Emergency Medical Procedures
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Questions and Answers

What is the first step in managing nausea and vomiting in a patient with abdominal pain?

  • Start a saline lock
  • Administer ondansetron (Zofran) ODT, 8 mg PO (correct)
  • Administer ondansetron (Zofran) IVP/IO/IM
  • Treat the underlying abdominal pain

    • What should be done if a patient is vomiting blood or bleeding large amounts per rectum?

  • Start a saline lock and only administer normal saline if the patient also has hypotension or tachycardia (correct)
  • Notify the EMS Division Supervisor prior to the end of your shift
  • Administer ondansetron (Zofran) ODT, 8 mg PO
  • Treat the underlying abdominal pain

    • What should a Fire-Rescue employee do when encountering a person who would benefit from the assistance provided through the Elder-Links Project or other Community Services?

  • Document the referral in the narrative section of the Patient Care Record
  • Complete the Elder-Helpline Referral Form (correct)
  • Deliver or fax the completed form to the EMS Division
  • Notify the Police

    • What is the phone number to report abuse, neglect, or exploitation of children or vulnerable adults?

    <p>305-670-HELP (4357)</p> Signup and view all the answers

    What is the fax number to report referral to the EMS Division?

    <p>305-222-4139</p> Signup and view all the answers

    What should be done after reporting abuse, neglect, or exploitation of children or vulnerable adults to the Florida Abuse Hotline?

    <p>Notify the EMS Division Supervisor prior to the end of your shift</p> Signup and view all the answers

    What is the organization responsible for providing assistance through the Elder-Links Project?

    <p>Alliance for Aging Inc.</p> Signup and view all the answers

    What should be done when a patient is experiencing abdominal pain with associated nausea?

    <p>Treat the underlying abdominal pain</p> Signup and view all the answers

    Which adjunct is best for a patient with acute pulmonary edema?

    <p>CPAP</p> Signup and view all the answers

    When is the Automatic Ventilator used in PPV?

    <p>In demand mode, manual mode, or automatic mode</p> Signup and view all the answers

    What is the purpose of using a BVM?

    <p>When CPAP or Automatic Ventilator is indicated but not available</p> Signup and view all the answers

    What is the minimum SpO2 required for CPAP application?

    <p>Any patient with acute respiratory distress and a low SpO2</p> Signup and view all the answers

    When should an advanced airway be used?

    <p>When the patient is in respiratory arrest or prolonged PPV is required</p> Signup and view all the answers

    What is the oxygen percentage that should be given to the patient before preparing for an advanced airway?

    <p>100%</p> Signup and view all the answers

    What is the correct placement of a Supraglottic Airway?

    <p>In the initial set of compressions in cardiac arrest</p> Signup and view all the answers

    What is the recommended setting for the manometer when using a BVM?

    <p>10</p> Signup and view all the answers

    What is the primary function of the capacitor in an AICD device?

    <p>To store and deliver shocks to the heart when indicated</p> Signup and view all the answers

    What should be done if the AICD is confirmed to be discharging inappropriately?

    <p>Monitor the ECG, verify the rhythm, and consider pain management in the conscious patient</p> Signup and view all the answers

    What is the recommended SpO2 level during AICD treatment?

    <p>94% or greater</p> Signup and view all the answers

    What should accompany the patient to the hospital during AICD treatment?

    <p>Identification information of the AICD type</p> Signup and view all the answers

    What is the primary purpose of the lead system in an AICD device?

    <p>To sense cardiac electrical activity</p> Signup and view all the answers

    What should be done during airway management of a patient with an AICD device?

    <p>Assess the patient's respiratory status by evaluating both the upper and lower airway</p> Signup and view all the answers

    What is a critical consideration when performing external defibrillation on a patient with an AICD device?

    <p>Avoid placing the defibrillator patches over the implanted device</p> Signup and view all the answers

    What should be done during the initial treatment of a patient with an AICD device?

    <p>Monitor the ECG and SpO2, and maintain SpO2 at 94% or greater</p> Signup and view all the answers

    What is the recommended rate of breath delivery in respiratory/cardiac arrest?

    <p>1 breath every 6 seconds (10-12 breaths per minute)</p> Signup and view all the answers

    What should you do if the patient's breathing has not improved and the SpO2 is less than 94%?

    <p>Insert a Supraglottic Airway device or intubate the patient with an appropriate sized ETT</p> Signup and view all the answers

    What medication should be used for intubation if the patient has a difficult airway to open and vascular access is available?

    <p>Etomidate (Amidate) 0.3 mg/kg IV/IO</p> Signup and view all the answers

    What should be done if the patient becomes combative following a successful placement of an Advanced Airway?

    <p>Reconfirm proper Advance Airway placement with ETCO2 and SpO2 measurements</p> Signup and view all the answers

    What is the maximum number of intubation attempts allowed?

    <p>2 attempts</p> Signup and view all the answers

    What should be done if the patient has a difficult airway to open and no vascular access is available?

    <p>Administer midazolam (Versed) 10 mg IM/IntraNasal</p> Signup and view all the answers

    What should be done if the patient's SpO2 is equal to or greater than 94%?

    <p>Continue with current airway management and transport</p> Signup and view all the answers

    What should be used to confirm correct tube placement?

    <p>Capnography</p> Signup and view all the answers

    What is the primary goal of establishing baseline vitals in an alcohol intoxication patient?

    <p>To determine the level of consciousness</p> Signup and view all the answers

    What is the indication for administering dextrose 50% (D50W) in an alcohol intoxication patient?

    <p>When the patient's blood glucose level is low</p> Signup and view all the answers

    What is the role of the police in the management of an alcohol intoxication patient who refuses to be transported to a facility?

    <p>To utilize the Marchman Act (FS397.6811) to transport the patient</p> Signup and view all the answers

    What is the typical timeframe for the onset of Delirium Tremens (DTs) after a decrease in alcohol intake?

    <p>Within 6-24 hours</p> Signup and view all the answers

    What should be considered when treating a patient with alcohol intoxication who has consumed highly caffeinated drinks?

    <p>The patient's level of intoxication may be masked</p> Signup and view all the answers

    What should be done if a patient with alcohol intoxication is agitated and/or combative?

    <p>Treat the patient per the Agitated Patient protocol</p> Signup and view all the answers

    What should be considered in addition to alcohol intoxication when treating a patient?

    <p>Concurrent drug overdose</p> Signup and view all the answers

    What is the primary goal of airway management in an alcohol intoxication patient?

    <p>To prevent aspiration</p> Signup and view all the answers

    What is the most invasive of the advanced airways?

    <p>Cricothyrotomy</p> Signup and view all the answers

    What is the primary goal of airway management in a patient with respiratory distress?

    <p>To oxygenate the patient</p> Signup and view all the answers

    What should be monitored to determine if the target organs are receiving enough oxygen?

    <p>Level of consciousness</p> Signup and view all the answers

    When should an advanced airway be used?

    <p>Only in patients with severe respiratory distress and depressed levels of consciousness</p> Signup and view all the answers

    What should be done if a patient's SpO2 level is less than 94%?

    <p>Move to a more invasive level of oxygen administration</p> Signup and view all the answers

    What is the purpose of monitoring capnography waveforms?

    <p>To monitor the patient's ventilations or ability to move oxygen in and out of the lungs</p> Signup and view all the answers

    What should be done if a patient's level of consciousness falls?

    <p>Move to a more invasive level of oxygen administration</p> Signup and view all the answers

    What is the key to managing patients with respiratory distress?

    <p>Repeated re-evaluations to determine whether the initial management chosen is correct</p> Signup and view all the answers

    What medication will be used in place of Ativan?

    <p>Versed</p> Signup and view all the answers

    What device will be used in place of a scoop stretcher?

    <p>Backboard</p> Signup and view all the answers

    Where can the ADULT TRAUMAS protocol be found?

    <p>Page 181</p> Signup and view all the answers

    What is the page number of the PEDIATRIC PROTOCOLS?

    <p>Page 211</p> Signup and view all the answers

    Where can the MEDICATIONS SECTION be found?

    <p>Page 349</p> Signup and view all the answers

    What is the page number of the ADMINISTRATIVE SECTION?

    <p>Page 565</p> Signup and view all the answers

    Where can the ADULT ALGORITHMS be found?

    <p>Page 619</p> Signup and view all the answers

    Where can the PEDIATRIC ALGORITHMS be found?

    <p>Page 679</p> Signup and view all the answers

    Under what circumstances can a person be forced into care or treatment without their consent?

