LACoFD Accreditation Study Guide

When should treatment of suspected crush syndrome during management of an entrapped patient?

As soon as possible while the victim is entrapped.

You are managing a pt w/ a dystonic reaction and have made base contact. The MAR is on diversion due to ED saturation. In addition to the diversion status of nearby facilities, what will determine the destination?

Driving time including traffic conditions.

You arrive on scene of a 52 yr old female complaining of SOB and a productive cough. She is awake and alert; BP 154/88 and regular; R 22 w/ decreased tidal volume. Lung sounds reveal rhonchi. What is the best provider impression?

Respiratory Distress / other

A 46 yr old male fell to the sidewalk and sustained a laceration to the forehead. Bleeding is controlled by applying pressure. A strong odor of alcohol is detected and he cannot state his name or present location. Where should you transport the patient?

The nearest trauma center, ETA - 25 minutes

What is your responsibility in cases where you suspect child abuse?

You must provide verbal notifications to a child protective service agency as soon as possible .

You respond to a school and find an unidentified child who is unconscious on a playground after a fall. When can you begin treatment?

Immediately and without obtaining consent for treatment

You have just delivered a full term newborn in the field. You dry and stimulate the infant. Respirations and crying are present, the trunk is pink but the extremities are blue. What should you do next?

Reassess heart rate in 30 seconds

Paramedics are transporting a 21 year old male acutely intoxicated w/ alcohol. He is intermittently sonorous with associated hypoxia, which resolves upon stimulation. What is the first step you should take to address the patient's intermittent hypoxia?

Place a nasopharyngeal airway.

A G3P2 27 year old female is being assisted at home by paramedics with an imminent delivery. During birth, the baby's anterior shoulder becomes stuck and the child is unable to deliver spontaneously. What should be performed next?

Hyperflex mother's legs tightly toward abdomen

A 25 year old pt who is 9 months pregnant and is in full arrest should be transported to which of the following facilities?

The most accessible receiving hospital.

Where should you transport a 26 yr old male who has sustained 2nd & 3rd degree thermal burns to his face, neck and chest?

The MAR, 5 mins away.

Among the restraint methods authorized by LA County EMS protocols, what is the safest way to restrain an agitated violent patient?

Metal handcuffs accompanied by police officer

What is the correct anatomical location for needle thoracostomy?

Anterior axillary line, 4th intercostal space.

You are treating a 66-year old with a history of diabetes, hypertension, and "heart problems". On arrival you note that the pt is in moderate respiratory distress with tachypnea and tachycardia. You auscultate wheezes in the upper lung fields and diminished breath sounds in the bases. You note lower extremity edema bilaterally to the mid-thigh and JVD. What field treatment should you provide immediately to reduce the patient's Lillie hood of intubation at the hospital?

CPAP

What is the target SPO2 for pts with COPD?

88-92%

What additional assessment must you perform in order to declare death in a pt with rigor mortis

Auscultate no apical pulse for 60 seconds

A patient demonstration confusion, diaphoresis, and agitation is approached by paramedics and is unable to be verbally de-escalated. After the patient is medicated on scene, he is placed on a cardiac monitor, able to be calmed and found to have a heart rate of 172 with a QTc of 540. What medication should be considered with base hospital involvement?

Sodium Bicarbonate

You perform resuscitation on a patient with out-of-hospital cardiac arrest for 25 minutes. The arrest was unwitnessed and the first rhythm was PEA. The patient has a return of spontaneous circulation and the ECG shows sinus bradycardia without STEMI. You have secured the airway. The patient's blood pressure is currently 60/30. What is the next priority in managing this patient?

Addressing the pts abnormal vital signs

What is required in order to report child or elder abuse?

A reasonable suspicion that abuse has occurred.

You have determined that a patient who has declined transport does not require emergency treatment or transport. What must you do prior to release of the patient at the scene?

Inform the patient that they should seek care with their provider.

In a 56-year-old male you get ROSC, BP 68/38. NS 250ml is given, then RALES heard bilaterally. BP now 72/40. What should be administered?

