southern fox valley emergency medical ......• alcohol. swab • gauze pad (2x2) procedure: 1. take...

SOUTHERN FOX VALLEY EMERGENCY MEDICAL SERVICES SYSTEM

300 Randall Road, Geneva, IL 60134

Telephone: (630) 208-4048

Dear System Entry Candidate,

Welcome to Southern Fox Valley EMSS. The enclosed materials are for your review to help you become familiar with our system. In addition to these handouts, please also refer to the Southern Fox Valley EMSS/Region IX Protocols as well as our policies and procedures. Policies and procedures can be found on our web site at www.sfvemss.com.

In order to be allowed to operate as an EMS personnel in our system, you must complete the skills and written exam. Your EMS Coordinator will review the skills with you and sign off your skills check sheets. You may use the enclosed information as well as your protocol book and the policies 84 procedures to complete the written exam.

In addition to the skills evaluation and exam, we will also need the following; a copy of your EMT-B license, a copy of your CPR card, and completed Personal Data Sheet (enclosed). Once all of this material is completed please get with your EMS Coordinator and they will get you entered into the system. You will be issued a system number and be allowed to operate in an EMS capacity. If you have any questions, do not hesitate to contact us.

Sincerely;

Edwin F. Garland, RN, NREMT-P, PHRN, ECRN, TNCC, CEN EMS Supervisor / EMS System Coordinator Southern Fox Valley EMS System Northwestern Medicine - Delnor Hospital 300 Randall Rd. Geneva, IL 60134 630.938.8460 Office 630.208.3496 Fax

DELNOR HOSPITAL • RESOURCE HOSPITAL

Southern Fox Valley EMS System

Paramedic System Entry

Personal Information Sheet

This form needs to be faxed to SFVEMSS as soon as you hire a new provider and prior to allowing an employee to have patient contact. Fax number: 630-208-3496. Please submit a copy of Illinois license and CPR card along with this sheet.

Social Security Number Drivers License Number

Name Date of Birth last first initial

Address street

city county state zip

Home Phone Work Phone

E-Mail

Agency Employed by:

Agency start date:

State of Illinois License Number: Licence Level:

Licensure date: License expiration date:

Other System Affiliations:

Will SFVEMSS be your Primary or Secondary system?

The above information is correct to the best of my knowledge. If any of this information changes in the future, it is my responsibility to inform the EMS Office in accordance with the policies and procedures within the SFV/EMS System and IDPH.

Signature Date

For EMS office use only" EMS System Number:

Entered into ESO:

Entered into Load-n-go:

• SFV EMSS Basic

Skills Packet

Southern Fox Valley EMS System Procedures

12-Lead Acquisition a Transmission of data

Equipment Needed: • BSI protection • Alcohol preps • Abrasive material (dry cloth or 2x2 gauze) • Cardiac monitor with 12-lead capabilities • Cardiac monitor paper • Electrodes (10) • Clippers or razor

Procedure:

1. Assemble and prepare the needed equipment, including turning on the monitor and checking battery life.

2. Employ BSI precautions

3. Position patient in a supine position if possible. • Head flat or elevated about 15° • If patient cannot lie flat, head is elevated more than 150 or the

position of comfort, document position for ECG

4. Prepare skin by cleansing with an alcohol prep to remove any oil from abrasive material to gently abrade the top layer of skin cells.

• If the chest is hairy, separate the hairs or clip/shave hair

5. Attach lead wires to the electrodes.

patient is in a

the skin and

6. Place limb leads • Limb leads can be placed proximal or distal on extremities to the core of the

body. If limb leads are placed on the torso document that limb lead placement.

• Placing limb leads on torso should be avoided due to the chance of increased artifact

• Avoid placing limb leads over bony prominences • RA lead wire goes on right arm • LA lead wire goes on left arm • RL lead wire goes on right leg • LL lead wire goes on left leg


7. Place chest (Precordial) leads Vi, V2, V3, V4, V5, V6 as follows: • Vi - Place in the 4th intercostal space to the right of the sternum • V2 - Place in the 4th intercostal space to the left of the sternum • V3 - Place directly between leads V2 and the [eft mid-clavicular line • V4 - Place in the 5th intercostal space at the mid-clavicular line • V5 - Place along the 5th intercostal space (level with V4) at the left anterior

axiltary line • V6 - Place along the 5th intercostal space (level with V4) at the left maxillary

line (directly under the midpoint of the arm pit)

8. Enter patient name (if available), gender and age into the cardiac monitor.

9. Instruct patient to lie still while ECG is being obtained. Do not obtain ECG in while vehicle is moving.

10. Obtain 12-Lead and print per monitor specific instructions.

II. Keep patient hooked up to monitor for possible repeat ECGs.

12.Contact hospital and transmit per monitor specific instructions.

Trouble Shooting: • Leads go on limbs not stomach. The quality of the signal is more important than the

proximity to the heart. Torso lead placement INCREASES interference. Tracing will improve when placed correctly on patient's extremities.

• Avoid bones, go over muscle when possible.


• If there is artifact in the first 6 leads (I, II, III, aVR, aVL, aVF), verify correct lead placement and contact on Limb leads.

• If artifact is present on the last 6 leads (Vi, V2, V3, V4, Vs, Vs), confirm skin prep, proper placement and contact of the chest Leads.

• If excess artifact on the V leads, remove electrodes, abrade skin with a towel or gauze pad, and then apply new electrode stickers.

Southern Fox Valley EMS System Skill Performance Record

12 Lead Acquisition and Transmission of Data

Name:

Date:

[ Performance Standard Done Not

Done Prepares equipment 1

[ ] Electrodes (10) [ ] Alcohol preps [ 1 2x2 gauze/washcloth [ 1 Checks monitor battery life is sufficient [ ] Ensures adequate ECG paper in monitor [ ] Turns on ECG monitor Prepares patient [ ] Positions patient supine or head elevated at 15° [ ] Removes excessive chest hair [ ] Cleans and gently abrades patient's skin Performs procedure [ 1 Places limb leads on the appropriate area [ ] Places precordial leads in the proper position [ ] Enters necessary patient information into monitor [ ] Instructs the patient to lie still while the ECG is being obtained [ ] Observes ECG for any artifact or irregularities [ ] Obtains 12-Lead [ ] Transmits 12-Lead and confirms receipt of the hospital [ ] Keeps patient hooked up to monitor for additional ECGs

0 Successful D Unsuccessful Evaluator:


Administration of an Epi Auto-injector

Equipment Needed: • BSI • Supplemental oxygen • Blood pressure cuff and stethoscope • Patient's Epi Auto-injector

Procedure:

1. Take infection control procedures

2. Perform a primary and secondary assessment and manage immediate life threats • Manage patients airway, breathing and circulation / provide oxygen • Signs/symptoms

• Progression of symptoms (Time of occurrence? Flow rapidly did symptoms start?)

• Allergies • Medications (including over-the-counter) • Pertinent history • Last oral intake • Events leading up to the emergency

• What was the patient exposed to? • How did the exposure occur? (Contact, ingestion, etc.)

3. Assess baseline vital signs

4. Determine if patient is experiencing an allergic reaction or anaphylaxis

System Allergic Anaphylactic

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d,7spnea,,tightness Respiratory sounds Wheezing Wheezing, muffled voice,

stridor Skin ' . t.::_ .iLocal hres-,-.-"— '.:

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Skin color

_

Possible pallor, little or no I Generalized pallor or flushing of the skin flushed skin

Swelling —

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Vital signs Normal or nearly normal vital signs

Tachycardia, hypotension, tachypnea, decreased oxygen saturation

Mental status - gild, er 1irg of impending doom 1

I:


5. Determine if the auto-injector is prescribed for the patient.

6. Determine that the auto-injector contains the correct dose. • 15-30 kg (33-66 Ws) 0.15 mg • 30 kg (66 lbs) 0.3 mg

7. Check the expiration date and check for cloudiness or discoloration of the medication if visible.

8. Remove the safety cap making sure you do not accidentally inject yourself

9. Press the injector against the patient's thigh to release the spring loaded needle and inject the medication into the patient. (All epinephrine injectors will work through clothing).

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10. Hold the device in place for at least 10 seconds

11. Document the patients response to the medication

12. Dispose of the used injector in an appropriate' bio hazard container

13. Reassess the patient, paying special attention to the patient's airway, breathing, circulation and vital signs while enroute to the hospital


Epi Auto-injector

Date: Name:

Performance Standard Done Not

Done Takes or verbalizes body substance isolation precautions

Assesses patient [ ] Completes initial assessment and confirms the need for using the Epi auto-

Injector . [ ]SAMPLE history Performs Pre-administration procedure [ ] Determines there are no contraindications and Applies the "Rights of

Medication Administration" [ ] Patient exhibits signs of severe allergic reaction [ ] Right patient - Medication is prescribed to the patient 1 1 Right medication — It is the correct medication [ 1 Right dose — Over 30 kg (66 lbs) : 0.3 mg; 15-30 kg (33-66 lbs): 0.15 mg [ 1 Right route [ ] Right documentation

Performs procedure [ ] Reevaluate that patient is having a sever reaction [ ] Re-check medication

[ ] Patient's prescribed injector [ 3 Dosage [ ] Expiration date [ ] No visible discoloration of medication

[ ] Removes safety cap from auto-injector [ ] Places auto-injector against the patient's thigh (lateral portion of thigh

between waist and knee) [ 1 Pushes injector firmly against the thigh until it activates [ ] Hold the injector in place until all the medication has been injected (at least

10 seconds) [ ] Disposes of injector in a safe manner and into the appropriate container [ 1 Re-assesses patient

El Successful 1:1 Unsuccessful Evaluator:


Blood Glucose Testing

Equipment Needed: • Glucose monitoring device • Test strips • Lancet device • Alcohol. swab • Gauze pad (2x2)

Procedure:

1. Take infection control procedures. 2. Determine the need for obtaining blood glucose level (altered mental status, known

diabetic, possible stroke patients, seizure activity, and intoxicated patients). 3. Explain the procedure to patient/family. 4. Prepares the appropriate equipment

• Make sure device is calibrated • Check expiration date on strips

5. Put test strip into monitoring device 6. Choose a puncture site on the distal end, palmar surface of a finger (15t finger -

thumb excluded). 7. Cleanse the site with the alcohol prep.

