ABCs
What is the first thing you do to maintain ABCs in a patient that starts seizing in front of you.
Turn them on their side
Pt has a deep laceration on the outer thigh, four inches up from the knee. You apply direct pressure. If bleeding is not controlled after 2–5 minutes, despite your direct pressure, what is your next step?
Apply a tourniquet. If one tourniquet doesn't control bleeding, apply a second tourniquet proximal to the first.
Can an obstetric patient in preterm labor or with a breech presentation go to Martha Jefferson?
No, MJH does not have neonatal intensive care (NICU) capabilities. Any OB patient with likely complications (premature labor, breech, trauma in pregnancy) goes to UVA.
What is the contraindication for Ondansetron (other than allergy)?
Prolonged QT interval
When must a stroke patient go to UVA rather than MJH?
If the patient is VAN positive with onset less than 24 hours — take to UVA. Also take wake up strokes to UVA
You arrive as the second unit on scene. You notice someone is bagging the pt, but they are clearly struggling and you don't see adequate chest rise and fall. Pt has an NPA and OPA in. Other than verbal advice you can give, what should you physically help with before putting in an artificial airway?
Assist with two person bag ventilations.
Your pt’s arm got completely amputated. How do you package the arm?
Wrap in damp gauze, place in a plastic bag, place the bag on ice or with cold packs. Do not clean the part unless very grossly contaminated.
A newborn delivered at 39 weeks has a heart rate of 90 bpm, is breathing slowly with a weak cry, has arms flexed but legs mostly extended, grimaces when suctioned, and has a pink body but blue hands and feet at 1 minute. What is the one minute APGAR score?
5
What is the main precaution with administering narcan? And how can it be avoided?
Pt can have a combative return to consciousness. Better to oxygenate first.
You are on scene after an ALS provider made pt contact first. In most cases, when should ALS transfer care to a BLS provider before transport to the hospital.
A. Medic administered epi for anaphylaxis
B. Medic administered 2 doses of narcan
C. You administered 1 dose of narcan
D. None of the above
D. None of the above
What are the two main types of COPD?
Emphysema, bronchitis
Why should we not dress a burn patient with a wet dressing/apply ice?
Promotes hypothermia
What are the five components of assessing a ped’s breathing
NSANS - Nasal flaring, sternal retractions, accessory muscle use, noisy breathing, see-saw breathing
Fill in the blank: You cannot administer acetaminophen if pt took a full dose __ hours ago.
4
True or false: a photocopy of a DNR form is acceptable per CARS protocol.
True. Photocopies of complete paperwork are acceptable, as are authorized DDNR jewelry, as long as all necessary information is present.
What are the two contraindications for using the LUCAS?
Pregnancy and patients who are too large or too small for the LUCAS to fit appropriately.
After applying a tourniquet and ensuring bleeding has stopped, what is the next thing you must do?
Note the time of tourniquet application. Make sure to communicate it at transfer of care.
How do you take a blood glucose on a newborn and what blood glucose level is considered hypoglycemic for a newborn
Heel of foot; 40 mg/dl
After opening the package, what are you supposed to do with an extra pill of a medication you did not administer
Waste box in med bag
You arrive on scene to Sick Person ALS at Scott Stadium before FM1 (ETA 10 min) and assess the patient. You realize that this is a completely BLS call and you can handle it. What should you do, logistically?
A BLS unit with enough lead-time to perform a patient assessment may cancel an incoming ALS unit based on their findings.
A patient has a tracheostomy and is in respiratory distress. Pt has a respiratory rate of 28 and SPO2 of 89%. What do you do and how?
Apply high-flow O2 to BOTH the mouth and the tracheostomy simultaneously using NRB masks while assessing patency.
Per the hemostatic gauze protocol, where can you use hemostatic gauze? And where is hemostatic gauze use specifically contraindicated?
Hemostatic gauze should NOT be used in the head, chest, or abdomen. It is only for extremity hemorrhage and junctional spaces (axilla, groin, neck).
Per the pediatric cardiac arrest protocol, how should you handle family presence during the resuscitation of a child?
Family presence during resuscitation has been shown to improve grief and coping outcomes and should be permitted when safe and logistically feasible. If resources allow, dedicate one provider to speaking with the family.
What must you do before administering aspirin to a pregnant patient?
Contact medical command.
If you need a refusal signature, put the following 6 people in order of who you would ask for a signature first:
Bystander, your driver, CPD officer, patient, family, a firefighter
Patient → Family → bystander → CPD officer → firefighter → your driver