ICEMA PROTOCOL STUDY GUIDE
QUESTIONS WITH CORRECT ANSWERS
Burns-adult #14070 - CORRECT ANSWER✔✔-- Estimate % TBSA burned and depth
| | | | | | | | | |
using rule of nines.
| | | |
- Thermal burns: Stop burning process. DO not break blisters. Cover affected body
| | | | | | | | | | | |
|surface with dry, sterile dressing or sheet.
| | | | | |
- Chemical burns: Brush off dry powder, if present. Remove any contaminated or
| | | | | | | | | | | | |
wet clothing. Irrigate with copious amounts of saline or water.
| | | | | | | | |
- Tar burns: Cool with water, do not remove tar
| | | | | | | | |
- Electrical burns: Remove from electrical source (without endangering self) with
| | | | | | | | | | |
nonconductive material. Cover affected body surface with dry, sterile dressing or
| | | | | | | | | | |
sheet
- Eye involvement: Continuous flushing with NS during transport. Allow patient to
| | | | | | | | | | | |
remove contact lenses if possible
| | | |
- Advanced airway as clinically indicated. King airway is contraindicated
| | | | | | | | |
- Iv access: Unstable- BP less than 90 and/or signs and symptoms of inadequate
| | | | | | | | | | | | | |
tissue perfusion, start 2nd IV line. Give 250mL boluses and repeat to max of 1L
| | | | | | | | | | | | | |
Stable- BP more than 90 and signs of adequate tissue perfusion, administer
| | | | | | | | | | | |
500ml/ hr. |
- Respiratory distress: Use BVM as needed. Contact receiving hospital ASAP.
| | | | | | | | | | |
Administer albuterol with Atrovent. High flow oxygen Is essential with known or
| | | | | | | | | | | |
potential respiratory injury. Beware of smoke inhalation. Do not apply ice water
| | | | | | | | | | | |
directly to skin surfaces, as additional injury will result. Intubate patient if facial/
| | | | | | | | | | | | |
oral swelling is present or if respiratory depression or distress develops due to
| | | | | | | | | | | | |
inhalation injury. CPAP may be considered if indicated after consultation with BH
| | | | | | | | | | |
,- Treat pain with analgesics as indicated
| | | | | |
Pain management #14100 - CORRECT ANSWER✔✔-Patients with a GCS of 15 or
| | | | | | | | | | | |
at baseline mentation and have a pain score of 5 or higher and have: acute
| | | | | | | | | | | | | | |
traumatic injuries, acute abdominal/ flank pain, burn injuries, cancer pain, or
| | | | | | | | | | |
sickle cell crisis | |
• What drugs/dosages are used?
| | | |
- Must always monitor and assess vital signs prior to administration of any
| | | | | | | | | | | | |
analgesic. After administration must continually monitor EKG and place on capno.
| | | | | | | | | |
|Reassess vital signs, capno, and pain scores every 5 minutes.
| | | | | | | | |
- Once a pain medication has been administered via route of choice, changing
| | | | | | | | | | | | |
route (i.e. IM to IV) requires BHO.
| | | | | |
- Shifting from one analgesic while treating a patient requires BHO
| | | | | | | | | |
- For pain and a SBP below 100, administer 0.3mg/kg Ketamine IVPB to a max
| | | | | | | | | | | | | | |
single dose of 30 mg. May repeat once in 15 minutes.
| | | | | | | | | |
- For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/IO push over
| | | | | | | | | | | | | | | |
1 minute. May repeat every 5 minutes titrated to pain but not to exceed 200 mcq
| | | | | | | | | | | | | | |
|OR 100 mcq IM/IN. May repeat 50 mcq every 10 minutes titrated to pain, not to
| | | | | | | | | | | | | | | |
exceed 200 mcq. Peds dose is 0.5mcq/kg slow IV/IO over 1 minute. May repeat in
| | | | | | | | | | | | | |
|5 min titrated to pain, not to exceed 100 mcq OR 1 mcq/kg IM/IN, may repeat
| | | | | | | | | | | | | | | |
every 10 minutes titrated to pain but not to exceed 200 mcq. Can also use
| | | | | | | | | | | | | | |
0.3mg/kg of Ketamine IVPB to a max of 30mg as a single dose in 50-100mL of NS
| | | | | | | | | | | | | | | | |
over 5 minutes. May repeat one time in 15 minutes, if pain is still a 5 or higher.
| | | | | | | | | | | | | | | | | |
DO not administer IVP, IO, IM, IN
| | | | | |
Respiratory emergencies-Peds #14120 - CORRECT ANSWER✔✔-- Maintain airway
| | | | | | | |
with appropriate adjuncts, obtain O2 sat room air if possible.