    <p>If they pose a real and present threat of substantial harm to themselves or others</p> Signup and view all the answers

    Who can impose the Baker Act?

    <p>A sworn law enforcement officer, a physician, clinical psychologist, or psychiatric nurse</p> Signup and view all the answers

    What is a critical consideration when restraining a patient under the Baker Act?

    <p>Using a supine or recovery position</p> Signup and view all the answers

    What right is preserved by the Baker Act?

    <p>The right to informed consent and privacy</p> Signup and view all the answers

    What is NOT a purpose of the Baker Act?

    <p>To enforce medical procedures</p> Signup and view all the answers

    Under what circumstances can reasonable force be applied to a patient under the Baker Act?

    <p>When restraint is necessary to prevent harm to themselves or others</p> Signup and view all the answers

    What documentation is required when imposing the Baker Act?

    <p>A detailed report of the patient's condition and the reason for imposing the Baker Act</p> Signup and view all the answers

    What is the primary goal of the Baker Act?

    <p>To provide care and treatment to individuals who need it</p> Signup and view all the answers

    What is the primary goal of oxygen therapy in patients with respiratory distress?

    <p>To achieve an SpO2 goal of 94% or greater</p> Signup and view all the answers

    When should a patient be considered for intubation?

    <p>When the patient is unable to protect their own airway</p> Signup and view all the answers

    What is the purpose of using a Nebulizer Mask?

    <p>To deliver medication to the lungs for acute bronchospasm</p> Signup and view all the answers

    What should be done if the patient's SpO2 is not improving with oxygen therapy?

    <p>Escalate to a higher level of oxygen delivery</p> Signup and view all the answers

    What is the primary concern in patients taking ACE-inhibitors?

    <p>Localized angioedema, particularly of the lips, tongue, and throat</p> Signup and view all the answers

    What is the recommended SpO2 goal for patients with severe COPD or emphysema?

    <p>88-92%</p> Signup and view all the answers

    What is the correct treatment for patients taking ACE-inhibitors who develop angioedema?

    <p>Administer epinephrine 1:1,000, 0.3 mg (0.3 mL) IM, and diphenhydramine (Benadryl) 50 mg slow IVP or IM</p> Signup and view all the answers

    When should a Non-Rebreather Mask (NRBM) be used?

    <p>In patients with moderate respiratory distress and a normal respiratory rate</p> Signup and view all the answers

    What is the duration of action of Benadryl compared to epinephrine?

    <p>Benadryl has a slower onset and longer duration than epinephrine</p> Signup and view all the answers

    What is the purpose of ongoing evaluation of the patient during oxygen therapy?

    <p>To assess the patient's response to oxygen therapy and adjust as needed</p> Signup and view all the answers

    What is the significance of observing patients taking ACE-inhibitors for developing or increasing respiratory difficulty and/or changes in their voices?

    <p>It may indicate localized angioedema involving the pharynx/vocal cords</p> Signup and view all the answers

    What should be considered when selecting an oxygen delivery device?

    <p>The patient's level of respiratory distress and response to oxygen therapy</p> Signup and view all the answers

    What is the correct administration route for epinephrine in patients taking ACE-inhibitors who develop angioedema?

    <p>0.3 mg (0.3 mL) IM</p> Signup and view all the answers

    What is the significance of the upper airway obstruction in patients taking ACE-inhibitors?

    <p>It can cause stridor and partial upper airway obstruction</p> Signup and view all the answers

    What is the correct dosage of diphenhydramine (Benadryl) in patients taking ACE-inhibitors who develop angioedema?

    <p>50 mg slow IVP or IM</p> Signup and view all the answers

    What is the correct timing of diphenhydramine (Benadryl) administration in patients taking ACE-inhibitors who develop angioedema?

    <p>Administer just as epinephrine is losing effectiveness</p> Signup and view all the answers

    What should be administered to a patient with nausea and vomiting in addition to treating their abdominal pain?

    <p>Ondansetron (Zofran) IVP/IO/IM, 8 mg</p> Signup and view all the answers

    When should a saline lock be started in a patient with vomiting blood or bleeding per rectum?

    <p>Only if the patient is hypotensive or tachycardic</p> Signup and view all the answers

    What should a Fire-Rescue employee do when encountering a person who would benefit from community services?

    <p>Complete an Elder-Helpline Referral Form and fax it to the EMS Division</p> Signup and view all the answers

    What should be done after reporting abuse, neglect, or exploitation of children or vulnerable adults to the Florida Abuse Hotline?

    <p>Notify the police and EMS Division Supervisor</p> Signup and view all the answers

    What is the purpose of the Elder-Helpline Referral Form?

    <p>To refer individuals to community services, such as the Elder-Links Project</p> Signup and view all the answers

    What organization is responsible for providing assistance through the Elder-Links Project?

    <p>Alliance for Aging Inc.</p> Signup and view all the answers

    What should be done when a patient is experiencing abdominal pain with associated nausea?

    <p>Treat the abdominal pain and monitor the patient's nausea</p> Signup and view all the answers

    What should accompany the patient to the hospital when reporting abuse, neglect, or exploitation of children or vulnerable adults?

    <p>The completed Elder-Helpline Referral Form</p> Signup and view all the answers

    Which individual is the Medical Director of Coral Gables, Hialeah, and Miami Beach?

    <p>Paul J Adams</p> Signup and view all the answers

    Which fire department is led by Fire Chief Zahralban?

    <p>City of Miami Fire Rescue</p> Signup and view all the answers

    What is the title of the document that acknowledges the contributions of the Protocol Review Committee?

    <p>Common EMS Protocols</p> Signup and view all the answers

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

    <p>Dr. Armando Clift</p> Signup and view all the answers

    Which fire department is led by Fire Chief Virnernandez?

    <p>Miami Beach Fire Rescue</p> Signup and view all the answers

    What is the title of the committee that worked on the 2022-24 Common EMS Protocols?

    <p>Protocol Review Committee</p> Signup and view all the answers

    Which city is led by Marcos DelaRosa, Fire Chief?

    <p>Coral Gables</p> Signup and view all the answers

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

    <p>Paul J Adams</p> Signup and view all the answers

    What is the page number for the Abdominal Pain protocol in the 2022-24 Common EMS Protocols?

    <p>page 5</p> Signup and view all the answers

    Where can the Pediatric Traumas protocol be found in the 2022-24 Common EMS Protocols?

    <p>page 325</p> Signup and view all the answers

    What is the page number for the Medications Section in the 2022-24 Common EMS Protocols?

    <p>page 349</p> Signup and view all the answers

    Where can the Administrative Section be found in the 2022-24 Common EMS Protocols?

    <p>page 565</p> Signup and view all the answers

    What is the page number for the Adult Traumas protocol in the 2022-24 Common EMS Protocols?

    <p>page 181</p> Signup and view all the answers

    Where can the Procedures section be found in the 2022-24 Common EMS Protocols?

    <p>page 419</p> Signup and view all the answers

    What is the page number for the Adult Algorithms protocol in the 2022-24 Common EMS Protocols?

    <p>page 619</p> Signup and view all the answers

    Where can the Pediatric Algorithms protocol be found in the 2022-24 Common EMS Protocols?

    <p>page 679</p> Signup and view all the answers

    What is the recommended temperature for administering cold normal saline to a patient with excited delirium syndrome?

    <p>34°F</p> Signup and view all the answers

    What is the maximum amount of morphine sulfate that can be administered to a patient with excited delirium syndrome?

    <p>20 mg</p> Signup and view all the answers

    What is the primary indication for administering midazolam (Versed) to a patient with excited delirium syndrome?

    <p>Shivering</p> Signup and view all the answers

    What is the recommended method for cooling a patient with excited delirium syndrome?

    <p>Removing clothing and using a fan</p> Signup and view all the answers

    What is the purpose of taking and documenting a baseline temperature before administering cold normal saline?

    <p>To monitor the patient's response to treatment</p> Signup and view all the answers

    What is the indication for administering sodium bicarbonate to a patient with metabolic acidosis?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended rate for administering cold normal saline to a patient with excited delirium syndrome?

    <p>30 mL/kg IV/IO</p> Signup and view all the answers

    What is the primary goal of establishing vascular access in a patient with excited delirium syndrome?

    <p>To administer medications</p> Signup and view all the answers

    In which situation is CPAP contraindicated?

    <p>Patient unable to follow directions</p> Signup and view all the answers

    What is the primary function of the Automatic Ventilator in PPV?

    <p>To assist patient with breathing that is too shallow</p> Signup and view all the answers

    When should a BVM be used in place of CPAP or Automatic Ventilator?

