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Patient Care Theory 1 > ACP-ALS Directives > Flashcards

ACP-ALS Directives Flashcards

1
Q

What are the indications for intubation?

A
  1. Need for ventilatory assistance or airway control.
  2. Other airway management is ineffective.
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2
Q

Conditions for lidocaine spray for intubation?

A

orotracheal intubation

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3
Q

Contraindications for lidocaine spray for intubation?

A
  1. Allergy or sensitivity to lidocaine.
  2. Unresponsive patient.
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4
Q

Contraindications for orotracheal intubation?

A

None

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5
Q

Contraindications for orotracheal intubation?

A
  1. Age less than 50 years AND
  2. current episode of asthma exacerbation AND
  3. not in or near cardiac arrest
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6
Q

What GCS should you consider topical lidocaine spray to the hypopharynx?

A

GCS greater than or equal to 4

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7
Q

Dose for lidocaine spray for intubation?

A

Max single dose of 5mg/kg; max of 20 doses

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8
Q

How many intubation attempts do you have?

A

2

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9
Q

What is the onset for topical lidocaine?

A

1 min; can take up to 3-4 minutes

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10
Q

Primary method to confirm intubation?

A

ETCO2 waveform capnography

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11
Q

Secondary methods to confirm intubation?

A
  1. ETCO2 non-waveform
  2. Visualization
  3. Auscultation
  4. Chest rise
  5. Esophageal detection device
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12
Q

What counts as an intubation attempt?

A

Insertion of laryngoscope blade into the mouth

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13
Q

How many secondary confirmation methods must be used if primary method is not available, in regards to intubation?

A

at least 3 secondary methods

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14
Q

What are the indications for tension pneumothorax medical directive?

A
  1. pre-arrest or VSA AND
  2. absent or severely diminished breath sounds on affected side(s)
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15
Q

Conditions for needle thoracostomy?

A

Hypotension or VSA

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16
Q

Contraindications for needle thoracostomy?

A

None

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17
Q

In a medical VSA, what is the minimum age for defibrillation?

A

Greater than or equal to 24 hours

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18
Q

In a medical VSA, what rhythms indicate the need for amiodarone?

A

VF or pulseless VT

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19
Q

In a medical VSA, what rhythms indicate the need for lidocaine?

A

VF or pulseless VT

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20
Q

In a medical VSA, how old does the patient need to be to receive amiodarone or lidocaine?

A

Greater than or equal to 24 hours

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21
Q

In a medical VSA, what are the conditions for a saline bolus?

A
  1. greater than equal to 24 hours
  2. PEA OR any other rhythm where hypovolemia is suspected.
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22
Q

What are the conditions for a medical TOR?

A
  1. Greater than or equal to 16 years
  2. Arrest not witnessed by EMS
  3. No ROSC after 20 mins resuscitation.
  4. No defibrillation delivered
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23
Q

Contraindications for a medical TOR (5)

A
  1. Known reversible cause unable to be addressed.
  2. Pregnancy presumed to be more than 20 weeks
  3. suspected hypothermia
  4. airway obstruction
  5. non-opioid drug overdose
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24
Q

What are the contraindications for amiodarone?

A

Allergy or sensitivity to amiodarone

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25
Q

What are the contraindications for lidocaine?

A

Allergy or sensitivity to lidocaine

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26
Q

What age do we shock at adult joule settings?

A

greater than or equal to 8 years old

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27
Q

What age do we use pediatric joule settings?

A

greater than or equal to 24 hours but less than 8

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28
Q

First shock joule setting for pediatrics?

A

2J/kg

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29
Q

Subsequent shock joule setting for pediatrics?

A

4 J/kg

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30
Q

What age receives adult dosage for epinephrine during a medical VSA?

A

Greater than or equal to 12 years old

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31
Q

What age receives pediatric dosage for epinephrine during a medical VSA?

A

24 hrs - less than 12 years old

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32
Q

During a VSA, what is the IV dose of epi for pediatrics?

A

Solution: 1:10,000 (1mg/10ml)
Dose: 0.01mg/kg
Min: 0.05mg
Max: None

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33
Q

How much epi in 1:10,000

A

1mg/10ml
0.1mg/ml

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34
Q

During a VSA, what is the IV dose of epi for adults?

A

Solution: 1:10,000 (1mg/10ml)
Dose: 1mg
Min: 1mg
Max: 1mg

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35
Q

During a VSA, what is the ETT dose of epi for pediatrics?

