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HCFR Medical Protcol > Adult Medical Protocol > Flashcards

Adult Medical Protocol Flashcards

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USMLE® Step 1 flashcards
1
Q

340.17
Cardiac STEMI (ST Elevation MI)
STEMI Alert criteria :

A

II-Paramedic interpretation of new ST elevation at the J point of >1mm (0.1) in at least 2 contiguous chest or limb leads or LBBB not known to be old in a pt w symptoms

III-cardiac symptoms (continuous or intermittent) lasting for greater than 15 min and less than 12 hrs.

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2
Q

340.01

Acute Abdomen

A
  1. Basic ALS treatment
  2. ALS transport criteria:

a. All pts w signs and symptoms of acute abdomen or abnormal vital signs.
b. Call Medic-1 for pain control orders if appropriate

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3
Q

II, III, AVF

A

Inferior wall MI

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4
Q

V3, V4

A

Anterior

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5
Q

V1, V2

A

Anteroseptal

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6
Q

I, AVL, V5, V6

A

Anterolateral

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7
Q

Any pt <28 days old or < 5 kg in body weight

A

Neonate

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8
Q

Any pt < 1 year of age and greater than or equal to 28 days of age also > or = to 5 kg body weight

A

Infant

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9
Q

Pediatric pt - legal standpoint

A

Any pt < 18 yrs of age

  1. Exception; emancipated minors, pregnant minors and/or married minors
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10
Q

Pediatric pt - Medical standpoint

A

Pts who weigh < 50 kg (110 lbs)

  1. Drug dosage for pediatric pts assume a body weight of < 50 kg
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11
Q

Pediatric pt - trauma standpoint

A

Any pt < or = to 15 yrs of age

  1. Anatomical and physical characteristics of a person this age.
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12
Q

Although not a narcotic medical drug, it too shall be treated as such and doubled locked on each apparatus.

A

Etomidate

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13
Q

What are the 4 situations which it is Permissible to withhold CPR? These conditions are termed “evidence of irreversible death”

A
  1. Decapitation
  2. Rigor Mortis
  3. Dependent lividity
  4. Tissue decomposition
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14
Q

Albuterol Pediatric dose

A

< 20kg, 2.5mg q 20 min PRN nebulized

> 20kg, 5.0mg q 20 min PRN nebulized

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15
Q

Epinephrine SQ pedi dose

A

0.01 mg/kg of 1:1,000 max dose of 0.4 mg SQ

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16
Q

Diphenhydramine pedi dose

A

1.0 mg/kg (max dose 50mg) IM or IV flush thoroughly

17
Q

Methylprednisolone pedi dose

A

2.0 mg/kg (max dose of 80mg) over 1-2 min IV

18
Q

Altered state of consciousness (340.02)

A

A. D50 (for known hypoglycemia <60 mg/dl) 12.5g IV over 1-2 min. May repeat 1 time.

B. Oral dextrose (gag reflex) 25-30g PO may be repeated every 5 min to a level > 90 mg/dl

C. Glucagon (when unable to establish IV) 1.0 mg only once

D. Naloxone (Narcan) when narcotics are suspected 0.5 mg IV,IM,SC or IN repeat q2 min as needed (titrate to desired effect)

19
Q

Anaphylaxis/ Allergic Reaction 340.03

A

A. Epi 0.3 mg 1:1,000 SQ may be repeated q3 min PRN for ongoing severe symptoms. IF UNRESPONSIVE TO SQ EPI 0.3mg 1:10,000 IV q5 min PRN for ongoing life threatening symptoms

B. Diphenhydramine (Benadryl) 50mg IM or IV once flush thoroughly

C. Methyprednisolone (Solumedrol) 125 mg IV over 2 min once

D. Albuterol 5.0 mg nebulized may repeat q20 not exceeding 15 mg per hour PRN ongoing bronchospasms

  • if pts tidal volume is inadequate consider Albuterol via BVM in line nebulizer or ETT after airway has been secured
20
Q

Asthma 340.04

A

Albuterol - 5.0 mg nebulized may be repeated q20 min (not exceeding 15 mg per hr)

Albuterol and Atrovent - ( Preferred for COPD and Emphysema pts) may be repeated up to 2 times if there has been a response to initial tx. 1.5 mg bromide and 7.5 albuterol

Methylprednisolon- 125mg IV over 2 min once. No steroids in past 24 hrs.

