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

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

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

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

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

    Who is the Fire Chief of the City of Miami?

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

    How many Medical Directors are mentioned in the document?

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

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

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

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

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

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

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

    Who is the EMS Captain mentioned in the content?

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

    What is the title of the document?

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

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

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

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

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

    What is the title of Robert Campos?

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

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

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

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

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

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

    <p>Allergic reaction</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</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</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</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</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</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.</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.</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.</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.</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.</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.</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.</p> Signup and view all the answers

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

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

    What is a common sign of dystonia in a patient?

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

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

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

    What is a rare but potential complication of certain medications?

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

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

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

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

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

    What is the breathing rate in respiratory/cardiac arrest?

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

    What is the maximum number of intubation attempts allowed?

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

    What is the primary function of the upper airway?

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

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

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

    What is a sign of an upper airway obstruction?

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

    Who can impose the Baker Act?

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

    What is the primary goal of the Baker Act?

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

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

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

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

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

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

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

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

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

    What is the primary concern in a patient with anaphylaxis?

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

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

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

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

    <p>Treating respiratory failure</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</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.</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.</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.</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.</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.</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.</p> Signup and view all the answers

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

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

    What is the replacement for Ativan?

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

    What will be used in place of a Scoop Stretcher?

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

    On which page can the Adult Trauma protocols be found?

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

    What is the page number of the Pediatric Trauma protocols?

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

    On which page can the Abdominal Pain protocols be found?

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

    What is the version of the Common EMS Protocols?

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

    Where can the Medications Section be found?

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

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

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

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

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

    How many Medical Directors are mentioned in the document?

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

    On which page is the Acknowledgements section found?

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

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

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

    What is the primary indication for using a BVM?

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

    When should an advanced airway be properly placed?

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

    Which of the following is a type of advanced airway?

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

    When is a Supraglottic Airway placed?

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

    What should be set to 10 when using a BVM?

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

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

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

    What is the characteristic of a patient categorized as Green?

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

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

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

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

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

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

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

    What is the 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</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</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</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</p> Signup and view all the answers

    What is the most invasive advanced airway?

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

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

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

    What is the purpose of monitoring SpO2 levels?

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

    What is the significance of monitoring capnography waveforms?

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

    What is the primary focus of airway management?

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

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

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

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

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

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

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

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

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

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

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

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

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

    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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