ICEMA PROTOCOL STUDY GUIDE
EXAM WITH COMPLETE SOLUTIONS
Burns-adult n#14070 n- ncorrect nanswers n-- nEstimate n% nTBSA nburned nand ndepth
nusing nrule nof nnines.
- nThermal nburns: nStop nburning nprocess. nDO nnot nbreak nblisters. nCover naffected
nbody nsurface nwith ndry, nsterile ndressing nor nsheet.
- nChemical nburns: nBrush noff ndry npowder, nif npresent. nRemove nany ncontaminated
nor nwet nclothing. nIrrigate nwith ncopious namounts nof nsaline nor nwater.
- nTar nburns: nCool nwith nwater, ndo nnot nremove ntar
- nElectrical nburns: nRemove nfrom nelectrical nsource n(without nendangering nself) nwith
nnonconductive nmaterial. nCover naffected nbody nsurface nwith ndry, nsterile ndressing
nor nsheet
- nEye ninvolvement: nContinuous nflushing nwith nNS nduring ntransport. nAllow npatient
nto nremove ncontact nlenses nif npossible
- nAdvanced nairway nas nclinically nindicated. nKing nairway nis ncontraindicated
- nIv naccess: nUnstable- nBP nless nthan n90 nand/or nsigns nand nsymptoms nof
ninadequate ntissue nperfusion, nstart n2nd nIV nline. nGive n250mL nboluses nand nrepeat
nto nmax nof n1L
,Stable- nBP nmore nthan n90 nand nsigns nof nadequate ntissue nperfusion, nadminister
n500ml/ nhr.
- nRespiratory ndistress: nUse nBVM nas nneeded. nContact nreceiving nhospital nASAP.
nAdminister nalbuterol nwith nAtrovent. nHigh nflow noxygen nIs nessential nwith nknown nor
npotential nrespiratory ninjury. nBeware nof nsmoke ninhalation. nDo nnot napply nice nwater
ndirectly nto nskin nsurfaces, nas nadditional ninjury nwill nresult. nIntubate npatient nif
nfacial/ noral nswelling nis npresent nor nif nrespiratory ndepression nor ndistress ndevelops
ndue nto ninhalation ninjury. nCPAP nmay nbe nconsidered nif nindicated nafter
nconsultation nwith nBH
- nTreat npain nwith nanalgesics nas nindicated
Pain nmanagement n#14100 n- ncorrect nanswers n-Patients nwith na nGCS nof n15 nor nat
nbaseline nmentation nand nhave na npain nscore nof n5 nor nhigher nand nhave: nacute
ntraumatic ninjuries, nacute nabdominal/ nflank npain, nburn ninjuries, ncancer npain, nor
nsickle ncell ncrisis
• nWhat ndrugs/dosages nare nused?
- nMust nalways nmonitor nand nassess nvital nsigns nprior nto nadministration nof nany
nanalgesic. nAfter nadministration nmust ncontinually nmonitor nEKG nand nplace non
ncapno. nReassess nvital nsigns, ncapno, nand npain nscores nevery n5 nminutes.
- nOnce na npain nmedication nhas nbeen nadministered nvia nroute nof nchoice, nchanging
nroute n(i.e. nIM nto nIV) nrequires nBHO.
- nShifting nfrom none nanalgesic nwhile ntreating na npatient nrequires nBHO
- nFor npain nand na nSBP nbelow n100, nadminister n0.3mg/kg nKetamine nIVPB nto na
nmax nsingle ndose nof n30 nmg. nMay nrepeat nonce nin n15 nminutes.
