BLS EMS PROTOCOLS
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What is the recommended dosage of oral glucose for a pediatric patient?

  • 20-25 grams
  • 10-15 grams (correct)
  • 15-20 grams
  • 5-10 grams

    • What is the primary purpose of bag-valve-mask (BVM) ventilation?

  • To administer inhaled medications for patients with COPD
  • To administer oxygen therapy
  • To intubate patients in cardiac arrest
  • To provide rescue breathing for patients with inadequate respiratory effort (correct)

    • What is the recommended oxygen flow rate for a pediatric patient with CO exposure?

  • 100% oxygen via nasal cannula
  • 6-12 lpm via nasal cannula
  • 2-6 lpm via nasal cannula
  • 12-15 lpm via NRB mask (correct)

    • What is the recommended action for a patient with a SpO2 reading of less than or equal to 85%?

    <p>Give 100% oxygen and intubate if indicated</p> Signup and view all the answers

    What is a contraindication for oxygen therapy?

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

    What is the effect of high concentrations of oxygen on some COPD patients?

    <p>Decreases respiratory drive</p> Signup and view all the answers

    What is the recommended oxygen flow rate for an adult patient via nasal cannula?

    <p>2-6 lpm</p> Signup and view all the answers

    What is the purpose of administering oxygen therapy in patients with trauma?

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

    What is the effect of changing the percentage of inspired oxygen on the blood and tissue level?

    <p>It takes 5-20 minutes to equilibrate</p> Signup and view all the answers

    In which patients may inaccurate or misleading SpO2 readings occur?

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

    What is the heart rate threshold for a child (1-12 years of age) to be considered symptomatic bradycardia?

    <p>Less than 80</p> Signup and view all the answers

    What is the recommended action if a patient does not have adequate chest rise and breath sounds with BVM?

    <p>Use a larger bag to increase the volume of air delivered into the patient</p> Signup and view all the answers

    What is the primary concern when using BVM on a pediatric patient?

    <p>Using an appropriate size mask to avoid pressure over the eyes</p> Signup and view all the answers

    What is the recommended age range for using an adult AED?

    <p>Child 8 years of age or greater</p> Signup and view all the answers

    What is a potential adverse effect of using an AED?

    <p>Deactivation of patient's implanted pacemaker</p> Signup and view all the answers

    What is the systolic blood pressure threshold below which nitroglycerin is contraindicated?

    <p>Below 90 mmHg</p> Signup and view all the answers

    What is the recommended action when using an AED on a child?

    <p>Use an AED with pediatric capability, using the pediatric capability</p> Signup and view all the answers

    What is a contraindication for BVM use?

    <p>None</p> Signup and view all the answers

    What is the maximum number of doses of nitroglycerin that can be administered to an adult?

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

    What is the heart rate threshold above which nitroglycerin is contraindicated?

    <p>Above 150 bpm</p> Signup and view all the answers

    What is the recommended size of resuscitation mask for an adult?

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

    What is the recommended reassessment interval for blood pressure after administering nitroglycerin?

    <p>Before and after administration</p> Signup and view all the answers

    What is the recommended size of resuscitation bag for an infant less than 1 year of age?

    <p>Infant (450-500 mL)</p> Signup and view all the answers

    What is a precaution when using an AED?

    <p>Make sure the patient and environment are dry</p> Signup and view all the answers

    What is the minimum age for which nitroglycerin is contraindicated?

    <p>Under 13 years</p> Signup and view all the answers

    What is the recommended action if the patient's systolic blood pressure drops more than 20 mmHg after administering nitroglycerin?

    <p>Obtain medical consultation</p> Signup and view all the answers

    Who is authorized to administer patient-prescribed sublingual nitroglycerin?

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

    What is the indication for oral glucose administration in a patient with an unknown reason for unconsciousness?

    <p>Unconscious for an unknown reason</p> Signup and view all the answers

    What is the primary purpose of the Go-Team activation?

    <p>To provide advanced surgical services during prolonged extrication</p> Signup and view all the answers

    What should you do after initiating shock to the patient using an AED?

    <p>Perform 5 cycles of CPR immediately</p> Signup and view all the answers

    When can you defibrillate a patient?

    <p>Only when the patient is in cardiac arrest</p> Signup and view all the answers

    What should you do if the patient remains pulseless after initiating shock?

    <p>Continue the cycle of CPR and shocks until the AED prompt states 'no shock advised' or ROSC is achieved</p> Signup and view all the answers

    Who should request the Go-Team?

