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`Crush Injury - CORRECT ANSWER: Crush Syndrome—is a reperfusion injury as a
result of traumatic rhabdomyalysis
Prolonged compression greater than four hours (i.e. Traumatic Crush patient trapped
waist deep in trench)
Suspicion of hyperkalemia
Treatment: Ref. 1273 Crush Injury/Crush Syndrome
Pain management:
Adult: 2-‐12 mg SIVP, titrate to pain relief
Pediatric: 0.1 mg/kg, SIVP (see Color Code Drug Doses/LACo Kids)
Normal Saline 20 mg/kg IV bolus Adult & Pediatric
Fluid resuscitation—hydrate prior to release of compressive force to minimize
hypovolemia and dilute cellular toxins
Albuterol
Adults: 5 mg via continuous mask nebulization
Pediatric: (see Color Code Drug Doses/LACo Kids)
Less than 1 y.o. - 2.5 mg
1 y.o. or older - 5.0 mg
Calcium Chloride
Adults: 1 gram SIVP over 1 min
Pediatrics: (see Color Code Drug Doses/LACo Kids)
20 mg/kg SIVP over 1 min, max single dose 500 mg
Sodium Bicarbonate
Adult: 1 mEq added to 1L NS, run IV wide open prior to extrication
,Pediatrics: (see Color Code Drug Doses/LACo Kids)
1 mEq added to 1L NS, administer 20 mL/kg IV
11-‐year-‐old female pt cuts her hand at the mall, she received first aid, she does not
want transport, what can/should you do? - CORRECT ANSWER: Treat and release. Not
required to AMA.
Ref. 832 Treatment/Transport of Minors
Procedures II.A—A minor child (excluding children ≤ 12 months of age who is evaluated
by EMS personnel and determined not to be injured, to have sustained only minor
injuries, or to have illnesss or injuries not requiring immediate tratment or transportation,
may be released to:
1. Self (consideration should be given to age, maturity, environment and other factors
that may be pertient to the situation)
Ref. 834 Patient Refusal of Treatment or Transport - Policy III.B—EMS personnel
should not require patients released at scene to sign the release (AMA) section of the
EMS Report Form, as this implies that the patient is at significant risk by not utilizing the
EMS system for treatment and/or transportation.
12 lead shows STEMI, pt goes unconscious en route to destination, transport patient
to? SRC is 15 min away, MAR is 5, SRC diversion due to STEMI 10min away, MAR
diversion. - CORRECT ANSWER: Ref. 513 Policy VI—In general, patients with a STEMI
12-‐lead ECG, (including hypotensive patients with signs and symptoms consistent with
cardiogenic shock) shall be transported to the most accessible open SRC if ground
transport is 30 minutes or less regardless of service area boundaries.
Ref. 513 Policy IX—The SRC may request diversion of STEMI patients for any of the
following conditions:
The hospital is unable to perform emergent percutaneous coronary intervention
because the cath lab staff is already fully committed to caring for STEMI patients in the
Cath lab. STEMI patients should be transported to the most accessible open SRC
regardless of ED diversion status.
The SRC experiences critical mechanical failure of essential cath lab equipment.
SRC is on diversion due to internal disaster.
, 2 min seizure treat and transport? - CORRECT ANSWER: Status Epilepticus - make
base contact
Active Seizures - Ref. LACo Drug Cards - Midazolam
Adult
2-‐5 mg SIVP at 1 mg/min; titrate IVP dose to suppress seizure activity, may repeat
dose every 3-‐5 min PRN
5 mg IM/IN, may repeat dose ONE time in 5 minutes
Maximum total dose 10 min
Pediatric
0.1 mg/kg SIVP at 1 mg/min, titrate IVP dose to suppress seizure activity
0.1 mg/kg IM/IN
May repeat IV/IM/IN dose ONE time PRN to a maximum total dose of 5 mg
28-‐year-‐old pt in active labor complaining of vaginal bleeding goes to? - CORRECT
ANSWER: Ref. 511 Policy I - Transport to the most accessible perinatal center
A. patients who appear to be in active labor, whether or not delivery appears imminent
808 Mandatory Base Contact: Pleuritic CP vs Isolated Hip Fx - CORRECT ANSWER:
Chest Pain or discomfort—Ref. 808 Section I - Base Hospital Contact Required
Pleuritic chest pain management? Treat as chest pain (Medina—there is no way you
can determine that it is pleuretic in the field)
Suspected isolated fracture of the hip—Ref. 808 Section II - Transport Required
814—downtime > 20 min = terminate resuscitation - CORRECT ANSWER: Ref. 814
Policy II.B—the base hospital physician may pronounce death with it is determined that
further resuscitative efforts are futile. Patients without ROSC after 20 minutes of
resuscitative efforts by EMS personnel should be considered candidates for termination
of resuscitation. Exceptions may include hypothermia or patients who remain in, or
whose rhythm changes to, ventricular fibrillation or pulseless ventricular tachycardia.