- nFor npain nand nan nSBP nabove n100, nadminister n50 nmcq nFetanyl nslow nIV/IO
npush nover n1 nminute. nMay nrepeat nevery n5 nminutes ntitrated nto npain nbut nnot nto
nexceed n200 nmcq nOR n100 nmcq nIM/IN. nMay nrepeat n50 nmcq nevery n10 nminutes
ntitrated nto npain, nnot nto nexceed n200 nmcq. nPeds ndose nis n0.5mcq/kg nslow nIV/IO
nover n1 nminute. nMay nrepeat nin n5 nmin ntitrated nto npain, nnot nto nexceed n100 nmcq
nOR n1 nmcq/kg nIM/IN, nmay nrepeat nevery n10 nminutes ntitrated nto npain nbut nnot nto
nexceed n200 nmcq. nCan nalso nuse n0.3mg/kg nof nKetamine nIVPB nto na nmax nof
n30mg nas na nsingle ndose nin n50-100mL nof nNS nover n5 nminutes. nMay nrepeat none
ntime nin n15 nminutes, nif npain nis nstill na n5 nor nhigher. nDO nnot nadminister nIVP, nIO,
nIM, nIN
Respiratory nemergencies-Peds n#14120 n- ncorrect nanswers n-- nMaintain nairway nwith
nappropriate nadjuncts, nobtain nO2 nsat nroom nair nif npossible.
- nAdminister n2.5mg nAlbuterol nwith n0.5mg nof nAtrovent nnebulized nas nindicated.
nMay nrepeat nAlbuterol n2 ntimes nand nAtrovent n1x.
- nIf nno nresponse nto nAlbuterol nor nAtrovent, nconsider n0.01mg/kg nEpi n1:1000 nvia
nIM nno nto nexceed nadult ndosage nof n0.3mg. nObtain nvascular naccess nat nTKO nrate
- nIf nallergic nreaction nsuspected, nadminister n1mg/kg ndiphenhydramine nIV/IO, nnot
nto nexceed nadult ndose nof n25mg nIV nor n2mg/kg nIM nnot nto nexceed nadult ndose nof
n50mg nIM. nNeed norders nfor npatients n2 nyears nof nage nor nolder
- nIf napneic nand nunable nto nventilate, nconsider noral ntracheal nintubation nfor npatients
nwho nare ntaller nthan nthe nmaximum nlength nof na npediatric nemergency nmeasuring
, ntape nor nequivalent nmeasuring nfrom nthe ntop nof nthe nhead nto nthe nheel nof nthe
nfoot. nBHO nmay norder nadditional nmedications nor ninterventions
- nBase nhospital: nfor nsevere nasthma n/ nrespiratory ndistress nthat nhas nfailed nto nthe
nother nprevious ntreatments, nadminister n50 nmg/kg nof nMagnesium nSulfate nslow nIV
ndrip nover n20 nminutes. nDO nnot nexceed nadult ndosage nof n2gm ntotal. nDo nnot
nrepeat.
Allergic nreactions-Peds n#14140 n- ncorrect nanswers n-- nMaintain nairway nwith
nappropriate nadjuncts, nobtain nroom nair nsaturation nif npossible. nAdminister n2.5mg
nAlbuterol nnebulized, nmay nrepeat n2x. nCombine nwith n0.5mg nof nAtrovent. nOnly
ngive n1x.
- nIf nno nresponse nto nAlbuterol, nconsider n0.01mg/kg nof nEpi n1:1000 nIM, nnot nto
nexceed nadult ndose nof n0.3mg nIM
- nAdminister n1mg/kg nBenadryl nIV/IO nnot nto nexceed n25mg nIV nor n2mg/kg nIM, nnot
nto nexceed n50mg nIM
- nFor nsymptomatic nhypotension nwith npoor nperfusion, nconsider nfluid nbolus nof
n20ml/kg nof nNS, nnot nto nexceed n300 nmL nNS nand nrepeat nas nindicated.
- nEst nIV/IO naccess nif nindicated
- nFor nanaphylactic nshock n(no npalpable nradial npulse nand na ndepressed nLOC)
nadminister n0.01mg/kg nof nEpi n1:10000 nIV/IO, nno nmore nthan n0.1mg nper ndose.
nMay nrepeat nto nmaximum nof n0.5mg.
- nIf napneic nand nunable nto nventilate, nconsider noral ntracheal nintubation nfor npatients
nwho nare ntaller nthan nthe nmaximum nlength nof na npediatric nmeasuring ntape nor
nequivalent nmeasuring nfrom nthe ntop nof nthe nhead nto nthe nheel nof nthe nfoot.