8. Use lancet according to manufacturer's instructions to puncture finger.


9. Wipe away first drop 'of blood. 10. Hold finger downward to increase blood flow and gently squeeze. 11. Collect drop of blood onto a test strip.

12. Apply gauze pad to finger to stop bleeding. 13. Interprets glucose reading. 14. Record results

15. Recheck patient's finger and apply band aid if needed. 16. Dispose of strip and lancet into appropriate receptacle.


Blood Glucose Testing

Name: Date:



Verbalizes need for procedure [ ] Altered mental status [ ] Known diabetic [j Intoxicated patients [ ] Seizure activity Prepares / assesses patient [ ] Advises patient/family need for procedure [ ] Explains procedure to patient/family Prepares appropriate equipment [ ] Glucose monitoring device [ ] Lancet device [ ] Test strips [ ] Alcohol swab [ 1 Gauze pad Performs procedure Chooses the side or enter area of the distal end of a finger (palm side) Cleanses site of puncture with alcohol swab

Uses lancet according to manufactures instructions to puncture finger

Wipes away first drop of blood

Holds finger downward to increase blood flow and gently squeezes

Collects the second drop of blood on a test strip

Applies gauze pad to finger to stop further bleeding

Rechecks patient's finger, cleans puncture site and applies a band aid if needed

Interprets glucose reading

Disposes of strip and lancet using appropriate precautions and receptacles

Records results

, CI Successful 0 Unsuccessful Evaluator:


Capnographv

Capnography may be used as a trending device for ventilation assessment and as an early warning system for changing patient ventilatory status.

Equipment Needed: • PPE • Appropriate monitoring equipment

Pre-Procedure: • Don PPE • Gather equipment • Explain procedure to patient

Procedure:

1. Plug in monitor and turn on 2. Calibrate monitor per manufacturer's instructions. 3. Attach airway to sensor cable and attach as close as possible to the ET tube or

nasal cannula on patient. 4. Attach on side to the patient and the other to the monitor. 5. Keep the window part of the sensor in the upright position to ensure secretions

don't pool into the window area. 6. Assess patient 7. Monitors and correlates ETCO2 reading 8. Evaluates curve shape (normal is squared off) 9. Records reading (normal 35-45 mmHg) 10. Set alarm limits per monitor instructions 11. Provide proper documentation 12. Continue to monitor patient status and reassess for any changes in 02

concentration or ventilatory rate


Capnography

Date: Name:


Done Takes or verbalizes appropriate BSI

Explains procedure to patient

Mainstream [ ] Attach disposable ETCO2 sensor to cable [ ] Mainstream sensor applied to bag-mask device, or applied to a bag

connected to an ETT. Sidestream

[ ] Connect tubing port on capnography unit [ ] Sidestream device may be incorporated into special nasal cannula

Apply device to patient's oxygen delivery system

Utilizes oxygenation and ventilatory devices in normal fashion

Monitors ETCO2 on display screen

Records reading (normal 35-45 mmHg

Evaluates curve shape (normal is squared off)

Sets alarm parameters to desired limits (minimum/maximum desired ETCO2 levels) Monitors patient status and reassess for any changes in 02 concentration or ventilatory rate.

I

CI Successful CI Unsuccessful Evaluator:


C-collar Immobilization

Equipment Needed: • Cervical collars • Padding (towels, wash cloths, etc.) • Long spine board • Tape or straps for securing patient to board

Procedure:


2. Approach patient from the front when possible and instruct them not to move their head

3. Establish manual c-spine stabilization to hold the patient's head in a neutral position • If moving patient's head into neutral alignment causes increased pain

immediately stop and stabilize using a blanket roll in position found.

4. Complete an initial assessment and address any immediate threats to life

5. Evaluate the mechanism of injury, level of responsiveness, location of injuries and complete a rapid neuro exam to help determine the need for spinal immobilization

6. Measure the patient's neck to estimate the proper size of cervical collar needed • Hold out your hand and tuck in your thumb (as if you were saluting) • Place your extended fingers between the patient's trapezius at the base of

the neck and the chin (Your little finger should almost be touching the patient's shoulder).

• Count how many fingers it takes to reach the jaw tine.


7. Find the right size collar for the patient by placing your extended fingers on the side of a cervical collar. Your little finger should be at the bottom edge. Remember how many fingers it took to reach the patient's jaw line in the last step

• On adjustable collars, ensure that both sides are set to the same size. Do not use the foam at the bottom of the collar to measure as it does not provide any support

8. Make sure the collar is locked and secure prior to placing it on the patient. Tug gently against the lock to ensure it is secure

9. Preform the collar by rolling it so it shapes to the neck.

10. Move clothing so that the collar fits next to the skin of the patient

11. Slide the collar up the patient's chest wall until the chin is firmly seated on the chin piece

• The chin should be flush with end of the chin piece


12.Tighten the collar by grasping the corner of the tracheal opening to prevent rotation of the collar during tightening. Pull the Velcro fastener and secure it to the front of the collar

13.Continue to manually stabilize the patient's head and neck until additional assessment determines whether the patient needs to be secured to a backboard. 1


C-collar Immobilization

Date: Name:



Prepares / assesses patient [ 1 Completes initial assessment and addresses any immediate life threats [ ] Instructs patient not to move their head [ ] Establishes manual c-spine stabilization [ ] Evaluates mechanism of injury [ ] Completes rapid neuro exam for evidence of spine injury Prepares appropriate equipment [ ] Measures patient's neck [ ] Selects appropriate size cervical collar Performs procedure [ ] Assesses patient's neck prior to placing collar [ ] Reassures patient [ ] Removes anything that may prohibit collar application or patient comfort

(necklaces, large earrings, hair) [ ] Keeps patient's head in neutral position [ ] Correctly positions the collar [ ] Properly secures the collar [ ] Limits lateral movement of the neck by maintaining manual stabilization [ ] Appropriately pads any voids between the patient and long board [ ] Determines whether the patient needs to be secured to a backboard Reassess patient [ ] Reassesses neuro exam

El Successful CI Unsuccessful Evaluator:

Southern Fox Valley EMS System Proced U res

CPAP

CPAP (Continuous Positive Airway Pressure), is a form of non-invasive positive pressure ventilation used in the awake and spontaneously breathing patient who need ventilatory support. CPAP is applied typically to patients with respiratory disease or cardiac failure with pulmonary involvement who are in moderate to severe respiratory distress or early respiratory failure and who have an intact mental status and airway reflex.

CPAP is often confused with PEEP (Positive end-expiratory pressure). The difference is that PEEP is applied only during expiration, whereas CPAP is applied during the entire respiratory cycle. Both CPAP and PEEP pressures are measured in centimeters of water (cm/H20),

Equipment Needed: • CPAP unit with mask

Boussignac CPAP Set

• Oxygen supply • Monitoring equipment

o Pulse oximetry o Capnography o ECG o Blood pressure

Pre-Procedure: • Determine criteria and indications for CPAP

o Awake, alert, oriented enough to obey commands. o Able to maintain his own airway. o Able to breath on his own.

• Tachypnea (rate over 25) o Exhibits signs and symptoms of moderate to severe respiratory distress or early

respiratory failure. • SOB


• Orthopnea • Use of accessory muscles ▪ Speaks in syllables ▪ Diminished or absent lung sounds; exhausted ▪ Heart rate & BP may be dropping

• Assess for contraindications for use of CPAP o Apnea, respiratory arrest, or agonal respirations. o Inability to understand or obey commands. o Inability to maintain his own airway (associated with a risk of vomiting and

aspiration). o Unresponsiveness. o Shock associated with cardiac insufficiency (signs of poor perfusion, SBP < 90

mmHg). o Cardiac arrest o Actively vomiting o Upper gastrointestinal bleeding or history of recent gastric surgery o Pneumothorax or trauma to the chest, especially penetrating trauma. o Tracheostomy o Facial trauma, especially midface fractures, or facial anomalies o Increased thoracic pressure causing hypotension (SBP < 90mmHg)

• Prepare resuscitation equipment; use 15 UNRM or assist with BVM if CPAP is unavailable or contraindicated.

o If SBP falls < 90 (MAP < 65). Titrate PEEP values downward to 5cm; remove CPAP is hypotension persists.

Procedure; 1. Don PPE 2. Explain the procedure and device to the patient. 3. Apply the appropriate monitoring equipment to the patient (listed above). 4. Assemble the breathing circuit to the CPAP device and ensure it is functioning

properly.


5. Attach CPAP to oxygen source. Ensure adequate oxygen supply to the device. Set airway pressure to initial setting.

6. Place patient in a seated or semi-Fowlers position. 7. Place CPAP mask over patient's mouth and nose. 8. Secure the mask with provided straps or other provided devices.

9. Check for air leaks. 10. Monitor and document the patient's respiratory response to treatment.

o Adjust airway pressure to desired setting. Start at 5 cm/H20 of PEEP valve. o If needed increase PEEP up to 10 cm/H20.


11. Reassess patient and document vital signs every 5 minutes. 12.Administer appropriate medications per SOP and Scope of Practice. 13. Continue to coach patient to keep mask in place and readjust as needed.

14. If deterioration continues, remove device and consider intermittent positive pressure ventilation via BVM and placement of an airway.


CPAP (Continuous Positive Airway Pressure)

Date: Name:


Done Determines criteria and indications for the use of CPAP

Assess for contraindications for the use of CPAP

Dons appropriate PPE

Explains procedure to the patient

Applies the appropriate monitoring equipment to the patient

Assemble the breathing circuit to the CPAP device and ensure it is functioning properly. [ ] Attaches CPAP unit to oxygen source [ ] Ensures adequate oxygen supply is available [ ] Sets airway pressure to initial setting of 5 cm/H20 Places patient in seated or semi-Fowlers position

Properly applies and secures mask to patients face and checks for any air leaks.

Adjusts airway pressure to desired setting. Between 5-10 cm/H20

Assess patient's response to treatment and verbalizes documentation

Continues to coach patient and readjust treatment as needed.

Verbalizes understanding of when to discontinue use of CPAP

I:1 Successful 0 Unsuccessful Evaluator:


Drawing Medication from a Vial

Equipment Needed: • BSI • Alcohol Prep • Proper size needle & syringe • Medication • Sharps container

Procedure:


2. Check your medication • Check the date on the vial. DO NOT use medicine that is out of date. • If you will use the medication more than once, write the date on the vial so you

can remember when it was opened. • Look at the medicine in the vial. Check for a change in color, small pieces of

particulate floating in the liquid, cloudiness, or any other changes,

3. Prepare the medicine vial • If this is the first time using the medication, take the cap off the vial • Wipe the rubber tip clean with an alcohol pad.

