EMS Test 1

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Questions and Answers

Under what condition can Fire Rescue personnel examine, treat, and/or transport a patient without their informed consent?

  • When the patient is unconscious
  • When the patient is under the influence of drugs
  • When the patient is incapacitated (correct)
  • When the patient has a mental illness

What is the purpose of the Baker Act?

  • To treat patients with kidney stones
  • To transport patients with cardiac conditions
  • To treat patients with back pain
  • To involuntarily examine patients with mental illness (correct)

When can a person be taken to a receiving facility for involuntary examination under the Baker Act?

  • When they are experiencing back pain
  • When they have refused voluntary examination and are unable to determine the need for examination (correct)
  • When they have a kidney infection
  • When they have a physical illness

What is the primary factor in determining the need for involuntary examination under the Baker Act?

<p>The patient's mental illness (D)</p> Signup and view all the answers

What is the purpose of the receiving facility in the Baker Act?

<p>To involuntarily examine and treat patients with mental illness (A)</p> Signup and view all the answers

What is the role of Fire Rescue personnel in regards to the Baker Act?

<p>To transport patients to receiving facilities (B)</p> Signup and view all the answers

What is the relationship between the Baker Act and FS 401.445?

<p>FS 401.445 specifies the conditions for which Fire Rescue personnel may examine, treat, and/or transport patients without their informed consent (B)</p> Signup and view all the answers

What is the primary goal of the Baker Act and FS 401.445?

<p>To ensure the patient receives necessary medical care (C)</p> Signup and view all the answers

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

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

Which of the following fire departments is NOT associated with a Medical Director?

<p>Miami Fire Rescue (C)</p> Signup and view all the answers

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

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

What is the page number of the document where the Acknowledgements are found?

<p>Page 1 of 1 (C)</p> Signup and view all the answers

Who is the Fire Chief of the City of Miami?

<p>Zahralban (C)</p> Signup and view all the answers

How many Medical Directors are mentioned in the document?

<p>4 (A)</p> Signup and view all the answers

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

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

What is the initial treatment for a patient with hemodynamically unstable back pain?

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

Who requires a 12-lead ECG with acute upper back pain?

<p>Any male 35 years or older and any female 45 years or older (B)</p> Signup and view all the answers

What is the next step after administering a 500 mL IV bolus of normal saline to a patient with hemodynamically unstable back pain?

<p>Re-evaluate the vital signs (C)</p> Signup and view all the answers

What is the appropriate management for a patient with back pain and associated shortness of breath or low SpO2?

<p>Follow the appropriate airway management protocol (C)</p> Signup and view all the answers

What is the dose of ondansetron (Zofran) administered to a patient with nausea and back pain?

<p>4 mg IVP/IO/IM (B), 8 mg PO (C)</p> Signup and view all the answers

What is the primary concern in a patient with back pain resulting from a traumatic injury?

<p>Following the appropriate trauma protocol (A)</p> Signup and view all the answers

What is the indication for performing a neurological exam in a patient with back pain?

<p>Acute lower back pain (A)</p> Signup and view all the answers

What is the primary consideration in a patient with back pain?

<p>Hemodynamic stability (B)</p> Signup and view all the answers

What is the primary reason for alerting the receiving facility of the specific snake bite?

<p>To ensure the correct antivenom is available (C)</p> Signup and view all the answers

What is the typical location of a Coral Snake bite on the human body?

<p>Finger or toe (A)</p> Signup and view all the answers

What is the purpose of wrapping an ace bandage around the affected limb following a Coral Snake bite?

<p>To immobilize the limb and prevent movement (C)</p> Signup and view all the answers

What is the type of venom present in Coral Snake bites?

<p>Neurotoxin (C)</p> Signup and view all the answers

What is the significance of the rhyme 'Red next to yellow can kill a fellow'?

<p>It identifies the Coral Snake as venomous (B)</p> Signup and view all the answers

What is a potential complication of Coral Snake bites that may develop over time?

<p>Respiratory paralysis (B)</p> Signup and view all the answers

Why should the injured area be kept low and splinted following a Coral Snake bite?

<p>To minimize movement and prevent venom spread (B)</p> Signup and view all the answers

What is the correct sequence of wrapping an ace bandage around the affected limb?

<p>Starting at the site of the bite and working towards the heart (B)</p> Signup and view all the answers

What is the primary focus of the vision of patient care and treatment?

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

Who is the EMS Captain mentioned in the content?

<p>Dan Feeney (A)</p> Signup and view all the answers

What is the title of the document?

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

Which medication is not mentioned as a substitute in the City of Miami Fire Department?

<p>Ativan (C)</p> Signup and view all the answers

What is the purpose of the medical director overrides?

<p>To restrict the use of certain protocols and medications (D)</p> Signup and view all the answers

Which of the following is not mentioned as something to be continuously improved?

<p>Our personnel (A)</p> Signup and view all the answers

What is the title of Robert Campos?

<p>Special Projects Coordinator (C)</p> Signup and view all the answers

What is a potential complication that may develop over time in patients who have had gastric bypass surgery?

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

What is the primary concern in a patient with abdominal pain?

<p>Nausea and vomiting (B)</p> Signup and view all the answers

What is the recommended treatment for hypotension in a patient with abdominal pain?

<p>Administer 500 mL IV bolus of normal saline (D)</p> Signup and view all the answers

What is the primary goal when questioning a patient with abdominal pain?

<p>To identify the underlying cause of the pain (A)</p> Signup and view all the answers

What is the significance of asking about the timing of the last menses in a patient with abdominal pain?

<p>To rule out ectopic pregnancy (A)</p> Signup and view all the answers

What is the recommended action for patients who have had gastric bypass surgery and are now complaining of abdominal pain?

<p>Transport to a hospital for further evaluation (C)</p> Signup and view all the answers

What is the primary focus of the vision of patient care and treatment?

<p>To continuously improve patient care and treatment (B)</p> Signup and view all the answers

What is the initial treatment for a patient with hemodynamically unstable abdominal pain?

