Suffolk County Protocols Flashcards
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Questions and Answers

What should you do if rhythm does not convert after four successive cardioversion attempts?

  • Continue cardioversion at 100 joules
  • Stop all attempts
  • Contact Medical Control (correct)
  • Increase joules to 300

    • What is the recommended dosage of Diltiazem for a symptomatic patient with a new onset of atrial fibrillation or atrial flutter?

  • 10 mg/kg with a maximum of 100 mg
  • 25 mg/kg to a max dose of 200 mg (correct)
  • 0.25 mg/kg to a max dose of 20 mg
  • 50 mg/kg to a max dose of 400 mg

    • What action should be taken if a patient is unstable without decompensation and has a rate greater than 150?

  • Administer Diltiazem 25 mg/kg to a max dose of 200 mg (correct)
  • Administer Diltiazem but only with Medical Control advice
  • Administer Diltiazem 0.25 mg/kg to a max dose of 20 mg
  • Do not give Diltiazem, always contact Medical Control

    • What is the correct dosage of ASA for a patient who is still symptomatic after taking aspirin?

    <p>324 mg oral/chewable</p> Signup and view all the answers

    What must you do after failing the maximum number of attempts to gain IV access?

    <p>Obtain IO access</p> Signup and view all the answers

    If a patient in medical shock has an SBP < 90 and exhibits respiratory distress, what action do you take?

    <p>D/C fluid bolus and initiate Dopamine Infusion</p> Signup and view all the answers

    What should be done if a patient's SBP drops suddenly below 120 during transport when they previously had a systolic BP of 120 or higher?

    <p>Contact Medical Control</p> Signup and view all the answers

    In cases of acute coronary syndrome, how many attempts are you allowed to gain IV access?

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

    What is the correct dosage of Epinephrine for a patient in respiratory failure due to asthma?

    <p>0.3 mg IM (1:1,000)</p> Signup and view all the answers

    What medication and dosage can be given according to standing orders after administering Epinephrine to a patient in respiratory failure?

    <p>Magnesium Sulfate IV infusion, 2 grams in 100 ml over 10 minutes</p> Signup and view all the answers

    What is the administration procedure for treating COPD exacerbation?

    <p>Albuterol with Ipratropium via nebulizer and initiate CPAP</p> Signup and view all the answers

    What is the definition of an On-Line Medical Control Physician?

    <p>A physician authorized by the Medical Director to provide advice and direction to ALS Providers providing out-of-hospital medical care</p> Signup and view all the answers

    What is the definition of a Disaster Medical Response Team (DMRT) Physician?

    <p>A physician receiving additional authority as a Deputy Fire Coordinator-Medical (DFC-Medical) to operate as an agent of the county, when specifically called upon</p> Signup and view all the answers

    What is the definition of a Designated EMS Field Physician?

    <p>A physician authorized by the Medical Director and the Regional Emergency Medical Advisory Committee (REMAC) to provide advice and direction when such physician is present at the scene of an out-of-hospital medical emergency</p> Signup and view all the answers

    Voice contact with Medical Control should be established as promptly as possible, but not more than _____ minutes, after technician-patient contact is established.

    <p>20</p> Signup and view all the answers

    Refusal of Medical Assistance (RMA) consults must take place via:

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

    An ALS Provider has the right to question an order that is believed to be contraindicated or for which the ALS Provider is not certified.

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

    An ALS Provider must carry out an order unless he/she is not credentialed or trained in that intervention, or if that intervention is not listed in the formulary of authorized procedures.

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

    Procedure attempts are limited to ____ attempts per patient.

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

    Standing orders are written with the assumption that there is a single ALS Provider and therefore must be performed in the order presented.

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

    Once standing orders are initiated in a particular protocol, the ALS Provider is obligated to that protocol.

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

    Once contact with Medical Control has been established, standing orders are no longer valid.

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

    A physician extender outside the normal setting of his/her usual place of employment may provide on-scene medical direction.

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

    If a Physician Extender is present at an emergency in their usual employment setting, and requests to assume responsibility for the care of the patient, they may do so.

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

    To assume responsibility for the care of a patient, an on-scene physician must agree to all responsibilities and document this on the Prehospital Care Report.

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

    What is the primary role of the EMS Medical Director, a Medical Control Physician, or a Designated EMS Field Physician?