4. Fill the syringe with medication following these steps. • Hold the syringe in your hand like a pencil with the needle pointing up. • With the cap still on, pull back the plunger to the line on the syringe for your

dose. This fills the syringe with air. • Insert the needle into the rubber top. DO NOT touch or bend the needle. • Push the air into the vial. This keeps a vacuum from forming. If you put in too

little air, you will find it hard to draw the medication. If you put in too much air, the medication may be forced out of the syringe.


• With the vial right side up, put the needle straight in. try not to bend the needle.

• Turn the vial upside down and hold it up in the air. Keep the needle tip in the medication.

• Pull back the plunger to the line on your syringe for your dose. For example, if you need 1 mL of medicine, pull the plunger to the 1 mL marked on the syringe.

5. Remove the bubbles from the syringe. • Keep the syringe tip in the medication. • Tap the syringe with your finger to move air bubbles to the top. Then push

gently on the plunger to push the bubbles back into the vial.

Southern Fox Valtey EMS System Procedures

• If you have a lot of bubbles, push the plunger to push all the medication back into the vial. Draw out the medication again slowly and tap air bubbles out. Double check that you still have the right amount of medication drawn up.

• Remove the syringe from the vial keeping the needle clean. • If you plan to put the syringe down, carefully put the cover back on the needle

using a scooping technique.


Drawing Medication from a Vial

Name: Date:



Checks patient allergies and current medications

Selects and prepares appropriate needle and syringe for type of medication to be administered. Selects correct medication vial and checks for concentration, dose, discoloration, humidity damage, and expiration date. Removes protective cap from medication vial

Removes needle cap and pulls plunger back to same volume that is to be withdrawn from the vial. Injects needle through the stopper and injects air taking care not to bend needle.

Inverts vial so fluid covers the bevel, pulls back on plunger, and withdraws to correct amount of medication. Rechecks medication and amount

Examines barrel of syringe and expels air and extra fluid.

Correctly documents

fl Successful 1:1 Unsuccessful Evaluator:

Vertical rine

Preferred site

Horizontal line

Hip

Fold separating the buttocks

Sciatic nerve.

Prefermd site

Gluteal artery


Intramuscular Injection

Equipment needed: O BSI protection O alcohol or betadine preps O packaged medication O syringe O 21- to 23- gauge hypodermic needle, 3/8 to 1 inch long O sterile gauze and adhesive bandage

Procedure: 1. Assemble and prepare the needed equipment.

2. Apply body substance isolation precautions.

3. Confirm the drug, indication, dosage, and need for intramuscular injection.

4. Confirm the medication indications and patient's allergies.

5. Select an appropriate site and prepare the site with alcohol or betadine.


6. Stretch the skin taut over the injection site with your nondominant hand.

7. Insert the needle just into the skin at a 900 angle with the bevel up.

8. Pull back the plunger to aspirate tissue fluid.

a. If blood appears, the hypodermic needle is in a blood vessel. Start the procedure over with a new syringe.

b. If no blood appears, proceed with Step 8.

9. Slowly inject the medication.

10. Place a dry sterile dressing over the insertion site and remove the needle quickly. Dispose of it in the sharps container.

11. Place an adhesive bandage over the site; use gauze for hemorrhage control if needed.

12.Assess the patient's response to the medication and document the following: O drug o dose given, including how much in each nostril O time administered o patient response (vitals, signs of improvement/decompensation)


intramuscular Injections

Name: Date:


Done

Takes or verbalizes body substance isolation precautions

Verbalizes the following drug information: 0 Actions 0 Side effects 0 Indications 0 Contraindications Explains the procedure to the patient Confirms the absence of allergy to the drug Prepares the equipment and medication 0 Selects the appropriate medication 0 Checks the medication for clarity and expiration date 0 Calculate appropriate amount of medication for administration 0 Selects appropriate size syringe and needle 0 Draws up medication for administration 0 Assembles alcohol preps, bandaid, and sharps container Selects appropriate injection site and cleanses with alcohol prep

Inserts needles at 90 deg angle and aspirates for blood return

If no blood return, injects medication at appropriate rate

If blood return, withdraws needle, discards and begins again Places dry sterile dressing over insertion site and holds while quickly removing needle

Disposes used needles and syringe in proper container

Applies band-aid over injection site

Assesses patient for response to medication

Correctly documents procedure: 0 Drug, dose, route 0 Time administered 0 Patient response

0 Successful 0 Unsuccessful Evaluator:


King LT-D Airway

Equipment Needed: o King LT-D Airway O water-based lubricant O 100 ml syringe O tape or commercial securing device

Procedure: 1. Test cuff and inflation system for leaks by injecting 80-100 mL of air into the cuffs.

2. Apply lubricant to the beveled distal tip and posterior aspect of the tube, taking care to avoid introduction of lubricant in or near the ventilatory openings.

3. Pre-oxygenate the patient.

4. Position the head. Ideal position is the sniffing position. In the trauma patient, maintain neutral alignment.

5. Hold the King LT-D at the connector with dominant hand. With non-dominant hand, hold mouth open and apply chin lift.

6. With the King LT-D rotated laterally 45-90° so that the blue orientation line is touching the corner of the mouth, introduce the tip into the mouth and advance behind the base of the tongue

7. As the tube tip passes under the tongue, rotate the tube back to midline (the blue orientation line facing the chin).

8. Without exerting excessive force, advance the tube until the base of the connector is aligned with the teeth or gums.

9. Using the syringe provided, inflate the cuffs of the King LT-D with 70 mL of air.

10. Attach BVM device to the connector. While gently bagging the patient to assess ventilation, simultaneously withdraw the King LT-D until ventilation is easy and free flowing (large tidal volume with minimal airway pressure.)

11. Confirm proper position by auscultation, chest movement, and verification of CO2 by capnography if available.

12. Readjust cuff inflation to just seal volume (cuffs inflated with minimum volume necessary to seal the airway at the peak ventilatory pressure employed).

13. Secure King LT-D to patient using tape or commercial device.


King LT-D Airway

Date: Name:


Done


Opens the airway manually

Ventilates patient immediately with bag-valve-mask device Assures patient is pre-oxygenated with 100% oxygen Prepares equipment: 0 Test cuff by inflating with 80-100 mL of air 0 Lubricates end of tube Positions the patient's head appropriately 0 Trauma patient: neutral alignment 0 Non-trauma patient: sniffing position Holds King LT-D with dominant hand, holds mouth open and applies chin lift Positions the King LT-D laterally with the blue orientation line touching the corner of the mouth Inserts tip into the mouth and advances behind the base of the tongue, rotating the tube back to midline as tube tip passes under the tongue (blue orientation line faces chin) Advances tube until base of connector is aligned with teeth or gums Does not exert excessive force when advancing the tube

Inflates the cuff with 80-100 mL of air

Attaches bag-valve-mask device to the connector of the King LT-D. Gently bags the patient while withdrawing the King LT-D until ventilation is easy and free flowing Confirms proper position: 0 auscultation 0 chest movement 0 capnography, if available

Readjusts cuff inflation to minimum volume necessary to seal the airway

Secures King LT-D with commercial device or tape

I:I Successful CI Unsuccessful Evaluator:

Relief valve Oxygen tubing

Mouthpiece

Oxygen port

Medication reservoir


Medications via Handheld Nebulizer

Equipment Needed: • nebulizer unit O oxygen tubing O oxygen source O medication

Procedure: 1. Put the medication in the medication

reservoir. Screw the reservoir in place.

2. Assemble the nebulizer.

3. Attach oxygen tubing to the oxygen port and oxygen source.

4. Set the oxygen source regulator for 6 Umin.

5. Place the nebulizer in the patient's mouth. Instruct them to exhale and then seal their lips around the mouthpiece. Now have them hold the nebulizer and slowly inhale as deeply as possible. Instruct the patient to hold in the medication for 1 to 2 seconds before exhaling.

6. Continue until medication is completely gone. Typically, this takes 3 to 5 minutes.

7. The medication reservoir may also be attached to a nebulization face mask. This is useful for patients that cannot hold the nebulizer.

(a) Nebulize( with attached face mask


Medications via Handheld Nebulizer

Name: Date:


Done


Verbalizes the following drug information: 0 Actions 0 Side effects 0 Indications CI Contraindications Explains the procedure to the patient Obtains baseline lung sounds Confirms the absence of allergy to the drug Prepares the equipment and medication 0 Collects nebulizer unit, oxygen tubing, oxygen source 0 Selects the appropriate medication El Checks the medication for clarity and expiration date 0 Adds medication to medication cup and reattaches the lid 0 Attaches mouthpiece/mask and oxygen tubing

Adjusts flow of oxygen to 6 Uminute

Places mask on patient or assists patient in holding mouthpiece in mouth

Coaches patient o breathe slowly and deeply

Begins transport

Monitors patient throughout administration 0 Lung sounds 0 Sp02 0 Vital signs 0 Ventilatory adequacy

Watches for change in patient condition — both desired and undesired effects

Correctly documents procedure: Cl Drug, dose, route 0 Time administered 0 Patient response



Monitoring OG/NG Tubes

Orogastric and nasogastric tubes are soft, small diameter tubes placed through the mouth (OG) or nose (NG) into the stomach. The tubes provide a route for enteral feeding and oral medication administration.

Although the provider practicing in the Southern Fox Valley EMS System will not be inserting such a device, they do need to know how to properly monitor these devices during patient care and transport.

Equipment Needed: • BSI

Indications: • Requires short term enteral feeding • Provides means for medication administration • Provides means for gastric lavage and/or decompression

Procedure:


2. Avoid lying patient flat if possible. Gastric juices may flow up the tube and can be

aspirated into the lungs.

3. Note tube placement by documenting insertion depth during your primary assessment

4. Insure tube is properly secured to avoid movement or dislodgement during transport.

Additional taping may be required prior to transport.

5. Ensure end of tube is clamped or properly plugged to avoid drainage of gastric

contents.


Monitoring OG/NG Tubes

Name: Date:


Done Verbalizes the indications a patient would have a OG/NG tube in place

[ j Requires short term enteral feeding [ ] Provides means for medication administration [ ] Provides means for gastric lavage and/or decompression

Performs procedure Takes infection control measures

Avoid lying patient flat if possible. Gastric juices may flow up the tube and can be aspirated into the lungs.

