2024 REMS Clinical Guidelines Practice Exam with Answers (190 Solved Questions)

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REMS Clinical GuidelinesQuestions2024Student Health Services-713-348-4966Send burns to:-Memorial HermannSend chemical exposures to:-Memorial HermannSend dental emergencies to:-hospital-based emergency departmentSend eye injury/condition to:-hospital-based emergency departmentSend psych to:--Ben Taub-Methodist(inpatient care)Send sexual assault to:--Ben Taub: SANE-TCH or Hermann for pedsPeds pads are used on:-pt less than 8 or under 25 kg5 rights of med administration--patient-route-dose-time-medicationContraindications of IV access--risk of introducing infection-distal to a fracture-underlying cellulitis/abscess-same extremity as AV fistula in ESRD pt-upper extremities of pt w/ axillary node removalWhen to stop attempting IV-after 2 min or 2 triesContraindications to IO--can't locate anatomical landmarks-suspected cellulitis at insertion site

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-suspected acute or non-healed fracture proximal to foot in same leg orproximal to forearm in same arm-suspected total knee arthroplasty/replacement-poor circulation extremityIO: Pink needle-15 mm for 3-39 kgIO: Blue needle-25 mm for 3 kgIO: Yellow needle-45 mm for 40 kgIO Complications--through and through bone penetration-extravasation-fracture of bone-infection-growth plate injury in pedsWhich pts require careful monitoring of the airway?-intoxicated, trauma,or AMSContraindications for O2-SpO2 > or equal to 95Flow rate of nasal cannula-2-6 L/minFlow rate of nebulizer-6-8 L/minFlow rate of NRB-10-15 L/minFlow rate of BVM-15-20 L/minCriteria for Supraglottic Airway--hypoxia and/or hypoventilationrefractory to noninvasive airway/respiratory management-airway protection to reduce aspiration in setting of sustained AMS w/GCS < 8Contraindications for Supraglottic Airway--maintainoxygenation/ventilation by less invasive methods (BVM)-intact gag reflex-known esophageal disease-ingestion of caustic substance or extensive airway burns-tracheotomy or laryngectomy

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-suspected foreign body airway obstructionGreen king tube--cuff volume: 25-35 mL-height: 35-45 in, 90-115 cmOrange king tube--cuff volume: 30-40 mL-height: 41-51 in, 105-130 cmYellow king tube--cuff volume: 45-60 mL-height: 4-5 ft, 122-155 cm-recalled for peds use, can use in adultsRed king tube--cuff volume: 60-80 mL-height: 5-6 ft, 155-180 cmPurple king tube--cuff volume: 70-90 mL-height: >6 ft, >180 cmLAPSS--Age > 45-no history of seizures and epilepsy-symptoms duration < 24 hr-BGL bn 60 and 400-obvious asymmetry in: facial smile, grip strength, arm strengthRACE--facial palsy-arm motor function-leg motor function-gaze deviation-aphasia-agnosia-score greater than or equal to 5--> LVOGCS eye:-4: spontaneously3: to command2: to pain1: no responseGCS verbal:-5: oriented, conversational4: disoriented, conversational3: inappropriate words2: inappropriate sounds

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1: no responseGCS motor-6: obeys verbal orders5: localizes to pain4: withdraws to pain3: flexion (decorticate)2: extension (decerebrate)1: no responseAbdominal Pain, N/V, Diarrhea: AEMT response--all EMT skills-consider 12-lead EKG-consider IV access and NS admin-consider Ondansetron (call Med command)Abdominal Pain, N/V, Diarrhea: IV and NS dose-adults--TKO if SBP > 100w/o hypotension symptoms-250 mL if SBP <100 w/ hypotension symptoms and no signs of pulmonaryedemaAbdominal Pain, N/V, Diarrhea: IV and NS dose-peds--TKO if SBP < 70 +2x age w/o hypotension symptoms-20 mL/kg bolus if SBP > 70 + 2x age w/ hypotensive symptoms and nosigns pulmonary edemaOndansetron-adults-4 to 8 mg IVOndansetron-peds-0.1 mg/kg IV (max 4 mg)Allergic Reactions and Anaphylaxis: IV and NS admin-adult--TKO if SBP> 100 w/o hypotension symptoms-250 mL if SBP < 100 w/ hypotension symptoms and no signs of pulmonaryedema (repeat up to 2 L)Allergic Reactions and Anaphylaxis: IV and NS admin-peds--TKO if SBP< 70 + 2x age w/o hypotension symptoms-20 mL/kg bolus if SBP > 70 + 2x age w/ hypotensive symptoms and nosigns pulmonary edema (repeat up to 60 mL/kg)Acute allergic reaction-give diphenhydramine IMDiphenhydramine dose-adults-1 mg/kg (max 50 mg)

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Diphenhdyramine dose-peds-1 mg/kg (max 50 mg)Anaphylaxis: order of meds for adults-1. Epi IM2. Diphenhydramine IV3. Albuterol4. Methylprednisolone IVEpi dose-adults-if greater than 10 kg:0.01 mg/kg IM (max 0.5 mg)When to consult med command for epi--patient greater than 50 years old-history of heart illness-BP > 140/90-if pt less than 10 kgEpi dose-peds-0.01 mg/kg IM (max 0.3 mg)Albuterol-adults-5 mg/6 mL (2 flasks)Albuterol-peds-2.5/3 mL (1 flask)Methylpredisolone-adults-125 mg IVMethylprednisolone-peds-2 mg/kg IV (max 125 mg)Anaphylaxis: order of meds for peds-1. Epi2. Diphenhydramine3. Methylprednisolone (med command)4. AlbuterolAMS-Differentials--hypoxemia (shock)-head injury-stroke-seizure-infection-medication/alcohol-heat or cold illnessWhat is considered hypoglycemia?-BGL below 60

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