Cardiac narrest-Peds n#14150 n- ncorrect nanswers n-- nHigh nquality nCPR nventilate n12-
20 nper nminute. nVentilation nrate ndecreases nas npatient nage nincreases. nObtain
nIV/IO naccess n(IO npreferred nif nunder n9)
- nFor ncontinued nsigns nof ninadequate ntissue nperfusion, nadminister nfluid nbolus nof
nNS. nReassess nafter neach nbolus. nMay nrepeat n2x nfor ncontinued nsigns nof
ninadequate ntissue nperfusion. n1-8 nyears: n20mL/kg nNS nand n9-14 nyears: n300mL
nNS
- nDetermine ncardiac nrhythm nand ndefibrillate nat n2J/kg n(or nmanufacturer
nrecommended nequivalent) nif nindicated. nAfter ndefibrillation, nimmediately nresume
nCPR, nbeginning na n2-minute ncycle.
- nUtilize nwaveform ncapno nfor nmonitoring nairway nand neffectiveness nof nchest
ncompressions nand nfor nearly nidentification nof nROSC. nDocument nwaveform nand
ncapno nnumber nin nePCR
- nET nintubation nis nadvanced nairway nof nchoice nfor npatients ntaller nthan nthe
nmaximum nlength nof npediatric nmeasuring ntape. nInsert nNG/OG ntube
- nV-fib/V-tach: nInitial nD-fib nat n2J/kg. nSecond nD-fib nat n4J/kg. nThird nand
nsubsequent ndefibrillation nattempts nshould nbe nadministered nat n10J/kg, nnot nto
nexceed nadult ndose. nAdminister n0.01mg/kg nEPI n1:10000 nevery n5 nminutes, nunless
ncapnography nindicates nROSC. nAfter n2 ncycles nof nCPR, nconsider nadministering
n1mg/kg nLidocaine nif nages n1-14, nmay nrepeat nafter n5 nminutes nat n0.5mg/kg, nto na
EXAM WITH COMPLETE SOLUTIONS
Burns-adult n#14070 n- ncorrect nanswers n-- nEstimate n% nTBSA nburned nand ndepth
nusing nrule nof nnines.
- nThermal nburns: nStop nburning nprocess. nDO nnot nbreak nblisters. nCover naffected
nbody nsurface nwith ndry, nsterile ndressing nor nsheet.
- nChemical nburns: nBrush noff ndry npowder, nif npresent. nRemove nany ncontaminated
nor nwet nclothing. nIrrigate nwith ncopious namounts nof nsaline nor nwater.
- nTar nburns: nCool nwith nwater, ndo nnot nremove ntar
- nElectrical nburns: nRemove nfrom nelectrical nsource n(without nendangering nself) nwith
nnonconductive nmaterial. nCover naffected nbody nsurface nwith ndry, nsterile ndressing
nor nsheet
- nEye ninvolvement: nContinuous nflushing nwith nNS nduring ntransport. nAllow npatient
nto nremove ncontact nlenses nif npossible
- nAdvanced nairway nas nclinically nindicated. nKing nairway nis ncontraindicated
- nIv naccess: nUnstable- nBP nless nthan n90 nand/or nsigns nand nsymptoms nof
ninadequate ntissue nperfusion, nstart n2nd nIV nline. nGive n250mL nboluses nand nrepeat
nto nmax nof n1L
,Stable- nBP nmore nthan n90 nand nsigns nof nadequate ntissue nperfusion, nadminister
n500ml/ nhr.