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

What is the recommended treatment for a moderate to severe anaphylactic reaction?

<p>Administer one injection from the Epi-Pen into the lateral thigh or upper arm (A)</p> Signup and view all the answers

What is the recommended fluid bolus for a hypotensive patient?

<p>500 mL IV fluid bolus of normal saline (A)</p> Signup and view all the answers

What is the recommended treatment for bronchospasm that is not relieved by the administration of epinephrine?

<p>Administer ipratropium/albuterol (DuoNeb) 0.5 mg/2.5 mg via nebulizer (D)</p> Signup and view all the answers

What is the recommended dose of epinephrine for a hypotensive patient who remains hypotensive after the IM dose?

<p>0.1 mg (1 mL) IV/IO (A)</p> Signup and view all the answers

What is the purpose of administering diphenhydramine (Benadryl) in the treatment of anaphylaxis?

<p>To provide a longer-acting treatment for anaphylaxis (A)</p> Signup and view all the answers

What is the recommended maximum dose of epinephrine that can be administered to a hypotensive patient?

<p>0.5 mg (5 mL) (C)</p> Signup and view all the answers

What is the recommended treatment for a patient with dystonic reactions?

<p>Not mentioned in the content (D)</p> Signup and view all the answers

What is the recommended rate of administration for premix dopamine in a patient with hypotension?

<p>30 drops per minute (B)</p> Signup and view all the answers

What is the primary goal when treating a patient with a marine animal envenomation?

<p>Immerse the puncture in non-scalding hot water to achieve pain relief (A)</p> Signup and view all the answers

What is the recommended action when attempting to remove tentacles from a patient with a marine animal sting?

<p>Use shaving cream and gentle scraping action with a wooden tongue depressor (C)</p> Signup and view all the answers

What is the primary concern when evaluating a patient with a marine animal envenomation?

<p>Allergic reaction (A)</p> Signup and view all the answers

What is the recommended treatment for pain relief in a patient with a marine animal envenomation?

<p>Immersing the puncture in non-scalding hot water (B)</p> Signup and view all the answers

What is the primary goal when transporting a patient with a marine animal envenomation?

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

What is the recommended action when a spine is still embedded in a patient with a marine animal envenomation?

<p>Leave the spine embedded and provide rapid transport (A)</p> Signup and view all the answers

What is the primary concern when evaluating a patient with signs of numbness and muscle twitching?

<p>Marine animal envenomation (B)</p> Signup and view all the answers

What is the recommended action when a patient with a marine animal sting is experiencing severe inflammation and swelling?

<p>Evaluate the patient's ABCs for signs of airway compromise (B)</p> Signup and view all the answers

What is the primary consideration for administering a 500 mL IV bolus of normal saline to a patient with back pain?

<p>The patient is hemodynamically unstable. (C)</p> Signup and view all the answers

What is the indication for performing a 12-lead ECG in a patient with acute upper back pain?

<p>Any male patient 35 years or older or female patient 45 years or older. (A)</p> Signup and view all the answers

What is the next step after administering a 500 mL IV bolus of normal saline to a patient with hemodynamically unstable back pain?

<p>Re-evaluate the vital signs and consider pain management. (C)</p> Signup and view all the answers

What is the appropriate management for a patient with back pain and associated shortness of breath or low SpO2?

<p>Follow the appropriate airway management protocol. (D)</p> Signup and view all the answers

What is the dose of ondansetron (Zofran) administered to a patient with nausea and back pain?

<p>8 mg PO or 4 mg IVP/IO/IM. (A)</p> Signup and view all the answers

What is the primary concern in a patient with back pain resulting from a traumatic injury?

<p>The patient's neurological status. (B)</p> Signup and view all the answers

What is the indication for performing a neurological exam in a patient with back pain?

<p>The patient has acute lower back pain. (D)</p> Signup and view all the answers

What is the primary consideration in a patient with back pain?

<p>The patient's hemodynamic stability. (B)</p> Signup and view all the answers

What is a common sign of dystonia in a patient?

<p>Protrusion of the tongue (B)</p> Signup and view all the answers

What medication is commonly prescribed to combat the untoward effects of certain medications?

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

What is the initial treatment for an allergic or systemic reaction?

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

What is a rare but potential complication of certain medications?

<p>Laryngospasm (D)</p> Signup and view all the answers

What is a common indication for administering diphenhydramine (Benadryl)?

<p>Allergic or systemic reaction (D)</p> Signup and view all the answers

What is a common characteristic of medications that can cause dystonia?

<p>Antipsychotic properties (D)</p> Signup and view all the answers

What is the correct sequence of action if you are unable to see chest rise?

<p>Consider an airway obstruction and manage appropriately (A), Reposition the head and try again (C)</p> Signup and view all the answers

What is the breathing rate in respiratory/cardiac arrest?

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

What is the next step if the patient's breathing has not improved and SpO2 is less than 94%?

<p>Intubate the patient with an appropriate sized ETT (A), Insert a Supraglottic Airway device (D)</p> Signup and view all the answers

What medication is used for intubation in a patient with a difficult airway to open and active gag reflex, if vascular access is established?

<p>Etomidate (Amidate) (B)</p> Signup and view all the answers

What is the maximum number of intubation attempts allowed?

<p>2 (C)</p> Signup and view all the answers

What is the dose of midazolam (Versed) used for sedation in a patient who becomes combative following a successful placement of an Advanced Airway, if vascular access is not established?

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

What is the purpose of reconfirming proper Advance Airway placement with ETCO2 and SpO2 measurements?

<p>To confirm correct tube placement (D)</p> Signup and view all the answers

What is the primary focus of the vision of patient care and treatment?

<p>To provide high-quality patient care (D)</p> Signup and view all the answers

What is the primary function of the capacitor in an Automatic Implantable Cardioverter/Defibrillator (AICD)?

