2025 Kern County Paramedic Protocols TEST no PEDS

Atropine for Organophosphate poisoning ADULT

Poisoning/Ingestion/Overdose (119) - Atropine for Organophosphate Poisoning, ADULT: If symptomatic organophosphate poisoning, administer Atropine 2 mg IV every 5 minutes as needed.

Atropine Doses - Bradycardias, ADULT:

Adult: 0.5mg - 1mg for Bradycardias

Do you give atropine for asystole?

No

Doses for Buprenorphine (Suboxone)?

16mg SL

Clinical Opiate Withdrawal Scale (COWS) score required for Buprenorphine administration

7 or higher.

Buprenorphine contraindications

- patient is under 16 years of age

- any methadone use with in the last 10 days

- altered mental status

- Sepsis

- Current intoxication or recent use of benzodiazepine

- COWS score of less than 7

What does the Red Tier indicate?

High Risk for Serious Injury

What is one criterion for all patients to be classified as Red Tier?

Unable to follow commands (motor GCS < 6)

What respiratory rate indicates a Red Tier classification for all patients?

RR < 10 or > 29 breaths/min

What condition related to breathing indicates a Red Tier classification for all patients?

Respiratory distress or need for respiratory support

What is the room-air pulse oximetry threshold for Red Tier classification?

Room-air pulse oximetry < 90%

What is the systolic blood pressure (SBP) threshold for children aged 0-9 years in Red Tier?

SBP < 70mm Hg + (2 x age years)

What is the SBP threshold for individuals aged 10-64 years in Red Tier?

SBP < 90 mmHg or HR > SBP

What is the SBP threshold for individuals aged 65 years and older in Red Tier?

SBP < 110 mmHg or HR > SBP

Red Tier Trauma:

Injury Patterns (2)

Penetrating injuries to head, neck, torso, and proximal extremities

• Skull deformity, suspected skull fracture

• Suspected spinal injury with new motor or sensory loss

• Chest wall instability, deformity, or suspected flail chest

• Suspected pelvic fracture

• Suspected fracture of two or more proximal long bones

• Crushed, de-gloved, mangled, or pulseless extremity

• Amputation proximal to wrist or ankle

• Active bleeding requiring a tourniquet or wound packing with continuous pressure

Red Tier trauma triage criteria for injuries in addition to burns shall be...

...transported to a Level I or II Trauma Center in accordance with Trauma Policies and Procedures.

Aspirin dose and contractions?

325mg and contraindications of aspirin which are GI bleed or allergy.

Ketamine dose and route ADULT:

IV - 15mg in 100mL N.S. infused over 5 minutes, may repeat one time in 15 minutes or

IN - 25mg, (after drawing up medication add NS to increase volume to 1mL total volume) may repeat one time in 15 minutes or

IM - 15mg - do not dilute. Repeat in 15 minutes prn X 1, maximum total dose 30mg.

KETAMINE Contraindications:

Age < 4 years, GCS 14 or less, Known or suspected alcohol or drug intoxication, Known or suspected pregnancy

Ketamine IN administration

The syringe must have a total of 1mL of fluid

Psych transport if pt has no other medical complaints?

KMC

Burns with trauma destination?

KMC (Trauma Center)

(Trauma Policies and Procedures: YELLOW TIER - "• Burns in conjunction with trauma")

How many minutes confirmed pulseless to not start cpr?

10 minutes

Needle decompression placement?

PEDS: 2nd intercostal space, mid-clavicular line for pediatric patients or

ADULT: 4th intercostal space, mid-axillary line for adult patients. The approved thoracic decompression device for adult is a 10-gauge IV needle with catheter at least 3.25 inches in length. Standard length 2-inch needle should be used for pediatric patients.

Heart rate when you start to see symptoms of tachycardia?

150 or greater

What type of stroke scale do we use?

Cincinnati Prehospital Stroke Scale (CPSS).

Cincinnati Prehospital Stroke Scale (CPSS) components

- Arm Drift,

- Facial Droop,

- Slurred (abnormal) Speech.

What is the push dose of epinephrine for adults?

0.5 mL every 1-5 minutes

What is the cardiac arrest dose of epinephrine for adults?

Epinephrine drip 2-8 mcg/min, starting at 8 mcg/min and titrating down to effect

What is the anaphylaxis dose of epinephrine for adults?

0.3 mg IM of 1:1000 to lateral thigh, may repeat after Benadryl is unsuccessful

What is the push dose of epinephrine for adults in anaphylaxis?

0.5 mL IVP every 1-5 minutes to maintain systolic B/P > 90

What is the epinephrine drip dose for adults in anaphylaxis?