Notes tube placement by documenting insertion depth during your primary assessment Insures tube is properly secured to avoid movement or dislodgement during transport. Additional taping may be required prior to transport.

Ensures end of tube is clamped or properly plugged to avoid drainage of gastric contents.

Verbalizes documentation



Orotracheal Suctioning

Orotracheal suctioning is the process in which a long, soft suction catheter is inserted through the tracheal tube to clear secretions.

Indications:

1. Obvious secretions in the tracheal tube 2. Poor compliance or an increase in resistance when ventilating with a bag-valve device

• Equipment: • Oxygen • Suction catheter • Suction tubing with canister • Wall mounted or portable suction unit • Bottle of saline or sterile water with basin (to flush secretions from catheter)

Procedure: 1. Take the necessary BS( 2. Explain the procedure to the patient even if they are unconscious. 3. Assemble and check all equipment to make sure it is in working order.

• Orotracheal suctioning is a sterile procedure. Do not contaminate the catheter while assembling or checking it.

4. Ventilate the patient for up to 2 minutes prior to suctioning. 5. Measure the catheter length from the patients lips to the ear and down to the level of

the nipple • This should allow catheter placement at about the level of the carina.


6. Set the suction between 80 and 120 mm/Gg (negative pressure) 7. Insert the suction catheter down the tracheal tube with no suction being applied.

(Thumb hole open) 8. Advance the catheter to the carina or the approximate depth that was previously

measured.

9. Apply suction by occluding the thumb hole while slowly withdrawing the catheter in a twisting motion. Do not apply suction for more than 15 second in the adult patient.

10.Ventilate the patient for 2 minutes 11. Clean the catheter using the sterile water to removed debris or secretions.

12. Be prepared to repeat the procedure if needed

Complications: 1. Hypoxia can result from a decrease in lung volume during the application of suction

because of the removal of residual air and also interrupting ventilation. 2. Cardiac dysrhythmias 3. Coughing may be triggered by the catheter stimulating the mucosa! lining. 4. The catheter may damage the mucosa causing swelling and bleeding. 5. Bronchospasm can occur if the catheter is inserted beyond the carina and into the

bronchi


Oratracheal Suctioning

Date: Name:


Done Gathers appropriate supplies:

[ ] Oxygen [ ] Suction catheter [ 1 Suction tubing with canister [ ] Wall mounted or portable suction unit [ ] Sterile water or saline [ ] Emesis basin

Dons appropriate PPE

Verbalizes indications for orotracheal suctioning

Explains procedure to patient even if unconscious

Assembles all equipment and checks make sure it is working properly

Pre-oxygenates the patient

Correctly measure the suction catheter (lips to ear and down to nipple level)

Carefully inserts suction catheter down endotracheal tube

Applies suction while slowly removing catheter with a twisting motion.

Suctions patient for no longer than 15 seconds at a time.

Reassesses patient

Clears debris from suction catheter by suctioning up fluid from basin.

Verbalizes complications that can arise from suctioning



Pulse Oximetry

Equipment Needed: • BSI protection • Oximeter • Oximeter sensor (reusable or disposable) • Acetone or nail polish remover and cotton swabs if needed

Procedure: 1. Perform hand hygiene and don any necessary BSI

2. Assess the patient for signs and symptoms of alterations in oxygen saturation. • Altered respiratory rate, depth, or rhythm • Adventitious breath sounds • Cyanosis • Restlessness, irritability, confusion or bizarre behavior • Decreased level of consciousness • Labored or difficulty breathing

3. Obtain a baseline Sp02.

4. Determine the most appropriate site for sensor placement. • Consult manufacturer's instructions for designated site placement of sensor. • Do not place a re-useable clip-on finger sensor on the thumb; it is not

designed for a thumb. • Do not place the sensor on the same extremity as an electronic blood pressure

cuff; blood flow is interrupted when the blood pressure cuff inflates, causing an inaccurate reading that can trigger alarms.

• Assess capillary refill. If capillary refill is prolonged select an alternative site. • Assess temperature of the site. If the site is cold to touch select an

alternative site; peripheral vasoconstriction alters Sp02. • Assess the skin integrity of the site. If the site is edematous or skin integrity is

compromised select an alternative site; the site must have adequate local circulation and be free of moisture.

• If the patient has cold fingers, decreased peripheral circulation, tremors or is Likely to move, use an earlobe or forehead sensor.

• If the patient is obese, use a disposable sensor; a clip on sensor may not fit properly on an obese patient.


5. If using a patient's finger, remove any nail polish with acetone or polish remover. • Opaque coatings decrease light transmission; nail polish containing blue

pigment absorbs light emissions and alters the Sp02 measurement.

6. Position patient comfortably. If using a finger sensor ensure the finger is clear of obstructions such as blankets and straps.

• Correct hand positioning ensures sensor position and decreases motion artifact that interferes with 5p02 determination.

7. Instruct patient to breath normally if possible • Normal breathing prevents large fluctuations in minute ventilation and

possible changes in Sp02.

8. Attach sensor to the selected site on the patient • Make sure the light source and the photodetector inside the sensor are

aligned directly opposite of each other.

9. Turn on the oximeter • Leave the sensor in place until the oximeter readout reaches a constant value

and the pulse display reaches full strength during each cardiac cycle.

• Read the SpOz on the digital display • Remove the sensor from the patient's finger and turn off the device

10. Document the procedure and results

11. Disinfect the device per manufacturer's recommendations


Pulse Oximetry

Name: Date:


Done Prepares appropriate equipment [ I Oximeter [ ] Oximeter sensor [ ] Acetone or nail polish remover Prepares / assesses patient Assess patient for signs & symptoms of alterations in oxygen saturation

Obtains a baseline Sp02

Determines most appropriate site for sensor placement

Verbalizes removal of nail polish from patients finger if applicable

Positions the patient comfortably when possible

Instructs patient to breathe normally when possible

Performs procedure Correctly attaches and aligns the sensor to the selected site on the patient

Turns on the oximeter

Leaves the sensor in place until the oximeter readout reaches a constant value.

Correctly reads the result on the display

Verbalizes documentation of the results

Verbalizes disinfection of the device

1:1 Successful El Unsuccessful Evaluator:

Southern Fox Valtey EMS System Procedures

Tourniquet Application for Hemorrhage Control

Although the use of tourniquets has long been controversial because of fears that they can result in unnecessary limb amputations and other problems, studies show that complications from tourniquet use are caused mainly by improper technique and inappropriate tourniquet selection.

The 2015 American Heart Association (AMA) guidelines state that the initial standard of care for the hemostasis of hemorrhage is direct pressure until bleeding has ceased. If this method doesn't provide hemostasis with a limb hemorrhage or if direct pressure isn't feasible, consider a tourniquet. Some research indicates that early application of a tourniquet, before the patient develops shock, strongly increases the patient's chance of survival versus late application of a tourniquet. Patients can exsanguinate from an arterial injury in 60-120 seconds.

• Never apply a tourniquet over a joint. • Apply tourniquets directly to the skin and tighten until the bleeding stops. Apply an

additional tourniquet proximal to the original tourniquet if the bleeding is not controlled by the first tourniquet.

• Clearly document the application time. • Do not cover a tourniquet with blankets or dressings. All health care providers should

be able to see that a tourniquet is in place.

Equipment Needed: • PPE (gloves, mask, eye protection, gown) • Appropriate tourniquet • Dressing supplies

Procedure:

1. If time permits, perform hand hygiene before patient contact and don gloves. If situation and time permits, don a gown, mask, and eye protection.

2. Confirm the need for a tourniquet; i.e., continued hemorrhage despite direct pressure or pressure bandage.

3. Remove the patient's clothing or other material from the area where the tourniquet will be placed.

Combat Application Tourniquets (C-A-T®)

I. Position the tourniquet on the injured limb 2-3 cm proximal to the wound (DO NOT apply over a joint) with plastic backing against the artery. It should be approximately four fingers proximal to joint.

2. Insert the tourniquet strap up through the inside slot of the buckle and pull. 3. Insert the strap down through the outside slot of the buckle. 4. Pull the tourniquet as tight as possible and press the strap back down onto itself. 5. Grab the twist rod and turn it until bleeding has stopped (usually 3-4 twists) and the

pulse distal to the tourniquet is no longer felt.

Southern Fox VaLley EMS System Procedures

6. Position the twist rod into the clip to lock it, then secure it with the hook-and-loop strap.

7. Time tourniquet applied needs to be documented on the white strap.

httits://youtu.be/x-adm1111,71-vg?list=PLIiu0PNeKThaxaLJ1mmnZ8litils-pLzbfC0

Completing the Procedure

1. Reassess bleeding. a. If the bleeding continues, tighten the tourniquet further. b. If bleeding continues after tightening, apply a second tourniquet just proximal

to the original tourniquet. 2. Reassess airway, breathing, and circulation (ABCs); vital signs; and oxygen

saturation. 3. Monitor for continued bleeding. 4. Prepare for the administration of blood products and patient transfer to the operating

room. 5. The tourniquet should remain on the patient until evaluated by the trauma surgeon. 6. Assess, treat, and reassess pain. 7. Discard supplies, remove personal protective equipment (PPE), and perform hand

hygiene. 8. Document the procedure in the patient's record.

Author•Hilary L.S. Hawkins, RN, MBA, -AEMT, CEN, CPEN, January 2016


Tourniquet Application for Hemorrhage Control

Date: Name:


Done If time permitted, performed hand hygiene before patient contact and donned gloves Confirmed need for tourniquet

Removed the patient's clothing or other material from the area where the tourniquet would be placed Combat Application Tourniquet (C-A-T)

Positioned the tourniquet on the injured limb 2-3 cm proximal to the wound and not over a joint. Inserted the tourniquet strap up through the inside slot of the buckle and pulled

Inserted the strap down through the outside slot of the buckle.

Pulled the tourniquet as tight as possible and pressed the strap back down onto itself. Turned the twist rod until bleeding stopped and the pulse distal to the tourniquet was no longer felt.

Positioned the twist rod into the clip to lock it, then secured it with the hook-and-loop strap. Completing the Procedure

Reassessed bleeding. If indicated, tightened the tourniquet further; if bleeding continued after tightening, applied a second tourniquet just proximal to the original tourniquet. Reassessed ABCs, vital signs, and oxygen saturation.