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

What is the initial treatment for a patient with an AICD that is discharging inappropriately?

<p>Monitor ECG and verify rhythm (D)</p> Signup and view all the answers

What is the purpose of the wallet card given to patients with an AICD?

<p>To provide identification information of the AICD type (C)</p> Signup and view all the answers

What is the primary concern when performing CPR on a patient with an AICD?

<p>There is no risk to the paramedic, CPR can be performed as usual (C)</p> Signup and view all the answers

What is the purpose of airway management in the care of a patient with an AICD?

<p>To assess the patient's respiratory status (A)</p> Signup and view all the answers

What should be done if external defibrillation is required for a patient with an AICD?

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

What should be done if a patient with an AICD has repetitive discharges?

<p>Consider pain management in the conscious patient (A)</p> Signup and view all the answers

What should accompany the patient to the hospital when they have an AICD?

<p>The wallet card with identification information (B)</p> Signup and view all the answers

What is the primary function of the upper airway?

<p>To allow air to enter the lungs (B)</p> Signup and view all the answers

What is the purpose of evaluating the lower airway?

<p>To determine the patient's ability to ventilate and oxygenate (A)</p> Signup and view all the answers

What is a common complication in patients with an altered mental status?

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

What is the significance of a CO2 monitor in evaluating a patient's airway?

<p>It determines the patient's ability to ventilate (D)</p> Signup and view all the answers

What is a sign of an upper airway obstruction?

<p>Gurgling, gasping, snoring, or stridor (B)</p> Signup and view all the answers

When is the evaluation of the upper airway considered easier?

<p>In patients who are alert and able to speak clearly (A)</p> Signup and view all the answers

What is the primary concern in patients with a compromised upper airway?

<p>Their ability to get air into their lungs (D)</p> Signup and view all the answers

What is the significance of the gag reflex in patients with an altered mental status?

<p>It increases the risk of airway obstruction from the tongue falling back against the back of the throat (C)</p> Signup and view all the answers

When can a person be taken to a receiving facility for involuntary examination under the Baker Act?

<p>When they are deemed to be a danger to themselves or others (C)</p> Signup and view all the answers

Who can impose the Baker Act?

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

What is the primary goal of the Baker Act?

<p>To preserve the rights of the individual (A)</p> Signup and view all the answers

What is the purpose of documentation on the Patient Care Record?

<p>To record the name and agency of the person imposing the Baker Act (A)</p> Signup and view all the answers

What is the primary consideration when using restraint on a patient?

<p>The use of a supine or recovery position (B)</p> Signup and view all the answers

What is the primary concern when dealing with a patient who poses a threat to themselves or others?

<p>Preventing harm to the patient or others (B)</p> Signup and view all the answers

What is the primary goal of the Baker Act in relation to patient care?

<p>To preserve the patient's rights (B)</p> Signup and view all the answers

What is the primary consideration when dealing with a patient who is deemed to be a threat to themselves or others?

<p>The patient's ability to cause harm (D)</p> Signup and view all the answers

What is the typical location of a Coral Snake bite on the human body?

<p>Finger or toe (C)</p> Signup and view all the answers

What is the purpose of wrapping an ace bandage around the affected limb following a Coral Snake bite?

<p>To constrict the venom from spreading (A)</p> Signup and view all the answers

What is the type of venom present in Coral Snake bites?

<p>Neurotoxin (A)</p> Signup and view all the answers

What is a potential complication of Coral Snake bites that may develop over time?

<p>Respiratory paralysis (A)</p> Signup and view all the answers

Why should the injured area be kept low and splinted following a Coral Snake bite?

<p>To minimize movement (C)</p> Signup and view all the answers

What is the significance of the rhyme 'Red next to yellow can kill a fellow'?

<p>It describes the color pattern of a Coral Snake (B)</p> Signup and view all the answers

What is the correct sequence of wrapping an ace bandage around the affected limb?

<p>Starting at the site of the bite and working towards the heart (B)</p> Signup and view all the answers

What is the primary concern in a patient with a Coral Snake bite?

<p>Neurological disturbances (C)</p> Signup and view all the answers

What is the primary goal of treatment for a patient with a mild allergic reaction?

<p>To make the patient comfortable and continually assess for respiratory distress and/or anaphylaxis (C)</p> Signup and view all the answers

What is the critical component in evaluating the severity of an allergic reaction?

<p>Evaluating lung sounds (A)</p> Signup and view all the answers

What medication is administered to treat bronchospasm in a patient with an allergic reaction?

<p>Ipratropium/albuterol (DuoNeb) (B)</p> Signup and view all the answers

What is the primary concern in a patient with anaphylaxis?

<p>Treating respiratory failure (D)</p> Signup and view all the answers

What is the indication for administering diphenhydramine (Benadryl) in a patient with an allergic reaction?

<p>To alleviate mild allergic reactions (A)</p> Signup and view all the answers

What is the dose of diphenhydramine (Benadryl) administered to a patient with a mild allergic reaction?

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

What is the potential complication that may develop over time in patients with anaphylaxis?

<p>Angioedema (C)</p> Signup and view all the answers

What is the primary focus of treatment for a patient with anaphylaxis?

<p>Treating respiratory failure (A)</p> Signup and view all the answers

Under what circumstances can a person be taken into involuntary custody for substance abuse impairment?

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

What is the primary goal of the initial assessment for a patient with a reptile or spider bite?

<p>To provide general treatment and care to the patient. (A)</p> Signup and view all the answers

What is the purpose of attempting to identify the insect, reptile, or animal that caused the injury?

<p>To determine the type of treatment to provide. (D)</p> Signup and view all the answers

What is the significance of the criteria for involuntary admission under the Baker Act?

<p>It provides a framework for involuntary admission for substance abuse impairment. (D)</p> Signup and view all the answers

What is the primary consideration in a patient with back pain resulting from a traumatic injury?

<p>The potential for hemodynamic instability. (C)</p> Signup and view all the answers

What is the primary focus of the vision of patient care and treatment?