    <p>Provide direct on-scene medical control and direction</p> Signup and view all the answers

    Psychiatric emergencies should be transported to the closest emergency department for medical evaluation.

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

    Patients that may require hyperbaric therapy should be transported to the closest emergency department for evaluation.

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

    Patients that are victims of sexual assault should be transported to a hospital that maintains a Sexual Assault Nurse Examiner (SANE) Program.

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

    Per NY State DOH, if the transport time from the scene to the Trauma Center is _____________, Medical Control must be contacted.

    <p>greater than (&gt;) thirty (30) minutes</p> Signup and view all the answers

    Nitrous Oxide is ok to use on the medevac aircraft.

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

    What is required on all endotracheal intubations performed in the ALS System?

    <p>End-Tidal CO2 waveform capnography, use of a commercially available tube holder, immobilization of the head with cervical collar, head blocks and long backboard</p> Signup and view all the answers

    When is the use of the RES-Q Pod™ required?

    <p>Either an endotracheal tube or supraglottic airway is used</p> Signup and view all the answers

    When is RES-Q-Pod™ contraindicated?

    <p>Suffering a traumatic arrest with chest injury</p> Signup and view all the answers

    A DNR order is an order not to perform ventilations, compressions, defibrillation, intubation or medication administration in the event of cardiac OR respiratory arrest.

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

    If a DNR order or MOLST Form is disputed, CPR may be started to avoid confrontation.

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

    What is the status of Termination of Resuscitation?

    <p>Is a standing order</p> Signup and view all the answers

    How is an adult defined in regards to medical treatment?

    <p>Fifteen or more (&gt;=15) years old and who weighs more than thirty-six (36) Kg</p> Signup and view all the answers

    Any patient greater than twelve (>12) years old and weighing greater than (>) thirty-six (36) Kg may be treated as an adult.

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

    Unstable patients include those with pulse < 50 or > 110.

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

    What is the correct dosage for Ventricular Fibrillation/Pulseless Ventricular Tachycardia?

    <p>Defibrillation 360 joules or biphasic equivalent, Epinephrine 1:10,000 1 mg IV/IO/EJ; repeat every 3-5 min, Amiodarone 300 mg IV/IO/EJ bolus, may repeat Amiodarone 150 mg IV/IO/EJ in 3-5 minutes.</p> Signup and view all the answers

    What is the correct dosage of Sodium Bicarbonate if renal failure, TCA OD, or hyperkalemia is suspected during Ventricular Fibrillation/Pulseless Ventricular Tachycardia?

    <p>1 mEq/kg IV/IO/EJ</p> Signup and view all the answers

    What is the correct dosage of Magnesium Sulfate if Torsade de Pointes is suspected during Ventricular Fibrillation/Pulseless Ventricular Tachycardia?

    <p>2 g IV/IO/EJ</p> Signup and view all the answers

    What are the H's & T's of Asystole / PEA?

    <p>Hypoglycemia, Hypovolemia, Hypoxia, Acidosis, Hyperkalemia, Toxins, Tension Pneumothorax</p> Signup and view all the answers

    What is the correct fluid bolus to administer during Asystole / PEA?

    <p>Fluid bolus of 20 ml/kg (may be repeated to a total of 40 ml/kg)</p> Signup and view all the answers

    What is the SHOCK/HYPOPERFUSION AFTER ROSC protocol intended for?

    <p>Both A and B</p> Signup and view all the answers

    What is the correct dosage of Dopamine in the SHOCK/HYPOPERFUSION AFTER ROSC protocol?

    <p>Infusion of 10 mcg/kg/min if Systolic B/P &lt; 90 mmHg</p> Signup and view all the answers

    What are the exclusion criteria for therapeutic hypothermia?

    <p>Patients known to be pregnant, trauma patients, suspected sepsis, other causes of coma, or recent major surgery within 14 days</p> Signup and view all the answers

    The THERAPEUTIC HYPOTHERMIA Protocol is intended for patients with ROSC following cardiac arrest and GCS < 8.

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

    If SBP drops below 90 mmHg during the THERAPEUTIC HYPOTHERMIA Protocol, what should be administered?

    <p>Administer Dopamine 10 mcg/kg/min after fluid bolus complete</p> Signup and view all the answers

    What is the correct amount of chilled normal saline to administer during the THERAPEUTIC HYPOTHERMIA Protocol?