A

Solution: 1:1,000 (1mg/1ml)
Dose: 0.1mg/kg
Min: 0.5mg
Max: 2mg

(20kg or greater pt gets max dose)
(5kg or less pt gets min)

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36
Q

During a VSA, what is the ETT dose of epi for adult?

A

Solution: 1:1,000 (1mg/1ml)
Dose: 2mg
Min: 2mg
Max: 2mg

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37
Q

How often is epi given during a VSA

A

q 4 mins

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38
Q

What is the route, solution, dose, max single dose, and number of doses for anaphylactic epi during a VSA?

A

route: IM
Solution: 1:1,000 (1mg/ml)
Dose: 0.01mg/kg
Max: 0.5mg
#: 1 dose

50kg and more gets max

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39
Q

What age receives adult dosage for amiodarone and lidocaine during a medical VSA?

A

12 years and older

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40
Q

What age receives pediatric dosage for amiodarone and lidocaine during a medical VSA?

A

24 hrs - less than 12 years

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41
Q

During a VSA, what is the IV dose of amiodarone for pediatrics?

A

5mg/kg to max of 300mg

(60kg gets max)

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42
Q

During a VSA, what is the subsequent IV doses, dosing interval and # of doses of amiodarone for pediatrics?

A

5mg/kg to max of 150mg
q 4 mins
max 2 doses

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43
Q

During a VSA, what is the IV dose of lidocaine for pediatrics?

A

1mg/kg (no max dose)

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44
Q

During a VSA, what is the subsequent IV doses, dosing interval and # of doses of lidocaine for pediatrics?

A

1mg/kg (no max)
q 4 mins
max 2 doses

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45
Q

During a VSA, what is the ETT dose of lidocaine for pediatrics?

A

2mg/kg

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46
Q

During a VSA, what is the ETT dose of lidocaine for adults?

A

3mg/kg

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47
Q

During a VSA, what is the subsequent ETT doses, dosing interval and # of doses of lidocaine for pediatrics?

A

2mg/kg
q 4 mins
max 2 doses

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48
Q

During a VSA, what is the subsequent ETT doses, dosing interval and # of doses of lidocaine for adults?

A

1.5mg/kg
q 4 mins
max 2 doses

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49
Q

During a VSA, what is the IV dose of lidocaine for adults?

A

1.5mg/kg

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50
Q

During a VSA, what is the subsequent IV doses, dosing interval and # of doses of lidocaine for adults?

A

0.75mg/kg
q 4 mins
max 2 doses

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51
Q

Pediatric normal saline bolus amount during a medical VSA?

A

20ml/kg
reassess q 100ml
max 2,000ml

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52
Q

Adult normal saline bolus amount during a medical VSA?

A

20ml/kg
reassess q 250ml
max 2,000ml

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53
Q

Criteria for trauma TOR

A
  1. greater than or equal to 16 years old AND;
  2. no palpable pulses AND;
  3. no defib delivered AND;
  4. asystole and no signs of life since full extricated OR;
    signs of life when extricated with closest ED greater than or equal to 30 minutes away OR;
    PEA with closest ED greater than or equal to 30 minutes away
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54
Q

Contraindications for trauma TOR

A
  1. pt less than 16 years old
  2. defib delivered
  3. signs of life at any time since fully extricated.
  4. PEA with ED less than 30 mins away
  5. Pts with penetrating trauma to torso or head/neck and lead trauma hospital less than 30 mins away.
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55
Q

What is considered signs of life under trauma VSA directive? (4)

A
  1. spontaneous movement
  2. respiratory efforts
  3. organized electrical activity on ECG
  4. reactive pupils
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56
Q

In a newborn VSA, what are the conditions for epinephrine administration?

A
  1. less than 24 hours old
  2. HR less than 60bpm
  3. after 30 seconds of PPV AND 30 seconds of CPR
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57
Q

What are the contraindications for epinephrine in newborn VSA?

A
  1. Allergy or sensitivity
  2. Presumed gestational age less than 20 weeks
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58
Q

In a newborn VSA, what is the IV/IO dose of epinephrine?

A

solution: 1:10,000
Most newborns weigh less than 5kg, so give the min dose of 0.05mg (0.5ml)

Dose: 0.01mg/kg
min: 0.05mg
q 4 mins

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59
Q

In a newborn VSA, what is the ETT dose of epinephrine?