    <p>When CPAP or Automatic Ventilator is not available</p> Signup and view all the answers

    What is the primary indication for using an advanced airway?

    <p>Patient requires prolonged PPV with a BVM or Automatic Ventilator</p> Signup and view all the answers

    How should the patient be prepared for an advanced airway?

    <p>By giving 100% oxygen</p> Signup and view all the answers

    What is the purpose of using a Supraglottic Airway?

    <p>To manage respiratory distress in cardiac arrest patients</p> Signup and view all the answers

    What should be done when using a BVM?

    <p>Use enough compression to visualize chest rise</p> Signup and view all the answers

    What is the recommended setting for the manometer when using a BVM?

    <p>10</p> Signup and view all the answers

    What is the first step in managing an exotic snake bite?

    <p>Have Dispatch contact Venom 1 immediately</p> Signup and view all the answers

    What is a common sign of a Brown Recluse spider bite?

    <p>Localized tissue necrosis</p> Signup and view all the answers

    What is the recommended treatment for severe muscle spasms in a Black Widow spider bite?

    <p>Administer midazolam (Versed) 5mg slow IV or 10mg IM/IntraNasal</p> Signup and view all the answers

    What should be done after reporting a scorpion sting?

    <p>Provide rapid transport to the hospital</p> Signup and view all the answers

    What is the primary goal in managing an exotic snake bite?

    <p>Provide rapid transport to the receiving facility</p> Signup and view all the answers

    What is a common symptom of a Black Widow spider bite?

    <p>Seizures and paralysis</p> Signup and view all the answers

    What should be considered when managing a Brown Recluse spider bite?

    <p>The type of spider that bit the patient</p> Signup and view all the answers

    What is the role of Venom 1 in managing snake bites?

    <p>Providing medical consultation and guidance</p> Signup and view all the answers

    What is the next step if the airway remains obstructed after attempting to ventilate and removing any visible objects?

    <p>Use a laryngoscope to visualize the obstruction and attempt to remove it using the Magill forceps</p> Signup and view all the answers

    What is the last resort in managing a complete airway obstruction if all other steps fail?

    <p>Perform an emergency cricothyrotomy if clinically warranted</p> Signup and view all the answers

    What is the purpose of using Magill forceps in airway management?

    <p>To attempt to remove the obstruction using the Magill forceps with a laryngoscope</p> Signup and view all the answers

    When should 5 cycles of 30:2 CPR be performed in airway management?

    <p>If unable to ventilate after opening the airway</p> Signup and view all the answers

    What is the purpose of re-attempting BVM ventilation with 2 NPAs and 1 OPA?

    <p>To improve mask seal and jaw thrust maneuver</p> Signup and view all the answers

    What should be done if the patient's airway remains obstructed after attempting to ventilate and removing any visible objects?

    <p>Repeat steps 2 and 3 above</p> Signup and view all the answers

    What should be done if the patient's airway is still obstructed after using a laryngoscope to visualize the obstruction?

    <p>Perform an emergency cricothyrotomy if clinically warranted</p> Signup and view all the answers

    What is the role of additional EMS personnel in airway management?

    <p>To use both hands to maintain a good mask seal with a jaw thrust maneuver</p> Signup and view all the answers

    What is the primary focus of the initial assessment and care for patients with unstable bradycardia?

    <p>Universal Initial Adult Patient Assessment and Care</p> Signup and view all the answers

    What is the primary goal of clinical assessment of the lower airway?

    <p>To identify the cause of respiratory difficulties</p> Signup and view all the answers

    What is the recommended maximum dose of atropine sulfate for unstable bradycardia?

    <p>0.04 mg/kg</p> Signup and view all the answers

    What is the least invasive option for managing a patient in apparent respiratory distress?

    <p>Blow by</p> Signup and view all the answers

    What is the recommended fluid bolus volume for patients with unstable bradycardia and low blood pressure?

    <p>500 mL IV/IO</p> Signup and view all the answers

    What is the primary indication for administering atropine sulfate in patients with unstable bradycardia?

    <p>Bradycardia with a normal QRS complex</p> Signup and view all the answers

    What is the term for the fine crackling sound similar to listening with an ear close to a glass of a carbonated beverage?

    <p>Rales</p> Signup and view all the answers

    What is the recommended rate and depth of ventilations for patients with unstable bradycardia?

    <p>Check rate and depth, no specific values</p> Signup and view all the answers

    What is assessed during the clinical assessment of the chest wall?

    <p>Accessory muscles used to assist in breathing</p> Signup and view all the answers

    What is the term for the deeper, coarse, almost gargling sound heard during lung assessment?

    <p>Rhonchi</p> Signup and view all the answers

    What is the critical consideration when performing external pacing in patients with unstable bradycardia?

    <p>Applying the external pacemaker as soon as possible</p> Signup and view all the answers

    What is the primary goal of treating patients with unstable bradycardia?

    <p>Raising the heart rate above 60 bpm</p> Signup and view all the answers

    What is the purpose of assessing the patient's skin during the clinical assessment of the lower airway?

    <p>To identify signs of respiratory distress</p> Signup and view all the answers

    What is the term for the musical sound heard during lung assessment?

    <p>Wheezing</p> Signup and view all the answers

    What is the recommended approach to managing patients with unstable bradycardia?

    <p>Team approach</p> Signup and view all the answers

    What is the significance of assessing the patient's mental status during the clinical assessment of the lower airway?

    <p>To assess the patient's ability to respond to verbal stimuli</p> Signup and view all the answers

    What should be done if a patient's bradycardia is due to a Beta Blocker or Calcium Channel Blocker excess/OD?

    <p>Administer atropine sulfate, 1 mg IV every 5 minutes to a maximum of 3 mg</p> Signup and view all the answers

    What is the first step in managing a patient with an acute inferior wall myocardial infarction and a bradycardia due to a high-grade Mobitz II or a Third Degree Heart Block?

    <p>External pacing is preferred as the first treatment</p> Signup and view all the answers

    What should be done if a patient has a heart rate of 40 bpm or less but is otherwise stable?

    <p>Apply the external pacemaker pads without turning the pacer on and observe for any signs/symptoms</p> Signup and view all the answers

    What is the recommended treatment for a patient with bradycardia due to an Organophosphates Overdose?

    <p>Administer atropine sulfate, 1 mg IV every 5 minutes until drying of the secretions occurs</p> Signup and view all the answers

    What should be done if a patient's bradycardia is refractory to initial treatment?

    <p>Consider other causes of shock, but do not delay transport</p> Signup and view all the answers

    What is the primary goal of managing a patient with bradycardia?

    <p>To manage underlying causes of shock</p> Signup and view all the answers

    What should be done if a patient with bradycardia is hypotensive?

    <p>Administer normal saline, 500 mL IV bolus</p> Signup and view all the answers

    What is a common complication of bradycardia?

    <p>Ventricular ectopy</p> Signup and view all the answers

    What is the primary goal when dealing with an agitated patient?

    <p>Speak softly and non-threateningly</p> Signup and view all the answers

    What is the recommended position for a patient who needs to be restrained?

    <p>Supine (face up)</p> Signup and view all the answers

    What is the recommended dose of ketamine for excited delirium syndrome?

    <p>4 mg/kg IM</p> Signup and view all the answers

    What should be done if the patient becomes agitated or aggressive as the effects of the ketamine are starting to wear off?

    <p>Administer lorazepam or midazolam</p> Signup and view all the answers

    What should be done if vascular access is not available?

    <p>Administer lorazepam IM or midazolam IM</p> Signup and view all the answers

    What is the primary goal of airway management in these situations?

    <p>Maintain a patent airway</p> Signup and view all the answers

    What should be monitored to ensure the patient's vital signs are stable?

    <p>SpO2, ETCO2, and cardiac rhythm</p> Signup and view all the answers

    What should be treated if indicated?

    <p>Hypoglycemia and other medical complaints</p> Signup and view all the answers

    What is the contraindication for using a Supraglottic Airway?

    <p>Damaged tissue in the supraglottic area</p> Signup and view all the answers

    What is the purpose of using a Bougie?

    <p>To place an Endotracheal Tube (ETT)</p> Signup and view all the answers

    What should be done if a patient's SpO2 level drops to less than 94% after an advanced airway is established?

    <p>Consider the possibilities of device displacement, obstruction, pneumothorax, or equipment failure</p> Signup and view all the answers

    What is the recommended head and neck position when an advanced airway is established?