    <p>Total of 30 ml/kg or 2 L maximum</p> Signup and view all the answers

    What should be administered for stable Ventricular Tachycardia with a pulse without decompensation?

    <p>Amiodarone 150 mg in 100 ml over 10 minutes</p> Signup and view all the answers

    What is the medication administered for unstable (Decompensated SBP < 90 mmHg) Ventricular Tachycardia with a pulse?

    <p>100 joules, repeat 200, 300, 360, continue with 360 joules during transport until rhythm converts</p> Signup and view all the answers

    What is the correct dosage for premedication in unstable Ventricular Tachycardia?

    <p>Premedicate with Lorazepam up to 4 mg IV/IM OR Diazepam up to 10 mg IV.</p> Signup and view all the answers

    Symptomatic Bradycardia in unstable conditions should always initiate with Atropine.

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

    For supraventricular tachycardia stable without decompensated shock, Adenosine administration is appropriate.

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

    For supraventricular tachycardia unstable, what is usually indicated?

    <p>Cardioversion at 100 joules. Repeat at 200 joules until rhythm converts.</p> Signup and view all the answers

    Study Notes

    On-Line Medical Control Physician

    • Authorized by the Medical Director and REMAC to provide advice at out-of-hospital medical emergencies.
    • Provides direction to ALS Providers during out-of-hospital medical care.

    Disaster Medical Response Team (DMRT) Physician

    • Holds additional authority as a Deputy Fire Coordinator-Medical.
    • Acts as an agent of the county when specifically called upon.

    Designated EMS Field Physician

    • Authorized to provide advice and direction at the scene of out-of-hospital medical emergencies by the Medical Director and REMAC.

    Voice Contact with Medical Control Protocol

    • Required to establish voice contact within 20 minutes after technician-patient contact.

    Refusal of Medical Assistance (RMA)

    • Consultations must be conducted via telephone.

    ALS Provider Rights

    • Has the right to question orders believed to be contraindicated or for which they are unqualified.

    Protocol Adherence

    • If an order is clarified and not retracted, the ALS Provider must execute it unless uncredentialed or untrained in the intervention.

    Procedure Attempts

    • Limited to 2 attempts per patient.

    Standing Orders

    • Written based on the assumption of a single ALS Provider; must be performed in order.

    Obligations to Protocols

    • Once standing orders are initiated, ALS Providers must adhere to that protocol.

    Standing Orders Authority

    • Medical Control physician assumes all treatment decisions, including transport, once contact is made; with exceptions for certain cases like defibrillation in specific rhythms.

    Physician Extender Responsibilities

    • A Physician Extender cannot provide on-scene direction outside their usual employment context.

    On-Scene Treatment Responsibilities

    • A Physician Extender in their usual setting may assume responsibility for patient care under their supervising physician's license.

    Patient Responsibility Documentations

    • On-scene physicians assuming care must document it and accompany the patient to the hospital.

    Psychiatric Emergencies

    • Transport to the nearest emergency department for medical evaluation is essential.

    Hyperbaric Therapy Transport

    • Patients requiring hyperbaric therapy should be taken to the nearest emergency department for evaluation.

    Sexual Assault Victims

    • Must have transportation to hospitals with a Sexual Assault Nurse Examiner (SANE) Program, barring unstable conditions.

    Trauma Center Transport Protocol

    • If transport time exceeds 30 minutes, Medical Control must be contacted for guidance.

    Nitrous Oxide Usage

    • Not permitted on medevac aircraft.

    Endotracheal Intubation Requirements

    • Must use End-Tidal CO2 waveform capnography and commercially available tube holders, along with head immobilization techniques.

    RES-Q Pod™ Usage

    • Required for all cardiac arrest patients; contraindicated for traumatic arrests with chest injury.

    DNR Orders

    • Specify not to perform certain resuscitation procedures in the event of cardiac or respiratory arrest.

    Dispute of DNR Orders

    • If a DNR or MOLST Form is contested, initiation of CPR is permissible to avoid confrontation.

    Termination of Resuscitation

    • Classified as a standing order.

    Adult Definition

    • An individual is classified as an adult if aged 15 years or older and weighing over 36 kg.

    Patient Treatment Guidelines

    • Patients over 12 years old and over 36 kg may be treated as adults.

    Criteria for Unstable Patients

    • Includes various vital sign threshold markers indicating instability, such as pulse irregularities and blood pressure extremes.