<p>Providing high-quality patient care. (B)</p> Signup and view all the answers

What is the recommended treatment for a patient with hemodynamically unstable back pain?

<p>Administration of a 500 mL IV bolus of normal saline. (B)</p> Signup and view all the answers

What is the primary concern in a patient with abdominal pain?

<p>The potential for hemodynamic instability. (B)</p> Signup and view all the answers

What is the replacement for Ativan?

<p>Versed (A)</p> Signup and view all the answers

What will be used in place of a Scoop Stretcher?

<p>Backboard (C)</p> Signup and view all the answers

On which page can the Adult Trauma protocols be found?

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

What is the page number of the Pediatric Trauma protocols?

<p>Page 325 (B)</p> Signup and view all the answers

What is the title of the document that outlines the protocols for EMS?

<p>2022-24 Common EMS Protocols (A)</p> Signup and view all the answers

On which page can the Abdominal Pain protocols be found?

<p>Page 5 (B)</p> Signup and view all the answers

What is the version of the Common EMS Protocols?

<p>Version 1.8 (D)</p> Signup and view all the answers

Where can the Medications Section be found?

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

What is the primary function of the capacitor in an Automatic Implantable Cardioverter/Defibrillator (AICD)?

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

What is the initial step in managing a patient with an AICD discharging inappropriately?

<p>Monitor the ECG and verify the rhythm (A)</p> Signup and view all the answers

Why is it safe for paramedics to perform CPR on a patient with an actively firing internal defibrillator?

<p>The paramedic will not be at risk of electrical shock (C)</p> Signup and view all the answers

What information should accompany the patient to the hospital when they have an AICD?

<p>The AICD type, as indicated on the wallet card (D)</p> Signup and view all the answers

What is the primary focus of airway management in a patient?

<p>Assessment of the patient's respiratory status (B)</p> Signup and view all the answers

What is the significance of maintaining a SpO2 of 94% or greater in a patient with an AICD?

<p>It reduces the risk of cardiac complications (C)</p> Signup and view all the answers

What is the primary goal when managing a patient with an AICD?

<p>To stabilize the patient's cardiac rhythm (A)</p> Signup and view all the answers

What should be done if the patient with an AICD is experiencing repetitive discharges?

<p>Administer pain management to the patient (C)</p> Signup and view all the answers

What is the primary goal when managing a patient with a marine animal envenomation?

<p>Achieve pain relief using non-scalding hot water (D)</p> Signup and view all the answers

What is the recommended method for removing visible tentacles from a marine animal sting?

<p>Using a 4x4 gauze with a double-gloved hand (A)</p> Signup and view all the answers

What is the temperature of the non-scalding hot water used for pain relief in marine animal envenomations?

<p>110-113°F (A)</p> Signup and view all the answers

What is the primary concern when evaluating a patient with a marine animal sting?

<p>Allergic reaction and airway compromise (A)</p> Signup and view all the answers

What is the recommended treatment for pain relief in a patient with a marine animal envenomation?

<p>Immersing the affected area in non-scalding hot water (D)</p> Signup and view all the answers

What is the purpose of applying a vinegar-soaked gauze to a marine animal sting?

<p>To neutralize the venom (B)</p> Signup and view all the answers

What is the recommended duration for immersing the affected area in non-scalding hot water?

<p>30-90 minutes (C)</p> Signup and view all the answers

What is the primary goal when transporting a patient with a marine animal envenomation?

<p>To rapidly transport the patient to a medical facility (B)</p> Signup and view all the answers

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

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

Which Fire Department does not have a Medical Director mentioned in the document?

<p>None of the above (D)</p> Signup and view all the answers

What is the title of the document that the Protocol Review Committee has worked on?

<p>2022-24 Common EMS Protocols (A)</p> Signup and view all the answers

Who is the Fire Chief of the Coral Gables Fire Department?

<p>Marcos DelaRosa (C)</p> Signup and view all the answers

How many Medical Directors are mentioned in the document?

<p>3 (C)</p> Signup and view all the answers

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

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

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

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

On which page is the Acknowledgements section found?

<p>Page I (C)</p> Signup and view all the answers

Which of the following adjuncts is best for acute pulmonary edema?

<p>CPAP (A)</p> Signup and view all the answers

In which mode is an Automatic Ventilator used with an advanced airway in apneic patients?

<p>Automatic mode (A)</p> Signup and view all the answers

What is the primary indication for using a BVM?

<p>When an Automatic Ventilator is not available (B)</p> Signup and view all the answers

When should an advanced airway be properly placed?

<p>When the patient is in respiratory arrest (A), When prolonged PPV is required with a BVM (C)</p> Signup and view all the answers

What is the purpose of giving 100% oxygen while preparing for an advanced airway procedure?

<p>To increase oxygenation (D)</p> Signup and view all the answers

Which of the following is a type of advanced airway?

<p>Oral Endotracheal Tube (B), Supraglottic Airway (C)</p> Signup and view all the answers

When is a Supraglottic Airway placed?

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

What should be set to 10 when using a BVM?

<p>The manometer (B)</p> Signup and view all the answers

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

<p>Angioedema of the lips, tongue, and throat (B)</p> Signup and view all the answers

What is the treatment for a patient experiencing respiratory difficulty due to ACE-inhibitor use?

<p>Epinephrine and Benadryl (D)</p> Signup and view all the answers

What is the potential complication of ACE-inhibitor use that can occur at any time?

<p>Angioedema (D)</p> Signup and view all the answers

What is the dose of epinephrine administered to a patient experiencing respiratory difficulty due to ACE-inhibitor use?

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

Why is Benadryl used in the treatment of respiratory difficulty due to ACE-inhibitor use?

<p>To prolong the effect of epinephrine (A)</p> Signup and view all the answers

What is the indication for administering diphenhydramine (Benadryl) in patients experiencing respiratory difficulty due to ACE-inhibitor use?