A

Solution: 1:10,000 (1mg/ml)
Dose: 0.1mg/kg
Min: None
Max: 0.3mg (3.0ml)
#: 1 dose

3kg pt gets max dose

60
Q

What are the conditions for dopamine?

A
  1. Greater than or equal to 8 years
  2. hypotension
61
Q

What are the contraindications for dopamine?

A
  1. Allergy or sensitivity to dopamine
  2. Tachydysrhythmias excluding sinus tach
  3. mechanical shock
  4. pheochromocytoma
62
Q

What age receives pediatric dose dopamine?

A

dose is the same, everyone 8 years and older

63
Q

What age receives adult dose dopamine?

A

dose is the same, everyone 8 years and older

64
Q

What routes can dopamine be given?

A

IV

65
Q

What is the initial infusion rate for dopamine?

A

5mcg/kg/min

66
Q

What is the titration increment for dopamine?

A

5mcg/kg/min

67
Q

How often can you increase dopamine increment?

A

q 5mins

68
Q

What is the max infusion rate for dopamine?

A

20mcg/kg/min

69
Q

When to discontinue dopamine?

A

SBP 90-110
discontinue over 5-10 minutes gradually

70
Q

Conditions for morphine for cardiac ischemia? (4)

A
  1. greater than or equal to 18 years
  2. unaltered
  3. normotensive
  4. severe pain
71
Q

Contraindications for morphine for cardiac ischemia? (2)

A
  1. allergy or sensitivity to morphine
  2. SBP drops by 1/3 or more after administration
72
Q

When to consider morphine for cardiac ischemia?

A

After 3rd dose of nitro or if nitro is contraindicated

73
Q

Route, dose, max single dose, interval and number of doses for morphine for cardiac ischemia?

A

Route: IV
Dose: 2mg
Max single: 2mg
q 5mins
Max # 5 (10mg)

74
Q

What are the conditions for atropine in a pt with symptomatic bradycardia?

A
  1. at least 18 years old
  2. HR less than 50bpm
  3. hypotensive
75
Q

Contraindications for atropine?

A
  1. Allergy or sensitivity to atropine
  2. hypothermia
  3. hx of heart transplant
76
Q

Route, dose, max single dose, interval and # of doses for atropine?

A

IV
1mg to max of 1mg
q 5mins
max 2 doses

77
Q

What are the conditions for dopamine in a pt with symptomatic bradycardia?

A
  1. at least 18 years old
  2. HR less than 50
  3. hypotensive
78
Q

What are the contraindications for dopamine in a pt with symptomatic bradycardia? (3)

A
  1. Allergy or sensitivity to dopamine
  2. Mechanical shock
  3. Pheochromocytoma
79
Q

What are the contraindications for transcutaneous pacing?

A

hypothermia

80
Q

What are 3 examples of mechanical shock listed in the companion document?

A
  1. tension pneumothorax
  2. PE
  3. cardiac tamponade
81
Q

What are the conditions for adenosine? (5)

A
  1. At least 18 years old
  2. Unaltered
  3. HR at least 150bpm
  4. Normotensive
  5. Narrow complex and regular rhythm
82
Q

What are the conditions for valsalva maneuver? (5)

A
  1. At least 18 years old
  2. Unaltered
  3. HR at least 150bpm
  4. Normotensive
  5. Narrow complex and regular rhythm
83
Q

In a pt with a tachydysrhythmia, what are the conditions for amiodarone and lidocaine?

A
  1. at least 18 years old
  2. unaltered
  3. HR at least 120
  4. Normotensive
  5. Wide complex and regular rhythm
84
Q

In a pt with a tachydysrhythmia, what are the conditions for synchronized cardioversion?

A
  1. At least 18 years old
  2. HR at least 120 (wide) or 150 (narrow)
  3. hypotensive
  4. altered LOA, ongoing chest pain, other signs of shock
85
Q

What are contraindications for adenosine?

A
  1. Allergy or sensitivity to adenosine
  2. Sinus tach, afib, or aflutter
  3. Pt taking dipyridamole or carbamazepine
  4. bronchoconstriction on exam
86
Q

Contraindications for Valsalva maneuver

A
  1. sinus tach, afib, or aflutter
87
Q

Contraindications for lidocaine

A

Allergy or sensitivity to lidocaine

88
Q

Contraindications for amiodarone

A

Allergy or sensitivity to amiodarone

89
Q

Route, dose, subsequent dose, interval and max # doses for adenosine?