    <p>Neutral position</p> Signup and view all the answers

    What is the airway of choice when there is a high risk of aspiration?

    <p>Endotracheal Tube (ETT)</p> Signup and view all the answers

    What should be checked when using a Bougie to change the airway from an I-gel to an ETT?

    <p>Resistance when passing the Bougie through the vocal cords</p> Signup and view all the answers

    What is the indication for using an Endotracheal Tube (ETT) in respiratory arrest?

    <p>Supraglottic Airways are contraindicated</p> Signup and view all the answers

    What should be done initially after an advanced airway is established?

    <p>Secure the advanced airway device</p> Signup and view all the answers

    Which of the following is a common symptom of traumatic damage to a solid organ?

    <p>Gastrointestinal bleeding</p> Signup and view all the answers

    A 40-year-old male patient is experiencing upper abdominal pain. What is the most important diagnostic consideration in this case?

    <p>12-lead ECG</p> Signup and view all the answers

    A female patient of childbearing age is experiencing lower abdominal pain. What is the most important diagnostic consideration in this case?

    <p>Ectopic pregnancy</p> Signup and view all the answers

    What is the characteristic of classic appendicitis pain?

    <p>Starts in the mid-upper abdomen or around the umbilicus and later moves to the right lower quadrant</p> Signup and view all the answers

    A patient is experiencing right upper quadrant pain. What is the most likely diagnosis?

    <p>Gallbladder pain</p> Signup and view all the answers

    A patient is experiencing left upper quadrant pain. What is the most likely diagnosis?

    <p>Pancreatitis</p> Signup and view all the answers

    What is the importance of determining the location of the pain in abdominal pain evaluation?

    <p>It is the most helpful piece of information in determining the cause of the pain</p> Signup and view all the answers

    A patient is experiencing kidney stones. What is the characteristic of the pain?

    <p>It starts in the posterior flank and radiates around to the lower abdomen on the side of the pain</p> Signup and view all the answers

    What is the primary goal of establishing baseline vitals in an alcohol intoxication patient?

    <p>To identify potential complications</p> Signup and view all the answers

    What is the indication for administering dextrose 50% (D50W) in an alcohol intoxication patient?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is the role of the police in the management of an alcohol intoxication patient who refuses to be transported to a facility?

    <p>To utilize the Marchman Act (FS397.6811)</p> Signup and view all the answers

    What is the typical timeframe for the onset of Delirium Tremens (DTs) after a decrease in alcohol intake?

    <p>6-24 hours</p> Signup and view all the answers

    What should be considered when treating a patient with alcohol intoxication who has consumed highly caffeinated drinks?

    <p>The potential for underestimating the level of intoxication</p> Signup and view all the answers

    What should be done if a patient with alcohol intoxication is agitated and/or combative?

    <p>Treat per the Agitated Patient protocol</p> Signup and view all the answers

    What should be considered in addition to alcohol intoxication when treating a patient?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of airway management in an alcohol intoxication patient?

    <p>To establish a patent airway</p> Signup and view all the answers

    What information should be obtained when reporting incidents to the Florida Abuse Hotline?

    <p>All of the above</p> Signup and view all the answers

    What should be done after reporting abuse, neglect, or exploitation to the Florida Abuse Hotline?

    <p>Document the referral and method of referral in the narrative section</p> Signup and view all the answers

    Why should the Florida Abuse Hotline Fax Transmittal Form not be faxed to the Florida Abuse Hotline?

    <p>There is no guaranteed process to confirm receipt of the form</p> Signup and view all the answers

    What is the responsibility of the Unit when a police agency responds to an incident scene?

    <p>The Unit is still responsible for reporting the incident to the Florida Abuse Hotline</p> Signup and view all the answers

    What should be included in the brief description of physical, mental, or behavioral indications?

    <p>All of the above</p> Signup and view all the answers

    Where should the completed Florida Abuse Hotline Fax Transmittal Form be delivered?

    <p>The EMS Division</p> Signup and view all the answers

    What should be documented in the narrative section of the Patient Care Record?

    <p>The referral and method of referral</p> Signup and view all the answers

    Why should the Unit report incidents to the Florida Abuse Hotline?

    <p>To comply with state regulations</p> Signup and view all the answers

    What is the page number for the pediatric traumas protocol in the Coral Gables, Hialeah, Miami, Miami Beach, and Key Biscayne EMS protocols?

    <p>page 325</p> Signup and view all the answers

    What is the section that begins on page 565 in the EMS protocols?

    <p>Administrative Section</p> Signup and view all the answers

    What is the page number for the adult algorithms in the EMS protocols?

    <p>page 619</p> Signup and view all the answers

    What is the section that begins on page 3 in the EMS protocols?

    <p>Adult Protocols</p> Signup and view all the answers

    What is the page number for the pediatric algorithms in the EMS protocols?

    <p>page 679</p> Signup and view all the answers

    What is the purpose of the Updates section in the EMS protocols?

    <p>To provide updates on changes to the protocols</p> Signup and view all the answers

    What is the page number for the abdominal pain protocol in the EMS protocols?

    <p>page 5</p> Signup and view all the answers

    What is the section that begins on page 349 in the EMS protocols?

    <p>Medications Section</p> Signup and view all the answers

    In cardiac arrest, how often should you ventilate?

    <p>Once every 6 seconds</p> Signup and view all the answers

    What should you consider inserting in situations where abdominal distention persists after successful endotracheal intubation?

    <p>An Oral Gastric Tube</p> Signup and view all the answers

    What should you continuously monitor in all patients with an Advanced Airway?

    <p>ETCO2</p> Signup and view all the answers

    If unable to place an advanced airway or deliver effective BVM breaths, what should you do?

    <p>Use additional EMS personnel to assist with ventilation</p> Signup and view all the answers

    What should you do if unable to ventilate a patient by any means?

    <p>Perform a cricothyrotomy if clinically warranted</p> Signup and view all the answers

    In partial airway obstruction, what should you allow the patient to do?

    <p>Assume a position of comfort</p> Signup and view all the answers

    In complete airway obstruction in conscious patients, what should you administer?

    <p>Abdominal thrusts</p> Signup and view all the answers

    What should you monitor and record after successful placement of an Advanced Airway and upon every patient transfer?

    <p>ETCO2</p> Signup and view all the answers

    Who is the Medical Director of Coral Gables, Hialeah, and Miami Beach?

    <p>Frederick M. Keroff, MD, FACEP</p> Signup and view all the answers

    What is the address of the Miami Beach Fire Department?

    <p>2300 Pinetree Drive, Miami Beach, FL 33140</p> Signup and view all the answers

    What is the version of the 2022-2024 EMS Common Medical Operations Manual?

    <p>1.8</p> Signup and view all the answers

    Who is the Fire Chief mentioned in the EMS Common Medical Operations Manual?

    <p>Virgil Fernandez, Fire Chief</p> Signup and view all the answers

    What is the primary goal of the Miami Beach Fire Department?

    <p>All of the above</p> Signup and view all the answers

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

    <p>Paul J. Adams, DO, MA, FACOEP</p> Signup and view all the answers

    What is the purpose of the EMS Common Medical Operations Manual?

    <p>To ensure the highest quality standards of pre-hospital emergency care</p> Signup and view all the answers

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

    <p>Armando Clift, MD, FAAEM</p> Signup and view all the answers

    What should be administered to a patient with bradycardia resulting from a Beta Blocker or Calcium Channel Blocker excess / OD?

    <p>Atropine sulfate, 1 mg IV every 5 minutes to a maximum of 3 mg</p> Signup and view all the answers

    What should be done if a patient with an acute inferior wall myocardial infarction and a bradycardia due to a high-grade Mobitz II or a Third Degree Heart Block has a wide QRS complex?

    <p>Apply external pacing as the first treatment</p> Signup and view all the answers

    What should be done if a patient has a heart rate of 40 bpm or less but is otherwise stable?

    <p>Apply external pacemaker pads without turning the pacer on and observe for signs/symptoms</p> Signup and view all the answers

    What should be considered in a patient with bradycardia?

    <p>Ventricular ectopy will frequently occur</p> Signup and view all the answers

    What establishes the foundation of patient care and treatment according to the provided vision?

    <p>High quality standards, patient safety, and customer service</p> Signup and view all the answers

    What should be done if a patient with bradycardia has a BP less than 90 mmHg after fluid administration?

    <p>Administer premix dopamine, 400 mg in 250 mL D5W</p> Signup and view all the answers

    What should be done if a patient has bradycardia due to an Organophosphates Overdose?

