A)</p> Signup and view all the answers

    Which of the following is NOT a potential cause of tachycardia?

    <p>Hypothyroidism (C)</p> Signup and view all the answers

    What is the most appropriate delivery method for adenosine?

    <p>Rapid IVP/IO (C)</p> Signup and view all the answers

    What physiological effect might drugs like cocaine or methamphetamines have that could lead to tachycardia?

    <p>They increase sympathetic nervous system stimulation. (A)</p> Signup and view all the answers

    Which of the following vital signs or symptoms is MOST indicative of instability in a patient with tachycardia?

    <p>Changes in mental status (D)</p> Signup and view all the answers

    A patient presents with a heart rate of 220 bpm, chest pain, and is hypotensive. The QRS complex is wide. After initial stabilization, which of the following interventions is MOST appropriate, assuming pharmacological intervention is deemed necessary?

    <p>Perform immediate synchronized cardioversion. (A)</p> Signup and view all the answers

    Imagine a patient with a history of Wolff-Parkinson-White (WPW) syndrome presents with atrial fibrillation and rapid ventricular response. Which medication should be AVOIDED, and why?

    <p>Digoxin, because it can enhance conduction down the accessory pathway, potentially leading to ventricular fibrillation. (D)</p> Signup and view all the answers

    Flashcards

    Oxygen Administration

    The process of providing supplemental oxygen to patients.

    BVM

    Bag-Valve-Mask; used to provide positive pressure ventilation.

    Extraglottic Device Placement

    Insertion of a device to secure airway above the glottis.

    Contraindications for Nasotracheal Intubation

    Conditions where nasotracheal intubation should not be performed.

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    Preoxygenation

    Providing oxygen before intubation to improve outcomes.

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    Trauma Field Triage Criteria

    Guidelines for transporting patients with traumatic injuries.

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    Burns Protocol

    Guidelines for transporting patients with burn injuries.

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    Pediatric Cardiac Arrest

    Guidelines for addressing cardiac arrest in children.

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    Hypotension with signs of shock

    Low blood pressure along with indicators of shock such as tachycardia or altered mental status.

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    Persistent hypoxia

    Continued low oxygen saturation (SpO2 < 94%) despite oxygen therapy.

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    Jugular venous distention

    Bulging veins in the neck indicating increased central venous pressure.

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    Respiratory rate > 25

    Increased breathing rate indicating respiratory distress.

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    Tracheal deviation

    Displacement of the trachea suggesting tension pneumothorax or lung collapse.

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    Needle thoracostomy

    Emergency procedure to relieve tension pneumothorax by inserting a needle into the pleural space.

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    Insertion site for thoracostomy

    Primary site is the 4th intercostal space in the mid-axillary line of the affected side.

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    Key procedural considerations

    Ensure patient assessment including vital signs and appropriate device use; document findings.

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    EMS Patient Care Record

    A documentation form that must be completed within four hours of clearing a call.

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    Field Response Low-Risk Alpha Form

    A form that must be completed and given to the patient for their records.

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    Medication Administration

    The procedure for administering medication to patients by EMS personnel.

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    Needle Cricothyroidotomy

    An emergency airway procedure for patients with total airway obstruction or inadequate ventilation.

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    Total Airway Obstruction

    A condition where the airway is completely blocked, preventing breathing.

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    Inadequate Ventilation

    A situation where a patient cannot be effectively ventilated by any emergency procedure.

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    Contraindications for Needle Cricothyroidotomy

    Situations where the cricothyroidotomy should not be performed, such as inability to identify landmarks.

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    Endotracheal Intubation

    A medical procedure to secure the airway by inserting a tube into the trachea.

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    Hemorrhage Control

    The methods used to stop excessive bleeding in a patient.

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    Inclusion Criteria for Hemorrhage Control

    Conditions that must be met for a patient to receive hemorrhage control.

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    Exclusion Criteria for Hemorrhage Control

    Conditions that prevent a patient from receiving hemorrhage control.

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    Tourniquet Application

    A method used to apply pressure to stop bleeding from an extremity.

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    Junctional Hemorrhage

    Bleeding occurring where limbs connect to the torso or neck.

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    Wound Packing

    A method of controlling bleeding by placing sterile material into a wound.

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    AEMT/Paramedic Authority

    The level of care and decision-making permitted for Advanced Emergency Medical Technicians and Paramedics.

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    General Adult Assessment

    Initial evaluation of an adult patient's condition.

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    Adult Trauma Assessment

    Comprehensive evaluation of traumatic injuries in adults.

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    Chest Pain Protocol

    Assessment and care for non-traumatic chest pain.

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    Sepsis

    Body's extreme response to infection leading to tissue damage.

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    Cardiac Arrest Protocol

    Guidelines for managing non-traumatic cardiac arrest.

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    Stroke (CVA)

    Condition caused by disrupted blood flow to the brain.

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    Respiratory Distress

    A state of difficulty in breathing indicating urgency.

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    Allergic Reaction

    An exaggerated immune response to allergens.

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    Altered Mental Status

    Change in a patient’s awareness or cognition.

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    Pain Management

    Protocols for assessing and alleviating patient pain.

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    Burn Management

    Protocols for treating various degrees of thermal injuries.

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    Neonatal Resuscitation

    Emergency procedures for newborns needing immediate care.

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    Shock

    Life-threatening condition where blood flow is insufficient.

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    Heat-Related Illness

    Health issues arising from prolonged heat exposure.

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    Ventilation Management

    Protocols for assisting or controlling a patient’s breathing.

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    Synchronized Defibrillation

    A procedure that delivers a shock to the heart in sync with the R wave of the ECG to restore normal rhythm.

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    Cardioversion

    A therapeutic procedure to restore normal heart rhythm using electrical shocks or medications.