Monitored for continued bleeding.

Prepared for the administration of blood products and patient transfer to the operating room. Assessed, treated, and reassessed pain

Discarded supplies, removed PPE, and performed hand hygiene.

Documented the procedure in the patient's record.

1:1 Successful CI Unsuccessful Evaluator:


Use of a Backboard

Equipment Needed: • Cervical collar (adjustable or various sizes) • Spine board • Straps (Spider straps or similar devices) • Head restriction device (Head bed or similar devices) • Padding (blankets, towels, etc.) • Tape

Procedure:

'1. Take appropriate BSI precautions

2. Instruct a helper to manually stabilize the patient's head while keeping the patient's head in a neutral position.

3. Assess each extremity for presence of distal pulse, motor function and sensory function.

4. Properly size and apply cervical collar to patient while maintaining manual spinal stabilization.


5. Place the long back board next to the patient on the opposite side where you will be positioned when performing the log roll. Be sure that the board is positioned so that when the patient is rolled onto it, the patient's head is not hanging off the top of the board. The person holding the patient's head will direct the move.

6. Position yourself next to the patient's torso. Instruct a second helper to position themselves at the patient's legs. Place on of your hands at the patient's shoulder and the other hand at the patients pelvis while your helper places their hands at the pelvis and legs.

7. When all personnel are in position and ready, the helper stabilizing the head will call for the log roll which will be performed in unison. The person at the head will make sure the patient's head remains in neutral position throughout the procedure. You and your other helper will log roll the patient towards you so that the patient is now positioned on their side. You can help support the patient's body with your thighs.

8. Now reach behind the backboard and tilt it so that it is positioned against the patient's back.


9. When all personnel are ready the helper at the head will call for the log roll onto the board.

10.When the tog roll is complete and the patient is supine, check the patient's position on the board. The patient should be centered on the board with the head close to the top of the board. If adjustments need to be made, perform those with the second helper positioned at the peMs and you at the patient's chest. All moves should be at the direction of the person maintaining manual c-spine and should be performed in unison by moving the body as a single unit. Avoid any twisting of the patient's body.

11.With the patient properly positioned on the board, begin securing the patient to the board. Apply padding to the voids between the torso and the board and other areas as necessary.

12. Secure the patient's torso first and remember to secure the bony portions of the body. Run the strap through the hole closest to the patient's underarm and across the chest to the corresponding hole on the other side. If possible have the patient inhale deeply and then tighten the strap. This will ensure that the strap does not impeded the patient's respirations. Next secure the pelvis, and finally the legs above and below the knees.


13.0nce the torso and leg are secure you can begin to secure the head. Secure the patient's head to the board with a commercial head/cervical restriction device or by using blanket rolls and tape. Do not remove manual in-line stabilization of the head until the head is completely restricted onto the long board.

14. Place arms securely under the strap passing across the lower torso or loosely tie the patient's wrists together with a cravat or other soft bandaging.

15.Transfer the patient and the spine board as a unit and secure the board to the cot.

16.After spinal restriction is completed„ reassess all four extremities for distal pulse, motor function and sensory function.



Done Prepares I assesses patient Assesses extremities for presence of distal pulses Performs procedure Properly sizes and applies cervical collar while maintaining patent's head in a neutral position Properly log rolls the patient on to their side while maintaining stabilization of the patient's head. Correctly positions the backboard against the patient and log rolls them onto the board as a unit while maintain the head in neutral position. Applies padding to voids between the torso and other areas as needed.

Secures patient to the backboard using spider straps (or other similar equipment) in correct sequence. Torso, pelvis, legs above and below knee's. Assesses tightness of torso strap to assure patient's respirations are not impeded by it. Secures the patient's head to the board using a commercial head/cervical restriction device or by using blanket rolls and tape Secures patient's arms to the board or gently ties wrist together.

Verbalizes transfer of patient to the cot

Reassess distal pulses in all four of the patient's extremities.



Use of Hemostatic Agents

If you cannot stop severe bleeding with pressure and cannot use a tourniquet, you may use a hemostatic agent such as QuickClot®. When used correctly, hemostatic agents in conjunction with direct pressure can be effective in stopping bleeding from penetration and laceration-type injuries.

Hemostatic agents should not be used in open abdominal or chest wounds. Hemostatic agents are an adjunct to assist in controlling hemorrhage, not a hemorrhage control by itself.

Equipment Needed: • PPE • QuickClote combat gauze • Gauze dressings rolls (Kling/Kerlex type)

Procedure: 1. Don necessary PPE 2. Maintain direct pressure to wound while preparing QuickClotO 3. Open package and remove QuickClote gauze. Keep empty package to bring to

hospital.

4. Pack combat gauze into wound and use it to apply pressure directly over the bleeding source.

• More than 1 combat gauze may be required. • Regardless of the shape of the wound it is important that you pack the wound

with QuickClotO gauze using it to apply pressure directly over the source of bleeding.


• Do not simply cover the wound with the gauze.

5. Continue to apply pressure for 3 minutes or until bleeding stops. • The time required for formation of a stable clot will vary depending on several

factors. • The key is to maintain firm, consistent pressure directly over the bleeding

source.

6. It is important to maintain consistent pressure to assist with clot formation. • Do not push up or down on the wound or move the gauze unnecessarily. • Do not lift the gapze away from the wound to see if the bleeding has stopped.


7. Wrap and tie bandage to maintain pressure. • Bandage the wound tightly securing the QuickClot® combat gauze in place

once bleeding is controlled. • The bandage should both maintain pressure on the wound and prevent further

contamination of the injury site.

8. Show/give product removal directions on package to hospital personnel • Once the bandage is secure, tuck the empty combat gauze package in the

outer wrap to alert the receiving medical personnel that QuickClot® gauze has been used.


Hemostatic Agent Application

Date: Name:


Done Dons necessary PPE

Maintains direct pressure over wound while preparing QuickClot®

Opens package keeping empty package to transport to hospital

Packs combat gauze into wound

Applies direct pressure over wound with QuickClot® for a minimum of 3 minutes

Does not move gauze unnecessarily

Does not lift gauze away from the wound to check bleeding

Bandages wound tightly once bleeding is controlled

Tucks the empty combat gauze package in the outer wrap to alert the

receiving medical personnel that QuickClot® gauze has been used. Reassess for continued bleeding control.



Sublingual Medication Administration

Date: Name:

I


Done


Verbalizes the following drug information: [ ] Actions [ ] Side effects [ ] Contraindications [ ] Indications

Explains the procedure to the patient Confirms the absence of allergy/contraindication to the drug Prepares the equipment and medication

[ ] Selects the appropriate medication [ ] Checks drug identity and expiration date [ I Calculates appropriate amount of medication for administration

Has patient lift tongue toward top and back of mouth Aerosol form:

[ ] Directs spray between underside of tongue and floor of oral cavity

Tablet form: [ ] With gloved hand, takes one tablet from container and places tablet

under patient's tongue. Instructs patient to relax tongue and close mouth

Replaces oxygen mask and monitor's patient's response

Monitors patient for desired effects or potential complications

Reassesses and documents patients response to medication

Correctly documents procedure: [ ] Drug, dose, route [ ] Time administered [ ] Patient response




Date: Name:


Done


Verbalizes the following drug information: [ ] Actions [ ] Side effects [ ] Contraindications [ ] Indications

Explains the procedure to the patient Confirms the absence of allergy/contraindication to the drug Prepares the equipment and medication

[ ] Selects the appropriate medication [ 1 Checks drug identity and expiration date [ ] Calculates appropriate amount of medication for administration

Has patient lift tongue toward top and back of mouth Aerosol form:

[ ] Directs spray between underside of tongue and floor of oral cavity

Tablet form: [ ] With gloved hand, takes one tablet from container and places tablet

under patient's tongue. Instructs patient to relax tongue and close mouth

Replaces oxygen mask and monitor's patient's response

Monitors patient for desired effects or potential complications

Reassesses and documents patients response to medication

Correctly documents procedure: [ ] Drug, dose, route [ ] Time administered [ ] Patient response

CI Successful 0 Unsuccessful Evaluator:



Sublingual medications are orally disintegrating or dissolving medications that are administered by being placed under the tongue. These medications are transferred to the bloodstream from the mucous membranes in the mouth after dissolving, allowing for quick absorption that avoids the loss of potency which may come with first-pass metabolism in the stomach and liver. Medications administered by the sublingual route are nitroglycerin tablets and nitroglycerin spray.

Procedure:

1. Take appropriate BSI

2. Verify the "5 Rights" of medication administration. Right patient, right medication, right route, right dose, and the right time (check expiration date).

3. Make sure the patient is alert

• Medication placed into the mouth of a patient who is not alert or who is unresponsive can become lodged in the airway or aspirated into the lungs.

4. Explain procedure to patient.

• Communicate the need for the medication, and its effects, to the patient/family member whenever possible.

5. Have the patient sit upright. The person taking any medication should always be situated in an upright sitting position before medication is administered. Do not allow the individual to lie down or try to administer the medication when the person is unconscious. This could lead to accidental aspiration of the medication.

6. If using nitroglycerin spray, prime the pump by spraying the medication once, away from the patient. Do not shake the bottle

7. Request that the patient lift their tongue towards the roof of their mouth and instruct them to not inhale when the spray is being administered.


8. Place the medication under the tongue. Medication can be administered on either side of the frenulum (the connective tissue under the tongue).

9. Have the patient keep the sublingual medication under the tongue for until dissolved. Most medications should have a dissolve time of approximately one to three minutes.

10. Do not let the patient eat or drink when administering medication. It's important not to eat or drink when sublingual medication is administered because this increases the risk of the medication being swallowed, which will make it less effective

11. Do not let the patient open their mouth, eat, talk, move or stand during this time to ensure that the tablet doesn't move and has time to dissolve completely and be absorbed. The onset of action of sublingual nitroglycerin is within 5 minutes and the duration can last up to 30 minutes. The amount of time it takes to dissolve may vary from one medication to the next.

12. Do not let the patient swallow the medication. Sublingual medication needs to be absorbed under the tongue. Swallowing sublingual medication may cause erratic or incomplete absorption and could lead to improper dosing.