    <p>Administer atropine sulfate, 1 mg IVP every 5 minutes until drying of the secretions occurs</p> Signup and view all the answers

    What is the primary goal of the EMS protocols/procedures and medications used by the City of Miami Fire Department?

    <p>To provide high quality patient care and treatment</p> Signup and view all the answers

    What should be done if a patient has bradycardia due to a Beta Blocker or Calcium Channel Blocker excess / OD and remains hypotensive?

    <p>Administer normal saline, 500 mL IV bolus</p> Signup and view all the answers

    Which of the following EMS protocols/procedures and medications are NOT used by the City of Miami Fire Department until available for use?

    <p>All of the listed options</p> Signup and view all the answers

    What should be prioritized in a patient with bradycardia?

    <p>Treating the underlying cause</p> Signup and view all the answers

    What is the primary role of the Medical Director in the City of Miami Fire Department?

    <p>To oversee the use of EMS protocols/procedures and medications</p> Signup and view all the answers

    What is the primary goal of the 'art' of emergency pre-hospital medicine?

    <p>To provide high quality patient care and treatment</p> Signup and view all the answers

    What is the primary role of the EMS protocols/procedures and medications in the City of Miami Fire Department?

    <p>To provide high quality patient care and treatment</p> Signup and view all the answers

    What is the primary goal of the City of Miami Fire Department in using EMS protocols/procedures and medications?

    <p>To provide high quality patient care and treatment</p> Signup and view all the answers

    What is the primary responsibility of the EMS personnel in the City of Miami Fire Department?

    <p>To provide high quality patient care and treatment</p> Signup and view all the answers

    What information should be obtained when reporting an incident of abuse or neglect?

    <p>The victim's name, address, telephone number, date of birth, race, sex, and medical conditions</p> Signup and view all the answers

    What should be done after reporting an incident of abuse or neglect to the Florida Abuse Hotline?

    <p>Document the referral and method of referral in the narrative section of the Patient Care Record</p> Signup and view all the answers

    What is the primary responsibility of the Unit when encountering a person who has been abused or neglected?

    <p>To report the incident to the Florida Abuse Hotline and complete the necessary forms</p> Signup and view all the answers

    What information should be included in the Florida Abuse Hotline Fax Transmittal Form?

    <p>The victim's name, address, telephone number, date of birth, race, sex, and medical conditions, as well as the counselor's name and identification number</p> Signup and view all the answers

    What is a potential symptom of dystonia?

    <p>Deviation of the head to one side</p> Signup and view all the answers

    What should be done if a police agency responds to the incident scene or transports the neglected or exploited person to a hospital?

    <p>The Unit should still report the incident to the Florida Abuse Hotline</p> Signup and view all the answers

    Which of the following medications may cause dystonia?

    <p>Metoclopramide (Reglan)</p> Signup and view all the answers

    What is the purpose of obtaining the victim's social security number when reporting an incident of abuse or neglect?

    <p>To verify the victim's identity</p> Signup and view all the answers

    What should be included in the brief history of the victim when reporting an incident of abuse or neglect?

    <p>The victim's medical conditions and situation found in the home</p> Signup and view all the answers

    What is the recommended treatment for dystonia?

    <p>Administer diphenhydramine (Benadryl), 50 mg slow IVP or IM</p> Signup and view all the answers

    Why is it important to document the referral and method of referral in the narrative section of the Patient Care Record?

    <p>To ensure that all necessary information is provided to the Florida Department of Children and Family Services</p> Signup and view all the answers

    What is a potential treatment for localized edema-swelling of the lips, tongue, and/or throat?

    <p>Administer diphenhydramine (Benadryl), 50 mg slow IVP or IM</p> Signup and view all the answers

    What is a potential cause of localized edema-swelling of the lips, tongue, and/or throat?

    <p>Allergic reaction to a medication</p> Signup and view all the answers

    What medication may be prescribed to counteract the adverse effects of certain medications?

    <p>Benztropine mesylate (Cogentin)</p> Signup and view all the answers

    What is the indication for administering sodium bicarbonate to a patient?

    <p>When the patient is exhibiting disrhythmias indicative of metabolic acidosis</p> Signup and view all the answers

    What is the primary goal of cooling the patient down in excited delirium syndrome?

    <p>To decrease the patient's body temperature</p> Signup and view all the answers

    What is the maximum amount of morphine sulfate that can be administered to a patient in excited delirium syndrome?

    <p>20mg</p> Signup and view all the answers

    At what temperature should cooling measures be initiated in a patient with excited delirium syndrome?

    <p>104°F (40°C)</p> Signup and view all the answers

    What is the dose of midazolam (Versed) to be administered to a patient in excited delirium syndrome?

    <p>5mg IV/IO</p> Signup and view all the answers

    What is the volume of cold normal saline to be administered to a patient in excited delirium syndrome?

    <p>30 mL/kg IV/IO</p> Signup and view all the answers

    What is the temperature of the cold normal saline to be administered to a patient in excited delirium syndrome?

    <p>34°F (1°C)</p> Signup and view all the answers

    What should be documented after administering cold normal saline to a patient in excited delirium syndrome?

    <p>Both the baseline temperature and the temperature at the time of patient transfer</p> Signup and view all the answers

    What is a critical criterion for imposing the Baker Act on an individual?

    <p>The person is a threat to themselves or others in the near future</p> Signup and view all the answers

    Who is authorized to impose the Baker Act on an individual?

    <p>A physician, clinical psychologist, or mental health professional</p> Signup and view all the answers

    What is a crucial aspect of patient care when imposing the Baker Act?

    <p>Documenting the patient's care and treatment in a thorough manner</p> Signup and view all the answers

    What is the primary goal of the Baker Act?

    <p>To protect individuals with mental health conditions from harming themselves or others</p> Signup and view all the answers

    What is a key consideration when using physical restraint on a patient subject to the Baker Act?

    <p>Using the supine or recovery position to restrain the patient</p> Signup and view all the answers

    What is a crucial aspect of the Baker Act?

    <p>It preserves the rights of individuals, including informed consent</p> Signup and view all the answers

    What is the purpose of the Baker Act?

    <p>To protect individuals with mental health conditions from harming themselves or others</p> Signup and view all the answers

    What is a key consideration when imposing the Baker Act on an individual?

    <p>The individual's potential to harm themselves or others</p> Signup and view all the answers

    What should be done if a patient is suspected of having a venomous reptile bite?

    <p>Contact Venom 1 and ensure they know your transport destination</p> Signup and view all the answers

    What should be evaluated for in a patient with a suspected North American Pit Viper bite?

    <p>All of the above, plus numbness, metallic taste, and hypotension</p> Signup and view all the answers

    What should be marked on the patient's skin in a suspected bite?

    <p>The initial swelling and time of the bite</p> Signup and view all the answers

    Why should the affected area be immobilized in a patient with a suspected bite?

    <p>To prevent further injury to the area</p> Signup and view all the answers

    What should be removed and secured in a safe location in a patient with a suspected bite?

    <p>The patient's jewelry</p> Signup and view all the answers

    What should be contacted for assistance in managing specific envenomations?

    <p>The Poison Control Center</p> Signup and view all the answers

    What should be maintained in a patient with a suspected bite?

    <p>SpO2 of 94% or greater</p> Signup and view all the answers

    What should be established in a patient with a suspected bite?

    <p>Vascular access with a saline lock on the unaffected extremity</p> Signup and view all the answers

    What is the primary goal when treating a patient with a bee sting?

    <p>Apply local ice packs</p> Signup and view all the answers

    What is categorized as symptomatic bradycardia?

    <p>A heart rate below 60 beats per minute with inadequate perfusion</p> Signup and view all the answers

    What should be considered when treating a patient with a yellow jacket sting?

    <p>The signs and symptoms of an allergic reaction</p> Signup and view all the answers

    What is the treatment for a patient with an allergic reaction to a wasp sting?

    <p>Administer epinephrine</p> Signup and view all the answers

    What is the definition of bradycardia?

    <p>A heart rate below 60 beats per minute</p> Signup and view all the answers

    What is the goal of treating a patient with bradycardia?

    <p>Monitor the patient for signs and symptoms</p> Signup and view all the answers

    What should be done if a patient develops an anaphylactic reaction to an insect sting?

    <p>Administer epinephrine</p> Signup and view all the answers

    What is the primary goal when treating a patient with an insect sting?

    <p>Reduce pain and swelling</p> Signup and view all the answers

    What is the recommended breathing frequency in cardiac arrest?