    <p>The on-scene incident commander</p> Signup and view all the answers

    What should you do while the AED is analyzing the patient's rhythm?

    <p>Ensure all individuals are clear of the patient</p> Signup and view all the answers

    What is the role of the Go-Team physician during patient transport?

    <p>To consult with the EMS system during transport</p> Signup and view all the answers

    Why should you not defibrillate while moving the patient?

    <p>It may cause harm to the patient or bystanders</p> Signup and view all the answers

    What should you do if the patient remains in cardiac arrest and shock is not indicated?

    <p>Perform 5 cycles of CPR</p> Signup and view all the answers

    What is the role of SYSCOM in Go-Team activation?

    <p>To coordinate the Go-Team's transport to and from the scene</p> Signup and view all the answers

    What is the recommended CPR fraction associated with improvements in survival?

    <p>Equal to or greater than 80%</p> Signup and view all the answers

    What should be the duration of compression pauses?

    <p>Less than 10 seconds</p> Signup and view all the answers

    What is the role of Clinician 1 in a 2-clinician crew?

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

    What is the recommended compression rate for High Performance CPR?

    <p>Between 100 and 120 per minute</p> Signup and view all the answers

    What is the role of the crew leader in High Performance CPR?

    <p>Keep time, record interventions, and give compression feedback</p> Signup and view all the answers

    What is the recommended interval for verbal announcements of time during High Performance CPR?

    <p>Every 1 minute, 30 seconds before reassessment, 15 seconds left, and countdown to reassessment at 10 seconds</p> Signup and view all the answers

    What is the recommended compression depth for a pediatric patient less than 1 year of age?

    <p>1 ½ inches</p> Signup and view all the answers

    What is the role of Clinician #3 or more in Pediatric High Performance CPR?

    <p>BLS coach, family support, and ALS responsibilities</p> Signup and view all the answers

    What is the recommended interval for rotation of personnel doing chest compressions in High Performance CPR?

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

    What is the priority of the crew leader in High Performance CPR?

    <p>Coordinating duties and keeping time</p> Signup and view all the answers

    What is the primary goal of High Performance Cardio-Pulmonary Resuscitation (HPCPR) in Maryland?

    <p>To improve survival of sudden out-of-hospital cardiac arrest patients</p> Signup and view all the answers

    Which of the following patients is NOT a candidate for High Performance CPR?

    <p>A patient who meets the criteria for Pronouncement of Death in the Field protocol</p> Signup and view all the answers

    What is the recommended depth of chest compressions for patients less than one year of age?

    <p>1½ inches</p> Signup and view all the answers

    What is the recommended rate of chest compressions during High Performance CPR?

    <p>100-120 per minute</p> Signup and view all the answers

    When should the defibrillator pads be placed on the patient during High Performance CPR?

    <p>While chest compressions are ongoing</p> Signup and view all the answers

    What is the purpose of the dispatcher's role in Telephone CPR (T-CPR)?

    <p>To initiate CPR by the lay rescuer</p> Signup and view all the answers

    When should rhythm interpretation occur in a cardiac arrest scenario?

    <p>After the two-minute cycle of CPR is performed</p> Signup and view all the answers

    How often should compressors be rotated during manual chest compressions?

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

    What is the recommended depth of chest compressions?

    <p>At least 2 inches (5 cm)</p> Signup and view all the answers

    What should rescuers do during the sequence of defibrillation?

    <p>Hover over the patient with hands ready</p> Signup and view all the answers

    What should be done during the brief pause to assess pulses and/or defibrillate?

    <p>Limit the pause to less than 10 seconds</p> Signup and view all the answers

    Why should compressors hover over the patient during defibrillation?

    <p>To immediately start compressions after a shock</p> Signup and view all the answers

    How often should ventilations be performed during CPR?

    <p>One ventilation every 10th compression</p> Signup and view all the answers

    What should be done immediately after a shock is delivered?

    <p>Immediately perform another two-minute cycle of compressions</p> Signup and view all the answers

    What is the recommended ratio of ventilations to compressions for single rescuer CPR in children up to age 13?

    <p>2 ventilations every 30th compression</p> Signup and view all the answers

    What should ALS clinicians prioritize in cardiac arrest management?

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

    What is the purpose of nasal capnography in cardiac arrest management?

    <p>To optimize CPR performance and evaluation of ROSC</p> Signup and view all the answers

    What is the formula for CPR Fraction?

    <p>Time CPR is being performed divided by the total time of the cardiac arrest</p> Signup and view all the answers

    What is the recommended ventilation volume for CPR?