2-8 mcg/min, starting at 2 mcg/min and titrating to effect

02 for CVA:

Apply O2 only if pulse ox <94% or signs of respiratory distress

Max dose for (NTG) nitroglycerin?

None if systolic BP is over 90mmHg

Does a child 0-9 years old automatically meet yellow tier criteria if unrestrained or not in a car seat?

Yes

Is a bougie mandatory if 1st intubation attempt?

Yes

Use a bougie if airway edema is present?

Yes

TCP (Transcutaneous Pacing) starts at...

80 bpm

Steps for Bradycardia

Set up TCP.

Consider atropine.

Consider push dose Epi

What is the first step in Transcutaneous Pacing (TCP)?

Acquire baseline rhythm strip

What premedication should be considered for conscious patients during TCP?

1 mg Midazolam ( Versed) and 50 mcg Fentanyl

Where should pacing electrodes be applied in TCP?

To clean, dry skin

What should the pacer rate be set at during TCP?

80

What is the procedure after activating the pacer in TCP?

Adjust current upward until electrical and mechanical capture is identified.

What is the typical capture threshold range in TCP?

50-90 mA

"Is nitro contraindicated 72 hours after taking sexual enhancing drugs?"

FALSE; 48hrs

Pain protocol and can you use more than one pain medication?

ONLY Acetaminophen IV can be used with Fentanyl, Ketamine, or Ketorolac if inadequate pain control with initial agent.

Calcium channel blocker overdose/ which medication is indicated?

1 gram of Calcium Chloride slow IV push for bradycardic and/or hypotensive patients

Referring to pain meds and Versed, what protocol can you give after intubating the patient?

Burns (108) ONLY.

What happens when you defibrillate someone with a pulse?

Resulting rhythm is likely VF

V-Tach on a Hypothermia patient

For a cardiac arrest patient in VF/VT who has a body temperature of <30oC (<86oF), a single defibrillation attempt is appropriate.

If the patient fails to respond to the initial defibrillation attempt, defer subsequent attempts and drug therapy until the core temperature rises above 30oC (86oF).

For patients in moderate hypothermia with a body temperature of 30oC to 34oC (86oF to 93.2oF), attempt defibrillation and give medications spaced at longer intervals (not specified in protocols).

V-FIB/Pulseless V-Tach (126)

Can you give pain medication to someone who cant verbally express pain?

YES: In the case of infants, children, or adults unable to verbally communicate where a painful situation may exist, vital signs should be assessed for elevations in respiratory rate and heart rate as indicators of pain.

Some one is seizing do you check sugar first or give medication?

Give medication and stop the seizure first.

Contraindication for nitro?

Suspected or known that the patient has taken sildenafil (Viagra) or vardenafil (Levitra) within the previous 24 hours or tadalafil (Cialis) within the previous 48 hours.

ALS: Systolic blood pressure less than 90 mm Hg or heart rate less than 50 beats per minute.

BLS: Systolic blood pressure is less than 100 mm Hg or heart rate less than 50 beats per minute.

BLS: Not prescribed to patient.

◦ Charcoal dose?

50 grams PO.

◦ Sexual assault hospital?

AHB (Adventist Health Bakersfield)

◦ Burn hospital?

BMH (Bakersfield Memorial Hospital)

◦ Torodol dose and administration routes?

• 15mg IV over 2 minutes OR

• a single dose of Ketorolac (Toradol) 15mg IM.

◦ You are inside a unit that has not moved and the pt is in blunt trauma cardiac arrest. What is the next step?

Wait for police to finish investigation and wait on scene for Coroner

Do we apply Spinal Motion Restriction (SMR) based on mechanism?

No

◦ What rhythm has a wide complex and is unstable?

"Assume it is VT until proven otherwise."

◦ Apgar score. What each letter is.

Appearance

Pulse

Grimace

Activity

Respiratory Effort

What is the first step in the CPAP protocol?

Support ABC's

What should be applied after supporting ABC's in the CPAP protocol?

Apply oxygen

What should be requested after applying oxygen in the CPAP protocol?

Request ALS or rapid transport to the appropriate facility

What age and GCS criteria must a patient meet for CPAP protocol?

Patient must be > 8 years old, GCS > 10, and able to follow commands with B/P > 90 systolic

Two of the following criteria indicating that indicate CPAP may be needed?

- Respiratory rate > 25,

- Retractions or accessory muscle use,

- SpO2 < 94%,

- Abnormal or diminished lung sounds

Contraindications for administering CPAP?

- Agonal respirations or apnea,

- Pneumothorax or penetrating chest trauma,

- Tracheostomy,

- Systolic B/P < 90,

- Aspiration risk (vomiting, epistaxis, facial trauma)

Ortho hospitals:

BMH, KMC, MERCY, MSW, AHB, AHD

Txa dose for hypovolemic shock.