<p>As an adjunct to epinephrine administration (D)</p> Signup and view all the answers

What is the route of administration for diphenhydramine (Benadryl) in patients experiencing respiratory difficulty due to ACE-inhibitor use?

<p>Slow IV infusion (A)</p> Signup and view all the answers

What is the dose of diphenhydramine (Benadryl) administered to a patient experiencing respiratory difficulty due to ACE-inhibitor use?

<p>50 mg IV (B)</p> Signup and view all the answers

What is the primary consideration for patients categorized as Yellow?

<p>Transportation via an ALS unit to the closest appropriate facility (D)</p> Signup and view all the answers

What is the appropriate action for a patient who refuses transportation and is of legal age?

<p>Having the patient sign AMA (A)</p> Signup and view all the answers

What is the characteristic of a patient categorized as Green?

<p>Walking and talking (B)</p> Signup and view all the answers

What is the primary reason for transporting a patient categorized as Red?

<p>The patient's condition is life-threatening (C)</p> Signup and view all the answers

What is the ultimate goal of the treatment protocol for patients with alcohol intoxication?

<p>To provide medical care to the patient (C)</p> Signup and view all the answers

What is the primary consideration for patients who are disoriented to person, place, time, or event?

<p>Transportation via an ALS unit to the closest appropriate facility (D)</p> Signup and view all the answers

What is the appropriate action for a patient who requires medical attention but refuses transportation?

<p>Having the patient sign an AMA form (A)</p> Signup and view all the answers

What is the primary consideration for patients categorized as Green in terms of transportation?

<p>Transportation via BLS unit when appropriate (D)</p> Signup and view all the answers

What is the primary reason for identifying the scientific or common name of an exotic snake in a bite victim?

<p>To alert the receiving facility and prepare for potential antivenin administration (D)</p> Signup and view all the answers

What is the characteristic sign of a Brown Recluse spider bite?

<p>Small bleb surrounded by a white ring (C)</p> Signup and view all the answers

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

<p>Administer midazolam (Versed) (B)</p> Signup and view all the answers

What is the primary concern in a patient with a scorpion sting?

<p>Neurological symptoms (C)</p> Signup and view all the answers

What is the purpose of alerting Venom 1 in the case of an exotic snake bite?

<p>To prepare for potential antivenin administration (B)</p> Signup and view all the answers

What is the typical presentation of a Brown Recluse spider bite?

<p>Localized tissue necrosis and ulceration (D)</p> Signup and view all the answers

What is the recommended treatment for a patient with a Black Widow spider bite who is experiencing severe muscle spasms?

<p>Administer midazolam (Versed) and consider morphine sulfate if necessary (D)</p> Signup and view all the answers

What is the primary focus in the management of a patient with a scorpion sting?

<p>Neurological symptom management and supportive care (D)</p> Signup and view all the answers

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

<p>To assess the patient's level of consciousness and responsiveness (A)</p> Signup and view all the answers

What is the term for the fine crackling sound heard when listening to lung sounds with a stethoscope?

<p>Rales (B)</p> Signup and view all the answers

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

<p>Blow-by (A)</p> Signup and view all the answers

What is the significance of assessing a patient's skin color during a clinical assessment of the lower airway?

<p>To assess for cyanosis, a potential indicator of respiratory distress (C)</p> Signup and view all the answers

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

<p>Listening to lung sounds and identifying respiratory patterns (A)</p> Signup and view all the answers

What is the purpose of assessing the chest wall and ribs during a clinical assessment of the lower airway?

<p>To assess for retractions or accessory muscle use (A)</p> Signup and view all the answers

What is the term for the deeper, coarse sound heard when listening to lung sounds with a stethoscope?

<p>Rhonchi (A)</p> Signup and view all the answers

What is the most invasive advanced airway?

<p>Cricothyrotomy (D)</p> Signup and view all the answers

What is the significance of assessing a patient's abdominal breathing pattern during a clinical assessment of the lower airway?

<p>To assess for abdominal muscle use and breathing patterns (D)</p> Signup and view all the answers

What is the primary consideration when choosing an airway management device?

<p>Severity of respiratory distress (C)</p> Signup and view all the answers

What is the purpose of monitoring SpO2 levels?

<p>To measure sufficient oxygen in the blood (B)</p> Signup and view all the answers

What is the next step if the initial airway management device is not effective?

<p>Move to a more invasive device (C)</p> Signup and view all the answers

What is the significance of monitoring capnography waveforms?

<p>To measure ventilation (C)</p> Signup and view all the answers

Why is repeated re-evaluation important in airway management?

<p>To determine if the initial management choice is correct (A)</p> Signup and view all the answers

What is the primary focus of airway management?

<p>Oxygenation (C)</p> Signup and view all the answers

When are invasive airways usually reserved?

<p>For patients with severe respiratory distress with depressed levels of consciousness (A)</p> Signup and view all the answers

In a patient with abdominal pain, what is the most helpful piece of information when trying to determine the cause of the pain?

<p>Location of the pain (B)</p> Signup and view all the answers

A patient with right upper quadrant pain may have which of the following conditions?

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

In a patient with upper abdominal pain, which of the following is a relevant consideration?

<p>Any female 45 years or older needs a 12-lead ECG (A)</p> Signup and view all the answers

What is a potential complication in patients taking ACE-inhibitors?

<p>Localized angioedema (B)</p> Signup and view all the answers

A patient with left upper quadrant pain may have which of the following conditions?

<p>Pancreatitis (C)</p> Signup and view all the answers

What is a potential complication that may develop over time in patients who have had gastric bypass surgery?

<p>Abdominal pain (A)</p> Signup and view all the answers

What should be observed in patients taking ACE-inhibitors during transport?

<p>Developing or increasing respiratory difficulty and/or changes in their voices (C)</p> Signup and view all the answers

In a patient with lower abdominal pain, which of the following is a relevant consideration?

