SIUH EMS Online CME. Test Score Percentage REMAC NYS Refresher Credits

Transcription

1 SIUH EMS Online CME Welcome to the LAST Staten Island University Hospital EMS Online CME. AFTER THIS MONTH S CME IS POSTED, THE SIUH ONLINE CME PROGRAM WILL BE ON HIATUS. Instructions: 1) In order to get CME for the following online activity, you must read through and answer the questions for the following case. a. Your CME credits earned will be detailed on the attestation form mailed to you after each case closes b. REMAC CME and NYS Refresher CME credit hours are granted based on test performance 2) After reviewing the case, please fill in the necessary demographics on the online answer sheet and key in your answers. Your submission will be time-stamped and saved immediately. Test Score Percentage REMAC NYS Refresher Credits Credits 10/10 100% 2 credit hours 1 credit hours 9/10 90% 2 credit hours 1 credit hours 8/10 80% 1 credit hour 0.5 credit hours 7/10 70% 1 credit hour 0.5 credit hours Notes: These case-based Online CME exercises are approved for NYS Paramedic Refresher program. A NYS CIC performs an independent review of the content and declares the amounts of credits that are allocated. The delivered CME form at the end of the month will reflect the number of hours you may apply per topic found on DOH-Form 4231 (06/12). The deadline for submission is 12/31/2016. If your answers are not recorded by then it will not be counted. You will receive your CME Certificate by . Please type your address into the online submission form to facilitate delivery. Some of the references for the following examination: o AAOS Emergency Care and Transportation of the Sick and Injured (aka The Orange Book ) 10 th Edition Jones & Bartlett Publishers. o o Good luck! --PJB NYC REMSCO Protocols Current peer-reviewed EMS literature such as Prehospital Emergency Care and Annals of Emergency Medicine Paul Barbara, MD FACEP Assistant Director, Division of Emergency Medical Services Staten Island University Hospital // Northwell Health pbarbara@northwell.edu

2 Case You are dispatched to an ALTMEN for a 28-year-old male in a fitness center. Upon arrival, the fitness staff directs you to the patient s location, which is the men s locker room. The patient has secured himself in the changing stall and has refused to come out on his own. Several gym members saw him acting odd and notified the staff, leading to the 911 call. You and your partner hear a loud commotion behind the door. They advise you that he is new to the gym and has been very active with his workout regime. Your BSI is adequate and you are the only crew on scene. 1. Your priority in this case is: a. To immediately assess the patient for life-threatening illnesses b. To determine the underlying reason for the situation c. To make sure your equipment does not get damaged d. The safety of you and your partner Another gym member arrives and admits knowing the patient outside the gym. He has no medical conditions but remembers him having been both a gambler and an alcohol abuser in years past. The patient had gone through a program and is now evidently working out to improve his health. The friend states the patient is easily addicted to stuff in the past. You enter the locker room and see the patient he is visibly sweating, pacing around in the area. He seems agitated and hyper-vigilant. You are not able to obtain vital signs. From gross inspection you see his pupils are large, ocular muscles moving in synchrony, his respiratory rate is approximately 20. He is moving all four extremities and walking with normal coordination. He is shouting and conversing with people who you do not see in the locker room, having a conversation without any responses returning. 2. Which of the following is not a likely cause of acute delirium in this patient? a. Substance abuse b. Substance withdrawal c. Severe sepsis d. Intracranial hemorrhage 3. Which of the following toxidromes best describes this patient? a. Sedative-hypnotic b. Anticholinergic c. Sympathomimetic d. Cholinergic

3 4. What is the significance of the conversation he is having without evidence of responses? a. He s yelling at the gym members who notified the staff b. He is hallucinating; this is more evidence of an excited delirium c. He is probably blowing off steam d. This cannot be due to exogenous substances Law enforcement arrives to assist you with the patient. They are present to protect you in the area with the dangerous patient. You notice a small pouch on the bench behind the patient with exposed syringes and an unlabeled medication bottle. 5. What is the term for this type of collaborative care allowing EMS to focus on patient care in a tactical environment? a. Force protection b. Forced entrance c. Cold Zone Care d. Care Under Fire With the law enforcement providers present, you approach the patient. He is not exhibiting behavior dangerous to those around him presently. 6. What is the first step in managing this patient? a. Verbal de-escalation techniques b. Physical restraint c. Intramuscular benzodiazepines by medical control option d. Questioning the patient s social history including substances of abuse While calmly discussing with the patient, he ignores the conversation you are making and begins acting in a dangerous manner to those around him, including you and the law enforcement providers. You estimate the patient s weight at approximately 90 kg. You make the decision to provide chemical sedation under the Excited Delirium protocol and administer midazolam 10 mg intramuscularly under standing orders. The medication is provided safely in his right thigh while the patient is softly restrained at each limb. 7. What is not an adverse effect of benzodiazepines? a. Hypotension b. Hypoxia c. Somnolence d. All of the above can be adverse effects of benzodiazepines The patient becomes sedated after approximately 5 minutes and is again safe to approach. Your partner obtains vital signs as following:

4 BP 140/90 HR 110 RR 22 SpO2 98% RA An IV heplock is placed with NS bolus infusion according to protocol. The monitor is placed on the patient and you receive the following rhythm strip: 8. What EKG abnormality associated with substance abuse and/or medication interactions is evident on this rhythm strip? a. U-waves b. Prolonged QT c. T wave inversions d. Multifocal atrial tachycardia The patient has been removed to the transport vehicle and law enforcement will accompany you to the destination facility. He begins to arouse as evidenced by an increased heart rate on the monitor. He is immediately uncomfortable with his surroundings and appears increasingly paranoid by law enforcement s presence in the ambulance. He begins to accuse you and the fitness center staff of stealing his gear in an attempt to get bigger than him. His mood is severely agitated and he begins to become physically violent. His heplock has become dislodged and so no IV access is present. Your partner stops the vehicle in a safe position and enters the cabin from the side door. He makes a call to Online Medical Control for orders. You have all medications in the REMAC formulary at your discretion. 9. Which of the following is not an available option for this patient by MCO under NYC REMAC protocol 530? a. Ketamine 150 mg IN b. Midazolam 5 mg IN c. Ketamine 400 mg IM d. Lorazepam 4 mg IM

5 10. Ketamine has emerged as a widely used medication for agitated patients in the prehospital setting. Emergence reactions and concern for use in psychiatric patients has been well documented. However, higher weight-based doses have been shown to have which specific adverse effect? a. Laryngospasm b. Rash c. Renal hemorrhage d. Complete heart block Online Medical Control authorizes additional sedative medications to facilitate a safe disposition to the closest 911-receiving facility. After administration, your partner begins driving again and you soon arrive at the destination facility. Your provision of a pre-arrival notification allows the ED team to have time to set a room for you and the patient is promptly dispositioned in a resuscitation room for further management.