    Ventricular Fibrillation / Pulseless Ventricular Tachycardia Treatment

    • Includes specific dosages for defibrillation and medications like Epinephrine and Amiodarone.

    Sodium Bicarbonate in Specific Situations

    • Administered at 1 mEq/kg if renal failure, TCA overdose, or hyperkalemia is suspected.

    Magnesium Sulfate Administration

    • 2 g IV/IO/EJ for Torsade de Pointes during arrhythmias like Ventricular Fibrillation.

    H's & T's of ASYSTOLE / PEA

    • Conditions such as Hypoglycemia, Hypovolemia, Hypoxia, and others must be assessed.

    Fluid Bolus Guidelines in ASYSTOLE / PEA

    • Administer 20 ml/kg, repeatable to a maximum of 40 ml/kg.

    Shock / Hypoperfusion After ROSC

    • Specifically for patients in shock from post-cardiac arrest.

    Dopamine Dosage During Shock

    • Infusion of 10 mcg/kg/min if Systolic B/P is below 90 mmHg.

    Exclusion Criteria for Therapeutic Hypothermia

    • Certain conditions including pregnancy, trauma, and others preclude treatment.

    Therapeutic Hypothermia Protocols

    • Aimed at patients following cardiac arrest.

    Chilled Normal Saline Infusion Limit

    • Maximum infusion is 30 ml/kg or 2 L.

    VENTRICULAR TACHYCARDIA WITH PULSE Protocols

    • Differentiations between stable and unstable patients dictate treatment pathways including medications and cardioversion specifics.

    Supraventricular Tachycardia Management

    • Requires specific medication administration and follow-up with Medical Control as needed.

    Atrial Fibrillation / Flutter Treatment

    • Protocols are determined by stability and specific rates, including medication dosages and cardioversion strategies.### Acute Coronary Syndrome Entry Protocol

    • Aspirin Dosage:

      • 2 x 81mg if patient has previously taken aspirin.
      • 324mg if patient is symptomatic and has taken aspirin.
      • 324mg if patient did not take aspirin this episode.

    • STEMI Management:

      • Administer Nitroglycerin 0.4 mg SL, repeat every 5 minutes, maximum 3 doses with SBP > 120.
      • Morphine Sulfate up to 10 mg IVP required if SBP drops below 90.

    IV Access and Procedures

    • Maximum attempts for IV access: 2.
    • If failed attempts reach the maximum, switch to intraosseous (IO) access.

    Medical Shock / Hypoperfusion

    • If SBP < 90 with inadequate tissue perfusion and respiratory distress:

      • Discontinue fluid bolus and initiate Dopamine Infusion at 10 mcg/kg/min.

    • If blood pressure remains < 90 after initial treatment:

      • Must contact Medical Control.

    Pulmonary Edema Management

    • Maintain cautious observation when systolic BP is 120 or higher during transport.

    • If BP suddenly drops below 120, contact Medical Control for further instructions.

    • For congestive heart failure suspected cases:

      • Perform continuous monitoring and oxygen saturation checks.
      • Administer Nitroglycerin 0.4 mg SL before applying CPAP.
      • Morphine Sulfate may be given up to 10 mg IVP.

    Asthma Protocol

    • In cases without imminent respiratory failure:

      • Administer Albuterol and Ipratropium Bromide via nebulizer; repeat once.
      • Provide Methylprednisolone 125 mg IV.

    • For patients with respiratory failure:

      • Administer Epinephrine 0.3 mg (0.3 ml of 1:1,000 solution) IM.
      • Magnesium Sulfate IV infusion at 2 grams in 100 ml over 10 minutes can follow.

    COPD / Exacerbation Management

    • Administer combination of Albuterol and Ipratropium Bromide via nebulizer.
    • Utilize CPAP titration up to 10 cmH2O with continuous capnography monitoring, if SBP > 120.
    • Include Methylprednisolone 125 mg IV in the treatment regimen.

    Anaphylactic Shock

    • Anaphylactic Shock characterized by respiratory failure and low SBP must be closely monitored and treated promptly with appropriate protocols.

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    Test your knowledge on the Suffolk County emergency medical protocols. This quiz focuses on key roles and definitions critical for understanding out-of-hospital medical emergencies. Perfect for healthcare professionals and EMTs looking to reinforce their understanding of medical control protocols.

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