    <p>10-12 breaths per minute</p> Signup and view all the answers

    What should be considered when a patient has abdominal distention after successful endotracheal intubation?

    <p>Insertion of an Oral Gastric Tube</p> Signup and view all the answers

    What should be done if unable to ventilate a patient by any means?

    <p>Perform a cricothyrotomy if clinically warranted</p> Signup and view all the answers

    What should be monitored in all patients with an advanced airway?

    <p>ETCO2</p> Signup and view all the answers

    What should be done in a patient with partial airway obstruction who is able to speak?

    <p>Apply a non-rebreather mask with high flow oxygen</p> Signup and view all the answers

    What should be done in a conscious patient with complete airway obstruction?

    <p>Perform abdominal thrusts</p> Signup and view all the answers

    What should be done if unable to place an advanced airway or deliver effective BVM breaths?

    <p>Insert 2 NPAs and 1 OPA, and use additional EMS personnel</p> Signup and view all the answers

    What is the primary goal of the initial assessment of a patient with back pain?

    <p>To rule out life-threatening conditions</p> Signup and view all the answers

    A patient presents with sudden onset of upper back pain associated with shortness of breath. What is the most likely diagnosis?

    <p>Pulmonary embolus</p> Signup and view all the answers

    What should be attached to the patient's airway during cardiac arrest, if available?

    <p>A CO2 sensor</p> Signup and view all the answers

    What is the primary difference between kidney infection and kidney stones?

    <p>Fever and nausea vs. vomiting and blood in the urine</p> Signup and view all the answers

    A patient presents with flank pain that radiates into the lower abdomen. What is the most likely diagnosis?

    <p>Kidney stones</p> Signup and view all the answers

    What is the primary goal of monitoring vital signs in a patient with back pain?

    <p>To monitor for life-threatening complications</p> Signup and view all the answers

    What should be done if the bite is unknown or known to be venomous from a reptile or spider?

    <p>Contact dispatch to have Miami-Dade Fire Rescue Venom 1 contacted</p> Signup and view all the answers

    A patient presents with lower back pain that radiates into the legs. What is the most likely diagnosis?

    <p>Sciatica</p> Signup and view all the answers

    What is the primary difference between upper back pain and lower back pain?

    <p>Pulmonary embolus vs. musculoskeletal pain</p> Signup and view all the answers

    What should be done to the patient's rings, bracelets, and jewelry in the affected area?

    <p>Remove and secure them in a safe location before swelling prevents easy removal</p> Signup and view all the answers

    What should be monitored in a patient with a venomous bite?

    <p>The development of any anaphylactic reaction</p> Signup and view all the answers

    What is the primary goal of the treatment plan for a patient with back pain?

    <p>To stabilize the patient's vital signs</p> Signup and view all the answers

    What should be done to the affected area in a patient with a venomous bite?

    <p>Immobilize the affected area and keep the patient calm</p> Signup and view all the answers

    What should be done if the patient's SpO2 is less than 94%?

    <p>Administer oxygen to maintain an SpO2 of 94% or greater</p> Signup and view all the answers

    What should be done if the patient is experiencing signs of anaphylaxis?

    <p>Administer epinephrine and follow the Systemic Reactions Protocol</p> Signup and view all the answers

    What should be done when evaluating a patient with a venomous bite?

    <p>Evaluate the patient for specific signs and symptoms, such as distinct 'fang marks' or puncture wounds</p> Signup and view all the answers

    What should be done to the patient's affected area after marking the endpoint of the initial swelling?

    <p>Re-mark the endpoint every 15 minutes</p> Signup and view all the answers

    What is a common cause of bradycardia that must be addressed during treatment?

    <p>Hypoxia</p> Signup and view all the answers

    What is the maximum dose of atropine sulfate that can be administered to a patient with an unstable bradycardia?

    <p>0.04 mg/kg</p> Signup and view all the answers

    When should external pacing be initiated in a patient with an unstable bradycardia?

    <p>As soon as possible</p> Signup and view all the answers

    What is the primary goal of administering a fluid bolus in a patient with an unstable bradycardia?

    <p>To improve blood pressure</p> Signup and view all the answers

    What is a sign of an unstable bradycardia?

    <p>Respiratory distress</p> Signup and view all the answers

    What should be considered in a patient with an unstable bradycardia who is conscious and not tolerating the pain from pacing?

    <p>Pain management</p> Signup and view all the answers

    Why is atropine sulfate unlikely to be effective in some patients with an unstable bradycardia?

    <p>Due to the presence of a widened QRS complex</p> Signup and view all the answers

    What should be done simultaneously with the application of an external pacemaker in a patient with an unstable bradycardia?

    <p>Start an IV and apply the external pacemaker</p> Signup and view all the answers

    Study Notes

    Abdominal Pain and Nausea/Vomiting

    • Administer ondansetron (Zofran) 8mg PO or 4mg IVP/IO/IM for nausea and vomiting
    • Treating abdominal pain may also relieve nausea
    • Consider pain management for patients with abdominal pain and nausea

    Vomiting Blood or Bleeding Large Amounts Per Rectum

    • Start a saline lock and administer normal saline only if the patient has hypotension or tachycardia

    Abuse Reporting and Community Services

    • Report abuse, neglect, or exploitation of children or vulnerable adults to the Florida Abuse Hotline
    • Notify police and the EMS Division Supervisor
    • Complete the Elder-Helpline Referral Form and deliver or fax it to the EMS Division for patients who may benefit from community services

    AICD (Automatic Implantable Cardioverter/Defibrillator)

    • An AICD is a device implanted in the patient's chest wall to sense cardiac electrical activity and analyze ECG rhythms
    • Treat AICD discharges with universal initial patient assessment and care, airway management, and monitoring of ECG and SpO2
    • Consider pain management for conscious patients with repetitive AICD discharges

    Airway Management

    • Assess respiratory status by evaluating the upper and lower airways
    • Use CPAP for acute pulmonary edema, respiratory distress, and acute bronchospasm
    • Use an automatic ventilator for PPV in demand, manual, or automatic mode
    • Use a BVM when CPAP or automatic ventilator is not available
    • Consider advanced airway placement for patients in respiratory arrest or requiring prolonged PPV

    Alcohol Intoxication

    • Identify signs of alcohol intoxication, including delirium tremens (DTs), a sign of alcohol withdrawal
    • Treat patients with delirium tremens with Agitated Patient protocol if agitated and/or combative
    • Consider concurrent drug overdose and treat accordingly
    • Individuals who have consumed highly caffeinated alcoholic drinks may not demonstrate the true level of their alcohol intoxication

    Adult Protocols

    • Versed will be used in place of Ativan
    • Backboard will be used in place of a scoop stretcher

    Airway Management

    • Invasive airways are usually reserved for patients with severe respiratory distress and depressed levels of consciousness
    • Three options for invasive airways:
    • Supraglottic devices
    • Oral ETT
    • Cricothyrotomy (most invasive)
    • Patient assessment:
    • Level of consciousness
    • SpO2 levels
    • Capnography waveforms
    • Repeated re-evaluations are necessary to determine if the initial management chosen is correct

    Oxygen Therapy

    • Oxygen treatment should be started with one of the following options:
    • Nasal cannula (for mild respiratory distress with SpO2 < 94%)
    • Non-rebreather mask (NRBM) (for moderate respiratory distress with normal respiratory rate and volume, and SpO2 < 94%)
    • Nebulizer mask (for acute bronchospasm or upper airway edema)
    • Positive pressure ventilation (PPV) (for severe respiratory distress or slow/shallow respirations)
    • Goal SpO2: 94% or greater, except in patients with severe COPD or emphysema (88-92%)
    • Oxygen is not indicated for patients with ischemic chest pain who have a normal SpO2 reading of 94% or greater

    Respiratory Adjuncts

    • Patients taking ACE-inhibitors may present with localized angioedema, particularly of the lips, tongue, and throat, and partial upper airway obstruction with stridor
    • During transport, observe for developing or increasing respiratory difficulty and/or changes in voice that may represent swelling involving the pharynx/vocal cords

    Allergic/Systemic Reactions

    • Angioedema is not an allergic reaction, but some patients may benefit from treatment with epinephrine and Benadryl
    • Treatment:
    • Epinephrine 1:1,000, 0.3 mg (0.3 mL) IM
    • Diphenhydramine (Benadryl), 50 mg slow IVP or IM