- nRespiratory ndistress: nUse nBVM nas nneeded. nContact nreceiving nhospital nASAP.
nAdminister nalbuterol nwith nAtrovent. nHigh nflow noxygen nIs nessential nwith nknown nor
npotential nrespiratory ninjury. nBeware nof nsmoke ninhalation. nDo nnot napply nice nwater
ndirectly nto nskin nsurfaces, nas nadditional ninjury nwill nresult. nIntubate npatient nif
nfacial/ noral nswelling nis npresent nor nif nrespiratory ndepression nor ndistress ndevelops
ndue nto ninhalation ninjury. nCPAP nmay nbe nconsidered nif nindicated nafter
nconsultation nwith nBH
- nTreat npain nwith nanalgesics nas nindicated
Pain nmanagement n#14100 n- ncorrect nanswers n-Patients nwith na nGCS nof n15 nor nat
nbaseline nmentation nand nhave na npain nscore nof n5 nor nhigher nand nhave: nacute
ntraumatic ninjuries, nacute nabdominal/ nflank npain, nburn ninjuries, ncancer npain, nor
nsickle ncell ncrisis
• nWhat ndrugs/dosages nare nused?
- nMust nalways nmonitor nand nassess nvital nsigns nprior nto nadministration nof nany
nanalgesic. nAfter nadministration nmust ncontinually nmonitor nEKG nand nplace non
ncapno. nReassess nvital nsigns, ncapno, nand npain nscores nevery n5 nminutes.
- nOnce na npain nmedication nhas nbeen nadministered nvia nroute nof nchoice, nchanging
nroute n(i.e. nIM nto nIV) nrequires nBHO.
- nShifting nfrom none nanalgesic nwhile ntreating na npatient nrequires nBHO
- nFor npain nand na nSBP nbelow n100, nadminister n0.3mg/kg nKetamine nIVPB nto na
nmax nsingle ndose nof n30 nmg. nMay nrepeat nonce nin n15 nminutes.
- nFor npain nand nan nSBP nabove n100, nadminister n50 nmcq nFetanyl nslow nIV/IO
npush nover n1 nminute. nMay nrepeat nevery n5 nminutes ntitrated nto npain nbut nnot nto
nexceed n200 nmcq nOR n100 nmcq nIM/IN. nMay nrepeat n50 nmcq nevery n10 nminutes
ntitrated nto npain, nnot nto nexceed n200 nmcq. nPeds ndose nis n0.5mcq/kg nslow nIV/IO
nover n1 nminute. nMay nrepeat nin n5 nmin ntitrated nto npain, nnot nto nexceed n100 nmcq
nOR n1 nmcq/kg nIM/IN, nmay nrepeat nevery n10 nminutes ntitrated nto npain nbut nnot nto
nexceed n200 nmcq. nCan nalso nuse n0.3mg/kg nof nKetamine nIVPB nto na nmax nof
n30mg nas na nsingle ndose nin n50-100mL nof nNS nover n5 nminutes. nMay nrepeat none
ntime nin n15 nminutes, nif npain nis nstill na n5 nor nhigher. nDO nnot nadminister nIVP, nIO,
nIM, nIN
Respiratory nemergencies-Peds n#14120 n- ncorrect nanswers n-- nMaintain nairway nwith
nappropriate nadjuncts, nobtain nO2 nsat nroom nair nif npossible.
- nAdminister n2.5mg nAlbuterol nwith n0.5mg nof nAtrovent nnebulized nas nindicated.
nMay nrepeat nAlbuterol n2 ntimes nand nAtrovent n1x.
- nIf nno nresponse nto nAlbuterol nor nAtrovent, nconsider n0.01mg/kg nEpi n1:1000 nvia
nIM nno nto nexceed nadult ndosage nof n0.3mg. nObtain nvascular naccess nat nTKO nrate
- nIf nallergic nreaction nsuspected, nadminister n1mg/kg ndiphenhydramine nIV/IO, nnot
nto nexceed nadult ndose nof n25mg nIV nor n2mg/kg nIM nnot nto nexceed nadult ndose nof
n50mg nIM. nNeed norders nfor npatients n2 nyears nof nage nor nolder
- nIf napneic nand nunable nto nventilate, nconsider noral ntracheal nintubation nfor npatients
nwho nare ntaller nthan nthe nmaximum nlength nof na npediatric nemergency nmeasuring
, ntape nor nequivalent nmeasuring nfrom nthe ntop nof nthe nhead nto nthe nheel nof nthe
nfoot. nBHO nmay norder nadditional nmedications nor ninterventions
- nBase nhospital: nfor nsevere nasthma n/ nrespiratory ndistress nthat nhas nfailed nto nthe
nother nprevious ntreatments, nadminister n50 nmg/kg nof nMagnesium nSulfate nslow nIV
ndrip nover n20 nminutes. nDO nnot nexceed nadult ndosage nof n2gm ntotal. nDo nnot
nrepeat.