A

IV
6mg
12mg
2 min
max 2 doses

90
Q

Route, dose, subsequent dose, interval and max # doses for amiodarone?

A

IV
150mg initial
subsequent 150mg
q 10 mins
max 2 doses

91
Q

Route, dose, subsequent dose, interval and max # doses for lidocaine?

A

IV
1.5mg/kg initial dose
0.75mg/kg subsequent dose
max single dose 150mg
q 10 mins
max 3 doses

92
Q

In setting of a patch failure, what energy settings should be used for synchronized cardioversion?

A

100J, 200J, 360J

93
Q

What are the indications for hyperkalemia medical directive?

A
  • currently on dialysis OR
  • hx end stage renal disease OR
  • relevent incident hx (crush injury)
    AND
  • cardiac arrest OR
  • 12 lead ECG changes associated with hyperK
94
Q

Conditions for calcium gluconate 10%?

A
  1. At least 18 years old
95
Q

Conditions for salbutamol for hyperk?

A
  1. At least 18 years old
96
Q

Contraindications for calcium gluconate 10%?

A

Allergy or sensitivity to calcium gluconate

97
Q

Contraindications for salbutamol (for hyperk)

A

Allergy or sensitivity to salbutamol

98
Q

Route, dose, subsequent dose, interval and max # doses for calcium gluconate 10%?

A

IV or IO or CVAD
1g over 2-3minutes
q 5 mins
max 2 doses
* you can give a 3rd dose if the pt initially improved but the symptoms return

99
Q

What are contraindications for IO access in a pediatric?

A
  1. Fracture or crush injuries proximal to access site
  2. Suspected or known replacement/prothesis proximal to the access site
99
Q

Does for salbutamol following the hyperk directive?

A

1600mcg (16 puffs)
repeat immediately
x2 doses

100
Q

What are indications for IO access in a pediatric pt?

A
  1. Actual or potential need for IV medicine or fluid therapy
  2. IV access unobtainable
  3. Cardiac arrest or pre-arrest state
101
Q

Contraindications for accessing a CVAD?

A
  1. Inability to confirm patency of CVAD line
  2. Inability to flush or aspirate
  3. Injury or suspected fracture proximal to access site
  4. Swelling of the involved limb
  5. Bleeding at insertion site
102
Q

What types of seizures can be treated by ACPs?

A

Active generalized motor seizure

103
Q

Conditions for midazolam for seizure medical direct? (1)

A

Unresponsive

104
Q

Contraindications for midazolam for seizure medical direct? (1)

A

Allergy or sensitivity to midazolam

105
Q

What routes can midazolam be given for seizure medical direct?

A

IV, IO, IM, IN, Buccal

106
Q

For seizure, what is the dose, max single dose, interval and repeats for midazolam given IV or IO?

A

0.1mg/kg
max single 5mg
q 5 mins
repeat x 2

107
Q

For seizure, what is the dose, max single dose, interval and repeats for midazolam given IM, IN or buccal?

A

0.2mg/kg
max single 10mg
q 5 mins
repeat x 2

108
Q

During a seizure, where hypoglycemia is suspected to be the cause, which should be prioritized - blood glucometery or midazolam?

A

Midazolam

109
Q

For hypoglycemia, what route can dextrose be given?

A

IV only

110
Q

For hypoglycemia, patients older 2 and older receive how much D10W?

A

0.2g/kg (2ml/kg)

111
Q

For D10W, how many grams of dextrose are in 10ml

A

1 gram

112
Q

For D10W, how many grams of dextrose are in 250ml?

A

25 grams

113
Q

For hypoglycemia, patients older 2 and older what is the max single dose of D10W they can receive?

A

25g (250ml)

114
Q

How heavy would someone older than 2 need to be to receive max single dose of D10W?

A

125kg

115
Q

For hypoglycemia, patients less than 2 years old, what is the max single dose of D10W they can receive?

A

5g (50ml)

116
Q

For hypoglycemia, patients less than 2 years old, what is the dose for D10W?

A

0.2g/kg (2mL/kg)

117
Q

For hypoglycemia, what is the dose interval for dextrose and number of repeats?

A

q 10 minutes
x 2 repeats

118
Q

For hypoglycemia, how old does a patient had to be to receive IN powder glucagon?

A

at least 4 years old

119
Q

What are the indications for procedural sedation?

A
  1. Post-intubation
  2. Transcutaneous pacing
120
Q

What are two drugs to be considered for procedural sedation?