<p>Females of childbearing years should be treated as a possible ectopic pregnancy (B)</p> Signup and view all the answers

What is NOT an allergic reaction in patients taking ACE-inhibitors?

<p>Localized angioedema (D)</p> Signup and view all the answers

A patient with right lower quadrant pain may have which of the following conditions?

<p>Classic appendicitis pain (C)</p> Signup and view all the answers

What medication may be administered to patients taking ACE-inhibitors who experience angioedema?

<p>Diphenhydramine (Benadryl) (A), Epinephrine (D)</p> Signup and view all the answers

What is the primary concern in a patient with abdominal pain?

<p>Determining the cause of the pain (B)</p> Signup and view all the answers

What is the dose of epinephrine administered to patients taking ACE-inhibitors who experience angioedema?

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

What is the duration of action of diphenhydramine (Benadryl) compared to epinephrine?

<p>Longer (A)</p> Signup and view all the answers

Why is diphenhydramine (Benadryl) administered to patients taking ACE-inhibitors who experience angioedema?

<p>To prolong the duration of epinephrine's effects (B)</p> Signup and view all the answers

What is the severity of angioedema that can occur in patients taking ACE-inhibitors?

<p>Severe, potentially blocking the upper airway (B)</p> Signup and view all the answers

What is the primary goal of the initial treatment for unstable bradycardia?

<p>Raise the patient's heart rate above 60 bpm (B)</p> Signup and view all the answers

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

<p>As soon as possible, without delaying for vascular access or atropine to take effect (D)</p> Signup and view all the answers

What is the recommended dose of atropine sulfate for a patient with unstable bradycardia?

<p>1.0 mg IVP/IO, repeated every 5 minutes as needed (D)</p> Signup and view all the answers

What is the primary concern in a patient with unstable bradycardia who is experiencing respiratory distress?

<p>Hypoxia and inadequate ventilations (B)</p> Signup and view all the answers

What is the indication for administering a fluid bolus of normal saline to a patient with unstable bradycardia?

<p>The patient's blood pressure is below 90 mmHg (B)</p> Signup and view all the answers

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

<p>0.04 mg/kg (3 mg for the average adult) (B)</p> Signup and view all the answers

Why is atropine sulfate unlikely to be effective in treating bradycardias with a wide QRS complex?

<p>Because the QRS complex is not affected by atropine sulfate (D)</p> Signup and view all the answers

What is the primary goal of pain management in a patient with unstable bradycardia who is conscious and not tolerating the pain from pacing?

<p>To alleviate the patient's discomfort and pain (A)</p> Signup and view all the answers

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Study Notes

Medical Directors and Fire Chiefs

  • Paul J. Adams, Medical Director for Coral Gables, Hialeah, and Miami Beach
  • Dr. Armando Clift, Associate Medical Director for City of Miami and Village of Key Biscayne
  • Marcos DelaRosa, Fire Chief for Coral Gables Fire Department
  • Zahralban, Fire Chief for Miami Fire Rescue
  • Virgernandez, Fire Chief for Miami Beach Fire Rescue

Acknowledgements

  • Protocol Review Committee members:
    • Frederick M. Keroff, Medical Director
    • Emmanuel Louis, Lieutenant, MFR
    • Raydel Castellanos, Firefighter, MFR
    • Jose Siut, EMS Training Instructor, MFR
    • Dan Feeney, EMS Captain, KBFR
    • Nicholas Johnson, EMS Lieutenant, KBFR
    • Robert Campos, Special Projects Coordinator, KBFR

Medical Director Overrides

  • The following EMS protocols/procedures and medications will not be used by personnel from the City of Miami Fire Department until available for use:
    • Ativan
    • Cardene
    • Nitrous Oxide
    • Racemic Epinephrine
    • Tetracaine Eye Drops
    • Scoop Stretcher's
    • T- Pod
    • Oral Gastric tubes

Adult Protocols

Back Pain

  • If patient is hemodynamically unstable (has a low blood pressure), administer normal saline, 500 mL IV bolus
  • Re-evaluate vital signs after patient has received fluids
  • May repeat once if needed
  • Consider Pain Management as indicated
  • With acute upper back pain:
    • Any male 35 years or older needs a 12-lead ECG
    • Any female 45 years or older needs a 12-lead ECG
  • With acute lower back pain, perform a neurological exam evaluating motor and sensory function in the lower extremities
  • If back pain is a result of traumatic injury, follow the appropriate trauma protocol

Baker Act / Marchman Act

  • Fire Rescue personnel may examine, treat, and/or transport a patient without their informed consent under certain conditions where the patient is incapacitated
  • Involuntary Examination, Florida Mental Health Act (“The Baker Act", FS 394.463)
  • A person may be taken to a receiving facility for involuntary examination if there is reason to believe that the person has a mental illness and because of their mental illness:
    • The person has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination
    • The person is unable to determine for himself or herself whether examination is necessary

Coral Snake Bites

  • Patients who have been bitten by a Coral Snake may not have any symptoms for a few hours
  • If there is a reliable history of a possible Coral Snake bite, the patient should be transported to the hospital for further observation and evaluation
  • Coral snakes do not have fangs but have small milk teeth
  • Typical story is that a patient is bitten on the finger or toe and the patient has to shake the snake off
  • "Red next to yellow can kill a fellow" (Coral Snake) vs. "Red next to black is a friend of Jack" (King Snake, non-poisonous)

Bites & Stings

  • For any known or suspected Coral Snake bite, alert Venom 1
  • Evaluate for specific signs/symptoms:
    • Most signs and/or symptoms may be delayed up to 12 hours and are related to the type of venom, which is a neurotoxin
    • CNS disturbances may be observed
    • Stroke-like signs and/or symptoms
  • Respiratory paralysis may develop
  • Be prepared to manage respiratory distress and provide ventilation assistance
  • Wrap an ace bandage snugly around the affected limb starting at the site of the bite and working towards the heart (proximal), wrapping the entire extremity
  • Monitor distal circulation by capillary refill and/or pulse to ensure the wrap does not become a tourniquet

Abdominal Pain

  • Abdominal pain may be associated with nausea and/or vomiting, diarrhea or constipation, urinary symptoms, difficulty breathing, cough, fever.
  • Patients who have had gastric bypass surgery are at increased risk for having complications.
  • Complications can occur shortly after surgery to many years following the surgical procedure.

