SNHD PARAMEDIC PROTOCOLS ACTUAL EXAM -

SNHD PARAMEDIC PROTOCOLS ACTUAL EXAM -

CLARK COUNTY (STATE OF NEVADA) WITH 300 QUESTIONS AND

100% CORRECT ANSWERS/ CLARK COUNTY SNHD PARAME DIC

PROTOCOLS REAL EXAM EVERYTHING YOU N EED TO KNOW

The protocols are - ANSWER-Guidelines, nothing contained in these protocols shall be constructed to expand the scope of practice of any licensed attendant beyond that which is identified in the CC Emergency Medical Services Regulations and these protocols

Nothing within these protocols is meant to - ANSWER-Delay rapid patient transport to a receiving facility. Patient care should be rendered while en-route

Order of protocols - ANSWER-General assessment protocol must be followed in the specific sequence noted. For all other treatment protocols, the algorithm defines the care every patient should receive, usually in the order described.

What is the purpose of the manual? - ANSWER-To provide guidance for all prehospital care providers and emergency department physicians within the Clark County EMS system

What is the goal of the manual? - ANSWER-To standardize prehospital patient care in Clark County.

A patient is any individual that meets at least one of the following criteria - ANSWER-A person who has a complaint or mechanism suggestive of potential illness or injury A person who has obvious evidence of illness or injury A person identified by an informed 2nd or 3rd party caller as requiring evaluation for potential illness or injury

Pediatric patient considerations - ANSWER-For patients < 18 yo, use the Pediatric Patient Destination protocol.Pediatric treatment protocols are to be used on children who have not yet experienced puberty. Signs of puberty include chest or underarm hair on males, and any breast development on females.

The protocols demonstrate a - ANSWER-Commitment to a consistent approach to quality patient care 1 / 4

General adult assessment 1 - ANSWER-Scene safety / scene size up Nature of call / mechanism of injury

PPE / BSI

Bring all equipment to patient's side

General adult assessment 2 - ANSWER-Level of consciousness -> unresponsive -> check pulse -> none -> *Cardiac arrest Airway -> signs of compromise or not protecting -> *ventilation management Breathing -> inadequate or respiratory distress -> *Respiratory distress Circulation -> bleeding -> *General trauma Disability -> altered or confused -> *altered mental status/syncope

General adult assessment 3 - ANSWER-History - HPI & AMPLE Vital signs and physical exam Blood glucose testing as indicated *Specific treatment protocol as indicated *Cervical stabilization as indicated Comfort measures (splint, position of comfort) Cardiac monitor as indicated Vascular access as indicated Oxygen therapy to keep SOP2 >94 Pain management as indicated

General adult assessment 4 - ANSWER-Radio contact for all trauma center patients, Code 3 returns, need for telemetry physician and as per protocol Transport per Disposition criteria, if applicable

*Transport to closest facility for: airway emergencies (inability to adequately

ventilate)

Contact with online medical control - ANSWER-Should only be established by radio. Telephone contact may only be used if the call is routed via a recorded phone patch through FAO at 702-382-9007

Pediatric patients shall be transported - ANSWER-In accordance with the pediatric destination protocol

Patients with evidence of a stroke shall be transported - ANSWER-In accordance with the Stroke (CVA) Protocol

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Sexual assault victims <13 yo - ANSWER-Shall be transported to Sunrise Hospital

Sexual assault victims 13 yo to 18 yo - ANSWER-Shall be transported to Sunrise or UMC

Sexual assault victims >18 yo - ANSWER-Shall be transported to UMC

For sexual assault victims outside a 50 mile radius from the above facilities - ANSWER-Transport to the nearest appropriate facility

Waiting room criteria - ANSWER-Excluding patients on a legal psychiatric hold, meeting all of the following criteria

• Normal vital signs
• Did not receive any parenteral medications during EMS transport except a single

dose of analgesia and/or an antiemetic

• In the judgment of the paramedic, does not require continuous cardiac

monitoring. Note: any ECG monitoring initiated by a transferring facility may not be discontinued by EMS personnel

• Can maintain a sitting position without adverse impact on their medical

condition

• Is left with a verbal report to hospital personnel

Waiting room vital signs - ANSWER-Heart rate: 60-100

Respiratory rate: 10-20

Systolic BP: 100-180

Diastolic BP: 60-110

Room air pulse oximetry >94% Alert and oriented x 4

Internal disaster - ANSWER-Facility is to be bypassed for all patients except patients in cardiac arrest or in whom the ability to adequately ventilate has not been established

General adult trauma assessment 1 - ANSWER-General adult assessment Cervical stabilization

General adult trauma assessment 2 - ANSWER-GCS < 8 -> *Ventilation

management: BVM if O2 < 94%

GCS >8 -> Oxygen keep SPO2 > 94%

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General adult trauma assessment 3 - ANSWER-Palpable radial pulse?Yes -> Vascular access No -> Vascular access -> 1 L NS or LR bolus IV/IO

General adult trauma assessment 4 - ANSWER-Secondary assessment:

Suspected tension pneumothorax -> *Needle Thoracentesis Sucking chest wound -> Apply 3 sided occlusive dressing Control active hemorrhage -> *Hemorrhage control Obvious fractures -> Immobilize fractures; assess distal pulse Suspected traumatic brain injury -> Raise head of bed 30 degrees and capnography

• ETCO2 35 mmHg

Open wounds -> cover with gauze; wet trauma dressing for abdominal evisceration

General adult trauma assessment 5 - ANSWER-Pain management Transport and radio contact to appropriate Trauma Center based on TFTC

Abdominal/Flank Pain, nausea and Vomiting 1 - ANSWER-General adult assessment 12 Lead ECG if age > 35 yo

Abdominal/Flank Pain, nausea and Vomiting 2 - ANSWER-Signs of hypovolemia?Yes -> vascular access -> 500 mL NS or LR bolus IV/IO; may repeat up to 2000 ml No -> next step

Abdominal/flank pain, nausea and vomiting 3 - ANSWER-Nausea or vomiting?

Yes -> consider an antiemetic: (A) Ondansetron 4 mg ODT/IM/IV/IO; (P)

Droperidol 1.25 mg IM/IV/IO or Metoclopramide 10 mg slow IV bolus over 1-2 minutes or IM OR Prochlorperazine up to 10 mg IV/IO/IM No -> Consider *Chest pain and suspected acute coronary syndrome

Abdominal/flank pain, nausea and vomiting 4 - ANSWER-Consider pain management Continue general adult assessment

Abdominal/flank pain, nausea and vomiting Pearls - ANSWER-Neuro disorders or signs of hypoperfusion/shock in the presence of abdominal pain may indicate an aneurysm

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