13. The sublingual nitroglycerin may cause a subtle tingling sensation on the tongue or cause a slight headache.

14.Thoroughly monitor and reassess the patient for desired effects or potential complications

15. Document the patient's condition prior to medication administration and their response to the medication.


Oral Medication Administration

Name: Date:


Done

Utilizes appropriate universal precaution

Determines what medication is needed based on protocol

Explains procedure to patient and confirms no allergy to medication to be administered Verbalizes the following drug information:

[ ] Actions [ ] Indications [ ] Side effects [ ] Contraindication

Verifies the "Rights" of medication administration [ ] Right patient [ ] Right medication [ ] Right dose [ ] Right time [ ] Right route

Obtains baseline vitals , pain level and other signs/symptoms

Administers medication

Monitors for desired effects or potential complications

Reassesses patient and documents response



Oral Medication Administration

Equipment Needed: • BSI protection

Procedure:


2. Determines what medication is needed. Based on protocol.

3. Verbalizes the following drug information:

• Actions • Indications • Side effects • Contraindications

4. Check the "Rights" of drug administration • Right drug • Right dose • Right route • Right time • Medication has not expired

5. Explain the procedure to the patient.

6. Confirms no allergy to drug.

7. Prepares the medication and equipment (if needed).

8. Obtains baseline vitals, pain level and other signs/symptoms.

9. Administers medication per protocol.

10.Monitors for desired effects or potential complications.

11 . Reassesses and documents response

• Making sure to document the 6 "Rights" with #6 being right documentation.


Oral Glucose Administration

Date: Name:

Performance Standard Done _

Not Done

Prepares appropriate equipment [ ] Makes sure tube of glucose is intact and has not expired. [ ] Makes sure glucometer is calibrated and test strips are not expired [ ] Tongue depressor Prepares / assesses patient Determines patient is a candidate for receiving oral glucose [ ] Hypoglycemic (determined by obtaining a blood glucose level) [ ] Alert (GCS 14-15) [ ] Intact gag reflex Performs procedure Verifies the "Rights" of medication administration [ ] Right patient [ ] Right medication [ ] Right dose [ 1 Right time [I Right route Squeezes a generous amount of oral glucose onto the bottom third of a tongue depressor. Opens the patient's mouth and places the tongue depressor between the patient's cheek and gum with the gel side next to the cheek in contact with the mucous membranes (may gently massage outer cheek to disperse medication). Repeats procedure until entire tube (25 Gm) is administered.

Verbalizes reassessment of patient's blood glucose level.



Oral Glucose Administration

Equipment Needed: • BSI protection • Glucometer and test strips • Lancet device • Alcohol preps • 2x2 gauze pads • Glucose paste/gel • Tongue depressor

Procedure:


2. Determines that a patient is a candidate for receiving oral glucose • The patient is hypoglycemic (determined by obtaining a BGL) • Check patient's responsiveness (GCS 14-15) • Check patient's ability to swallow and presence of a gag reflex.

3. Check the "Rights" of drug administration • Right drug • Right dose • Right route • Right time • Medication has not expired

4. Explain the procedure to the patient.

5. Open the glucose and apply a generous amount on to the tongue depressor.


6. Insert the tongue depressor into the patient's mouth between the cheek and gum or under the patient's tongue with the gel side next to the cheek.

7. Remove the tongue depressor and reapply more glucose gel until all the glucose is gone from the tube.

8. Reassess patient's BGL and vital signs

9. If the patient loses the ability to swallow or becomes unresponsive, immediately discontinue administration and be prepared to suction.


Intranasal Drug Administration

Name: Date:


Done Equipment Needed:

[ ] syringe with leur lock [ ] Needle [ ] Mucosal Atomizer device (MAD) [ ] Medication [ ] Towel


Inspects the patient's nostrils for mucus, blood, or other problems that might inhibit absorption.

Loads the syringe with the appropriate dose of medication.

Expels the air from the syringe and attach the MAD.

Places the atomizer within the nostril.

Briskly compresses the syringe to administer 1/2 of the correct drug dose, no more than 0.5 - 1 mL per nostril. Have a towel available to catch any secretions.

Removes the atomizer and repeat the process in the other nostril, if indicated, until the full therapeutic dose is administered Continues to assure the patient is ventilated and secures the airway as needed.

Assesses the patient's response to the medication and document the following:

[ ] Medication given [ ] Dose given, including amount administered to each nostril [ ] Time administered [ ] Patient response (vitals, signs of improvement/decompensation

1:1 Successful ID Unsuccessful Evaluator:


Intranasal Drug Administration

Equipment Needed: O Syringe with leur lock O Needle O Mucosal Atomizer Device (MAD) O Medication O Towel

Procedure:

1. Inspect the patient's nostrils for mucus, blood, or other problems that might inhibit absorption.

2. Load the syringe with the appropriate dose of medication.

3. Expel the air from the syringe and attach the MAD.

4. Place the atomizer within the nostril.

5. Briskly compress the syringe to administer the Y2 the correct drug dose, no more than 0.5 — 1 mL per nostril. Have a towel available to catch any secretions.

6. Remove the atomizer and repeat the process in the other nostril, if indicated, until the full therapeutic dose is administered.

7. Continue assuring the patient is ventilated and secure the airway as needed.

8. Assess the patient's response to the medication and document the following: O drug O dose given, including how much in each nostril o time administered O patient response (vitals, signs of improvement/decompensation)


Aspirin Administration

Name: Date:


Done


Verbalizes the following drug information: [ ] Indications [ 1 Contraindications [ ] Actions [ ] Side effects Explains the procedure to the patient

Confirms the absence of allergy to the drug

Verifies correct medication and dosage

Administers medication to patient [ ] Verifies that patient chews tablets

Checks patient's mouth

Monitors patient for potential complications [ ] Nausea [ ] Vomiting [ ] Heartburn [ ] Bleeding [ ] Bronchospasm and wheezing (if patient is allergic) Reassesses and documents patients response to medication Correctly documents procedure: [ ] Drug, dose, route [ ] Time administered [ ] Patient response

13 Successful CI Unsuccessful Evaluator:


Aspirin Administration

Equipment Needed: • BSI • Chewable aspirin

Procedure:


2. Verifies the following drug information • Indications

— Patient presenting with suspected acute cardiac symptoms (angina, unstable angina, acute myocardial infarction).

— Patient must be alert and able to swallow (If unable to give due to altered mental status or vomiting, notify ED so aspirin can be given upon arrival).

— Patient does not need to be experiencing pain • Contraindications

— Children 5. 18 years of age — Patients with chest pain due to trauma — Patients with possible stroke — Currently vomiting — Allergy to aspirin (Caution: patients may have ASA sensitivity which may cause

bronchospasm) — Recent surgery (within 2 weeks) — Bleeding disorders — ?. 6 months pregnant — Active peptic ulcer disease — Severe liver disease — Altered mental status (PO route)

• Actions — Prevents clot from getting bigger by platelet aggregation — Blocks formation of thromboxane A2 — Blocks prostaglandin release (antipyretic. Analgesic) — Anti-inflammatory agent

• Side effects — Nausea/vomiting — Irritation/bleeding — Prolonged bleeding time — Wheezing

3. Confirms correct medication and dosage


• Ensures the "Rights of medication administration": (right medication, right t e, right patient, right dose (324 mg chewable tablets; four 81 mg tablets), right route

4. Administers medication to patient • Ensures patient is alert and can swallow • Ask the patient to chew and swallow the medication • Check patients mouth to ensure medication has been swallowed (sips of water

may help dissolve tablets and move the drug out of the mouth and esophagus where it can irritate lining).

5. Reassess and documents patients response to medication • Monitor patient for potential side effects • Correctly document procedure; (drug, dose route; time administered; patient

response).

SFVEMSS EMT-B System Entry Written Exam With Expanded Scope of Practice Updates for 2017

Name: Date:

1. What is the ventilation rate for a patient with a rescue airway or advanced airway? A. 1 breath every 4 seconds B. 1 breath every 6 seconds C. 1 breath every 10 seconds D. 1 breath every 12 seconds

2. What is the adult compression to ventilation rate during the initial treatment of a witnessed adult cardiac arrest during single and/or two person CPR without a rescue airway? A. 15:2 B. 3:1 C. 30:2, 5 cycles = 2 minutes and administer 02 15L when available. D. Continuous chest compressions, 3 cycles (200 compressions) with high flow apneic

oxygenation at 15 L NRM.

3. What is the adult compression to ventilation ratio during the initial treatment of an unwitnessed adult cardiac arrest patient during single and/or two person CPR without a rescue airway? A. 3:1 B. 15:2 C. 30:2, 5 cycles = 2 minutes and administer 02 15 L when available. D. Continuous chest compressions, 3 cycles (200 compressions) with high flow apneic

oxygenation at 15 L NRM.

4. Which of the following is NOT a component of a valid DNR order? A. The words "Do Not Resuscitate" or "DNR" B. 1 witness signature C. Effective date D. Expiration date

5. You are caring for an asthma patient who is wheezing and will require the administration of a DuoNeb via nebulizer. What are the two medications that are combined to comprise a DuoNeb? A. Albuterol 2.5mg/Atrovent 0.5mg B. Albuterol 3.0mg/Atrovent 1.0mg C. Atropine 2.5mg/Albuterol 0.5mg D. Amiodorone 2.5mg/Atrovent 0.5mg

6. When administering a DuoNeb, the proper oxygen flow rate should be? A. 4 Ipm B. 6 Ipm C. 10 Ipm D. 15 Ipm


Name: Date:

7. A patient continues to present with wheezing and increased work of breathing after administration of one DuoNeb. What is the total number of DuoNeb nebulizers which may be administered prior to contacting medical control? A. 1 B. 2 C. 3 D. Continuous as long as symptoms persist.

8. When a patient is having symptoms suggestive of an acute coronary syndrome, what procedure should the EMT Basic perform within the first five minutes of patient contact? A. Nitroglycerin 0.4 mg SL spray/SL tablet B. Fentanyl 1 mcg/kg up to 100 mcg C. Administration of aspirin 324 mg (4 - 81 mg tablets) D. Acquire a properly placed 12-Lead ECG and immediately transmit to medical control

9. When a patient is having chest pain suggestive of acute coronary syndrome, what is the first drug administered? A. Nitroglycerin 0.4 mg SL spray/SL tablet B. Fentanyl 1 mcg/kg up to 100 mcg C. Administration of aspirin 324 mg (4 - 81 mg tablets) D. Dopamine 5 mcg/kg/min titrated to a SBP 90.