Evaluation

  • Questions to ask the patient:
    • Onset of pain: sudden or gradual?
    • Is the pain constant or intermittent?
    • Has the pain moved since it started?
    • Have you had this type of pain before?
    • Are there any associated symptoms or clinical findings, such as nausea, vomiting, diarrhea, urinary symptoms, and/or shortness of breath?
    • On a scale of 1 to 10, how bad is the pain now?
    • Have you taken any medications to make yourself feel better? If so, did it make a difference?
    • When was the timing of last menses?

Treatment

  • Universal Initial Adult Patient Assessment / Care.
  • Hypotension:
    • Administer normal saline, 500 mL IV bolus. May repeat once if needed.
    • Administer epinephrine 1:1,000, 0.3 mg IM (0.3 mL) for asthma or allergic reactions.

Allergic / Systemic Reactions

  • Signs and symptoms:
    • Protrusion of the tongue
    • Jaw/teeth clenching
    • Facial grimacing
    • Deviation of the head to one side
    • Sustained upward deviation of the eyes
    • Extreme arching of the back
    • Or rarely, laryngospasm
  • Suspect possible dystonia in patients exhibiting these signs and who have taken certain medications.
  • Treatment:
    • Administer diphenhydramine (Benadryl), 50 mg slow IVP or IM.

Back Pain

  • Localized edema-swelling usually of the lips, tongue, and/or throat.
  • If the patient is hemodynamically unstable, administer normal saline, 500 mL IV bolus.
  • Consider Pain Management as indicated.
  • With acute upper back pain:
    • Any male 35 years or older needs a 12-lead ECG.
    • Any female 45 years or older needs a 12-lead ECG.

Bites & Stings

  • Marine Animal Envenomations:
    • Immerse the puncture(s) in non-scalding hot water as warm as tolerable (110-113°F) to achieve pain relief.
    • Consider Pain Management in the conscious patient.
  • Marine Animal Stings:
    • Evaluate ABCs for evidence of an allergic reaction, severe inflammation and swelling that might compromise airway and breathing.
    • Remove visible tentacles using 4x4s with a double-gloved hand.
    • Apply a vinegar (acetic acid) soaked gauze to the affected areas for 30 minutes.
    • Consider Pain Management in the conscious patient.
    • After pain relief, attempt to remove any remaining tentacles by using shaving cream and gentle scraping action with a wooden tongue depressor.

AICD (Automatic Implantable Cardioverter/Defibrillator)

  • AICD is a device implanted in the soft tissues of the patient's chest wall.
  • It consists of a lead system, computer circuitry, power supply, and capacitor.
  • The device stores and delivers shocks to the heart when indicated.

AICD Discharges

  • Universal Initial Adult Patient Assessment/Care is the first step.
  • Airway management is crucial.
  • Monitor ECG and SpO2, maintaining SpO2 at 94% or greater.
  • Establish vascular access and treat dysrhythmias per appropriate protocol.
  • Transport the patient to the closest appropriate hospital.

AICD Confirmed by ECG to be Discharging Inappropriately

  • Monitor ECG, verify rhythm, and identify any inappropriate defibrillator discharges.
  • For repetitive discharges, consider pain management in the conscious patient.

Airway Management

  • Assessment of a patient's respiratory status is divided into two categories: upper airway and lower airway evaluation.
  • The upper airway includes the tongue, soft palate, throat, oropharynx, and vocal cords.
  • The lower airway includes the trachea, bronchi, and lungs.
  • Evaluation of the upper airway involves assessing the openness or patency of the upper airway.
  • Evaluation of the lower airway involves assessing ventilation and oxygenation.

Airway Management Protocol

  • Deliver 1 breath every 6 seconds (10-12 breaths per minute) in respiratory/cardiac arrest.
  • If the patient's breathing improves, continue with current airway management and transport.
  • If not, insert a Supraglottic Airway device or intubate the patient with an appropriate sized ETT, if indicated.
  • Confirm and monitor proper placement with capnography.

Baker Act / Marchman Act

  • The Baker Act is a Florida law that allows for the involuntary examination of a person suspected of having a mental illness.
  • The Act can only be imposed by a judge, sworn law enforcement officer, or certain medical professionals.
  • Reasonable force (restraint) may be applied, but the patient should not be placed in a prone (face down) position.

Coral Snake Bites

  • Coral snakes do not have fangs, but have small milk teeth.
  • The typical story is that a patient is bitten on the finger or toe and has to shake the snake off.
  • Patients who have been bitten may not have any symptoms for a few hours.
  • If there is a reliable history of a possible Coral Snake bite, the patient should be transported to the hospital for further observation and evaluation.

General Snake Bites

  • For any known or suspected bite, alert Venom 1.
  • Evaluate for specific signs/symptoms, including delayed CNS disturbances and stroke-like signs.
  • Respiratory paralysis may develop, so be prepared to manage respiratory distress and provide ventilation assistance.
  • Wrap an ace bandage snugly around the affected limb to minimize movement and monitor distal circulation.

Common EMS Protocols

  • The protocols are applicable in Coral Gables, Hialeah, Miami, Miami Beach, and Key Biscayne.

Adult Protocols

  • AICD (Automatic Implantable Cardioverter/Defibrillator) is a device implanted in the patient's chest wall, consisting of a lead system, computer circuitry, power supply, and capacitor.
  • AICD discharges require Universal Initial Adult Patient Assessment/Care, airway management, ECG and SpO2 monitoring, vascular access, and treatment of dysrhythmias.