    Baker Act/Marchman Act

    • Criteria for imposing the Baker Act:
    • The person is likely to suffer from neglect or refuse to care for themselves, posing a real and present threat of substantial harm to their well-being
    • The person is likely to cause serious bodily harm to themselves or others in the near future
    • The Baker Act can only be imposed by a judge, sworn law enforcement officer, or a physician, clinical psychologist, or psychiatric nurse
    • Reasonable force (restraint) may be applied, but not in a prone position

    Adult Protocols

    • Abdominal Pain:
      • Administer ondansetron (Zofran) ODT, 8 mg PO, or IF AVAILABLE, administer ondansetron (Zofran), 4 mg IVP/IO/IM
      • Consider pain management
      • Vomiting blood or bleeding large amounts per rectum: start a saline lock and only administer normal saline if patient also has hypotension or tachycardia

    Abuse Reporting and Community Services

    • Reporting to Community Services:
      • Complete the Elder-Helpline Referral Form
      • Deliver or fax the completed form to the EMS Division
      • If the person is a patient, document the referral in the narrative section of the Patient Care Record
    • Elder Links Information:
      • Florida Department of Elder Affairs, Alliance for Aging Inc. (Elder Links)
      • Phone: 305-670-HELP (4357) or 1-800-96ELDER (1-800-963-5337)
      • Fax: 305-222-4100 or 305-222-4139
    • Reporting ABUSE, NEGLECT, or EXPLOITATION of Children or Vulnerable Adults:
      • Immediately report to the Florida Abuse Hotline
      • Notify Police
      • Notify the EMS Division Supervisor prior to the end of your shift

    Agitated Patient/Excited Delirium Syndrome

    • If the patient is febrile or hot to the touch (temperature reading of 104°F (40°C) or higher) and exhibiting signs of excited delirium:
      • Attempt to cool the patient down
      • Remove as much clothing as possible
      • Move patient to a cooler environment and/or fan blowing on patient
      • Apply ice packs to the neck, axillae, and groin areas
      • Establish vascular access and bolus cold (34°F) normal saline, 30 mL/kg IV/IO (maximum 2 Liters)
      • Administer midazolam (Versed), 5 mg IV/IO or 10 mg IM/IntraNasal if the patient is shivering
      • Administer morphine sulfate, 5 mg IV/IO/IM if the patient is agitated and/or in pain

    Airway Management

    • Three adjuncts are available for PPV:
      • CPAP: Best for Acute Pulmonary Edema, patient must be awake and able to follow directions
      • Automatic Ventilator: Used for PPV in either the demand mode or manual mode
      • BVM: Used when CPAP or Automatic Ventilator is indicated, but not available
    • Advanced Airway:
      • When the patient is in respiratory arrest, or prolonged PPV is required with a BVM or Automatic Ventilator
      • Choice of a Supraglottic Airway or an oral Endotracheal Tube
      • Patient should be given 100% oxygen while preparing for the procedure

    Clinical Assessment of the Lower Airway

    • The clinical assessment of the lower airway consists of several elements, including:
      • Assessment of the patient's mental status (alert, confused, responsive to verbal stimuli, responsive to painful stimuli, or unresponsive)
      • Assessment of the patient's skin (warm/dry, pink, ashen, or cyanotic)
      • Assessment of the chest wall and the ribs and muscles used to assist in moving air in and out of the chest
      • Listening for lung sounds (wheezing, rhonchi, rales, or the absence of breath sounds)

    Management of Respiratory Distress

    • The management of a patient in apparent respiratory distress involves a continuum of options, including:
      • Blow-by
      • Nasal cannula
      • Nebulizer
      • NRB mask
      • BVM with reservoir
      • CPAP

    Complete Airway Obstruction

    • In unconscious patients with a pulse, the management of complete airway obstruction involves:
      • Opening the airway
      • Attempting to ventilate
      • Checking the mouth for an object and attempting to remove it or use suction
      • Performing 5 cycles of 30:2 CPR if unable to ventilate
      • Using a laryngoscope to visualize the obstruction and attempting to remove it
      • Using a Magill forceps to remove the obstruction
      • Performing an emergency cricothyrotomy as a last resort

    Bites and Stings

    Exotic Snakes

    • Identify the snake's scientific or common name
    • Contact Venom 1 immediately
    • Signs and symptoms vary greatly among different species

    Brown Recluse Spider Bites

    • Evaluate for signs and symptoms (small bleb surrounded by a white ring, localized pain, redness, swelling, and localized tissue necrosis)
    • No specific pre-hospital treatment

    Black Widow Spider Bites

    • Evaluate for signs and symptoms (immediate localized pain, progressive muscle spasms, rigid abdomen, seizures, and paralysis)
    • Administer midazolam (Versed) 5 mg slow IV or 10 mg IM/IntraNasal to reduce severe muscle spasms
    • Administer morphine sulfate 5 mg IV/IO/IM if patient still has severe muscle spasms
    • Consider pain management in the conscious patient

    Scorpion Stings

    • Evaluate for signs and symptoms (generalized weakness, dizziness, nausea, and mild anxiety)
    • Treat unstable bradycardias according to protocol

    Bradycardia

    General Management

    • Use a team approach in the management of patients with unstable bradycardia
    • Apply external pacing as soon as possible
    • Administer atropine sulfate 1 mg IVP/IO
    • Consider pain management in the conscious patient
    • Administer fluid bolus of normal saline 500 mL IV/IO if the patient remains hypotensive
    • Administer premix dopamine 400 mg in 250 mL D5W if the patient remains hypotensive

    Special Circumstances

    • If the bradycardia is the result of a Beta Blocker or Calcium Channel Blocker excess/OD, administer atropine sulfate 1 mg IV every 5 minutes to a maximum of 3 mg
    • If the bradycardia is the result of an Organophosphate overdose, administer atropine sulfate 1 mg IVP every 5 minutes until drying of the secretions occurs
    • If the bradycardia is the result of a high-grade Mobitz II or Third Degree Heart Block in a patient with an acute inferior wall myocardial infarction, external pacing is preferred as the first treatment.

    Abdominal Pain

    • Traumatic damage to solid organs, such as the spleen, kidney, and liver, can cause gastrointestinal bleeding, nausea, and vomiting, or bleeding from the mouth or rectum.
    • Upper abdominal pain (above the umbilicus) requires a 12-lead ECG for males over 35 years and females over 45 years.
    • Lower abdominal pain (below the umbilicus) requires consideration of ectopic pregnancy in females of childbearing years.
    • Past medical/surgical history and current medication use are important in determining the cause of abdominal pain.
    • Location of pain is crucial in determining the cause: renal colic (kidney stones) starts in the posterior flank and radiates around to the lower abdomen, never crossing the midline.

    Renal Colic and Kidney Stones

    • Renal colic starts in the posterior flank and radiates around to the lower abdomen, never crossing the midline.
    • Right upper quadrant pain may indicate gallbladder pain, which can move around the upper abdomen into the mid-back.
    • Right lower quadrant pain may indicate kidney stones, ectopic pregnancy, or classic appendicitis.
    • Left upper quadrant pain may indicate pancreatitis, especially with a history of pancreatitis, alcohol abuse, or gallbladder stones.
    • Left lower quadrant pain may indicate diverticulitis.

    Abuse Reporting and Community Services

    • Report incidents of abuse by calling the Florida Abuse Hotline (1-800-96ABUSE).
    • Obtain necessary information, including victim's name, address, phone number, date of birth, age, race, and sex, and brief description of physical, mental, or behavioral indications.
    • Complete the Florida Abuse Hotline Fax Transmittal Form and deliver or fax it to the EMS Division for follow-up.

    Agitated Patient/Excited Delirium Syndrome

    • Use the least restrictive method of restraint and ensure provider safety.
    • If chemical restraint is indicated, administer ketamine 4mg/kg IM (max dose 400mg) or lorazepam/midazolam IV or IM if ketamine is not available.
    • Monitor cardiac rhythm, ETCO2, and SpO2, and provide supplemental O2 if indicated.

    Airway Management

    • Supraglottic Airways are contraindicated when there is damaged tissue in the supraglottic area or high risk of aspiration.
    • Endotracheal Tube (ETT) is the airway of choice when there is a high risk of aspiration.
    • Bougie can be used to place an ETT or change the airway from an I-gel to an ETT.

    Alcohol Intoxication

    • Delirium tremens (DTs) is a sign of alcohol withdrawal, presenting as fine tremors to tonic-clonic seizures, usually 6-24 hours after a decrease in alcohol intake.
    • Treat agitated patients per the Agitated Patient protocol.
    • Consider concurrent drug overdose, as drugs and alcohol can be a deadly combination.
    • Individuals who have consumed highly caffeinated alcoholic drinks may not demonstrate the true level of their alcohol intoxication.

