Emergency Medical Treatment Protocols Quiz
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Questions and Answers

Patients that are agitated and presenting with verbally and/or physically threatening behavior may be experiencing _________ syndrome.

Excited Delirium

Patients with the Excited Delirium Syndrome may demonstrate extremely aggressive or violent behavior and may be attracted to bright lights, loud sounds, and their own reflections in glass or mirrors. They may also be naked or near naked, have rapid breathing, and display _________ strength.

superhuman

Law enforcement agencies may utilize a TASER as a non-lethal method to temporarily incapacitate individuals who exhibit threatening behavior. Thus, it is important when approaching a patient who has been TASERed, to evaluate the patient for possible excited _________ syndrome.

delirium

Alcohol withdrawal and head trauma may contribute to the condition of ________ patients.

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

Fire Rescue may be called to the scene to manage patients that are agitated, restless, confused, and appear to be out of control. Their agitated condition may be related to mental illness and/or drug use, particularly _________ such as cocaine.

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

Patients that are agitated and presenting with threatening behavior may be agitated, restless, crying, and confused. This behavior may be related to mental illness and/or drug use, particularly _______.

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

Patients with excited delirium syndrome often remain ______ after being TASERed

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

Treatment guidelines include having enough ______ to handle the situation and physically manage the patient

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

Restraint should be the least ______ method, and providers must ensure their safety

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

______ is the preferred chemical restraint, administered at 4 mg/kg 1M

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

If ketamine is not available, ______ or midazolam can be administered

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

Initial patient ______ includes maintaining airway, checking blood glucose, and monitoring cardiac rhythm

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

Ventricular Fibrillation (VF) and Pulseless V-Tach are the initial recorded rhythms that require immediate ______ and CPR.

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

Defibrillation should be performed at specific joules (200J, 360J, 150J, or 200J depending on the stage) and CPR should be resumed without checking for pulse or rhythm change for ______ minutes.

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

Epinephrine should be administered within the first minute after resuming CPR, and repeated every ______ to 5 minutes during the arrest.

<p>3</p> Signup and view all the answers

Amiodarone should be administered within the first minute after resuming CPR in specific ______.

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

After 10 minutes of cardiac arrest, sodium bicarbonate may be considered, especially if a preexisting metabolic acidosis is ______.

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

Patients with Tension Pneumothorax can present with a PEA situation, and bilateral lung assessment is ______.

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

Continuous chest ______ should be maintained while charging the monitor or AED to minimize interruption in delivering a shock

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

When there is no pulse and the patient is not breathing, continue compressions and start ______ with a BVM until ready to place an Advanced Airway

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

Supraglottic Airway is suitable for initial set of ______ in cardiac arrest and in respiratory distress without a gag reflex

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

Endotracheal Tube (ETT) is acceptable on the initial ______ Airway attempt in cardiac arrest and when there is a high risk of aspiration

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

ETC02 sensor and waveform capnography should be used during resuscitation efforts to ensure proper placement of the Advanced ______

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

Airway management can be deferred to the next cycle of ______ in witnessed/unwitnessed cardiac arrest, with emphasis on continuous ______ and early defibrillation if a shockable rhythm is present

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

Patients or firefighters suspected of carbon monoxide (CO) exposure should be monitored using a CO monitor, and treatment options are determined based on the CO ______

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

High-risk situations for CO/CN poisoning include building fires, areas with generators, enclosed spaces with fire or smoke, and places with poor ______

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

Treatment of cyanide poisoning requires immediate attention to airway patency, oxygenation, hydration, cardiovascular support, and management of any seizure activity, in addition to ______ administration

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

For a patient with a normal/fast and narrow rhythm with pulseless electrical activity (PEA), CPR should be resumed for 2 minutes, followed by the administration of epinephrine and consideration of hypovolemia with normal saline ______

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

PEA, if not treated, may progress to asystole, so determining and correcting the underlying causes of PEA is ______

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

In the case of asystole, CPR should be resumed for 2 minutes, followed by epinephrine administration, and pacing is not ______

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

  1. What is the preferred dosage for ketamine administration as a chemical restraint for excited delirium syndrome?

<p>4 mg/kg 1M</p> Signup and view all the answers

  1. What initial assessments are recommended for patients with excited delirium syndrome?

<p>Maintaining airway, checking blood glucose, and monitoring cardiac rhythm</p> Signup and view all the answers