    <p>Low volume (approximately 500 cc)</p> Signup and view all the answers

    What should rescuers do if the patient remains pulseless after CPR and defibrillation?

    <p>Check for a pulse and then continue CPR</p> Signup and view all the answers

    Study Notes

    BLS Pharmacology: Nitroglycerin

    • Indication: Chest pain
    • Adverse effects: Hypotension, Headache, Dizziness, Tachycardia
    • Precautions:
      • BLS clinician may only administer patient-prescribed sublingual nitroglycerin
      • Reassess blood pressure before and after administration
      • If systolic blood pressure drops more than 20 mmHg per dose, obtain medical consultation before further administration
    • Contraindications:
      • Blood pressure below 90 mmHg systolic
      • Heart rate less than 60 or greater than 150 bpm
      • Medication not prescribed for the patient
      • Pediatric patient under age 13
      • Patient having taken medication for Pulmonary Artery Hypertension or erectile dysfunction within the past 48 hours
    • Preparation: Spray or tablet
    • Dosage:
      • Adult: 0.4 mg sublingually (one tablet or one spray)
      • Repeat in 3 to 5 minutes if chest pain persists
      • Maximum of three doses of nitroglycerin

    BLS Pharmacology: Oral Glucose

    • Indication:
      • Altered mental status with known diabetic history
      • Unconscious for an unknown reason
      • Measured blood glucose less than 70 mg/dL
    • Adverse effects: Not clinically significant
    • Precautions: Patient without gag reflex may aspirate
    • Contraindications: Not clinically significant
    • Preparation: 10–15 grams of glucose (contained in 24, 30, or 37.5 gram tube)
    • Dosage:
      • Adult: Administer 10–15 grams of oral glucose between the gum and cheek
      • Consider single additional dose of oral glucose if not improved after 10 minutes
      • Pediatric: Administer 10–15 grams of oral glucose between the gum and cheek; this may be accomplished through several small administrations

    BLS Pharmacology: Oxygen

    • Pharmacology:
      • Increases oxygen content of the blood
      • Improves tissue oxygenation
      • Decreases energy expended for respirations
    • Pharmacokinetics: Changing the percentage of inspired oxygen results in an increased blood and tissue level equilibration within 5–20 minutes
    • Indications:
      • If evidence of hypoxia (Less than 94% SpO2)
      • Respiratory distress
      • Cardiopulmonary arrest
      • Trauma
      • Suspected CO exposure
      • Dyspnea
    • Contraindications: Not clinically significant
    • Adverse effects: High concentrations of oxygen will reduce the respiratory drive in some COPD patients
    • Precautions:
      • Never withhold oxygen from those who need it
      • Oxygen should be given with caution to patients with COPD
      • Simple or partial rebreather face masks must be supplied with a minimum 6 lpm
      • Non-breather (NRB) face masks must be supplied with a minimum 12 lpm
    • Dosage:
      • Adult: Administer 12–15 lpm via NRB mask or 2–6 lpm via nasal cannula, as needed
      • CO exposure: Administer 100% oxygen via NRB mask
      • Maintain SpO2 at 100%

    Procedures: Airway Management - Bag-Valve-Mask (BVM) Ventilation

    • Purpose: Provide rescue breathing for patients with inadequate respiratory effort or cardiac arrest
    • Indications:
      • Inadequate respiratory rate
      • Inadequate respiratory effort
      • Symptomatic Bradycardia
      • Cardiac arrest
      • Altered mental status
    • Contraindications: None
    • Potential adverse effects/complications:
      • Gastric distension
      • Vomiting
      • Increased intracranial pressure
    • Precautions:
      • Have suction available
      • Use an appropriate size airway adjunct with BVM
      • Use an appropriate size mask to avoid pressure over the eyes
      • Use the “E-C clamp” technique to achieve an adequate seal
    • Suggested sizes for resuscitation masks and bags based on age

    Procedures: Electrical Therapy - Automated External Defibrillation (AED)

    • Indications: Sudden cardiac arrest
    • Contraindications:
      • Patient exhibiting signs of life
      • Newly born patients (up to one hour after birth)
    • Potential adverse effects/complications:
      • Burns to skin
      • Deactivation of patient’s implanted pacemaker
      • Injury to patient, self, and/or bystanders
    • Precautions:
      • Make sure the patient and the environment are dry
      • Avoid placing pads over cardiac pacemakers/defibrillators or nitroglycerin patches
      • DO NOT touch the patient while the AED is analyzing the patient or discharging energy
      • Ensure all individuals are clear of the patient
    • Procedure:
      • Initiate analysis of rhythm
      • If shock is indicated, ensure all individuals are clear of the patient and initiate shock
      • If shock is not indicated, perform 5 cycles of CPR and initiate analysis of rhythm