| | | | | | | | |
, - Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as indicated. May
| | | | | | | | | | | |
repeat Albuterol 2 times and Atrovent 1x.
| | | | | |
- If no response to Albuterol or Atrovent, consider 0.01mg/kg Epi 1:1000 via IM
| | | | | | | | | | | | | |
no to exceed adult dosage of 0.3mg. Obtain vascular access at TKO rate
| | | | | | | | | | | |
- If allergic reaction suspected, administer 1mg/kg diphenhydramine IV/IO, not to
| | | | | | | | | | |
exceed adult dose of 25mg IV or 2mg/kg IM not to exceed adult dose of 50mg
| | | | | | | | | | | | | | | |
IM. Need orders for patients 2 years of age or older
| | | | | | | | | |
- If apneic and unable to ventilate, consider oral tracheal intubation for patients
| | | | | | | | | | | | |
who are taller than the maximum length of a pediatric emergency measuring
| | | | | | | | | | | |
tape or equivalent measuring from the top of the head to the heel of the foot.
| | | | | | | | | | | | | | | |
BHO may order additional medications or interventions
| | | | | |
- Base hospital: for severe asthma / respiratory distress that has failed to the
| | | | | | | | | | | | | |
other previous treatments, administer 50 mg/kg of Magnesium Sulfate slow IV
| | | | | | | | | | |
drip over 20 minutes. DO not exceed adult dosage of 2gm total. Do not repeat.
| | | | | | | | | | | | | |
Allergic reactions-Peds #14140 - CORRECT ANSWER✔✔-- Maintain airway with
| | | | | | | | |
appropriate adjuncts, obtain room air saturation if possible. Administer 2.5mg
| | | | | | | | | |
Albuterol nebulized, may repeat 2x. Combine with 0.5mg of Atrovent. Only give
| | | | | | | | | | | |
1x.
- If no response to Albuterol, consider 0.01mg/kg of Epi 1:1000 IM, not to exceed
| | | | | | | | | | | | | | |
adult dose of 0.3mg IM
| | | |
- Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/kg IM, not to
| | | | | | | | | | | | | | |
exceed 50mg IM | |
- For symptomatic hypotension with poor perfusion, consider fluid bolus of
| | | | | | | | | | |
20ml/kg of NS, not to exceed 300 mL NS and repeat as indicated.
| | | | | | | | | | | |
- Est IV/IO access if indicated
| | | | |
QUESTIONS WITH CORRECT ANSWERS
Burns-adult #14070 - CORRECT ANSWER✔✔-- Estimate % TBSA burned and depth
| | | | | | | | | |
using rule of nines.
| | | |
- Thermal burns: Stop burning process. DO not break blisters. Cover affected body
| | | | | | | | | | | |
|surface with dry, sterile dressing or sheet.
| | | | | |
- Chemical burns: Brush off dry powder, if present. Remove any contaminated or
| | | | | | | | | | | | |
wet clothing. Irrigate with copious amounts of saline or water.
| | | | | | | | |
- Tar burns: Cool with water, do not remove tar
| | | | | | | | |
- Electrical burns: Remove from electrical source (without endangering self) with
| | | | | | | | | | |
nonconductive material. Cover affected body surface with dry, sterile dressing or
| | | | | | | | | | |
sheet
- Eye involvement: Continuous flushing with NS during transport. Allow patient to
| | | | | | | | | | | |
remove contact lenses if possible
| | | |
- Advanced airway as clinically indicated. King airway is contraindicated
| | | | | | | | |
- Iv access: Unstable- BP less than 90 and/or signs and symptoms of inadequate
| | | | | | | | | | | | | |
tissue perfusion, start 2nd IV line. Give 250mL boluses and repeat to max of 1L
| | | | | | | | | | | | | |
Stable- BP more than 90 and signs of adequate tissue perfusion, administer
| | | | | | | | | | | |
500ml/ hr. |
- Respiratory distress: Use BVM as needed. Contact receiving hospital ASAP.
| | | | | | | | | | |
Administer albuterol with Atrovent. High flow oxygen Is essential with known or
| | | | | | | | | | | |
potential respiratory injury. Beware of smoke inhalation. Do not apply ice water
| | | | | | | | | | | |
directly to skin surfaces, as additional injury will result. Intubate patient if facial/
| | | | | | | | | | | | |
oral swelling is present or if respiratory depression or distress develops due to
| | | | | | | | | | | | |
inhalation injury. CPAP may be considered if indicated after consultation with BH
| | | | | | | | | | |
,- Treat pain with analgesics as indicated
| | | | | |
Pain management #14100 - CORRECT ANSWER✔✔-Patients with a GCS of 15 or
| | | | | | | | | | | |
at baseline mentation and have a pain score of 5 or higher and have: acute
| | | | | | | | | | | | | | |
traumatic injuries, acute abdominal/ flank pain, burn injuries, cancer pain, or
| | | | | | | | | | |
sickle cell crisis | |
• What drugs/dosages are used?