  1. What measures should be implemented for febrile or hot patients with excited delirium syndrome?

<p>Cooling measures</p> Signup and view all the answers

  1. What are the alternatives for ketamine if it is not available for chemical restraint?

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

  1. What should be the focus of initial patient assessment in cardiac arrest situations?

<p>Checking for responsiveness, breathing, and pulse</p> Signup and view all the answers

  1. When should an automatic compression device be applied in cardiac arrest situations?

<p>After 2 minutes of manual compressions have been performed</p> Signup and view all the answers

Explain the treatment protocol for Ventricular Fibrillation (VF) and Pulseless V-Tach in the event of a cardiac arrest.

<p>Immediate defibrillation and CPR, with specific joules for defibrillation and administration of epinephrine.</p> Signup and view all the answers

What medications should be administered within the first minute after resuming CPR in a cardiac arrest situation?

<p>Epinephrine and Amiodarone.</p> Signup and view all the answers

Under what conditions should double sequential defibrillation be considered, and what energy levels should be used?

<p>If standard defibrillation levels have failed to convert, and specific energy levels should be used if available.</p> Signup and view all the answers

When should sodium bicarbonate and magnesium sulfate be considered in the treatment of cardiac arrest?

<p>Sodium bicarbonate may be considered after 10 minutes of cardiac arrest, especially if a preexisting metabolic acidosis is suspected. Magnesium sulfate may be considered in specific conditions, such as Torsades de Pointes or persistent ventricular fibrillation not responsive to other medications.</p> Signup and view all the answers

What is the recommended treatment for Pulseless Electrical Activity (PEA)?

<p>Treatment should be based on the presenting rhythm.</p> Signup and view all the answers

What is a viable indication of asystole, and what treatment is recommended?

<p>A viable indication of asystole is indicated by a CO2 reading of 20 with good CPR on waveform capnography, and treatment should include CPR, epinephrine, and evaluation for and treatment of underlying causes.</p> Signup and view all the answers

  1. What are the recommended protocols for treating a patient with a slow and wide rhythm with pulseless electrical activity (PEA)?

<p>Similar CPR and epinephrine administration are advised, with special attention to kidney dialysis patients who may have high potassium levels, necessitating sodium bicarbonate and calcium chloride administration.</p> Signup and view all the answers

  1. What are the treatment options for patients or firefighters suspected of carbon monoxide (CO) exposure?

<p>They should be monitored using a CO monitor, and treatment options are determined based on the CO level.</p> Signup and view all the answers

  1. What are the signs and symptoms of CO poisoning?

<p>Signs and symptoms include dyspnea, headache, chest pain, muscle weakness, nausea, vomiting, dizziness, altered mental status, and potential death.</p> Signup and view all the answers

  1. What are the high-risk situations for CO/CN poisoning?

<p>High-risk situations include building fires, areas with generators, enclosed spaces with fire or smoke, and places with poor ventilation, among others.</p> Signup and view all the answers

  1. What are the immediate attention requirements for the treatment of cyanide poisoning?

<p>Immediate attention to airway patency, oxygenation, hydration, cardiovascular support, and management of any seizure activity, in addition to Cyanokit administration.</p> Signup and view all the answers

  1. What should be considered for potential causes and appropriate interventions in all PEA rhythms?

<p>The 6Hs and 5Ts should be considered for potential causes and appropriate interventions.</p> Signup and view all the answers

What are some possible causes of the agitated condition in patients that Fire Rescue may be called to manage?

<p>Possible causes include mental illness, drug use (particularly stimulants such as cocaine), alcohol withdrawal, and head trauma.</p> Signup and view all the answers

What are some characteristics or behaviors that patients with Excited Delirium Syndrome may demonstrate?

<p>Patients with Excited Delirium Syndrome may demonstrate extremely aggressive or violent behavior, constant physical activity, restlessness, attraction to bright lights and loud sounds, being naked or near naked, rapid breathing, profuse sweating, little response to pain, and superhuman strength.</p> Signup and view all the answers

Why is it important to evaluate a patient for possible excited delirium syndrome when managing the care of agitated patients?