    Procedures: Go-Team Activation

    • Purpose: To provide advanced surgical team care to seriously injured patients
    • Indications:
      • Patients with potentially life or limb threatening injuries
      • Extrication times are anticipated to be more than 1 hour
    • Contraindications: None
    • Procedure:
      • On-scene incident commander requests the Go-Team
      • Go-Team coordinates transport to and from the scene
      • Go-Team operates within the Incident Command System
      • Go-Team documents care provided and files a patient care report

    Procedures: High Performance CPR

    • Purpose: To improve survival of sudden out-of-hospital cardiac arrest patients

    • Indications: Patients in cardiac arrest who are greater than 24 hours old

    • Contraindications:

      • Patients meeting the criteria for Pronouncement of Death in the Field protocol
      • Patients who are less than 24 hours old

    • Potential adverse effects/complications: None

    • Precautions: None

    • Important role of dispatcher telephone CPR (T-CPR)

    • Procedure:

      • The first clinician at the patient’s side will assess and initiate compressions
      • Effective Compressions:
        • Compressions at a rate of 100–120 per minute
        • Compression depth of at least 2 inches
        • Chest compressions will be performed at a rate of 100–120 per minute
      • Continuous Compressions:
        • Compressions will not be interrupted during the two-minute cycle
        • Ventilations and other treatments will be done while compressions are ongoing
      • Defibrillation:
        • Automatic External Defibrillation
        • Cardiac Monitor/Defibrillator
      • Ventilations:
        • Ventilations will be performed without stopping chest compressions
        • Ventilations will be interposed asynchronously with uninterrupted compressions### High Performance CPR

    • Rescuers should perform chest compressions at a rate of 100-120/min and compress to a depth of at least 2 inches (5 cm) for adults.

    • Rescuers should allow full recoil after each compression and minimize pauses in compressions.

    • Rescuers should ventilate adequately (1 breath every 10th compression during recoil).

    • Advanced Life Support (ALS) clinicians will address defibrillation, IV/IO access, medication administration, and advanced airway placement.

    • The placement of an advanced airway is no longer an early focus of cardiac arrest management and will not interrupt chest compressions.

    • Nasal capnography may be utilized to optimize CPR performance and evaluation of ROSC (Return of Spontaneous Circulation).

    Quality Improvement/Performance Metrics

    • Time to CPR, time to defibrillation, and quality of CPR are factors that have a positive impact on survival.
    • CPR Fraction is a metric that can be used to evaluate performance, calculated as the time CPR is being performed divided by the total time of the cardiac arrest.
    • A target goal for crews is a CPR fraction of equal to or greater than 80%.
    • Minimizing pre-shock pauses (e.g., charging defibrillator while clinicians performing chest compressions) is important.
    • Feedback is best provided in real-time or as close to the provision of care as possible.

    Procedure: Code Resource Management (CRM)

    • Crews should coordinate their duties keeping the call priorities in mind.
    • Intervention priorities are (in order of highest to lowest):
      • Release Date: July 1, 2023
    • Appropriate crew roles are outlined based on the number of personnel on a given incident and their qualifications.

    Pediatric High Performance CPR (HPCPR)

    • Assess Patient (less than 10 seconds) and remain on scene if unresponsive, not breathing, and no pulse.
    • Clinician #1 starts chest compressions (100-120/min) and ventilations (2 breaths: 30 compressions).
    • Clinician #2 attaches AED/defibrillator and assumes ventilation role.
    • Continue HPCPR for 2-minute cycles with less than 10-second pause for coordinated activities.
    • Check pulse, check rhythm (AED), shock if indicated, and change compressors every 2 minutes.

    Essentials of High Performance CPR for Pediatrics

    • Ensure proper chest compression rate (100-120/min) and call for AED.
    • Ensure proper compression depth (less than 1 year: 1 ½ inches or 4 cm, greater than or equal to 1 year: 2 inches or 5 cm).
    • Minimize interruptions (less than 10 second pause).
    • Ensure full chest recoil.
    • Coordinate 2-minute cycles, rotate compressors, and assume timekeeper role.
    • IO Access, Medications, Establish ALS Airway, and Family Support are also important roles.

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    Description

    This quiz covers the indications, adverse effects, and precautions for nitroglycerin administration in patients. It's essential for BLS clinicians to understand the proper administration and potential side effects of this medication.

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