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ICEMA PROTOCOL STUDY GUIDE
Questions with Detailed Verified Answers
Burns-adult #14070 Ans: - 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
, Page | 2
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 Ans: 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.
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- 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 Ans: - 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.
ICEMA PROTOCOL STUDY GUIDE
Questions with Detailed Verified Answers
Burns-adult #14070 Ans: - 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
, Page | 2
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 Ans: 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.
, Page | 3
- 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 Ans: - 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.
