Emergency Response Priority Levels
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Questions and Answers

What is the priority for patients in cardiac or respiratory arrest?

  • Priority 2
  • Priority 1 (correct)
  • Priority 4
  • Priority 3

    • What is the transportation destination for a patient meeting trauma center criteria?

  • The closest Trauma Center (correct)
  • The closest STEMI facility
  • The closest ED
  • The closest urgent care

    • What is the recommended on-scene time for 'TRAUMA ALERT' patients?

  • < 5 minutes
  • < 20 minutes
  • < 15 minutes
  • < 10 minutes (correct)

    • What is the transportation destination for a pregnant trauma alert patient?

    <p>The closest Level 1 Trauma Center by air</p> Signup and view all the answers

    What is the contraindication for placing patients in the prone position?

    <p>Risk of asphyxia</p> Signup and view all the answers

    What is the transportation destination for a patient with cardiac arrest without ROSC?

    <p>The closest ED (excluding free standing ED's)</p> Signup and view all the answers

    What is the priority for unstable patients with immediate life-threatening conditions?

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

    What is the recommended mode of transportation if ground transport exceeds 20 minutes for trauma patients?

    <p>Air transport, if available</p> Signup and view all the answers

    What is the destination for a patient with cardiac arrest with ROSC?

    <p>The closest STEMI facility</p> Signup and view all the answers

    What are the symptoms of a true allergy to a medication?

    <p>Rash, SOB, swelling of the tongue, face and/or throat</p> Signup and view all the answers

    What is the purpose of the 10 Rights of drug administration?

    <p>To ensure patient safety during medication administration</p> Signup and view all the answers

    In what situations should an IO be placed?

    <p>For patients with emergency medical conditions that require urgent vascular access</p> Signup and view all the answers

    Which of the following is NOT a suitable site for IO placement in adults?

    <p>Lateral thigh</p> Signup and view all the answers

    What is the maximum volume of medication that can be administered per site in adult IM injections?

    <p>4mL</p> Signup and view all the answers

    What is the preferred site for IM injections in adults?

    <p>Lateral thigh</p> Signup and view all the answers

    What type of needle is used for pediatric IM injections?

    <p>23 gauge 1 inch needle</p> Signup and view all the answers

    What happens if more than 1mL of medication needs to be administered in pediatric IM injections?

    <p>Split the dose between both thighs</p> Signup and view all the answers

    What device can be used to administer certain medications?

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

    What should be done for a pediatric patient found to be bradycardic with signs of poor perfusion and AMS?

    <p>Refer to the Bradycardia protocol</p> Signup and view all the answers

    What is the minimum number of vital sign assessments required for patients being cared for over an extended period of time?

    <p>Varies depending on patient condition</p> Signup and view all the answers

    What should be included in the physical exam for all patients?

    <p>Primary and secondary assessments</p> Signup and view all the answers

    What is the definition of an unstable patient?

    <p>A patient with chest pain, hypotension, AMS and/or SOB</p> Signup and view all the answers

    What is the frequency of vital sign assessments for unstable patients?

    <p>Every 5 minutes</p> Signup and view all the answers

    What should be assessed in a patient's circulation?

    <p>Pulse, capillary refill, and skin condition</p> Signup and view all the answers

    What is the contraindication for administering aspirin in a patient with chest pain?

    <p>Active GI bleeding</p> Signup and view all the answers

    What is the purpose of the focused exam?

    <p>To identify injuries or abnormalities</p> Signup and view all the answers

    What vital sign is used to assess a patient's oxygenation status?

    <p>Pulse oximetry</p> Signup and view all the answers

    What is the recommended dose of nitroglycerin for a patient with CHF?

    <p>0.4 mg SL</p> Signup and view all the answers

    What is a contraindication for using CPAP in a patient with CHF?

    <p>SBP &lt; 90 mmHg</p> Signup and view all the answers

    What should be done for a patient found to be pulseless?

    <p>Refer to the Cardiac Arrest algorithm</p> Signup and view all the answers

    What is the recommended course of action for a pediatric patient with CHF?

    <p>Call for orders</p> Signup and view all the answers

    What is a sign of CHF?

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

    What is the recommended frequency of assessing lung sounds and BP in a patient with CHF?

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

    What is a contraindication for administering nitroglycerin?

    <p>SBP &lt; 90 mmHg</p> Signup and view all the answers

    What should be done if a patient with CHF has pulmonary edema and hypotension?

    <p>Refer to Cardiogenic Shock Protocol</p> Signup and view all the answers

    What is a complication that requires particular care when administering nitroglycerin?

    <p>Renal failure</p> Signup and view all the answers

    What should be done immediately for a patient with a Left Ventricular Assist Device (LVAD)?