Airway Management

  • Assessment of a patient's respiratory status is divided into upper and lower airway evaluation.
  • Appropriate management includes transport to the closest appropriate facility for further observation.

Allergic/ Systemic Reactions

  • Mild allergic reactions involve making the patient comfortable and assessing for respiratory distress and anaphylaxis.
  • Treatment includes diphenhydramine (Benadryl) administration, ipratropium/albuterol (DuoNeb) for bronchospasm, and transport.
  • Anaphylaxis is a severe allergic reaction resulting in circulatory shock and respiratory distress, requiring Universal Initial Adult Patient Assessment/Care and treatment.

Bites and Stings

  • For any reptile or spider bite, request the Miami-Dade County Venom 1 Unit.
  • General treatment includes Universal Initial Adult Patient Assessment/Care, ECG and SpO2 monitoring, pain management, and rapid transport if symptomatic.
  • Marine animal envenomations involve immersion in non-scalding hot water for pain relief, and avoiding removal of embedded spines.
  • Marine animal stings require evaluation of ABCs, removal of tentacles, vinegar (acetic acid) soaked gauze application, and pain management.

EMS Protocols

  • The 2022-24 Common EMS Protocols involve the collaboration of multiple medical directors and fire chiefs from Coral Gables, Hialeah, Miami, Miami Beach, and Key Biscayne.
  • The protocol review committee consists of individuals who have worked tirelessly to produce a state-of-the-art protocol manual.

Airway Management

  • There are three adjuncts for Positive Pressure Ventilation (PPV):
  • CPAP (Continuous Positive Airway Pressure): best for Acute Pulmonary Edema, and can be used for respiratory distress that does not respond to medication.
  • Automatic Ventilator: used for PPV in demand, manual, or automatic mode.
  • BVM (Bag-Valve-Mask): used when CPAP or Automatic Ventilator is indicated but not available, and can be used with an advanced airway.
  • Advanced Airway options include Supraglottic Airway or oral Endotracheal Tube, and should be properly placed in cases of respiratory arrest or prolonged PPV.

Adult Protocols

Alcohol Intoxication

  • Patients can be categorized into Green, Yellow, and Red categories based on their level of intoxication.
  • Green category patients can be transported BLS when appropriate, while Yellow category patients should be transported via an ALS unit to the closest appropriate facility.
  • Red Category patients shall be transported via an ALS unit to the closest appropriate facility.
  • Treatment options include:
  • Establishing baseline vitals, level of consciousness, and glucose testing.
  • Ruling out possible drug ingestion/overdose.
  • Trying to persuade the patient to go to an appropriate hospital.

Allergic / Systemic Reactions

  • Treatment for allergic reactions includes:
  • Administering epinephrine 1:1,000, 0.3 mg (0.3 mL) IM.
  • Administering diphenhydramine (Benadryl), 50 mg slow IVP or IM.

Bites and Stings

  • Exotic snake bites require rapid transport and identification of the snake's scientific name or common name.
  • Brown Recluse Spider bites have signs and symptoms including:
  • Small bleb (blister) surrounded by a white ring.
  • Localized pain, redness, and swelling.
  • Localized tissue necrosis.
  • Black Widow Spider bites have signs and symptoms including:
  • Immediate localized pain.
  • Progressive muscle spasms.
  • Rigid abdomen.
  • Seizures.
  • Paralysis.
  • Treatment for Black Widow Spider bites includes:
  • Alerting Venom 1.
  • Evaluating for specific signs and symptoms.
  • Administering midazolam (Versed) to reduce severe muscle spasms.
  • Administering morphine sulfate to reduce severe muscle spasms.
  • Considering pain management in the conscious patient.

Abdominal Pain

  • Traumatic damage to solid organs (spleen, kidney, liver) can cause gastrointestinal bleeding
  • Important signs and symptoms:
    • Upper abdominal pain (above umbilicus)
    • Nausea and/or vomiting
    • Bleeding from the mouth or rectum
  • Evaluation considerations:
    • Age and gender: males ≥35 years and females ≥45 years require a 12-lead ECG
    • Location of pain:
      • Right upper quadrant pain: gallbladder pain, kidney stones
      • Right lower quadrant pain: kidney stones, ectopic pregnancy, classic appendicitis
      • Left upper quadrant pain: pancreatitis
      • Left lower quadrant pain: diverticulitis

Airway Management

  • Clinical assessment of the lower airway:
    • Mental status
    • Skin assessment (warm/dry, pink, ashen, or cyanotic)
    • Chest wall and accessory muscle assessment (retractions, abdominal breathing)
    • Lung sounds (wheezing, rhonchi, rales, absent breath sounds)
  • Management options:
    • Blow-by
    • Nasal cannula
    • Nebulizer
    • NRB mask
    • BVM with reservoir
    • CPAP
    • Invasive advanced airways (supraglottic devices, oral ETT, cricothyrotomy)
  • Monitoring:
    • Level of consciousness
    • SpO2 levels
    • Capnography waveforms

Angioedema

  • Patients taking ACE-inhibitors may present with:
    • Localized angioedema (lips, tongue, throat)
    • Partial upper airway obstruction with stridor
  • Treatment:
    • Epinephrine 1:1,000, 0.3 mg (0.3 mL) IM
    • Diphenhydramine (Benadryl), 50 mg slow IVP or IM
  • Observation during transport for developing or increasing respiratory difficulty and/or changes in voice

Bradycardia

  • Unstable bradycardia signs and symptoms:
    • New onset of altered mental status
    • Syncope
    • Respiratory distress/CHF
    • Chest pain
    • Low blood pressure
    • Signs/symptoms of shock
    • STEMI
  • Treatment:
    • Universal initial adult patient assessment/care
    • External pacing as soon as possible
    • Atropine sulfate, 1.0 mg IVP/IO (may be repeated every 5 minutes until maximum dose reached)
    • Ensure adequate ventilations
    • Fluid bolus of normal saline, 500 mL IV/IO (may repeat once as needed) if BP remains <90 mmHg

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