ICEMA PROTOCOL STUDY GUIDE Verified questions and answers..

ICEMA PROTOCOL STUDY GUIDE
Verified questions and answers.

Burns-adult #14070 - (correct answers)- Estimate yu yu yu yu yu yu



% TBSA burned and depth using rule of nines.
yu yu yu yu yu yu yu yu




-
Thermal burns: Stop burning process. DO not break blisters. Cover affected body s
yu yu yu yu yu yu yu yu yu yu yu yu yu



urface with dry, sterile dressing or sheet.
yu yu yu yu yu yu




-
Chemical burns: Brush off dry powder, if present. Remove any contaminated or we
yu yu yu yu yu yu yu yu yu yu yu yu yu



t clothing. Irrigate with copious amounts of saline or water.
yu yu yu yu yu yu yu yu yu




- Tar burns: Cool with water, do not remove tar
yu yu yu yu yu yu yu yu yu




-
Electrical burns: Remove from electrical source (without endangering self) with non
yu yu yu yu yu yu yu yu yu yu yu



conductive material. Cover affected body surface with dry, sterile dressing or sheet
yu yu yu yu yu yu yu yu yu yu yu




-
Eye involvement: Continuous flushing with NS during transport. Allow patient to re
yu yu yu yu yu yu yu yu yu yu yu yu



move contact lenses if possible
yu yu yu yu




- Advanced airway as clinically indicated. King airway is contraindicated
yu yu yu yu yu yu yu yu yu




- Iv access: Unstable- BP less than 90 and/
yu yu yu yu yu yu yu yu



or signs and symptoms of inadequate tissue perfusion, start 2nd IV line. Give 250m
yu yu yu yu yu yu yu yu yu yu yu yu yu



L boluses and repeat to max of 1L
yu yu yu yu yu yu yu




Stable- BP more than 90 and signs of adequate tissue perfusion, administer 500ml/
yu yu yu yu yu yu yu yu yu yu yu yu



hr.
yu




-
Respiratory distress: Use BVM as needed. Contact receiving hospital ASAP. Adminis
yu yu yu yu yu yu yu yu yu yu yu



ter albuterol with Atrovent. High flow oxygen Is essential with known or potential re
yu yu yu yu yu yu yu yu yu yu yu yu yu



spiratory injury. Beware of smoke inhalation. Do not apply ice water directly to skin
yu yu yu yu yu yu yu yu yu yu yu yu yu yu



surfaces, as additional injury will result. Intubate patient if facial/
yu yu yu yu yu yu yu yu yu



oral swelling is present or if respiratory depression or distress develops due to inha
yu yu yu yu yu yu yu yu yu yu yu yu yu yu



lation injury. CPAP may be considered if indicated after consultation with BH
yu yu yu yu yu yu yu yu yu yu yu




- Treat pain with analgesics as indicated
yu yu yu yu yu yu




Pain management #14100 -
yu yu yu



(correct answers)Patients with a GCS of 15 or at baseline mentation and have a pai
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu

,n score of 5 or higher and have: acute traumatic injuries, acute abdominal/
yu yu yu yu yu yu yu yu yu yu yu yu



flank pain, burn injuries, cancer pain, or sickle cell crisis
yu yu yu yu yu yu yu yu yu yu




• What drugs/dosages are used?
yu yu yu yu




-
Must always monitor and assess vital signs prior to administration of any analgesic
yu yu yu yu yu yu yu yu yu yu yu yu yu



. After administration must continually monitor EKG and place on capno. Reassess v
yu yu yu yu yu yu yu yu yu yu yu yu



ital signs, capno, and pain scores every 5 minutes.
yu yu yu yu yu yu yu yu




-
Once a pain medication has been administered via route of choice, changing route
yu yu yu yu yu yu yu yu yu yu yu yu yu yu



(i.e. IM to IV) requires BHO.
yu yu yu yu yu




- Shifting from one analgesic while treating a patient requires BHO
yu yu yu yu yu yu yu yu yu yu




- For pain and a SBP below 100, administer 0.3mg/
yu yu yu yu yu yu yu yu yu



kg Ketamine IVPB to a max single dose of 30 mg. May repeat once in 15 minutes.
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu




- For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/
yu yu yu yu yu yu yu yu yu yu yu yu yu



IO push over 1 minute. May repeat every 5 minutes titrated to pain but not to exce
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu



ed 200 mcq OR 100 mcq IM/
yu yu yu yu yu yu



IN. May repeat 50 mcq every 10 minutes titrated to pain, not to exceed 200 mcq. P
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu



eds dose is 0.5mcq/kg slow IV/
yu yu yu yu yu



IO over 1 minute. May repeat in 5 min titrated to pain, not to exceed 100 mcq OR 1
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu y



umcq/kg IM/ yu



IN, may repeat every 10 minutes titrated to pain but not to exceed 200 mcq. Can al
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu



so use 0.3mg/kg of Ketamine IVPB to a max of 30mg as a single dose in 50-
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu



100mL of NS over 5 minutes. May repeat one time in 15 minutes, if pain is still a 5
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu



or higher. DO not administer IVP, IO, IM, IN
yu yu yu yu yu yu yu yu




Respiratory emergencies-Peds #14120 - (correct answers)- yu yu yu yu yu



Maintain airway with appropriate adjuncts, obtain O2 sat room air if possible.
yu yu yu yu yu yu yu yu yu yu yu yu




-
Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as indicated. May rep
yu yu yu yu yu yu yu yu yu yu yu yu



eat Albuterol 2 times and Atrovent 1x.
yu yu yu yu yu yu




- If no response to Albuterol or Atrovent, consider 0.01mg/
yu yu yu yu yu yu yu yu yu



kg Epi 1:1000 via IM no to exceed adult dosage of 0.3mg. Obtain vascular access at
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu



TKO rate
yu yu




- If allergic reaction suspected, administer 1mg/kg diphenhydramine IV/
yu yu yu yu yu yu yu yu



IO, not to exceed adult dose of 25mg IV or 2mg/
yu yu yu yu yu yu yu yu yu yu



kg IM not to exceed adult dose of 50mg IM. Need orders for patients 2 years of age
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu



or older yu




-
If apneic and unable to ventilate, consider oral tracheal intubation for patients who
yu yu yu yu yu yu yu yu yu yu yu yu yu y



are taller than the maximum length of a pediatric emergency measuring tape or eq
u yu yu yu yu yu yu yu yu yu yu yu yu yu

, uivalent measuring from the top of the head to the heel of the foot. BHO may order
yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu yu y



additional medications or interventions
u yu yu yu




- Base hospital: for severe asthma /
yu yu yu yu yu yu



respiratory distress that has failed to the other previous treatments, administer 50
yu yu yu yu yu yu yu yu yu yu yu yu yu



mg/
kg of Magnesium Sulfate slow IV drip over 20 minutes. DO not exceed adult dosage
yu yu yu yu yu yu yu yu yu yu yu yu yu yu y



of 2gm total. Do not repeat.
u yu yu yu yu yu




Allergic reactions-Peds #14140 - (correct answers)-
yu yu yu yu yu



Maintain airway with appropriate adjuncts, obtain room air saturation if possible. A
yu yu yu yu yu yu yu yu yu yu yu yu



dminister 2.5mg Albuterol nebulized, may repeat 2x. Combine with 0.5mg of Atrove
yu yu yu yu yu yu yu yu yu yu yu



nt. Only give 1x.
yu yu yu




- If no response to Albuterol, consider 0.01mg/
yu yu yu yu yu yu yu



kg of Epi 1:1000 IM, not to exceed adult dose of 0.3mg IM
yu yu yu yu yu yu yu yu yu yu yu yu




- Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/
yu yu yu yu yu yu yu yu yu yu yu



kg IM, not to exceed 50mg IM
yu yu yu yu yu yu




- For symptomatic hypotension with poor perfusion, consider fluid bolus of 20ml/
yu yu yu yu yu yu yu yu yu yu yu



kg of NS, not to exceed 300 mL NS and repeat as indicated.
yu yu yu yu yu yu yu yu yu yu yu yu




- Est IV/IO access if indicated
yu yu yu yu yu




-
For anaphylactic shock (no palpable radial pulse and a depressed LOC) administer
yu yu yu yu yu yu yu yu yu yu yu yu yu



0.01mg/kg of Epi 1:10000 IV/ yu yu yu yu



IO, no more than 0.1mg per dose. May repeat to maximum of 0.5mg.
yu yu yu yu yu yu yu yu yu yu yu yu




-
If apneic and unable to ventilate, consider oral tracheal intubation for patients who
yu yu yu yu yu yu yu yu yu yu yu yu yu y



are taller than the maximum length of a pediatric measuring tape or equivalent me
u yu yu yu yu yu yu yu yu yu yu yu yu yu



asuring from the top of the head to the heel of the foot.
yu yu yu yu yu yu yu yu yu yu yu yu




Cardiac arrest-Peds #14150 - (correct answers)- High quality CPR ventilate 12-
yu yu yu yu yu yu yu yu yu yu



20 per minute. Ventilation rate decreases as patient age increases. Obtain IV/
yu yu yu yu yu yu yu yu yu yu yu



IO access (IO preferred if under 9)
yu yu yu yu yu yu




-
For continued signs of inadequate tissue perfusion, administer fluid bolus of NS. Re
yu yu yu yu yu yu yu yu yu yu yu yu yu



assess after each bolus. May repeat 2x for continued signs of inadequate tissue per
yu yu yu yu yu yu yu yu yu yu yu yu yu



fusion. 1-8 years: 20mL/kg NS and 9-14 years: 300mL NS
yu yu yu yu yu yu yu yu yu




- Determine cardiac rhythm and defibrillate at 2J/
yu yu yu yu yu yu yu



kg (or manufacturer recommended equivalent) if indicated. After defibrillation, imm
yu yu yu yu yu yu yu yu yu



ediately resume CPR, beginning a 2-minute cycle.
yu yu yu yu yu yu




-
Utilize waveform capno for monitoring airway and effectiveness of chest compressi
yu yu yu yu yu yu yu yu yu yu yu



ons and for early identification of ROSC. Document waveform and capno number in
yu yu yu yu yu yu yu yu yu yu yu yu yu



ePCR