<p>It is important to evaluate for possible excited delirium syndrome to provide appropriate care and ensure the safety of both the patient and the responders.</p> Signup and view all the answers

What method may law enforcement agencies utilize to temporarily incapacitate individuals exhibiting threatening behavior, and why is it important to evaluate the patient for excited delirium syndrome after this method is used?

<p>Law enforcement agencies may utilize a TASER as a non-lethal method to temporarily incapacitate individuals exhibiting threatening behavior. It is important to evaluate the patient for excited delirium syndrome after TASER use due to the potential risk of excited delirium syndrome in these patients.</p> Signup and view all the answers

What are some signs that may indicate a patient is experiencing excited delirium syndrome?

<p>Signs may include extremely aggressive or violent behavior, constant physical activity, restlessness, attraction to bright lights and loud sounds, being naked or near naked, rapid breathing, profuse sweating, little response to pain, and superhuman strength.</p> Signup and view all the answers

What are some possible treatment guidelines for managing agitated patients presenting with verbally and/or physically threatening behavior?

<p>Treatment guidelines may include having enough personnel to handle the situation and physically manage the patient, as well as evaluating for possible excited delirium syndrome and providing appropriate care.</p> Signup and view all the answers

  1. What are the initial airway management options for a patient in cardiac arrest with no pulse and not breathing?

<p>Continuous chest compressions and start ventilations with a BVM until ready to place an Advanced Airway.</p> Signup and view all the answers

  1. When is Endotracheal Tube (ETT) acceptable for initial Advanced Airway attempt in cardiac arrest?

<p>When there is a high risk of aspiration.</p> Signup and view all the answers

  1. What monitoring tools should be used during resuscitation efforts to ensure proper placement of the Advanced Airway?

<p>ETCO2 sensor and waveform capnography.</p> Signup and view all the answers

  1. In what situations can airway management be deferred to the next cycle of compressions in witnessed/unwitnessed cardiac arrest?

<p>Emphasis on continuous compressions and early defibrillation if a shockable rhythm is present.</p> Signup and view all the answers

  1. What are the preferred vascular access and the time frame for obtaining IV access in cardiac arrest?

<p>The preferred vascular access is IO, with IV access acceptable if obtainable within 30-60 seconds.</p> Signup and view all the answers

  1. What medications can be given down the Advanced Airway, and at what dose?

<p>Epinephrine, atropine sulfate, and naloxone at 2 times the IO/IV dose diluted with normal saline to a total of 10 mL.</p> Signup and view all the answers

Explain the appropriate airway management in cases of witnessed/unwitnessed cardiac arrest, with emphasis on continuous compressions and early defibrillation if a shockable rhythm is present.

<p>Airway management can be deferred to the next cycle of compressions in witnessed/unwitnessed cardiac arrest, with emphasis on continuous compressions and early defibrillation if a shockable rhythm is present.</p> Signup and view all the answers

What are the preferred vascular access and the acceptable alternative if obtainable within 30-60 seconds in cases of cardiac arrest?

<p>The preferred vascular access should be 10, with IV access acceptable if obtainable within 30-60 seconds.</p> Signup and view all the answers

When is Endotracheal Tube (ETT) acceptable in cardiac arrest and what are the indications for its use?

<p>Endotracheal Tube (ETT) is acceptable on the initial Advanced Airway attempt in cardiac arrest and when there is a high risk of aspiration.</p> Signup and view all the answers

What medications can be given down the Advanced Airway, and at what dose and dilution?

<p>Only epinephrine, atropine sulfate, and naloxone can be given down the Advanced Airway, at 2 times the IO/IV dose diluted with normal saline to a total of 10 mL.</p> Signup and view all the answers

What should be used during resuscitation efforts to ensure proper placement of the Advanced Airway?

<p>ETCO2 sensor and waveform capnography should be used during resuscitation efforts to ensure proper placement of the Advanced Airway.</p> Signup and view all the answers

What are the guidelines for attaching the AED and defibrillator pads during compressions in cardiac arrest?

