ALS
When do you call ALS for a behavioral emergency?
When a chemical restraint is necessary.
Name the contraindications for nitroglycerin.
SBP > 120 mmHg, no ED meds within the last 72 hours (call OLMC)
List all the demos we ask for.
Name, gender, DOB, height, weight, address (incl. Mailbox number), affiliation and graduation year, phone number, PMH, allergies, meds (11)
Describe how to get to the biohazard room in the SMED Adult ED.
After entering through the ambulance bay double doors, take a R and walk to the end of the hallway, enter the door with the red biohazard sign, place any biohazard trash in red trashcan inside.
List the three signs of diabetes mellitus.
- Increase in thirst (polydipsia)
- Increase in urination (polyuria)
- Increase in appetite (polyphagia)
Name 3 reasons why you would call ALS.
Cardiac/respiratory arrests, patients "in extremis", major trauma, active seizures, BGL > 300 mg/dl and AMS, tachypnea or signs of dehydration, respiratory distress where patient requires assisted ventilations
What is the GCS of a pt who does not open their eyes to any stimuli, is making incomprehensible sounds, and exhibits decorticate posturing?
E - 1
V - 2
M - 3
What does AVPU stand for?
Alert, verbal, pain, unresponsive.
Your pt is a 20 y/o F who requests to be transported to Presby. How do you get there from 600 W 116th St and what is the ambulance bay code?
L Broadway, L 120th, R Riverside, R 165th, L Fort Washington, R 168th, Park at Presby Adult ED
Code: 911#
What is Cushing's Triad and what are its physiological signs?
Signs that are indicative of increased intracranial pressure.
- Hypertension with widened pulse pressure
- Bradycardia
- Irregular respirations
How do you contact ALS via the MARS Radio?
Ensure CUEMS is logged into service with RCC/MARS. When ALS is required, turn MARS radio on, switch to Channel 1, Manhattan North. When transmission is clear, say "91-Boy to MARS" and await acknowledgement, before requesting additional resources.
What are the steps for treating a marine envenomation?
1. Remove bristles by patting area with adhesive tape and then wipe with alcohol
2. Remove stinging spine
3. Cover with sterile dressing.
4. Call for ALS but begin transport to Venomous Bite Center
What assessments should be completed for all patients?
HEENT assessment, mental status, neurological, pulses, skin
How do you get from Harlem Hospital back to 524 W 114th Street in the shortest number of turns?
R 5th Ave, R 125th, L Broadway, L 114th St.
What is APGAR used for, and when do you assess it? Name the 5 categories of APGAR.
Used to assess health of newborns; assess 1 and 5 minutes after birth. Appearance, Pulse, Grimace, Activity, Respiration.
When do you request ALS assistance for a suspected croup or epiglottitis peds patient?
If the patient is unconscious
Name the call ahead criteria for an MVA.
Ejection from vehicle, death of occupant in same passenger compartment, intrusion >12 in., rollover with unrestrained passenger, motorcyclist who was separated from vehicle or > 20 mph, pedestrian or bicyclist struck by vehicle traveling > 5 mph.
Give 5 reasons we would check S-LAMS.
-Visual asymmetry
- c/o one-sided numbness or weakness
- Slurred speech
- Sudden vision difficulties
- Sudden dizziness or loss of balance
- Sudden severe headache
- Sudden confusion or trouble understanding speech.
You are transporting a pt from CPS. Which hospital will they refer you to and what are the cross streets for this hospital?
Weill Cornell
70th and York Ave.
What BP is considered a hypertensive crisis?
180/120 and above.
Under what conditions can ALS providers transfer care to a BLS unit for transport.
- Hemodynamically stable
- Able to follow simple. commands
- Not received any medications or treatments under ALS protocols.
- Not expected to require any ALS interventions during transport.
- No reports of acute coronary syndrome either ongoing or within the past 24 hours.
You ATF an infant pt with partial thickness burns to the anterior trunk, anterior and posterior L leg and perineum. What is the TBSA of the burn and where should you txp?
33%; txp to Harlem
- Anterior trunk = 18%
- Anterior and posterior L leg = 13%
- Perineum = 1%
How do you calculate a mean arterial pressure (MAP)?
MAP= [(2×Diastolic Blood Pressure)+ Systolic Blood Pressure] / 3
Your pt is stable and has an above the elbow amputation. Where should you txp them? As you are loading into the bus, your pt goes into cardiac arrest. Does this change your answer?
Bellevue Hospital is the closest replantation center.
Any pt in cardiac arrest should go to the closest ED (SMED)
What is pre-eclampsia and what are the physiological signs
High BP after 20 weeks into pregnancy (SBP ≥ 160 mmHg, or DBP ≥ 110 mmHg)