2 gram administered slow IV push.

Can drugs be given down the tube

NAVEL so NO

◦ Hypothermia treatment and shocks.

A single defibrillation attempt is appropriate.

Which hospital do we take a patient with overdose and behavioral issues.

Closest/Most appropriate ED for medical clearance.

◦ Can we nasal tracheal intubate?

No

◦ Trauma Activation timetable:

10 Minutes

Severe Agitation (129) Entry Medication

• Administer Olanzapine (Zyprexa) 10 mg PO single dose for cooperative, anxious patients with behavioral health presentation and with a history of psychiatric disorder.

- Restraints may be utilized after medication administration.

What medication is administered for agitation control? (129)

Midazolam 5 mg IM/IN

What should be administered if there is no response to Midazolam after 5 minutes?

Droperidol 5 mg IM single dose

What is the maximum additional dose of Midazolam that can be repeated after 5 minutes if there is no response?

5 mg IM/IN

What is an indication for using Droperidol?

Severe agitation in patients who pose serious probable and imminent bodily harm to self or others.

What symptoms may indicate the need for Droperidol in agitated patients?

- Paranoia,

- disorientation,

- hyper-aggression,

- hallucination,

- tachycardia,

- diaphoresis,

- increased strength,

-hyperthermia.

Contraindications for use of Droperidol (Severe Agitation 129)

Hypersensitivity and Pediatrics

What age group falls under the adult category for intubation policy (203)?

Patients 14 years of age or older

What device is required for all intubation attempts (203)?

Tube introducers, aka: Bougie

What is required for all advanced airways for both ALS and BLS patients (203)?

End Tidal CO2 monitoring

How should BLS placed LMA Airways be confirmed?

With colorimetric End Tidal CO2 OR wave form Capnography

How should ALS placed LMA Airways or Endotracheal Tubes be confirmed?

With waveform End Tidal CO2 Capnography

What should be done in the event of equipment failure or persistent ETCO2 level less than 10?

A colorimetric device may be used to confirm placement

What should be done if both ETCO2 confirmation devices do not adequately confirm positioning?

The device SHALL be removed and BVM ventilation with adjuncts shall be used

What should be done with tubes that have persistent ETCO2 below 10?

They should be removed

What defines an intubation attempt?

Insertion of tube introducer and tube passed the teeth

Does the removal of foreign bodies count as an intubation attempt?

No

the paramedic is authorized during interfacility patient transfers to provide the

following:

1. Monitor and administer paramedic scope of practice medications through pre-existing vascular access including and limited to peripheral venous and central venous IV access where no special procedures out of paramedic scope of practice are required.

2. Monitor arterial vascular access lines, not for use in the administration of vascular fluids or medications.

3. Monitor pre-existing thoracostomy tubes.

4. Monitor vascular infusion of IV solution containing Potassium Chloride with concentration equal to or less than 40 mEq, per liter of IV solution.

5. Monitor naso-gastric infusions.

Medical Extremis Criteria: Extremis criteria shall include any one of the following:

• Unmanageable airway or respiratory arrest

• Uncontrolled hemorrhage with signs of hypovolemic shock

• Cardiopulmonary arrest

• Unconscious, unresponsive (BLS UNIT ONLY)

Trauma Extremis Criteria: Trauma EXTREMIS CRITERIA shall include any of the following:

• Traumatic arrest

• Unmanageable airway or inability to ventilate

Emergent Medical Pediatric Criteria are defined as:

• Cardiac dysrhythmia

• Evidence of poor perfusion

• Severe respiratory distress

• Cyanosis

• Persistent altered mental status

• Status Epilepticus

• Brief Resolved Unexplained Event in less than one (1) year of age.

What is the criteria for transporting patients with burns greater than 10% total body surface area?

Patients with partial thickness (2°) or full thickness (3°) burns that are more than ten percent (10%) total body surface area should be transported directly to the closest most appropriate Burn Center.

(All Provider Protocols; DESTINATION DECISION SUMMARY)

What should be done for patients with circumferential burns?

Patients with partial thickness (2°) or full thickness (3°) circumferential burns of any part should be transported directly to the closest most appropriate Burn Center.

(All Provider Protocols; DESTINATION DECISION SUMMARY)

What is the protocol for burns to critical areas?

Patients with partial thickness (2°) or full thickness (3°) burns to the face, hands, feet, major joints, perineum, or genitals should be transported directly to the closest most appropriate Burn Center.

(All Provider Protocols; DESTINATION DECISION SUMMARY)

What is the voltage threshold for electrical burns requiring transport to a Burn Center?

Voltage greater than 120 volts

(All Provider Protocols; DESTINATION DECISION SUMMARY)