Emergency Response Priority Levels

Podcast Beta

Play an AI-generated podcast conversation about this lesson

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?

The closest Level 1 Trauma Center by air Signup and view all the answers

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

Risk of asphyxia Signup and view all the answers

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

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

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

Priority 2 Signup and view all the answers

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

Air transport, if available Signup and view all the answers

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

The closest STEMI facility Signup and view all the answers

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

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

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

To ensure patient safety during medication administration Signup and view all the answers

In what situations should an IO be placed?

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

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

Lateral thigh Signup and view all the answers

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

4mL Signup and view all the answers

What is the preferred site for IM injections in adults?

Lateral thigh Signup and view all the answers

What type of needle is used for pediatric IM injections?

23 gauge 1 inch needle Signup and view all the answers

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

Split the dose between both thighs Signup and view all the answers

What device can be used to administer certain medications?

MAD 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?

Refer to the Bradycardia protocol 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?

Varies depending on patient condition Signup and view all the answers

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

Primary and secondary assessments Signup and view all the answers

What is the definition of an unstable patient?

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

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

Every 5 minutes Signup and view all the answers

What should be assessed in a patient's circulation?

Pulse, capillary refill, and skin condition Signup and view all the answers

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

Active GI bleeding Signup and view all the answers

What is the purpose of the focused exam?

To identify injuries or abnormalities Signup and view all the answers

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

Pulse oximetry Signup and view all the answers

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

0.4 mg SL Signup and view all the answers

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

SBP < 90 mmHg Signup and view all the answers

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

Refer to the Cardiac Arrest algorithm Signup and view all the answers

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

Call for orders Signup and view all the answers

What is a sign of CHF?

Orthopnea Signup and view all the answers

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

Frequently Signup and view all the answers

What is a contraindication for administering nitroglycerin?

SBP < 90 mmHg Signup and view all the answers

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

Refer to Cardiogenic Shock Protocol Signup and view all the answers

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

Renal failure Signup and view all the answers

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

Contact the patient's primary caretaker and the LVAD coordinator Signup and view all the answers

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

Apply direct pressure Signup and view all the answers

What is a characteristic sound of a properly functioning LVAD?

A humming sound Signup and view all the answers

What should be taken to the ED with the patient?

All equipment associated with the LVAD system Signup and view all the answers

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

Significant coronary heart disease, CHF, and renal failure Signup and view all the answers

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

Assist the patient or caretaker in replacement Signup and view all the answers

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

In case of an emergency situation Signup and view all the answers

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

Treat in accordance with the appropriate protocol Signup and view all the answers

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

The chest and upper abdominal quadrants Signup and view all the answers

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

Call a STROKE ALERT immediately Signup and view all the answers

What is a characteristic of Subarachnoid Hemorrhage (SAH)?

Sudden onset of severe headache Signup and view all the answers

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

The last time the patient was seen asymptomatic Signup and view all the answers

What is a consideration for paramedic judgment in stroke patients?

Neurologic etiology, especially if RACE score is 0 Signup and view all the answers

What is the transportation destination for a stroke alert patient?

A stroke center Signup and view all the answers

What should be done immediately for a stroke alert?

Notify the receiving hospital Signup and view all the answers

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

AMS with a GCS < 10 Signup and view all the answers

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

To determine if the patient is having a stroke Signup and view all the answers

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

Place the patient with head elevated 15 degrees Signup and view all the answers

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

2 LPM NC Signup and view all the answers

What should be done to a patient in respiratory distress?

Manage airway as needed and consider advanced airway intervention Signup and view all the answers

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

2 Signup and view all the answers

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

10 minutes or less Signup and view all the answers

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

Stroke Alert Signup and view all the answers

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

Pulse, capillary refill, and skin temperature Signup and view all the answers

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

Every 5 minutes Signup and view all the answers

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

Primary and secondary assessments, and focused exam when necessary Signup and view all the answers

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

A patient with hypotension, chest pain, AMS, and/or SOB 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?

Refer to the Bradycardia protocol Signup and view all the answers

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

Color, temperature, and condition Signup and view all the answers

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

Refer to the Cardiac Arrest algorithm Signup and view all the answers

When should a manual blood pressure be taken?

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

Which of the following patients requires ECG monitoring?

A patient with chest pain or discomfort Signup and view all the answers

What is the definition of hypotension for adults?

Systolic BP < 90 mm Hg Signup and view all the answers

When should a 12-lead ECG be performed?

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

Which of the following patients requires oxygen monitoring?

A patient with respiratory distress Signup and view all the answers

When should a blood glucose level be documented?

On all patients with a history of diabetes Signup and view all the answers

What information should be obtained during a patient history?

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

What is a STEMI alert criterion?

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

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

Left Ventricular Hypertrophy (LVH) Signup and view all the answers

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

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

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

Administering 1 L IV/IO of normal saline to desired effect 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?

to diagnose Right Ventricular Failure Signup and view all the answers

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

Early repolarization with a concave morphology Signup and view all the answers

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

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

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

Head elevated 15 degrees Signup and view all the answers

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

2 LPM NC Signup and view all the answers

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

Antecubital vein Signup and view all the answers

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

Ventricular rates > 150 beats per minute Signup and view all the answers

What is the transportation destination for pediatric Stroke Alert patients?

Pediatric Stroke Center Signup and view all the answers

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

Advanced airway intervention may be necessary Signup and view all the answers

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

Because they require specialized care and treatment 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?

Manage the airway as needed Signup and view all the answers

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

Stabilize the patient's airway Signup and view all the answers

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

An appropriate-sized IV catheter 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.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

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.