Harsh Environment
Water temperature <70 degrees F at recovery depth.
What is a cold water drowning?
Contraindicated in Right ventricular AMI.
What is Nitroglycerin?
Device used to provide irrigation to the eye.
What is Morgan Lens?
-Administer Tetracaine 2 drops per eye
-Attach mixed saline to tube and device. Then run fluid
-Instruct pt to look towards feet while retracting eyelid and insert device under lid.
-Release and reverse.
DO NOT RUN DRY. To remove reverse process THEN terminate flow.
Apply full spinal immobilization for these patients
-Abnormal sensory or motor examination
-Distracting injures
-Complaints of pain or tenderness on exam of spine including palpation of entire spine including range of motion.
-Patient reliability is questioned such as intoxication, elderly young, AMS, chemically altered or unable to communicate properly with.
Three things to remember for parents of a SIDS patient.
1. Do not make judgments concerning the situation.
2. Do not add to the parent’s sense of guilt or helplessness.
3. Remember, people react differently to stressful situations.
West Virginia has two native venomous snakes. These are the _________ and ___________. They are both ____toxic
What are the timber rattlesnake and copperhead. Both are hemotoxic.
Envenomed patients will have one or more fang marks with ecchymosis, progressive edema,severe burning pain, and/or non-clotted oozing blood.
This completely stable patient most likely with have no palpable pulses.
What is a patient using an LVAD (Left Ventricular Assist Device)?
These types of patients qualify for transport by aviation.
A. Trauma Criteria:1. Patient meets Field Trauma Triage Protocol 9103 Immediate Transport: OR P1 Criteria; OR P2 Criteria.
Note: Patients meeting only P2 (Mechanism Criteria)may need a helicopter, but require that you discuss the details with MCP for approval.
B. Medical Criteria:
1. Some non-trauma patients with life-threatening medical conditions and far from definitive care, may benefit from air evacuation. Such circumstances may include:
a. Acute stroke patients within the window of opportunity for thrombolytic or endovascular intervention at an appropriate hospital.
b. Acute myocardial infarction patients needing thrombolytics or angioplasty.
c. Major overdose patients with coma.
d. Major burns > 20% TBSA (second or third degree) needing flown directly to a Burn Center.
Treat all painful, swollen or deformed areas as...
What are "fractures"?
Infants and Toddlers with minor injuries or no apparent injury from MVA may be immobilized in this manner.
What is left in seat and immobilized, provided the seat is undamaged?
• A slight increase in work of breathing with no wheezing or stridor evident.
• A considerable increase in work of breathing with wheezing and/or abnormal breath sounds evident.
• Extreme work of breathing (retractions) with a decreased LOC.
What are three levels of distress according to allergic reaction protocol?
• Minimal Distress
• Moderate Distress
• Severe Distress
Setting for Joules in a shock able rhythm for both ALS and BLS protocols.
What is MAX joules per AED/monitor manufacturer guidelines?
Adult IO site preferences in order.
Pediatric IO site preferences in order.
Adult: Proximal Humerus, Proximal tibia , distal tibia.
Pediatric: Proximal tibia, distal tibia, then proximal humerus
You arrive on scene of a trauma patient who is pulseless and apenic on arrival. This is your next step per protocol.
If patient is found pulseless and apneic, contact MCP directly for consultation on not beginning resuscitation. Follow Death in the Field Protocol 9101.
This is the amount of time a provider has to report suspected abuse or neglect per WV state law for mandatory reporters.
What is 48 hours?
List four things not to do with frost bite.
What is...
-DO NOT rub, massage area or break blisters.
-DO NOT apply direct heat
-DO NOT allow patient to use affected area
-DO NOT re-expose to cold.
In cases of Torsades administer this medication and dosage.
What is Magnesium sulfate 1 gram diluted in 10 ml NS over 5-20 minutes?
preferred sites for chest decompression
What is 2-3 intercostal space at the mid-clavicular line
Three categories of shock and their causes.
1. Hypovolemic (loss of fluid) is most common. Usually from bleeding or vomiting and diarrhea.
2. Distributive (loss of vascular tone) is usually from sepsis (infection). Other causes include anaphylaxis, toxic chemicals, or spinal cord injury.
3. Cardiogenic (heart pump failure) - most common cause in adults is acute MI or CHF. Is rare in children
Three reasons for pediatric seizures
What is febrile, Trauma and history of seizures and or currently taking anti- seizure medications?
A patient has warm, moist skin, with general weakness, dizziness, nausea, or occasionally syncope.
Treatments.....
What is heat exhaustion?
BLS- If conscious and alert give oral fluids, cool without chilling and apply moist towels to muscles.
ALS- decrease LOC or vomiting administer 250 ml bolus IV then run at 250 ml/hr in addition to above.
H's and T's please
What is...
Hypoxia Toxins
Hydrogen Ion Tension Pneumothorax
Hypothermia Tamponade (cardiac)
Hypovolemia Thrombus (pulmonary)
Hypo/Hyperkalemia Trauma
Hypoglycemia
Cricothyrotomy contraindications
What is
Absolute contraindications: Child< 12 years of age;Inability to locate landmarks for procedure;lack of training in surgical airway interventions; tracheal transection.
Relative contraindications: Direct laryngeal injury and known laryngeal pathology such as a stricture or tumor.
For inhalation injury, specific history and physical exam include...
1. Type and amount of toxin, if known.
2. Duration of exposure.
3. History of loss of consciousness.
4. If thermal injury, assess nares and oropharynx for singeing and soot.
5. Assess lung sounds; if wheezing, refer to Bronchospasm Protocol 4302.
6. If burns are present, treat per Burn Protocol 4110.
Pediatric Diabetic emergencies ALS treatment for a patient 1 month of age or younger and blood glucose is <60mg/dl.
What is administer 5ml/kg Dextrose 10% IV IO?
How do you prepare this solution?
Mix 40 ML NS with 10 ml D50W