    Adult Protocols

    • Abdominal Pain protocol is on page 5
    • Agitated Patient – Excited Delirium Syndrome protocol is on page 11
    • Airway Management protocol is on page 17
    • Allergic / Systemic Reactions protocol is on page 29
    • Bradycardia protocol is on page 48

    Airway Management

    • Consider inserting an Oral Gastric Tube in situations where abdominal distention persists after successful endotracheal intubation
    • Monitor and record ETCO2 after successful placement of an Advanced Airway and again upon every patient transfer
    • Continuously monitor ETCO2 in all patients with an Advanced Airway (Supraglottic or ETT)
    • If unable to place an advanced airway or deliver effective BVM breaths, re-attempt BVM ventilation by inserting 2 NPAs (one in each nostril) and 1 OPA (if possible)
    • Use additional EMS personnel to assist with ventilation and positioning
    • If unable to ventilate patient by any means, perform a cricothyrotomy if clinically warranted

    Partial Airway Obstruction

    • Allow patient to assume a position of comfort
    • If patient will allow it, apply a NRBM with high flow oxygen
    • Transport and monitor

    Complete Airway Obstruction in CONSCIOUS patients

    • Administer abdominal thrusts (use chest thrusts for obese or pregnant patients)
    • Repeat until cleared or the patient becomes unconscious

    Bradycardia

    • If the bradycardia is the result of a Beta Blocker or Calcium Channel Blocker excess / OD, administer atropine sulfate, 1 mg IV every 5 minutes to a maximum of 3 mg
    • If the bradycardia is the result of an Organophosphates Overdose, administer atropine sulfate, 1 mg IVP every 5 minutes until drying of the secretions (atropinization) occurs, or 2 mg IM with an Atropen Auto Injector if available
    • In a patient with an acute inferior wall myocardial infarction and a bradycardia due to a high-grade Mobitz II or a Third Degree Heart Block (complete heart block) with a wide QRS complex, external pacing is preferred as the first treatment
    • Dopamine may be used to increase the heart rate while applying the transcutaneous pacer

    Abuse Reporting & Community Services

    • Incidents of abuse should be reported to the Florida Abuse Hotline by calling 1-800-96ABUSE (1-800-962-2873)
    • The following information should be obtained when reporting abuse:
      • Victim's name
      • Full address (including zip code, apartment, building, or lot number)
      • Telephone number
      • Date of birth, age, race, and sex
      • Social Security Number
      • Brief description of physical, mental, or behavioral indications demonstrating that the person is infirm or disabled
      • Signs or indications of harm or injury, including a physical description if possible
      • Brief history including medical conditions and the situation found in the home
      • Incident number and police case number if applicable
    • The Florida Abuse Hotline Fax Transmittal Form should be completed and faxed to the EMS Division for follow-up with the local office of the Florida Department of Children and Family Services
    • The referral and method of referral should be documented in the narrative section of the Patient Care Record

    The Agitated Patient / Excited Delirium Syndrome

    • If the patient is exhibiting signs of excited delirium and is febrile or hot to the touch (temperature reading of 104°F or higher), attempt to cool the patient down
      • Remove as much clothing as possible
      • Move the patient to a cooler environment and/or use a fan to cool them
      • Apply ice packs to the neck, axillae, and groin areas
      • Establish vascular access and bolus cold (34°F) normal saline, 30 mL/kg IV/IO (maximum 2 Liters)
    • If the patient is agitated and/or in pain, administer midazolam (Versed), 5 mg IV/IO or 10 mg IM/IntraNasal
    • If the patient continues to be agitated and/or in pain, morphine sulfate, 5 mg IV/IO/IM, may be administered

    Signs and Symptoms of Dystonia

    • Protrusion of the tongue
    • Sustained upward deviation of the eyes
    • Jaw/teeth clenching
    • Facial grimacing
    • Deviation of the head to one side
    • Rarely, laryngospasm
    • Suspect possible dystonia in patients who have taken certain medications, including:
      • Haloperidol (Haldol)
      • Fluphenazine HCL (Prolixin)
      • Perphenazine (Trilafon)
      • Prochlorperazine (Compazine)
      • Thiothixene (Navane)
      • Trifluoperazine (Stelazine)
      • Trimethobenzamide HCL (Tigan)
      • Metoclopramide (Reglan)

    Allergic / Systemic Reactions

    • Treatment involves:
      • Universal Initial Adult Patient Assessment/Care
      • Administering diphenhydramine (Benadryl), 50 mg slow IVP or IM
    • Angioedema is a localized edema-swelling usually of the lips, tongue, and/or throat

    Baker Act / Marchman Act

    • The Baker Act can only be imposed by:
      • A Judge
      • A sworn law enforcement officer
      • A physician, clinical psychologist, or psychiatric nurse, mental health counselor, marriage and family therapist, or clinical social worker
    • The Baker Act requires:
      • Reasonable force (restraint) may be applied
      • Careful documentation on the Patient Care Record, including the name and agency of the person imposing the Baker Act
      • The Baker Act preserves the rights of individuals, including informed consent, the right to refuse treatment, privacy, confidentiality, communications, and/or abuse reporting

    Bites & Stings

    • For any known or suspected bite, alert Venom 1
    • Evaluate for specific signs/symptoms:
      • Distinct "fang marks" or puncture wounds
      • Swelling and pain at the site
      • Weakness, nausea, and vomiting
      • Muscle twitching
      • Numbness and tingling around the face and head
      • Metallic taste, change in taste sensation
      • Hypotension and shock
      • Allergic reactions
    • Mark the end point of the initial swelling and the time directly on the skin, and repeat every 15 minutes if applicable
    • The time of the bite should also be recorded on the Patient Care Record

    Airway Management

    • In cardiac arrest, ventilate once every 6 seconds (10-12 breaths per minute) and attach a CO2 sensor if available.
    • Monitor waveform capnography.

    Advanced Airway Management

    • Consider inserting an oral gastric tube in situations where abdominal distention persists after successful endotracheal intubation.
    • Monitor and record ETCO2 after successful placement of an advanced airway and again upon every patient transfer.
    • Continuously monitor ETCO2 in all patients with an advanced airway (supraglottic or ETT).

    Difficult Airway Management

    • If unable to place an advanced airway or deliver effective BVM breaths, re-attempt BVM ventilation by inserting 2 NPAs (one in each nostril) and 1 OPA (if possible).
    • Use additional EMS personnel to assist with ventilation and positioning the head and jaw thrust.

    Cricothyrotomy

    • If unable to ventilate patient by any means, perform a cricothyrotomy if clinically warranted.

    Partial Airway Obstruction

    • Allow patient to assume a position of comfort.
    • If patient will allow it, apply a NRBM with high flow oxygen.
    • Transport and monitor.

    Complete Airway Obstruction in CONSCIOUS patients

    • Administer abdominal thrusts (use chest thrusts for obese or pregnant patients).
    • Repeat until cleared or the patient becomes unconscious.

    Back Pain

    • Musculoskeletal pain
    • Sciatica (pinched nerve)
    • Flank Pain: kidney infection, kidney stones
    • Upper Back Pain: dissecting aortic aneurysm, acute coronary syndrome, acute cholecystitis, pulmonary embolus

    Treatment of Back Pain

    • Universal Initial Adult Patient Assessment/Care
    • Monitor vital signs
    • Be alert for the development of any anaphylactic reaction and treat according to the Systemic Reactions Protocol

    Bites and Stings

    • North American Pit Vipers (rattlesnakes, copperheads, and cottonmouths/moccasins): evaluate for specific signs/symptoms, mark the end point of the initial swelling and the time directly on the skin
    • Bees/Wasps/Hornets/Yellow Jackets/Ant Stings: apply local ice packs, consider pain management, and refer to the anaphylactic reaction protocol if necessary

    Bradycardia

    • Defined as a heart rate less than 60 beats per minute (bpm)
    • Symptomatic bradycardia means that the patient’s signs and symptoms are related to the bradycardia
    • STABLE bradycardia patients have adequate perfusion on exam, while UNSTABLE bradycardia patients require immediate treatment
    • Treatment of unstable bradycardias includes universal initial adult patient assessment/care, external pacing, and atropine sulfate administration.

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    2022-2024 Common EMS Protocols (Coral Gables, Hialeah, Miami, Miami Beach, Key Biscayne) PDF

    Description

    This quiz covers emergency medical procedures for abdominal pain, nausea, and vomiting, as well as reporting abuse and providing community services.

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