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

2024 REMS Clinical Guidelines Practice Exam with Answers offers you a structured way to prepare for your exam with solved past exam papers.

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    REMS Clinical Guidelines Questions 2024 Student Health Services - 713 - 348 - 4966 Send burns to: - Memorial Hermann Send chemical exposures to: - Memorial Hermann Send dental emergencies to: - hospital - based emergency department Send eye injury/condition to: - hospital - based emergency department Send psych to: - - Ben Taub - Methodist (inpatient care) Send sexual assault to: - - Ben Taub: SANE - TCH or Hermann for peds Peds pads are used on: - pt less than 8 or under 25 kg 5 rights of med administration - - patient - route - dose - time - medication Contraindications 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 removal When to stop attempting IV - after 2 min or 2 tries Contraindications 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 or proximal to forearm in same arm - suspected total knee arthroplasty/replacement - poor circulation extremity IO: Pink needle - 15 mm for 3 - 39 kg IO: Blue needle - 25 mm for 3 kg IO: Yellow needle - 45 mm for 40 kg IO Complications - - through and through bone penetration - extravasation - fracture of bone - infection - growth plate injury in peds Which pts require careful monitoring of the airway? - intoxicated, trauma, or AMS Contraindications for O2 - SpO2 > or equal to 95 Flow rate of nasal cannula - 2 - 6 L/min Flow rate of nebulizer - 6 - 8 L/min Flow rate of NRB - 10 - 15 L/min Flow rate of BVM - 15 - 20 L/min Criteria for Supraglottic Airway - - hypoxia and/or hypoventilation refractory to noninvasive airway/respiratory management - airway protection to reduce aspiration in setting of sustained AMS w/ GCS < 8 Contraindications for Supraglottic Airway - - maintain oxygenation/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 obstruction Green king tube - - cuff volume: 25 - 35 mL - height: 35 - 45 in, 90 - 115 cm Orange king tube - - cuff volume: 30 - 40 mL - height: 41 - 51 in, 105 - 130 cm Yellow king tube - - cuff volume: 45 - 60 mL - height: 4 - 5 ft, 122 - 155 cm - recalled for peds use, can use in adults Red king tube - - cuff volume: 60 - 80 mL - height: 5 - 6 ft, 155 - 180 cm Purple king tube - - cuff volume: 70 - 90 mL - height: >6 ft, >180 cm LAPSS - - 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 strength RACE - - facial palsy - arm motor function - leg motor function - gaze deviation - aphasia - agnosia - score greater than or equal to 5 -- > LVO GCS eye: - 4: spontaneously 3: to command 2: to pain 1: no response GCS verbal: - 5: oriented, conversational 4: disoriented, conversational 3: inappropriate words 2: inappropriate sounds

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    1: no response GCS motor - 6: obeys verbal orders 5: localizes to pain 4: withdraws to pain 3: flexion (decorticate) 2: extension (decerebrate) 1: no response Abdominal 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 > 100 w/o hypotension symptoms - 250 mL if SBP < 100 w/ hypotension symptoms and no signs of pulmonary edema Abdominal 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 no signs pulmonary edema Ondansetron - adults - 4 to 8 mg IV Ondansetron - 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 pulmonary edema (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 no signs pulmonary edema (repeat up to 60 mL/kg) Acute allergic reaction - give diphenhydramine IM Diphenhydramine 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 IM 2. Diphenhydramine IV 3. Albuterol 4. Methylprednisolone IV Epi 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 kg Epi 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 IV Methylprednisolone - peds - 2 mg/kg IV (max 125 mg) Anaphylaxis: order of meds for peds - 1. Epi 2. Diphenhydramine 3. Methylprednisolone (med command) 4. Albuterol AMS - Differentials - - hypoxemia (shock) - head injury - stroke - seizure - infection - medication/alcohol - heat or cold illness What is considered hypoglycemia? - BGL below 60

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