    <p>Contact the patient's primary caretaker and the LVAD coordinator</p> Signup and view all the answers

    What should be done if there is bleeding at the driveline site?

    <p>Apply direct pressure</p> Signup and view all the answers

    What is a characteristic sound of a properly functioning LVAD?

    <p>A humming sound</p> Signup and view all the answers

    What should be taken to the ED with the patient?

    <p>All equipment associated with the LVAD system</p> Signup and view all the answers

    What is a precaution to consider when administering normal saline to a patient with an LVAD?

    <p>Significant coronary heart disease, CHF, and renal failure</p> Signup and view all the answers

    What should be done when replacing the device's batteries or cables?

    <p>Assist the patient or caretaker in replacement</p> Signup and view all the answers

    Why should the patient's emergency 'bag' with backup equipment be located?

    <p>In case of an emergency situation</p> Signup and view all the answers

    What should be done when treating non-LVAD associated conditions?

    <p>Treat in accordance with the appropriate protocol</p> Signup and view all the answers

    What should be auscultated when evaluating a patient with an LVAD?

    <p>The chest and upper abdominal quadrants</p> Signup and view all the answers

    What should be considered if a patient awakes with stroke symptoms?

    <p>Call a STROKE ALERT immediately</p> Signup and view all the answers

    What is a characteristic of Subarachnoid Hemorrhage (SAH)?

    <p>Sudden onset of severe headache</p> Signup and view all the answers

    What should be obtained from the patient or witness during a stroke assessment?

    <p>The last time the patient was seen asymptomatic</p> Signup and view all the answers

    What is a consideration for paramedic judgment in stroke patients?

    <p>Neurologic etiology, especially if RACE score is 0</p> Signup and view all the answers

    What is the transportation destination for a stroke alert patient?

    <p>A stroke center</p> Signup and view all the answers

    What should be done immediately for a stroke alert?

    <p>Notify the receiving hospital</p> Signup and view all the answers

    What is a symptom of stroke that requires particular attention from paramedics?

    <p>AMS with a GCS &lt; 10</p> Signup and view all the answers

    What is the purpose of the Cincinna Prehospital Stroke Scale or the Los Angeles Prehospital Stroke Screen?

    <p>To determine if the patient is having a stroke</p> Signup and view all the answers

    What should be done to a patient with a diagnosed intracerebral hemorrhage during transport?

    <p>Place the patient with head elevated 15 degrees</p> Signup and view all the answers

    What should be administered to a patient with a pulse oximetry reading of less than 94%?

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

    What should be done to a patient in respiratory distress?

    <p>Manage airway as needed and consider advanced airway intervention</p> Signup and view all the answers

    How many IVs should be started on a patient meeting stroke alert criteria?

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

    What is the goal for minimizing the Stroke Alert on scene time?

    <p>10 minutes or less</p> Signup and view all the answers

    What should be considered for a patient with any abnormal findings on the stroke assessment?

    <p>Stroke Alert</p> Signup and view all the answers

    What should be assessed in a patient's circulation according to the Ven latory Assistance Protocol?

    <p>Pulse, capillary refill, and skin temperature</p> Signup and view all the answers

    What is the recommended frequency of vital sign assessments for unstable patients?

    <p>Every 5 minutes</p> Signup and view all the answers

    What should be included in the physical exam for all patients according to the Ven latory Assistance Protocol?

    <p>Primary and secondary assessments, and focused exam when necessary</p> Signup and view all the answers

    What is the definition of an unstable patient according to the Ven latory Assistance Protocol?

    <p>A patient with hypotension, chest pain, AMS, and/or SOB</p> Signup and view all the answers

    What should be done for a pediatric patient found to be bradycardic with signs of poor perfusion and AMS?

    <p>Refer to the Bradycardia protocol</p> Signup and view all the answers

    What should be assessed in a patient's skin according to the Ven latory Assistance Protocol?

    <p>Color, temperature, and condition</p> Signup and view all the answers

    What should be done for a patient found to be pulseless?

    <p>Refer to the Cardiac Arrest algorithm</p> Signup and view all the answers

    When should a manual blood pressure be taken?

    <p>To confirm any abnormal or significant changes of an automated blood pressure cuff reading</p> Signup and view all the answers

    Which of the following patients requires ECG monitoring?

    <p>A patient with chest pain or discomfort</p> Signup and view all the answers

    What is the definition of hypotension for adults?

    <p>Systolic BP &lt; 90 mm Hg</p> Signup and view all the answers

    When should a 12-lead ECG be performed?

    <p>On patients with a heart rate less than 50 or greater than 150</p> Signup and view all the answers

    Which of the following patients requires oxygen monitoring?

    <p>A patient with respiratory distress</p> Signup and view all the answers

    When should a blood glucose level be documented?