| | | |
- Must always monitor and assess vital signs prior to administration of any
| | | | | | | | | | | | |
analgesic. After administration must continually monitor EKG and place on capno.
| | | | | | | | | |
|Reassess vital signs, capno, and pain scores every 5 minutes.
| | | | | | | | |
- Once a pain medication has been administered via route of choice, changing
| | | | | | | | | | | | |
route (i.e. IM to IV) requires BHO.
| | | | | |
- Shifting from one analgesic while treating a patient requires BHO
| | | | | | | | | |
- For pain and a SBP below 100, administer 0.3mg/kg Ketamine IVPB to a max
| | | | | | | | | | | | | | |
single dose of 30 mg. May repeat once in 15 minutes.
| | | | | | | | | |
- For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/IO push over
| | | | | | | | | | | | | | | |
1 minute. May repeat every 5 minutes titrated to pain but not to exceed 200 mcq
| | | | | | | | | | | | | | |
|OR 100 mcq IM/IN. May repeat 50 mcq every 10 minutes titrated to pain, not to
| | | | | | | | | | | | | | | |
exceed 200 mcq. Peds dose is 0.5mcq/kg slow IV/IO over 1 minute. May repeat in
| | | | | | | | | | | | | |
|5 min titrated to pain, not to exceed 100 mcq OR 1 mcq/kg IM/IN, may repeat
| | | | | | | | | | | | | | | |
every 10 minutes titrated to pain but not to exceed 200 mcq. Can also use
| | | | | | | | | | | | | | |
0.3mg/kg of Ketamine IVPB to a max of 30mg as a single dose in 50-100mL of NS
| | | | | | | | | | | | | | | | |
over 5 minutes. May repeat one time in 15 minutes, if pain is still a 5 or higher.
| | | | | | | | | | | | | | | | | |
DO not administer IVP, IO, IM, IN
| | | | | |
Respiratory emergencies-Peds #14120 - CORRECT ANSWER✔✔-- Maintain airway
| | | | | | | |
with appropriate adjuncts, obtain O2 sat room air if possible.
| | | | | | | | |
, - Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as indicated. May
| | | | | | | | | | | |
repeat Albuterol 2 times and Atrovent 1x.
| | | | | |
- If no response to Albuterol or Atrovent, consider 0.01mg/kg Epi 1:1000 via IM
| | | | | | | | | | | | | |
no to exceed adult dosage of 0.3mg. Obtain vascular access at TKO rate
| | | | | | | | | | | |
- If allergic reaction suspected, administer 1mg/kg diphenhydramine IV/IO, not to
| | | | | | | | | | |
exceed adult dose of 25mg IV or 2mg/kg IM not to exceed adult dose of 50mg
| | | | | | | | | | | | | | | |
IM. Need orders for patients 2 years of age or older
| | | | | | | | | |
- If apneic and unable to ventilate, consider oral tracheal intubation for patients
| | | | | | | | | | | | |
who are taller than the maximum length of a pediatric emergency measuring
| | | | | | | | | | | |
tape or equivalent measuring from the top of the head to the heel of the foot.
| | | | | | | | | | | | | | | |
BHO may order additional medications or interventions
| | | | | |
- Base hospital: for severe asthma / respiratory distress that has failed to the
| | | | | | | | | | | | | |
other previous treatments, administer 50 mg/kg of Magnesium Sulfate slow IV
| | | | | | | | | | |
drip over 20 minutes. DO not exceed adult dosage of 2gm total. Do not repeat.
| | | | | | | | | | | | | |
Allergic reactions-Peds #14140 - CORRECT ANSWER✔✔-- Maintain airway with
| | | | | | | | |
appropriate adjuncts, obtain room air saturation if possible. Administer 2.5mg
| | | | | | | | | |
Albuterol nebulized, may repeat 2x. Combine with 0.5mg of Atrovent. Only give
| | | | | | | | | | | |
1x.
- If no response to Albuterol, consider 0.01mg/kg of Epi 1:1000 IM, not to exceed
| | | | | | | | | | | | | | |
adult dose of 0.3mg IM
| | | |
- Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/kg IM, not to
| | | | | | | | | | | | | | |
exceed 50mg IM | |
- For symptomatic hypotension with poor perfusion, consider fluid bolus of
| | | | | | | | | | |
20ml/kg of NS, not to exceed 300 mL NS and repeat as indicated.
| | | | | | | | | | | |
- Est IV/IO access if indicated
| | | | |