Allergic nreactions-Peds n#14140 n- ncorrect nanswers n-- nMaintain nairway nwith
nappropriate nadjuncts, nobtain nroom nair nsaturation nif npossible. nAdminister n2.5mg
nAlbuterol nnebulized, nmay nrepeat n2x. nCombine nwith n0.5mg nof nAtrovent. nOnly
ngive n1x.
- nIf nno nresponse nto nAlbuterol, nconsider n0.01mg/kg nof nEpi n1:1000 nIM, nnot nto
nexceed nadult ndose nof n0.3mg nIM
- nAdminister n1mg/kg nBenadryl nIV/IO nnot nto nexceed n25mg nIV nor n2mg/kg nIM, nnot
nto nexceed n50mg nIM
- nFor nsymptomatic nhypotension nwith npoor nperfusion, nconsider nfluid nbolus nof
n20ml/kg nof nNS, nnot nto nexceed n300 nmL nNS nand nrepeat nas nindicated.
- nEst nIV/IO naccess nif nindicated
- nFor nanaphylactic nshock n(no npalpable nradial npulse nand na ndepressed nLOC)
nadminister n0.01mg/kg nof nEpi n1:10000 nIV/IO, nno nmore nthan n0.1mg nper ndose.
nMay nrepeat nto nmaximum nof n0.5mg.
- nIf napneic nand nunable nto nventilate, nconsider noral ntracheal nintubation nfor npatients
nwho nare ntaller nthan nthe nmaximum nlength nof na npediatric nmeasuring ntape nor
nequivalent nmeasuring nfrom nthe ntop nof nthe nhead nto nthe nheel nof nthe nfoot.
Cardiac narrest-Peds n#14150 n- ncorrect nanswers n-- nHigh nquality nCPR nventilate n12-
20 nper nminute. nVentilation nrate ndecreases nas npatient nage nincreases. nObtain
nIV/IO naccess n(IO npreferred nif nunder n9)
- nFor ncontinued nsigns nof ninadequate ntissue nperfusion, nadminister nfluid nbolus nof
nNS. nReassess nafter neach nbolus. nMay nrepeat n2x nfor ncontinued nsigns nof
ninadequate ntissue nperfusion. n1-8 nyears: n20mL/kg nNS nand n9-14 nyears: n300mL
nNS
- nDetermine ncardiac nrhythm nand ndefibrillate nat n2J/kg n(or nmanufacturer
nrecommended nequivalent) nif nindicated. nAfter ndefibrillation, nimmediately nresume
nCPR, nbeginning na n2-minute ncycle.
- nUtilize nwaveform ncapno nfor nmonitoring nairway nand neffectiveness nof nchest
ncompressions nand nfor nearly nidentification nof nROSC. nDocument nwaveform nand
ncapno nnumber nin nePCR
- nET nintubation nis nadvanced nairway nof nchoice nfor npatients ntaller nthan nthe
nmaximum nlength nof npediatric nmeasuring ntape. nInsert nNG/OG ntube
- nV-fib/V-tach: nInitial nD-fib nat n2J/kg. nSecond nD-fib nat n4J/kg. nThird nand
nsubsequent ndefibrillation nattempts nshould nbe nadministered nat n10J/kg, nnot nto
nexceed nadult ndose. nAdminister n0.01mg/kg nEPI n1:10000 nevery n5 nminutes, nunless
ncapnography nindicates nROSC. nAfter n2 ncycles nof nCPR, nconsider nadministering
n1mg/kg nLidocaine nif nages n1-14, nmay nrepeat nafter n5 nminutes nat n0.5mg/kg, nto na