<p>AED should be attached as soon as possible without interrupting compressions, and defibrillator pads should be placed during compressions, with shockable rhythm prompting immediate defibrillation and 2 minutes of CPR between each rhythm check.</p> Signup and view all the answers

Study Notes

Emergency Medical Treatment Protocols

  • For a patient with a normal/fast and narrow rhythm with pulseless electrical activity (PEA), CPR should be resumed for 2 minutes, followed by the administration of epinephrine and consideration of hypovolemia with normal saline bolus.
  • In the case of a slow and wide rhythm with PEA, similar CPR and epinephrine administration are advised, but special attention should be given to kidney dialysis patients who may have high potassium levels, necessitating sodium bicarbonate and calcium chloride administration.
  • If the patient presents with a slow and narrow rhythm with PEA, the same CPR and epinephrine administration protocol applies, with consideration of hypovolemia and normal saline bolus.
  • In the case of asystole, CPR should be resumed for 2 minutes, followed by epinephrine administration, and pacing is not recommended. If return of spontaneous circulation (ROSC) is not achieved after 30 minutes, the Death in the Field Protocol should be followed.
  • PEA, if not treated, may progress to asystole, so determining and correcting the underlying causes of PEA is crucial.
  • For all PEA rhythms, the 6Hs and 5Ts should be considered for potential causes and appropriate interventions.
  • Patients or firefighters suspected of carbon monoxide (CO) exposure should be monitored using a CO monitor, and treatment options are determined based on the CO level.
  • Signs and symptoms of CO poisoning include dyspnea, headache, chest pain, muscle weakness, nausea, vomiting, dizziness, altered mental status, and potential death.
  • Cyanide (CN) poisoning, which may result from inhalation, ingestion, or dermal exposure, requires assessment for exposure to fire or smoke, presence of soot, and altered mental status before administration of Cyanokit.
  • High-risk situations for CO/CN poisoning include building fires, areas with generators, enclosed spaces with fire or smoke, and places with poor ventilation, among others.
  • High-risk patients for CO/CN poisoning include the elderly, children, pregnant women, patients with cardiac or chronic lung disease, and symptomatic divers from contaminated air.
  • Treatment of cyanide poisoning requires immediate attention to airway patency, oxygenation, hydration, cardiovascular support, and management of any seizure activity, in addition to Cyanokit administration.

Advanced Cardiac Life Support Protocols

  • Continuous chest compressions should be maintained while charging the monitor or AED to minimize interruption in delivering a shock.
  • When there is no pulse and the patient is not breathing, continue compressions and start ventilations with a BVM until ready to place an Advanced Airway.
  • Supraglottic Airway is suitable for initial set of compressions in cardiac arrest and in respiratory distress without a gag reflex.
  • Endotracheal Tube (ETT) is acceptable on the initial Advanced Airway attempt in cardiac arrest and when there is a high risk of aspiration.
  • ETC02 sensor and waveform capnography should be used during resuscitation efforts to ensure proper placement of the Advanced Airway.
  • Airway management can be deferred to the next cycle of compressions in witnessed/unwitnessed cardiac arrest, with emphasis on continuous compressions and early defibrillation if a shockable rhythm is present.
  • Endotracheal intubation might be preferred in cases of suspected upper airway inhalation burns, severe facial trauma, or presence of vomitus in the mouth.
  • Early ventilation is appropriate in respiratory arrests, pediatric arrests, near drowning, asystole/PEA, and unwitnessed arrest.
  • In cardiac arrest, the preferred vascular access should be 10, with IV access acceptable if obtainable within 30-60 seconds.
  • Only epinephrine, atropine sulfate, and naloxone can be given down the Advanced Airway, at 2 times the IO/IV dose diluted with normal saline to a total of 10 mL.
  • AED should be attached as soon as possible without interrupting compressions, and defibrillator pads should not be placed over a pacemaker, internal defibrillator, or transdermal medication patch.
  • Monitor/defibrillator should be turned on and defibrillator pads attached during compressions, with shockable rhythm prompting immediate defibrillation and 2 minutes of CPR between each rhythm check.

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Description

Test your knowledge of emergency medical treatment protocols with this quiz. Explore protocols for different pulseless electrical activity (PEA) rhythms, management of carbon monoxide (CO) and cyanide (CN) poisoning, and high-risk situations and patients.

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