    <p>On all patients with a history of diabetes</p> Signup and view all the answers

    What information should be obtained during a patient history?

    <p>The patient's chief complaint, SAMPLE history, and medical history</p> Signup and view all the answers

    What is a STEMI alert criterion?

    <p>ST-Segment Elevation in 2 or more contiguous leads</p> Signup and view all the answers

    What is a STEMI mimic that can disqualify a patient from STEMI alert criteria?

    <p>Left Ventricular Hypertrophy (LVH)</p> Signup and view all the answers

    What is the formula for calculating Left Ventricular Hypertrophy (LVH)?

    <p>counting the small boxes of VI and V2, and V5 or V6, and adding the largest deflection from the isoelectric line</p> Signup and view all the answers

    What is the treatment for Right Ventricular Failure with a positive V4R and clear lung sounds with hypotension?

    <p>Administering 1 L IV/IO of normal saline to desired effect</p> Signup and view all the answers

    What is the purpose of completing a V4R on patients with ST segment elevation in 2 or more Inferior Leads?

    <p>to diagnose Right Ventricular Failure</p> Signup and view all the answers

    What is a symptom of STEMI that can be mistaken for a STEMI mimic?

    <p>Early repolarization with a concave morphology</p> Signup and view all the answers

    What is a criterion for transporting a patient as a CARDIAC ALERT?

    <p>Patient presentaions indicative of myocardial ischemia that do not meet STEMI alert criteria</p> Signup and view all the answers

    What is the recommended positioning for pediatric patients with a diagnosed intracerebral hemorrhage during interfacility transport?

    <p>Head elevated 15 degrees</p> Signup and view all the answers

    What is the recommended oxygen therapy for pediatric patients with a pulse oximetry less than 94%?

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

    Where is the preferred site for IV access in pediatric patients?

    <p>Antecubital vein</p> Signup and view all the answers

    What is the definition of rapid atrial fibrillation and atrial flutter?

    <p>Ventricular rates &gt; 150 beats per minute</p> Signup and view all the answers

    What is the transportation destination for pediatric Stroke Alert patients?

    <p>Pediatric Stroke Center</p> Signup and view all the answers

    What should be considered when managing a pediatric patient's airway during transport to a Stroke Center?

    <p>Advanced airway intervention may be necessary</p> Signup and view all the answers

    Why should pediatric patients with a stroke alert be transported to a Pediatric Stroke Center?

    <p>Because they require specialized care and treatment</p> Signup and view all the answers

    What should be done for a pediatric patient who is short of breath during transport to a Stroke Center?

    <p>Manage the airway as needed</p> Signup and view all the answers

    What is the priority for pediatric patients with a stroke alert during transport to a Stroke Center?

    <p>Stabilize the patient's airway</p> Signup and view all the answers

    What should be established for pediatric patients during transport to a Stroke Center?

    <p>An appropriate-sized IV catheter</p> Signup and view all the answers

    Study Notes

    Priority Levels for Patients

    • Priority 1 patients: those in cardiac or respiratory arrest
    • Priority 2 patients: unstable patients with immediate life-threatening conditions requiring immediate attention by ER personnel on arrival
    • Priority 3 patients: stable patients with no immediate life-threatening conditions

    Patient Transportation

    • Priority 1 patients:
      • Cardiac arrest with ROSC: transport to the closest STEMI facility
      • Cardiac arrest without ROSC: transport to the closest ED (excluding free-standing ED's)
      • Patients meeting trauma center criteria: transport to the closest Trauma Center
    • Priority 2 patients: transport to the closest appropriate ED
    • Trauma alert patients: transport to the closest Trauma Center

    Intraosseous Sites (EZ-IO)

    • Adult:
      • Proximal humerus (only if the surgical neck can be palpated)
      • Distal femur
      • Proximal tibia
    • Pediatric:
      • Proximal humerus (only if the surgical neck can be palpated)
      • Distal femur
      • Proximal tibia

    IM Injections

    • Adults:
      • 21 to 23 gauge 1.5-inch needle
      • 4mL maximum per site
    • Pediatrics:
      • 23 gauge 1-inch needle
      • 1mL maximum per site
      • If > 1mL needs to be administered, split the dose between both thighs

    Circulation

    • Assess pulse (carotid, brachial, or radial pulse)
    • Assess capillary refill
    • Assess skin (color, condition, and temperature)

    Physical Assessment

    • All patients shall receive a physical exam
    • Physical exams include primary and secondary assessments
    • When injuries or abnormalities are found, focused exams shall be conducted and refer to specific protocols