Push-dose-epi

Firefighter inhaled toxic gasses at fatality fire what do you do?

Administer O2

How much fentanyl can be given in the field for an isolated extremity fracture?

150mcg

39 week pregnant female with vaginal bleeding. What is most appropriate provider

impression and where do we transport?

Pregnancy complications - perinatal center

Adult male mid 50s chest pain, 12 lead showed STEMI. PT arrests on scene, you have done

30 minutes of CPR with no ROSC. Base physician orders transport. What is the most appropriate

facility for transport?

STEMI center open to STEMI 15 mins away

4 year old male fell off the top of a jungle gym and sustained isolated extremity fracture, BP

78/40. Where do we transport?

PTC

Very pregnant mother in active labor, water broke. Upon examination you see the umbilical

cord presenting and not pulsating. What do you do first?

D. Displace the presenting body part until pulse is felt and transport in that position.

Cardiac arrest with refractory V-fib, how long do we attempt resuscitation?

40 mins

Responding to a SNF you find an elderly patient pulseless and apneic with a properly signed

POLST. Sec A shows DNR, sec B shows FULL TREATMENT. How do you proceed?

Withhold resuscitation per the patients wishes.

Adult male burned 40% of his body. What is the most appropriate facility for transport?

Trauma center / burn center

Adult patient, warm, tachycardic, sweating, saying inappropriate things, is not violent but will not follow commands. What do we do?

Midazolam

15 year old male with GSW to anterior chest. What is the most appropriate facility for transport?

Trauma center

Six-year-old in Cardiac arrest, patient's mother on scene request that you withhold resuscitation due to terminal illness, how do you proceed?

Honor the mother's wishes and withhold resuscitation.

What is the maximum allowable transport time to an approved Primary Stroke Center (PSC) bypassing the MAR?

30 mins

Adult male found altered unconscious with blood glucose level 14. You have already

established IV access and given 250ml Dextrose 10% with patients blood glucose level

improving to 50. What do you do?

Administer an additional 250 ml dextrose 10%

You respond to an 11 year old female at the mall EMT station with a cut finger. Bleeding is

controlled and she does not want transport. Her 15 year old friend is there at the mall with her.

When can you release this patient?

Release to herself

Adult female patient with chest pain, sister is cardiologist on scene and wants patient to be

transported to specific hospital. How do you proceed?

Transport to the requested hospital since they have assumed care.

You have initiated CPR on a diabetic cardiac arrest patient. You have obtained IV access and

blood sugar is 20, what drug do you administer first?

Epinephrine IV

6 year old male in T-bone TC with right sided chest pain and difficulty breathing. Absent

lung sounds on right side. Vitals as follows: BP108/60, P110, RR20, SPo296%. What is your

intervention?

Give O2

10 month old BRUE where do you transport?

PMC (If less than 30 minutes)

COPD patient already treating with Albuterol still in extreme respiratory distress, SPo2 92%,

other vitals slightly elevated. What is your next treatment?

CPAP

For stroke patients which assessment/intervention is going to be most important in

determining if patient qualifies for thrombolytics?

LKWT

2 year old male with fever, lethargic, only responds when stimulated, decent vitals, what is

your next assessment?

Give fluids and reassess

Kid broke through a window found in full arrest, significant bleeding from leg pool of blood

on ground. What is your first intervention?

Tourniquet

75 year old woman, ALOC, poor responsiveness which is a change from her normal baseline mental status. Skin is hot to touch, she's tachycardic at 126, tachypneic 28, 200/70, 90% on RA, she has rales on her right lung exam only, GCS of 13 what is your primary and secondary provider impression?

Sepsis - ALOC

Meth user with infected arm, BP 80 systolic, A/ox3 all other vitals look good, used meth one

hour prior, wants to AMA because he has court the next day and assures you he will follow up

with his primary care physician after that. How do you proceed?

AMA

What type of abuse are you mandated to report?

Dependent adult

3 yr old playing outside..... severe diff breathing and swollen lips what do you give?

Epi IM