10. When oxygen administration is indicated, it should be initiated at the lowest flow rate then titrated upwards to maintain a SPO2 of? A. 98-100% for all patients B. 90% or greater; 88% or greater with history of COPD C. 94% or greater; 92% or greater with history of COPD D. 02 should be reserved for only patients in respiratory failure.

11. You have placed the AED pads on a cardiac arrest patient and the machine states, "Shock advised". How many shocks should it give before advising, "Resume CPR"? A. 1 B. 2 C. 3 D. 4

12. When will the AED re-analyze a heart rhythm in a cardiac arrest patient after administering the initial defibrillation? A. After 10 minutes B. After 5 minutes C. After 2 minutes D. After 1 minute


Name: Date:

13. After a ventricular fibrillation/pulseless ventricular tachycardia patient has be defibrillated, what is the next step that should be immediately performed? A. Check for a pulse B. Give two forceful breaths over two minutes C. Load and transport the patient D. Resume chest compressions immediately for two minutes

14. Which of the following treatments would be most appropriate for the heart failure/pulmonary edema patient in mild to moderate distress? A. CPAP 5 — 10 cm PEEP B. Administration of Epinephrine 0.3mg IM (1mg/1m1) C. Administration of a DuoNeb, may repeat x 1 D. Administration of Glucagon 1mg IM

15. You suspect your patient is experiencing heart failure or pulmonary edema. Which of the following would be inclusion criteria for the utilization of CPAP? A. Minimal distress with exertion, presence of bilateral lower extremity edema, irregular heart rate

with a history of CHF B. Inability to maintain his/her airway, actively vomiting, inability to understand and obey

commands C. Low acuity to emergent cardiopulmonary compromise, patient is awake, alert, oriented and able

to obey commands, is tachypnic with difficulty breathing but are able to breathe on their own. D. Cardiac arrest secondary to cardiogenic shock with pulmonary edema.

16. In which of the following patients would cervical spine clearance be appropriate? A. The unrestrained driver of a car traveling 45 miles per hour, involved in a head-on collision with

airbag deployment and presents with an altered mental status. B. A patient involved in a low impact MVC without air bag deployment, who denies, head, neck and

back pain during the initial assessment but then complains of point tenderness to the spins at the base of the neck during the secondary assessment.

C. A patient whose foot was run over by a forklift; only trauma identified during complete assessment is to the foot.

D. A patient who fell off his roof (25 feet) on to the driveway

17. During the treatment of a patient with excited delirium who requires post TASER care, the EMT's treatment focus should be? A. Removing the probes and irrigating the puncture wounds B. Assess for hyperthermia and treat according to proper heat emergency SOP C. Administer Tetanus toxoid D. Administer Naloxone 0.4mg IN/IM


Name: Date:

18. In which situation below would there be no individual radio reports nor completed patient care reports? A. When an accident scene has more than four people B. When the ED has already heard of the accident by a news report C. Radio and written reports must be completed on all transported patients regardless of the level

of the incident D. Mass casualty incident where the number of patients and/or nature of injuries make a normal

level of EMS stabilization and care unachievable.

19. What Is the Region IX method of triage for pediatric patients? A. Youth START B. Peds START C. Jump START D. Mini START

20. According to the START method of triage, an adult patient unable to walk due to a suspected right femoral fracture with controlled hemorrhage, BP 110/62, Respiration 32, would be categorized as: A. Red — Priority 1 B. Yellow — Priority 2 C. Green — Priority 3 D. Deceased — Priority 0

21. What is the antidote for nerve agent exposure? A. EpiPen B. Mark I Kit C. Amyl Nitrate D. Mark ll Kit

22. What is the compression to ventilation ratio for newborn resuscitation with one rescuer CPR? A. 3:1 B. 10:1 C. 30:2 D. 10:2

23. What is the compression ventilation ratio for a pediatric patient with two rescuer CPR? A. 3:1 B. 10:1 C. 15:2 D. 30:2

24. According to Region IX, pediatric SOP's are for children of what age? A. 8 years or younger B. 12 years or younger C. 10 years or younger D. 14 years or younger


Name: Date:

25. The most appropriate EMT-Basic treatment for the pediatric asthma patient presenting with low acuity to emergent distress would include? A. DuoNeb (Albuterol 2.5mg with Atrovent 0.5mg) via nebulizer. May repeat x 1 B. DuoNeb (Albuterol 2.5mg with Atrovent 0.5mg) via nebulizer — single dose. Additional

nebulizers if needed, include Albuterol 2.5mg continuously until symptoms resolve C. Epinephrine 0.01 mg/kg (1mg/1mI) to max of 0.3mg (0.3m1) IM, followed immediately by

DuoNeb via HHN, mask or BVM D. DuoNeb (Albuterol 2.5mg with Atrovent 0.5mg) via nebulizer), continuously

26. What is the appropriate allergic reaction/anaphylactic dose of epinephrine for a pediatric patient with emergent acuity in moderate distress? A. 0.5mg IM (1mg/m1) B. 0.3mg IM (1mg/m1) C. 0.01 mg/kg to max of 0.3mg IM (1mg/m1) D. Pediatric patients do not receive Epi

27. What is the most appropriate adult first-line medication, proper dose, route of administration, and continuing treatments for the emergent patient who is having a moderate allergic reaction? A. Epi 0.3mg (!mg/1mI) IN and immediate transport B. Benadryl 1mg/kg to total dose of 50mg I M, immediate transport C. Benadryl 1mg/kg to total of 50 mg 1M, Epi 0.3mg (1mg/m1) IM and immediate transport D. Epi 0.3mg (1mg/m1) IM, immediate transport, Benadryl 1mg/kg (IM). Max 50kg and if wheezing

present, DuoNeb via nebulizer

28. A pediatric trauma score of A. <10 B. <8 C. <12 D. <15

usually indicates the need for evaluation at a trauma center.

29. Your adult patient presents with lethargy. They are pale, cool and diaphoretic. GCS 13; BP 100/60; P 110; RR 16; Sp02 97% on room air. A medical alert bracelet is found on their wrist indicating they are diabetic. You suspect: A. Hyperglycemia B. Hypoglycemia C. Acute onset of OVA/Stroke D. Sepsis

30. For the adult hypoglycemic patient with a decreased GCS of 13, what would be the BEST medication to administer as well as the MOST appropriate route of administration for the Basic? A. 25% of 10% dextrose IV solution B. Oral Glucose gel C. Glucagon 1mg IN/IM D. Oxygen 15 L via NRM


Name: Date:

31. What is the IN/IM dose of Glucagon for the pediatric patient experiencing an acute diabetic, hypoglycemic emergency with altered mental status and the ability to swallow? A. 0.1mg/kg up to 1mg B. 3mg/kg up to 10mg C. 1mg/kg up to 10mg D. 0.03mg/kg up to 1mg

32. When obtaining a blood glucose sample, you should: A. Take and ensure infectious control procedures B. Determine the need for obtaining a BGL C. Explain the procedure to the patient D. All are correct

33. You have been called to the scene of a suspected heroin overdose. There are syringes, needles, and a spoon on the table next to the patient. The patient is pale, diaphoretic with a GCS of 10. He is responsive to painful stimuli with garbled words and limited purposeful movement. RR 12, Sp02 96%, P 110, BP 92/56. After IMC, the next treatment should include: A. Naloxone (Narcan) 0.4mg IN/IM, repeated as needed, to a total dose of 2.0mg to achieve a

GCS of 15 B. Insert a King LT airway based on patient's height, maintain Sp02 > 94% with supplemental 02,

and administer Narcan 4mg IN/IM C. Establish IMC, obtain a BGL and treat accordingly, continue to monitor and maintain airway,

ensuring Sp02 greater than 94% with RR greater than 10 breaths per minute, consider the use of Narcan with OLMC.

D. Secure BLS airway, administer one dose of Naloxone 2mg IN/IM and transport immediately.

34. A patient who is to have a King LT size 4 placed, should be in what height range? A. Between 3-4 feet tall B. Between 5-6 feet tall C. Between 6-8 feet tall D. None are correct

35. What is one contraindication of using a King LT? A. A patient who is apneic B. A patient who is unconscious C. A patient who is 20 years-old or younger D. A patient with an intact gag reflex

36. When placing leads V1 and V2 for ECG, the correct anatomical land marks would be? (Use the patient's right and left as reference). A. Right- mid-axillary line (V1) and left mid-axillary line (V2), 5th intercostal B. 4th intercostal space right of sternum (V2) and left of sternum (V1) C. 4th intercostal space right of sternum (V1)and left of sternum (V2) D. Right mid-clavicular line (V1) and left mid-clavicular line (V2), 4th intercostal


Name: Date:

37. Once proper 12 lead placement has been confirmed, the next step is to: A. Interpret the 12 Lead ECG and relay the information to OLMC B. Acquire the 12 Lead, print a copy from the monitor, and transmit the data to medical control C. Monitor the patient and only transmit if the patient starts to deteriorate. D. Disconnect the leads from patient after acquiring a copy of the 12 Lead.

