Name: Score:
153 Multiple choice questions
Definition 1 of 153
1. general adult assessment
2. remove from environment; temperature measurement; remove wet clothing; dry/warm
patient; passive warming measures
3. localized cold injury: monitor and reassess; general wound care; do not rub skin to warm; do
not allow refreezing
Systemic hypothermia:
Unresponsive > pulse present > no > cardiac arrest
Awake with/without altered mental status >
respiratory distress: yes - respiratory distress protocol
no: activate warming measures > vascular access > NS or LR bolus 500 mL IV/IO repeat to
effect SBP > 90 max 2 L > General adult trauma assessment > shock > monitor and reassess
Continue general patient care and transport
Adult altered mental status / syncope
Allergic Reaction
Cold related illness
STEMI (suspected)
,Definition 2 of 153
1. General adult assessment
2. Blood glucose testing, vascular access
3. BG <60 mg/dl: Oral glucose if patient is protecting airway
D10, 25 g IV/IO (250 mL of 10% solution) may repeat once in 5 min; glucagon 1 mg IM for no IV
access
Improved mental status? no: go to BG > 60
Yes: other treatment protocols as indicated
BG > 60 consider NS or LR 500 mL IV; may repeat up to 2000 mL
4. Consider the following:
Signs of stroke? -> Stroke protocol
Signs of hypoperfusion? -> Shock protocol
Signs of a seizure of post-ical state? -> Seizure protocol
Signs of trauma or head injury? -> general trauma protocol
Cardiac causes/known disease? -> Appropriate cardiac protocol
Unresponsive with respiratory depression and suspected narcotic overdose ->
poisoning/overdose protocol
Adult Burns thermal exposure
Childbirth/Labor Normal presentation
Adult Burn Chemical/electrical exposure
Adult altered mental status / syncope
,Definition 3 of 153
Upon arrival in the ED, if transfer of care has not occurred in accordance with NRS 450B.790,
any patient, excluding patients on a legal psychiatric hold, meeting ALL criteria may be placed
in a waiting room
1. Normal vital signs
Heart rate 60-100
Respiratory rate 10-20
Systolic BP 100-180
Diastolic BP 60-110
Room air pulse ox > 94%
A&Ox4
2. Did not receive any parenteral medications during EMS transport except a single dose of
analgesia and/or an anti-emetic
3. In the judgment of the Paramedic, does not require continuous cardiac monitoring
4. Can maintain a sitting position without adverse impact on their medical condition
5. Is left with a verbal report to hospital personnel
Hypothermia mechanisms
Heat related illness pearls
Infant burn percentages
Waiting room criteria
Definition 4 of 153
If a hospital declares internal disaster, that 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
Operational exceptions may be initiated in regard to transport to hospitals on internal disaster.
Mass casualty event
Internal disaster
Technological disaster
Workplace violence
, Definition 5 of 153
Extremes of age are more prone to cold emergencies
Obtain and document patient temp
Active warming includes hot packs that can be used on the armpit and groin; care should be
taken not to place the packs directly on the skin
Warm saline or LR IV may be used
Recognize the cardiac arrest resuscitation guidelines for the hypothermic patient
Heat related Illness
Cold-related illness Pearls
General adult trauma pearls
Drowning caveats
Definition 6 of 153
1. general pediatric assessment
2. airway protected and ventilation adequate?
no > ventilation management > consider Cervical stabilization
Yes: consider cervical stabilization
3. oxygen 15 L NRB > SPO2
4. albuterol 2.5 mg in 3 mL SVN; repeat until improvement
5. P: consider 12 lead ECG
Pediatric abdominal pain, nausea and vomiting
Pediatric drowning
Pediatric cold related illness
Pediatric shock
153 Multiple choice questions
Definition 1 of 153
1. general adult assessment
2. remove from environment; temperature measurement; remove wet clothing; dry/warm
patient; passive warming measures
3. localized cold injury: monitor and reassess; general wound care; do not rub skin to warm; do
not allow refreezing
Systemic hypothermia:
Unresponsive > pulse present > no > cardiac arrest
Awake with/without altered mental status >
respiratory distress: yes - respiratory distress protocol
no: activate warming measures > vascular access > NS or LR bolus 500 mL IV/IO repeat to
effect SBP > 90 max 2 L > General adult trauma assessment > shock > monitor and reassess
Continue general patient care and transport
Adult altered mental status / syncope
Allergic Reaction
Cold related illness
STEMI (suspected)
,Definition 2 of 153
1. General adult assessment
2. Blood glucose testing, vascular access
3. BG <60 mg/dl: Oral glucose if patient is protecting airway
D10, 25 g IV/IO (250 mL of 10% solution) may repeat once in 5 min; glucagon 1 mg IM for no IV
access
Improved mental status? no: go to BG > 60
Yes: other treatment protocols as indicated
BG > 60 consider NS or LR 500 mL IV; may repeat up to 2000 mL
4. Consider the following:
Signs of stroke? -> Stroke protocol
Signs of hypoperfusion? -> Shock protocol
Signs of a seizure of post-ical state? -> Seizure protocol
Signs of trauma or head injury? -> general trauma protocol
Cardiac causes/known disease? -> Appropriate cardiac protocol
Unresponsive with respiratory depression and suspected narcotic overdose ->
poisoning/overdose protocol
Adult Burns thermal exposure
Childbirth/Labor Normal presentation
Adult Burn Chemical/electrical exposure
Adult altered mental status / syncope
,Definition 3 of 153
Upon arrival in the ED, if transfer of care has not occurred in accordance with NRS 450B.790,
any patient, excluding patients on a legal psychiatric hold, meeting ALL criteria may be placed
in a waiting room
1. Normal vital signs
Heart rate 60-100
Respiratory rate 10-20
Systolic BP 100-180
Diastolic BP 60-110
Room air pulse ox > 94%
A&Ox4
2. Did not receive any parenteral medications during EMS transport except a single dose of
analgesia and/or an anti-emetic
3. In the judgment of the Paramedic, does not require continuous cardiac monitoring
4. Can maintain a sitting position without adverse impact on their medical condition
5. Is left with a verbal report to hospital personnel
Hypothermia mechanisms
Heat related illness pearls
Infant burn percentages
Waiting room criteria
Definition 4 of 153
If a hospital declares internal disaster, that 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
Operational exceptions may be initiated in regard to transport to hospitals on internal disaster.
Mass casualty event
Internal disaster
Technological disaster
Workplace violence
, Definition 5 of 153
Extremes of age are more prone to cold emergencies
Obtain and document patient temp
Active warming includes hot packs that can be used on the armpit and groin; care should be
taken not to place the packs directly on the skin
Warm saline or LR IV may be used
Recognize the cardiac arrest resuscitation guidelines for the hypothermic patient
Heat related Illness
Cold-related illness Pearls
General adult trauma pearls
Drowning caveats
Definition 6 of 153
1. general pediatric assessment
2. airway protected and ventilation adequate?
no > ventilation management > consider Cervical stabilization
Yes: consider cervical stabilization
3. oxygen 15 L NRB > SPO2
4. albuterol 2.5 mg in 3 mL SVN; repeat until improvement
5. P: consider 12 lead ECG
Pediatric abdominal pain, nausea and vomiting
Pediatric drowning
Pediatric cold related illness
Pediatric shock