A
  1. Fentanyl
  2. Midazolam
121
Q

Under procedural sedation, what are the conditions for fentanyl?

A
  1. At least 18 years old
  2. RR greater than 10 bpm (non intubated)
  3. normotensive
122
Q

Under procedural sedation, what are the conditions for midazolam?

A
  1. At least 18 years old
  2. RR greater than 10 bpm (non intubated)
  3. normotensive
123
Q

What are the contraindications for fentanyl under procedural sedation medical directive?

A

Allergy or sensitivity to fentanyl

124
Q

What are the contraindications for midazolam under procedural sedation medical directive?

A

allergy or sensitivity to midazolam

125
Q

Procedural sedation: Route, dose, max single dose, interval, repeats and max total dose for fentanyl?

A

IV, IO, CVAD, IN
25-75mcg
max 75mcg
q 5 mins
max total 150mcg

126
Q

Procedural sedation: Route, dose, max single dose, interval, repeats and max total dose for midazolam?

A

IV, IO, CVAD, IN
up to 0.1mg/kg
max 5mg
q 5 mins
max total 10mg

127
Q

Indications for combative patient medical directive?

A

Combative or violent or agitated behaviour that requires sedation for patient safety.

128
Q

What is the age requirement for combative patient medical directive?

A

At least 18 years old

129
Q

What is the condition to use ketamine for combative patients?

A

Suspected excited delirium or severe violent psychosis

130
Q

What are the contraindications for ketamine under the combative patient medical directive?

A

Allergy or sensitivity to ketamine

131
Q

What are the contraindications for midazolam under the combative patient medical directive?

A

Allergy or sensitivity to midazolam

132
Q

Combative pt: Route, dose, max single dose, interval, total cumulative dose for midazolam?

A

IV, IM, IN
up to 0.1mg/kg
max single dose 5mg
q 5 mins
max total 10mg

133
Q

Combative pt: Route, dose, max single dose, interval, total cumulative dose for ketamine for less than 65 years old.

A

IM
5mg/kg
500mg max single dose
no repeats

134
Q

Combative pt: Route, dose, max single dose, interval, total cumulative dose for ketamine for older than 65 years old.

A

IM
3mg/kg
300mg max single dose
no repeats

135
Q

Analgesia medical directive: Conditions for morphine

A
  1. At least 1 year old
  2. unaltered
  3. normotensive
136
Q

Analgesia medical directive: Conditions for Fentanyl

A
  1. At least 1 year old
  2. unaltered
  3. normotensive
137
Q

Analgesia medical directive: What are the contraindications for fentanyl and morphine (6)

A
  1. Allergy or sensitivity to the drug being given.
  2. Treatment of h/a
  3. Treatment of chronic pain
  4. SBP drops by 1/3 of initial value after first dose.
  5. Suspected ischemic c/p
  6. active labour
138
Q

What age is a patch required for opioid analgesia?

A

If pt is less than 12 years old.

139
Q

Analgesia medical directive: Route, dose, max single dose, interval, max cumulative dose for patients at least 18 years old for morphine.

A

IV or SC
2-10mg
max 10mg single dose
q 15 mins
max total 20mg

140
Q

Analgesia medical directive: Route, dose, max single dose, interval, max cumulative dose for patients less than 18 years old for morphine.

A

IV or SC
0.05mg-0.1mg/kg
max 5mg single dose
q 15 minutes
max 10mg total

141
Q

Analgesia medical directive: Route, dose, max single dose, interval, max cumulative dose for patients at least 18 years old for fentanyl.

A

IV or IN
25-75 mcg
max 75 mcg single dose
q 5 mins
max 200 mcg total

142
Q

Analgesia medical directive: Route, dose, max single dose, interval, max cumulative dose for patients less than 18 years old for fentanyl.

A

IV or IN
up to 1mcg/kg
max 75 mcg single dose
q 5 mins
max 200 mcg total

143
Q

Indications for a cricothyrotomy (3)

A
  1. Need for advanced airway management
  2. Intubation AND SGA insertion unsuccessful or contraindicated
  3. Unable to ventilate
144
Q

Conditions for a cricothyrotomy (2)

A
  1. At least 12 years old
  2. Altered
145
Q

Contraindications for cricothyrotomy (2)

A
  1. Suspected fractured larynx
  2. inability to landmark

Patient Care Theory 1 (3 decks)

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