48 Questions
What is the primary goal when identifying and treating a seizure patient?
Identifying and treating the underlying cause of the seizure
What is the definition of hypotension in an adult patient?
Systolic BP less than 90 mmHg
What is the primary purpose of the 'sepsis alert' during hospital notification?
To notify hospital staff of potential sepsis diagnosis
Which of the following patient populations is considered high-risk for sepsis?
Patients with altered mental status
What is the primary goal of aggressive fluid therapy in pediatric sepsis patients?
To improve survival rates and patient outcomes
What is the definition of fever in an adult patient?
Temperature greater than 100.4°F (38°C)
Which of the following is a contraindication for aggressive fluid therapy in pediatric sepsis patients?
No specific contraindication is mentioned in the content
What is the primary criterion for initiating a fluid bolus in pediatric sepsis patients?
Meeting at least three of the Pediatric Sepsis Rule-In Criteria by Age
Which of the following is not a component of the Pediatric Sepsis Rule-In Criteria by Age?
Blood Oxygen Saturation
What is the primary role of the pediatric base station in pediatric sepsis cases?
To provide medical consultation for patients not meeting the Pediatric Sepsis Rule-In Criteria by Age
What is the primary goal of managing a patient with sepsis?
To meet the oxygen demands of the cells
Which of the following patients is at a higher risk for sepsis?
A 5-year-old with sickle cell disease
What is the recommended position for a patient with hypotension?
Supine position with legs elevated
What is the definition of shock?
A state of inadequate blood flow to meet the oxygen demands of the cells
Which of the following is a sign of shock in a pediatric patient?
Delayed capillary refill greater than 2 seconds
What is the recommended action for a pregnant patient with hypotension?
Provide constant left lateral uterine displacement
Which of the following is a complication of sepsis?
Altered mental status
What is the recommended frequency for monitoring vital signs in a patient with shock?
Every 5 minutes
What is the definition of hypotension in a pediatric patient?
A systolic blood pressure of less than [70 + (2 x years)]
What is the recommended action for a patient with suspected sepsis?
Transport to the closest appropriate facility
What is the increased risk of stroke associated with in children?
Congenital heart defects, brain injury, and sickle cell disease
What is the primary goal of the EMS STROKE ALGORITHM?
To transport patients to the closest Stroke Center as quickly as possible
What is the indication for transporting a patient to a Comprehensive Stroke Center or thrombectomy-capable Primary Stroke Center?
If the patient has a stroke severity of LAMS 4 or greater
What is the primary symptom of syncope?
Transient loss of consciousness with an inability to maintain postural tone
What is the recommended treatment for a patient with a blood glucose level less than 70 mg/dL?
Refer to the Hypoglycemia protocol
What is the indication for referring to the ALTE/BRUE protocol?
For children less than 24 months of age
What is the recommended treatment for a postpartum hemorrhage patient with a SBP less than 90 or HR greater than 110?
Administer TXA
What is the increased risk of stroke associated with in mothers-to-be and postpartum mothers?
Because they have a higher risk of stroke in general
What is the purpose of the Cincinnati Stroke Scale?
To determine the severity of stroke
What is the recommended treatment for a patient who has sustained a fall and requires assessment for trauma?
Refer to the Trauma protocol
What is the primary indication for administering oxygen to pediatric patients suspected of having a stroke?
Hypoxia or respiratory distress
What is the purpose of the Posterior Cerebellar Assessment?
To assess balance and vision
What is the Correct LAMS score for a patient with facial droop and arm drift?
4
What should be done if the patient cannot be delivered to an appropriate stroke center within 30 minutes?
Transport the patient to a Designated Acute Stroke Ready or Primary Stroke Center
What should be done for pediatric suspected stroke patients who have not reached their 18th birthday?
Consult with a local base station and pediatric base station to arrange transport to a Pediatric Trauma Center
What should be done during the notification of the receiving stroke center or hospital?
Use the verbiage, 'Priority 1, Stroke Alert patient with a last known well time of XX:XX'
What is the purpose of the Cincinnati Prehospital Stroke Scale?
To assess the patient's facial droop, arm drift, and speech
What should be done if the patient's LAMS score is 0-3?
Transport the patient to the closest Designated Acute Stroke Ready, Primary, or Comprehensive Stroke Center
What should be done for suspected stroke patients who are greater than 30 minutes from any stroke center?
Transport the patient to the closest hospital
What should be done for all suspected stroke patients within 22 hours of last known well time?
Notify the receiving stroke center or hospital as soon as possible
What is the primary indication of a seizure?
Involuntary, repetitive muscle movements, usually abrupt in onset
What is the first step in managing a patient who has stopped seizing?
Identify and treat injuries
What is the primary goal when managing a patient during an active seizure?
Protect the patient from injury
What is the recommended treatment for a patient with a blood glucose level less than 70 mg/dL?
Administer oral glucose paste (10-15 grams)
What is the recommended action if the patient does not improve after 10 minutes of oral glucose administration?
Administer a second dose of oral glucose
Which of the following is a potential underlying cause of a seizure?
Hypoxia
What is the recommended device to use when protecting a patient's mouth during an active seizure?