Mag Sulfate ( for severe symptoms ) 2 gms in 50ml over 20 min IV once.

CPAP ( primarily for COPD pts)

Epinephrine ( for near fatal asthma or COPD) if unable to nebulize pt and tidal volume is inadequate
0.3 mg of 1:1,000 SQ q 20 min PRN

21
Q
  • Incompatible with Lactated ringers solution

- must avoid contact with catecholamines

A

Sodium bicarbonate

22
Q

Atropine for organophosphate poisoning dose

A

2 mg IVP until secretions dry up. No max dose

23
Q

340.05

Behavioral Emergencies

A

Midazolam 2.5 mg IV/IM or IN may repeat once after 5 min.

1.25 mg in pts > 60 yrs of age and those with COPD

24
Q

Class - depolarizing neuromuscular blocking agent

Onset - 1 min
Duration - 4-10 min

Dose- 1.5 mg/kg over 30 sec
If initial dose is not effective give a second dose at: 1 mg/kg IV over 30 sec.

Be prepared to give atropine for bradycardia if giving a 2nd dose of succinylcholine

Adult dose 0.5 - 1.0 mg IV
Pedi dose 0.02 mg/kg IV - minimum dose 0.1 mg, max dose = 1.0 mg

A

Succinylcholine

25
Q

Class- hypnotic

Dose- 0.3 mg/kg

Duration 3-5 min

If contraindicated use 0.2mg/kg Midazolam

If pt has a head injury use Lidocane 1 mg/kg

A

Etomidate

26
Q

Organophosphate poisoning medication and dose

A

Atropine- 2.0 mg repeat as needed every 5-10 minutes no max dose.

> 65 y/o 1 mg IM repeat every 5-10 min for severe cases admin 4 mg IM

27
Q

340.10

Cardiac Arrest Algorithm- V fib, pulseless V- Tach

A
  • If cardio version is successful begin an infusion Amiderone at 0.5 mg w adequate signs of perfusion.
  • for recurrent VF/VT while on the drip admin and additional 150mg/min IV/IO and restart protocol
  • Torsades de points - mag sulfate 2 gms IV/IO as a bolus. IV drip of 1.0 mg/min if successful cardio version
  • Lidocaine - 1 mg/kg IV/IO loading dose
    If cardio version is successful begin an infusion at 2 mg/min IV/IO and repeat the bolus if he infusion is started more than 15 min after initial bolus.

If pt is in CHF, renal failure, liver failure the dose of the infusion is halved to 1mg/min IV/IO

28
Q

340.11

Cardiac Dysrhythmias - AFIB/ A Flutter

A

Stable - diltiazem 0.25 mg/kg IV over 2 min. May repeat once after 15 min at 0.35mg/kg IV over 2 min.

Unstable - paramedic discretion to use one round of meds

Cardio version for- AFib 125j, 200j,300j,360j

                       A Flutter  50j, 100j, 200j, 300j, 360j

If systolic BP > 100 mmHg

  • midazolam 1.25 mg IV may repeat once in 5 min
  • fentanyl 50 mcg IV may repeat once in 5 min
29
Q

340.12 Bradycardia/ Block

A
  • Atropine 0.5 mg rapid IVP q 3-5 min max dose 3.0 mg
  • Transcutaneous pacing
  • Dopamine infusion starting at 5mcg/kg/min q 5min PRN titration to effect. Max dose 20 mcg/kg/min
  • Epi infusion starting at 2mcg/min IV/IO increase by 2.0 mcg/kg/min q 5 min titration to effect max dose of 10mcg/min
30
Q

Not effective for infranodal blocks (i.e. Type 2 AV block and 3rd degree block with wide QRS complexes) may cause a paradoxical slowing, be prepared to initiate transcutaneous pacing

A

Atropine in bradycardia / heart blocks

31
Q

340.13 - SVT

A
  • vagal maneuvers
  • adenosine 6 mg IV over 1-3 sec followed by 20 cc flush

If no response in 1-2 min give 12 mg

Unstable pt: paramedic discretion may give 12 mg IV before cardioversion

Synchronized cardioversion : 50j, 100j, 200j, 300j, 360j

Adjuncts to cardioversion if systolic > 100 mmHg
- sedation - midazolam 1.25 mg IV q 5 min PRN anxiety

  • Analgesia- fentanyl 50 mcg IV q 5 min PRN pain max dose 250 mcg

12 lead as soon as pt is stabilized

HCFR Medical Protcol (2 decks)

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