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    Sedation and Analgesia

    Medication use to relax and relieve pain during procedures like cardioversion.

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    AMIODARONE

    An antiarrhythmic medication used for various heart rhythm issues, often administered IV during emergencies.

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    ADENOSINE

    A medication that can rapidly slow heart rate, used in cases of certain types of tachycardia.

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    Stable Tachycardia

    Tachycardia (heart rate >150) where the patient displays stable vital signs and mental status.

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    Unstable Tachycardia

    Tachycardia with mental status changes or absence of palpable pulse indicating urgent action needed.

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    Mental Status Changes

    Alterations in consciousness or awareness; a sign of severe tachycardia or other conditions.

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    Wide Complex Tachycardia

    A type of tachycardia characterized by a QRS duration of ≥0.12 seconds, may indicate serious issues.

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    Narrow Complex Tachycardia

    Tachycardia with QRS duration of ≤0.11 seconds, generally less serious than wide complex.

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    Torsades de Pointes

    A specific type of polymorphic ventricular tachycardia characterized by a changing QRS morphology.

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    Monomorphic VT

    A type of ventricular tachycardia where the QRS complexes are of uniform shape and size.

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    Cardiac Monitor

    A device used to continuously assess heart activity for abnormalities during tachycardia.

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    Vascular Access

    Obtaining access to a blood vessel to administer fluids or medications rapidly.

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    Patient History for Tachycardia

    Reviewing patient's medical history for potential causes of tachycardia, including medications or health conditions.

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    Study Notes

    Clark County EMS System Emergency Medical Care Protocols

    • Effective Date: January 6, 2025
    • Version: Replaces July 1, 2024 version
    • Purpose: To standardize prehospital patient care in Clark County, Nevada
    • Scope: Protocols are guidelines, not meant to extend scope of practice beyond that defined by regulations. Procedures should not delay rapid patient transport.

    Table of Contents

    • Documents protocols for adult and pediatric treatment, procedures, and a formulary
    • Includes sections on foreword, terms & conventions, adult/pediatric treatment protocols, procedures, and appendices.

    Adult Treatment Protocols (Detailed list)

    • General Adult Assessment
    • General Adult Trauma Assessment
    • Abdominal Pain/Flank Pain, Nausea & Vomiting
    • Allergic Reaction
    • Altered Mental Status/Syncope
    • Behavioral Emergencies
    • Bradycardia
    • Burns
    • Cardiac Arrest (Non-Traumatic)
    • Chest Pain (Non-Traumatic) and Suspected Acute Coronary Syndrome
    • Childbirth/Labor
    • Cold Related Illness
    • Epistaxis
    • Heat-Related Illness
    • Hyperkalemia (Suspected)
    • Obstetrical Emergency
    • Overdose/Poisoning
    • Pain Management
    • Pulmonary Edema/CHF
    • Respiratory Distress
    • Seizure
    • Sepsis
    • Shock
    • Smoke Inhalation
    • STEMI (Suspected)
    • Stroke (CVA)
    • Tachycardia/Stable
    • Tachycardia/Unstable
    • Ventilation Management

    Pediatric Treatment Protocols (Detailed List)

    • General Pediatric Assessment
    • General Pediatric Trauma Assessment
    • Abdominal/Flank Pain, Nausea & Vomiting
    • Allergic Reaction
    • Altered Mental Status/Syncope
    • Behavioral Emergencies
    • Bradycardia
    • Burns
    • Cardiac Arrest (Non-Traumatic)
    • Cold Related Illness
    • Epistaxis
    • Heat Related Illness
    • Neonatal Resuscitation
    • Overdose/Poisoning
    • Pain Management
    • Respiratory Distress
    • Seizure
    • Shock
    • Smoke Inhalation
    • Tachycardia/Stable
    • Tachycardia/Unstable
    • Ventilation Management

    Procedures/Protocols (Detailed List)

    • Cervical Stabilization
    • Electrical Therapy/Defibrillation
    • Electrical Therapy/Synchronized Cardioversion
    • Electrical Therapy/Transcutaneous Pacing
    • Endotracheal Intubation
    • Extraglottic Device
    • First Response Evaluate/Release
    • Hemorrhage Control
    • Medication Administration
    • Needle Cricothyroidotomy
    • Needle Thoracostomy
    • Non-Invasive Positive Pressure Ventilation (NIPPV)
    • Patient Restraint
    • Tracheostomy Tube Replacement
    • Traction Splint
    • Vagal Maneuvers
    • Vascular Access
    • FOA (FYI - possible organization in system)

    Appendices and Other Information

    • Formulary: Lists approved medications and their dosages
    • Appendices: Contain additional information, such as practice scope, policy documents, hospital locations & contact information
    • Mass Casualty Incident (MCI) Procedures: Details how to handle incidents requiring enhanced resources
    • Waiting Room Criteria: Defines criteria for patient placement in waiting rooms at facilities
    • Quality Improvement Review (QIR): process for reviewing and aggregating incidents
    • Inter-Facility Transport of Patients By Ambulance: Protocol for transportation between facilities
    • Prehospital Death Determination: Clarifies procedures for situations where resuscitation is not attempted. Details presumptive and conclusive signs of death.
    • Public Intoxication: Outlines circumstances to transport clients, instead of to hospitals.
    • Other Protocols: detailed protocols for other scenarios like Childbirths.

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    Description

    Test your knowledge on advanced airway management techniques, including the use of Bag-Valve-Mask (BVM) and nasotracheal intubation protocols. This quiz covers critical concepts such as preoxygenation, pediatric defibrillation dosage, and emergency airway interventions. Perfect for medical professionals looking to evaluate their skills in managing difficult airway scenarios.

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