None, do not place any device into the patient's mouth
What is the primary goal of BLS in managing a patient with a seizure?
Support the patient's airway, breathing, and circulation
Study Notes
Seizures - Adult
- Indications: involuntary, repetitive muscle movements, observed seizure activity, decreased mental status, unconsciousness, incontinence, and head injury
- Post-seizure management:
- Identify and treat injuries
- Check blood glucose and treat per Hypoglycemia protocol if necessary
- Administer oral glucose paste (10-15 grams) between the gum and cheek if blood glucose is less than 70 mg/dL
- Administer a single additional dose of oral glucose if not improved after 10 minutes
- Active seizure management:
- Do not restrain the patient or place any device into the patient's mouth
- Protect the patient from injury
- Identify and treat potential underlying causes of seizure: epilepsy, head injury, hypoxia, hypoglycemia, hypoperfusion, infection, stroke, alcohol or drug abuse or withdrawal, and head injury
Seizures - Pediatric
- Indications: same as adult, plus pediatric-specific considerations
- Post-seizure management:
- Same as adult, plus pediatric-specific considerations
- Active seizure management:
- Same as adult, plus pediatric-specific considerations
Sepsis - Adult
- Indications: adult patients (18 years of age and older) with a suspected source of infection and present with at least two of the following criteria:
- Temperature greater than 100.4°F (38°C) or less than 95.9°F (35.5°C)
- Heart rate greater than 100 bpm
- Respiratory rate greater than 25 (or ETCO2 less than or equal to 32 mmHg)
- Hypotension (systolic BP less than 90 mmHg)
- Management:
- Place patient in position of comfort, or supine if hypotension is present
- Monitor airway and respiratory status, manage as required using the appropriate respiratory distress protocol
- Rendezvous with ALS or transport to the closest appropriate facility
- Use the term "sepsis alert" during hospital notification
- Priority 1 patients: those with suspected sepsis and either altered mental status or hypotension
Sepsis - Pediatric
- Indications: pediatric patients (less than 18 years of age) with a suspected source of infection and present with at least three of the Pediatric Sepsis Rule-In Criteria by Age
- Management:
- Place patient in position of comfort, or supine if hypotension is present
- Monitor airway and respiratory status, manage as required using the appropriate respiratory distress protocol
- Transport to the closest appropriate facility
- Use the term "sepsis alert" in consultation with the receiving facility
- Priority 1 patients: those with suspected sepsis and either altered mental status or hypotension
Shock/Hypoperfusion - Adult
- Indications: shock is a state of inadequate blood flow to meet the oxygen demands of the cells
- Symptoms:
- Altered mental status
- Cool, clammy skin
- Diaphoresis
- Hypotension
- Tachycardia or weak pulses
- Shallow, labored respirations
- General weakness
- Decreasing pulse pressure
- Management:
- Place patient in supine position with legs elevated
- Closely monitor airway and vital signs every 5 minutes
- Pregnancy: for pregnant patients greater than 20 weeks gestation with hypotension, provide constant left lateral uterine displacement
Shock/Hypoperfusion - Pediatric
- Indications: same as adult
- Symptoms:
- Same as adult, plus pediatric-specific considerations
- Management:
- Same as adult, plus pediatric-specific considerations
Stroke - Adult & Pediatric
- Indications:
- Blurred vision
- Difficulty speaking
- Numbness or weakness
- Sudden onset of dizziness or loss of balance
- Severe, unexplained headache
- Management:
- Position patient with head elevated at 30 degrees
- Check blood glucose level; if less than 70 mg/dL, treat per Hypoglycemia protocol
- Perform Cincinnati Prehospital Stroke Scale (any abnormality is positive for stroke)
- Perform Posterior Cerebellar Assessment (any abnormality is positive for stroke)
- If either the Cincinnati Prehospital Stroke Scale or Posterior Cerebellar Assessment is positive, then calculate the suspected stroke patient's Los Angeles Motor Scale (LAMS) score
- Destination determination for a suspected stroke patient who can be delivered to the appropriate stroke center within 30 minutes from when the patient was last known well
- Notify the receiving stroke center or hospital as soon as possible
Syncope - Adult & Pediatric
- Indications:
- Transient loss of consciousness with an inability to maintain postural tone
- Symptoms may resolve without intervention or prior to EMS arrival
- Patients who "feel like they are going to pass out" (near-syncope)
- For children less than 24 months of age, refer to ALTE/BRUE protocol
- Management:
- Place patient in the supine position, with feet elevated
- Check blood glucose
- If less than 70 mg/dL, refer to Hypoglycemia protocol
- Perform Cincinnati Stroke Scale
- If any abnormal findings are present, refer to Stroke protocol
Obstetrics/Gynecological Emergencies: Childbirth Algorithm
- Indications: labor, fetal distress, or other obstetric emergencies
- Management:
- Follow the Childbirth Algorithm
- Perform uterine massage
- ALS administer TXA (e)
This quiz covers the signs and symptoms of a seizure, as well as the BLS protocol for managing a seizure, including treating injuries and hypoglycemia. It is essential for emergency medical responders to know how to identify and treat seizures.
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