Icema Protocol Study Guide Exam Questions And Answers

ICEMA PROTOCOL STUDY GUIDE EXAM QUESTIONS AND ANSWERS Burns-adult #14070 - Answer-- Estimate % TBSA burned and depth using rule of nines. - Thermal burns: Stop burning process. DO not break blisters. Cover affected body surface with dry, sterile dressing or sheet. - Chemical burns: Brush off dry powder, if present. Remove any contaminated or wet clothing. Irrigate with copious amounts of saline or water. - Tar burns: Cool with water, do not remove tar - Electrical burns: Remove from electrical source (without endangering self) with nonconductive material. Cover affected body surface with dry, sterile dressing or sheet - Eye involvement: Continuous flushing with NS during transport. Allow patient to remove contact lenses if possible - Advanced airway as clinically indicated. King airway is contraindicated - Iv access: Unstable- BP less than 90 and/or signs and symptoms of inadequate tissue perfusion, start 2nd IV line. Give 250mL boluses and repeat to max of 1L Stable- BP more than 90 and signs of adequate tissue perfusion, administer 500ml/ hr. - Respiratory distress: Use BVM as needed. Contact receiving hospital ASAP. Administer albuterol with Atrovent. High flow oxygen Is essential with known or potential respiratory injury. Beware of smoke inhalation. Do not apply ice water directly to skin surfaces, as additional injury will result. Intubate patient if facial/ oral swelling is present or if respiratory depression or distress develops due to inhalation injury. CPAP may be considered if indicated after consultation with BH - Treat pain with analgesics as indicated Pain management #14100 - Answer-Patients with a GCS of 15 or at baseline mentation and have a pain score of 5 or higher and have: acute traumatic injuries, acute abdominal/ flank pain, burn injuries, cancer pain, or sickle cell crisis • What drugs/dosages are used? - Must always monitor and assess vital signs prior to administration of any analgesic. After administration must continually monitor EKG and place on capno. Reassess vital signs, capno, and pain scores every 5 minutes. - Once a pain medication has been administered via route of choice, changing route (i.e. IM to IV) requires BHO. - Shifting from one analgesic while treating a patient requires BHO - For pain and a SBP below 100, administer 0.3mg/kg Ketamine IVPB to a max single dose of 30 mg. May repeat once in 15 minutes. - For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/IO push over 1 minute. May repeat every 5 minutes titrated to pain but not to exceed 200 mcq OR 100 mcq IM/IN. May repeat 50 mcq every 10 minutes titrated to pain, not to exceed 200 mcq. Peds dose is 0.5mcq/kg slow IV/IO over 1 minute. May repeat in 5 min titrated to pain, not to exceed 100 mcq OR 1 mcq/kg IM/IN, may repeat every 10 minutes titrated to pain but not to exceed 200 mcq. Can also use 0.3mg/kg of Ketamine IVPB to a max of 30mg as a single dose in 50-100mL of NS over 5 minutes. May repeat one time in 15 minutes, if pain is still a 5 or higher. DO not administer IVP, IO, IM, IN Respiratory emergencies-Peds #14120 - Answer-- Maintain airway with appropriate adjuncts, obtain O2 sat room air if possible. - Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as indicated. May repeat Albuterol 2 times and Atrovent 1x. - If no response to Albuterol or Atrovent, consider 0.01mg/kg Epi 1:1000 via IM no to exceed adult dosage of 0.3mg. Obtain vascular access at TKO rate - If allergic reaction suspected, administer 1mg/kg diphenhydramine IV/IO, not to exceed adult dose of 25mg IV or 2mg/kg IM not to exceed adult dose of 50mg IM. Need orders for patients 2 years of age or older - If apneic and unable to ventilate, consider oral tracheal intubation for patients who are taller than the maximum length of a pediatric emergency measuring tape or equivalent measuring from the top of the head to the heel of the foot. BHO may order additional medications or interventions - Base hospital: for severe asthma / respiratory distress that has failed to the other previous treatments, administer 50 mg/kg of Magnesium Sulfate slow IV drip over 20 minutes. DO not exceed adult dosage of 2gm total. Do not repeat. Allergic reactions-Peds #14140 - Answer-- Maintain airway with appropriate adjuncts, obtain room air saturation if possible. Administer 2.5mg Albuterol nebulized, may repeat 2x. Combine with 0.5mg of Atrovent. Only give 1x. - If no response to Albuterol, consider 0.01mg/kg of Epi 1:1000 IM, not to exceed adult dose of 0.3mg IM - Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/kg IM, not to exceed 50mg IM - For symptomatic hypotension with poor perfusion, consider fluid bolus of 20ml/kg of NS, not to exceed 300 mL NS and repeat as indicated. - Est IV/IO access if indicated - For anaphylactic shock (no palpable radial pulse and a depressed LOC) administer 0.01mg/kg of Epi 1:10000 IV/IO, no more than 0.1mg per dose. May repeat to maximum of 0.5mg. - If apneic and unable to ventilate, consider oral tracheal intubation for patients who are taller than the maximum length of a pediatric measuring tape or equivalent measuring from the top of the head to the heel of the foot. Cardiac arrest-Peds #14150 - Answer-- High quality CPR ventilate 12-20 per minute. Ventilation rate decreases as patient age increases. Obtain IV/IO access (IO preferred if under 9) - For continued signs of inadequate tissue perfusion, administer fluid bolus of NS. Reassess after each bolus. May repeat 2x for continued signs of inadequate tissue perfusion. 1-8 years: 20mL/kg NS and 9-14 years: 300mL NS - Determine cardiac rhythm and defibrillate at 2J/kg (or manufacturer recommended equivalent) if indicated. After defibrillation, immediately resume CPR, beginning a 2-minute cycle. - Utilize waveform capno for monitoring airway and effectiveness of chest compressions and for early identification of ROSC. Document waveform and capno number in ePCR - ET intubation is advanced airway of choice for patients taller than the maximum length of pediatric measuring tape. Insert NG/OG tube - V-fib/V-tach: Initial D-fib at 2J/kg. Second D-fib at 4J/kg. Third and subsequent defibrillation attempts should be administered at 10J/kg, not to exceed adult dose. Administer 0.01mg/kg EPI 1:10000 every 5 minutes, unless cap