    Vital Signs

    • All patients shall receive a minimum of 2 sets of vitals if time allows
    • Patients being cared for over an extended period should also have the appropriate number of vital sign assessments
    • Vital signs include:
      • Pulse (rate, rhythm, and quality)
      • Respirations (rate and quality)
      • Skin (color, temperature, and condition)
      • Monitor temperature
      • Lung sounds
      • Pulse oximetry
      • Blood pressure (capillary refill)
      • Pupillary response
      • EtCO2
      • Blood glucose level (BGL)

    STEMI Alert

    • Aspirin:
      • 162 mg to 324 mg PO
      • Contraindications:
        • < 16 years old
        • Active GI bleeding

    CHF (Pulmonary Edema)

    • Signs and symptoms:
      • Hypertension
      • Tachycardia
      • Orthopnea (SOB while lying flat)
      • Rales
      • Pedal edema
    • Nitroglycerin:
      • 0.4 mg SL, as long as BP is > 90 mmHg
      • May repeat with 0.4 mg SL
      • Contraindications:
        • SBP < 90 mmHg
        • Heart rate < 50 beats per minute
        • EDD (Viagra and Levitra within 24 hours and Cialis within 48 hours)
        • STEMI
        • Right ventricular infarction (positive V4R)

    Supraventricular Tachycardia

    • Differentiation between sinus tachycardia (ST) and supraventricular tachycardia (SVT) can be difficult at very rapid rates

    Le Ventricular Assist Device (LVAD)

    • Contact the patient's primary caretaker and the LVAD coordinator immediately
    • Auscultate:
      • Determine the type of device
      • Assess alarms
      • Auscultate for pump sounds
    • Locate the driveline site on the patient's abdomen
    • DO NOT cause any trauma to the driveline site or wires

    Stroke Assessment and Management

    • Minimize Stroke Alert response time to 10 minutes or less when possible.
    • Use the Cincinnati Prehospital Stroke Scale or the Los Angeles Prehospital Stroke Screen to determine if a patient is having a stroke.
    • Consider a patient a Stroke Alert if there are any abnormal findings on the test.

    Adult Patient Care

    • Positioning: supine, except for patients with diagnosed intracerebral hemorrhage (interfacility transport) or shortness of breath, who should be positioned with head elevated 15°.
    • Oxygen: 2 LPM NC if pulse oximetry is less than 94%.
    • IV access: start 2 IVs if possible.
    • Circulation: assess pulse, capillary refill, and skin (color, condition, and temperature).

    Pediatric Patient Care

    • Positioning: supine, except for patients with diagnosed intracerebral hemorrhage (interfacility transport) or shortness of breath, who should be positioned with head elevated 15°.
    • Oxygen: 2 LPM NC if pulse oximetry is less than 94%.
    • IV access: establish an appropriate-sized catheter, with the antecubital being the preferred site.

    Patient Assessment

    • Perform a physical exam, including primary and secondary assessments.
    • Conduct a focused exam when injuries or abnormalities are found.
    • Take vital signs, including pulse, respirations, skin condition, temperature, lung sounds, pulse oximetry, blood pressure, pupillary response, and EtCO2.

    Seizure and Stroke Management

    • Assess patients for stroke signs and symptoms, including blood glucose level assessment.
    • Call a Stroke Alert if symptoms are within 3-4.5 hours with any of the following: awakening with stroke symptoms, no return to baseline after hypoglycemic treatment.
    • Consider Subarachnoid Hemorrhage (SAH) if: sudden onset of severe headache, nausea and vomiting, neck pain/stiffness, SBP > 180 mmHg, altered LOC GCS < 10.

    Stroke Alerts

    • Obtain information: last time seen asymptomatic, witness name and phone number, patient's medications (especially anticoagulation meds).
    • All Stroke Alerts shall only be transported to a Stroke Center.
    • Immediate notification of a Stroke Alert needs to be relayed to a Stroke Center.

    ECG Monitoring

    • Continuously monitor all ALS patients in Lead II.
    • Perform a 12-lead ECG on patients with chest/arm/neck/jaw/upper back/shoulder/epigastric pain or discomfort, palpitations, syncope, etc.

    STEMI Alert

    • Criteria: ST-Segment Elevation in 2 or more contiguous leads, new onset Left Bundle Branch Block.
    • Disqualifiers: LVH, pericarditis, early repolarization, preexisting Left Bundle Branch Block or pacemaker.
    • Transport patients with myocardial ischemia that do not meet STEMI Alert Criteria as a Cardiac Alert.

    Pediatric Stroke Alerts

    • Transport all pediatric Stroke Alerts to a pediatric Stroke Center, if available.

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    Description

    This quiz covers the priority levels for patients in emergency situations, including cardiac or respiratory arrest, unstable patients, and stable patients. It also discusses contraindications for placing patients in the prone position.

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