38. When you cannot stop severe bleeding with direct pressure and a tourniquet is contraindicated, you may utilize: A. Saline to flush out the wound B. Hemostat to clamp the injured vessel C. A hemostatic agent (QuickClot®) to pack the wound D. Lights and sirens to transport the patient quickly to the hospital

39. What is the maximum amount of fluid per nostril that may be administered via the intranasal route per single dose? A. 1mL B. 2mL C. 3mL D. 4mL

40. The most appropriate site to administer an IM injection of 0.3mg epinephrine (1mg/mL) is called the vastus lateralus muscle. This site would be best described as: A. The anterior mid-point of the thigh muscle B. The lateral mid-point of the thigh muscle C. The anterior mid-point of the shoulder muscle D. The posterior mid-point of the calf muscle

41. When placing lead 4 for 12-Lead ECG, which anatomical landmark is the MOST appropriate? A. Angle of Louis B. Bundle of HIS C. Left mid-clavicular line at the 5th intercostal space D. Left mid-axillary line at the 5th intercostal space

42. When administering an Albuterol/Atrovent "DuoNeb" breathing treatment, which is NOT listed as a possible side effect in the SMO's? A. Tremors, nervousness, anxiety, dizziness, headache B. Nausea/vomiting C. Paradoxical bronchospasm D. Lightheadedness, drowsiness, sedation, confusion


Name: Date:

43. What is the total allowable dose of Naloxone for an apneic patient presenting with possible opioid overdose I N/IM? A. 0.4mg; repeat every 30 seconds until ventilations increase, up to 2mg. B. 1mg; repeat every 30 seconds until ventilations resume, up to 4mg. C. 1mg; repeat every 30 seconds until ventilations resume, up to 2mg D. 0.4mg; repeat every 30 seconds until ventilations resume up to 4mg

44. What is NOT a contraindication for the use of CPAP? A. Apnea, respiratory arrest, or agonal respirations B. Inability to understand or obey commands C. Unresponsiveness D. Ability to maintain own airway

45. Which of the following blood glucose readings would be considered "borderline"? A. 48 mg/di B. 62 mg/di C. 120 mg/di D. 30 mg/di

46. An adult patient is receiving CPR with a rescue airway or advanced airway in place. Which is the correct compression to ventilation rate to follow? A. 30:2 B. 15:2 C. Continuous compressions at 100-120 compressions per minute with 1 ventilation every 3-5

seconds D. Continuous compressions at 100-120 compressions per minute with 1 ventilation every 6

seconds

47. Which is NOT a contraindication for aspirin administration? A. Currently vomiting B. Possible stroke C. SBP < 90mmHg D. Over 6 months pregnant

48. Which is NOT a contraindication for the administration of nitroglycerin? A. SBP < 90, HR < 50, or > 100 B. Use of erectile dysfunction drugs in the last 24-48 hours C. Hepatic or renal failure D. Increased ICP or glaucoma


Name: Date:

49. When administering epinephrine with an Epi Pen, how long should the pen be held to the patient's thigh in order to allow the device to inject the medication? A. 5 seconds B. 10 seconds C. 30 seconds D. 5 minutes

50. The proper dose and route for aspirin administration for Acetaminophen is? A. 650mg PO B. 1000mg PO C. 650mg 1M D. 1000mg 1M

51. A capnography reading of less than lOmmHg for a patient receiving CPR with a rescue airway or advanced airway indicates which of the following? A. The quality of compressions needs to be improved B. The patient has achieved ROSC C. 10mmHg is a normal TCO2 reading during CPR D. The patient is being ventilated too slowly.

52. You are assessing a patient with suspected acute coronary syndrome (ACS). The patient complains of severe substernal chest pain radiating to his neck and left arm. A 12-Lead ECG has been acquired and sent to medical control. You have given aspirin 324mg. Vital signs obtained are: BP 100/72, P 49, RR 18, Sp02 90%. What medication in the ACS protocol is contraindicated for this patient? A. Diphenhydramine B. Oxygen C. Nitroglycerin D. Aspirin

53. Which is NOT a method for administering a DuoNeb? A. Handheld nebulizer B. Nebulizer mask (converted from NRM) C. In-line nebulizer with bag valve mask D. Intranasal

54. If you aspirate blood into your syringe while preparing to give an IM injection, you should: A. Insert the needle deeper into the muscle to exit the blood vessel B. Start the procedure over using a new needle and syringe C. Simply move to a new site using the same needle and syringe D. It is OK to inject the medication in the current location


Name: Date:

55. When administering a medication IN, you should push the plunger of the syringe: A. Over 5 seconds B. Rapidly C. Over 10 seconds D. Over 30 seconds

56. A suction unit should be set to what setting for the suctioning of a stoma in an adult patient? A. 120-150 mmHG B. 100-120 mmHG C. 80-100 mmHG D. 60-80 mmHG

57. A suction unit should be set to which setting for the suctioning of a pediatric patient? A. 120-150 mmHG B. 100-120 mmHG C. 80-100 mmHG D. 60-80 mmHG

58. What is the appropriate dose of Diphenhydramine to be administered to a patient having a mild to moderate allergic reaction? A. 25mg IM/PO B. 1mg/kg C. Diphenhydramine is not indicated D. lmg/kg, max dose 50mg (PO/IM)

59. A person has been stung by a bee and is having difficulty breathing. Initial assessment shows a patient in acute respiratory distress and near respiratory failure. She has symptomatic hives and significant edema to the eyes and mouth. Your immediate treatment should be? A. Load the patient into the ambulance and transport immediately B. Administer 5mg epinephrine (1mg/mL) IM, begin transport immediately, do not wait for

improvement C. Once transporting administer 25mg Benadryl IM/PO, begin a DuoNeb and repeat after 10

minutes D. If no improvement after 5 minutes, administer a second dose of epinephrine 0.5mg (1mg/mL)

60. Which is NOT an indication for the administration of Glucagon? A. Anaphylaxis refractory to usual Rx B. Symptomatic bradycardia if patient is on 13 blockers and unresponsive to norepinephrine C. A dialysis patient with a GCS of 12 with BGL of 48mg/dI D. Suspected ACS with chest pain


Name: Date:

61. A CORD patient with low to emergent acuity breathing difficulty who presents with wheezing should receive the following treatment: A. DuoNeb with albuterol 2.5mg and albuterol 0.5mg via nebulizer. May repeat x1 if needed during

transport B. Albuterol 2.5mg via nebulizer C. Atrovent 0.5mg via nebulizer D. Oxygen only to maintain SP02 < 92%

62. A trauma patient presents with a significant scalp laceration with suspected unstable skull fracture. The BEST treatment would include: A. Direct pressure over the injury to stop the bleeding B. There is no way to stop the bleeding and immediate transport is indicated. C. Application of a hemostatic agent with care not to apply pressure directly over the unstable skull

fracture. D. Apply a tourniquet

63. An elderly patient is complaining of not feeling well. The patient has been nauseous throughout the evening with several episodes of emesis. Vitals are stable with BP 142/78; P 98; RR 18; 5p02 96% on room air. The patient continues to complain of nausea. The BEST treatment for this patient includes: A. Benadryl 1mg/kg (max 50mg) IM B. DuoNeb x1 C. Glucagon 1mg IN D. Ondansetron (Zofran) 4mg ODT

64. You are called to transport a patient with an LVAD (Left Ventricular Assist Device). The device appears to not be working correctly. The MOST important thing to do in the treatment of this patient is: A. Unplug the battery pack and plug the device into a wall socket B. Contact the LVAD Coordinator for instructions and follow their direction in troubleshooting the

device failure C. Contact OLMC for direction and further orders D. Wait for the patient to become unconscious so you can treat them

65. The qS0FA scale is a bedside indicator of the potential septic patient. This scale includes all of the following EXCEPT: A. Urine output B. Respiratory rate of 22 C. Systolic BP < 100 D. Altered level of consciousness


Name: Date:

66. Which of the following patients would you be suspicious of sepsis? A. 22 year-old, unresponsive with a respiratory rate of 8, BP 100/62, P 98, Spo2 90% B. 2 year-old with wheezing, temperature of 101.1 F, RR 30, has had a runny nose for the past 2

days. C. 87 year-old who is being treated for a UTI over the past week. Has developed a fever today of

100.8F, is lethargic and poorly responsive with a GCS of 12. BP 94/78, P 104, RR 26 with an Sp02 of 92% room air

D. 35 year-old who is complaining of fever and chills the past 24 hours and has developed abdominal pain throughout the day.

67. MOI alone should determine the need for complete spinal immobilization. A. True B. False

68. A viable birth is from what week(s) of gestation? A. 38-40 weeks B. 30-32 weeks C. 20-26 weeks D. < 18 weeks

69. You are called to the scene of a local drinking establishment for a patient who has become belligerent and combative. Police state that the patient is "intoxicated". You should: A. Restrain the patient to prevent him from attempting to escape B. Allow the patient to refuse care and transport C. Obtain a 12-Lead ECG to r/o a potential cardiac emergency D. Obtain a BGL to r/o a potential diabetic emergency

70. A 13 year-old was playing with lighter fluid and sustained 2nd and 3rd degree burns to both arms and hand. The patient's airway is not compromised. The MOST appropriate treatment for this patient would be: A. Apply ice packs to the hands to cool B. Cover the burns with moist dressings C. Cover the burns with plastic wrap, being careful to wrap each finger individually D. Apply Vaseline to burns

71. In the management of a stroke patient, you must obtain the following information and report this information to the receiving Emergency Department ASAP. A. Identify the "Last seen normal" time B. Obtain a complete pre hospital stroke screen C. Obtain a complete list of current medications D. All are correct


Name: Date:

72. You are called to the scene of a suspected diabetic emergency. The patient is slightly confused, pale and diaphoretic. A medical alert bracelet confirms the patient's history of diabetes. The patient is able to swallow without risk of aspiration or choking. The BGL is 58. After administration of oral glucose gel, the patient becomes alert and refuses transport to the ED. What must be performed before you can leave the scene? A. Obtain a repeat BGL ensuring it is over 70mg/dI B. Confirm the patient is decisional C. Contact OLMC prior to leaving the patient with a complete report D. All are correct

73. You are treating a patient with CHF with CPAP. The patient is tolerating CPAP well at 5cm PEEP, yet Sp02 continues to remain below 92%. You increase PEEP to 8 and assessment of vitals find the BP has dropped to 88/60. What should you do? A. Continue to increase PEEP to 10cm B. Decrease PEEP back to 5cm and reassess vitals C. Continue to monitor patient for changes in mental status D. Do nothing, a drop in BP during CPAP administration is normal

74. EMS providers are mandatory reporters of elder abuse A. True B. False

75. The BEST indicator of proper ventilation during resuscitation would be: A. Sp02 B. ETCO2 C. Depth of breaths D. Rate of respirations

ilnsidoer 4y PASS i j 70% Southern ox Valley EMS - Paramedic Training

Basic Pre-Screening Examination summing!' mannign

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1. A • C D

2.A B tip D

3.A BOD

4.A B C •

5. 0 B C D

6.A 0 C D

7.A • C D

8.A B C •

9.A B OD

10. A B 0 D

11. • B C D

12. A B . D

13. A B C • 14. 0 B C D

15. A BID

16. A BOD

17.A Sc D

18.A B CO

19. A B • D

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22. 11, B C D

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31. A B C • 32.A B C •

33. A B • D

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38. A B • D

39. • B C D

40.A 0 C D

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66. A BOD

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Southern Fox Valley EMS - Paramedic Training Basic Pre-Screening Examination

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southern fox valley emergency medical ......• alcohol. swab • gauze pad (2x2) procedure: 1. take...

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