Adult Medical Protocols Flashcards
What 5 medications are treatment options for pain management?
Morphine Sulfate Dilaudid Fentanyl Nitrous Oxide Ketamine
According to the pain management protocol by what routes can Morphine Sulfate be given?
IV/IO
IM
According to the pain management protocol what is the IV/IO adult dose for Morphine Sulfate?
2-10 mg
May repeat every 5 minutes
Max 3 doses
According to the pain management protocol what is IM adult dose for Morphine Sulfate?
2-20mg
May repeat every 15 minutes
Max 3 doses
What is the blood pressure requirement for a pt to be given Morphine Sulfate?
SBP>100
According to the pain management protocol by what routes can Dilaudid be given?
IV/IO
IM
According to the pain management protocol what is the IV/IO adult dose for Dilaudid?
1-2mg
May repeat every 10 minutes
Max 3 doses
According to the pain management protocol what is the IM adult dose for Dilaudid?
1-2mg
May repeat every 15 minutes
Max 3 doses
What is the blood pressure requirement for a pt to be given Dilaudid?
SBP>100
According to the pain management protocol by what routes can Fentanyl be given?
IV/IO
IN
According to the pain management protocol what is the IV/IO adult dose for Fentanyl?
1mcg/kg
May repeat every 3-5 minutes
Max 3 doses
According to the pain management protocol what is the IN adult dose for Fentanyl?
2mcg/kg
May repeat every 3-5 minutes
Max 3 doses
What is the blood pressure requirement for a pt to be given Fentanyl?
SBP>90
According to the pain management protocol by what routes can Nitrous Oxide be given?
Inhalation
According to the pain managment protocol what is the adult dose for Nitrous Oxide?
Apply and deliver until the pt drops the mask
What is the blood pressure requirement for a pt to be given Nitrous Oxide?
There is none
According to the pain management protocol by what routes can Ketamine be given?
IV/IM/IO/IN
According to the pain management protocol what is the IV/IM/IO/IN adult dose for Ketamine?
10mg
May repeat every 10 minutes
Max 3 doses
True or False. Pain management is acceptable for the pt experiencing abdominal pain?
True
True or False. Pain management is acceptable for the pregnant pt in pain?
True. Pain medication should not be withheld from the pregnant pt in pain however caution should be taken and the pt should understand the risks/benefits
What 3 medications are treatment options for Nausea and Vomiting?
Zofran
Reglan
Phenergan
According to the Nausea/Vomiting protocol what medication is considered first line for the treatment of Nausea?
Zofran
According to the Nausea/Vomiting protocol by what routes can Zofran be given?
IV/IM/IN/IO/PO
According to the Nausea/Vomiting protocol what is the IV/IM/IN/IO/PO adult dose of Zofran?
4-8mg
SLOW
According to the Nausea/Vomiting protocol what medications are considered first line for active vomiting?
Reglan
Phenergan
According to the Nausea/Vomiting protocol by what routes can Reglan be given?
IV/IM/IO
According to the Nausea/Vomiting protocol what is the IV/IM/IO adult dose of Reglan?
5-10mg
SLOW
According to the Nausea/Vomiting protocol by what routes can Phenergan be given?
IV/IO
IM
According to the Nausea/Vomiting protocol what is the IV/IO adult dose for Phenergan?
12.5mg
(Place in 20cc syringe and fill with NS)
VERY SLOW
According to the Nausea/Vomiting protocol what is the IM adult dose for Phenergan?
25mg
According to the Nausea/Vomiting protocol if Nausea/Vomiting persists after initial treatment medication what is a treatment option?
Give dose of another agent
According to the Nausea/Vomiting protocol what is a possible complication of Reglan?
Dystonic reaction
According to the Nausea/Vomiting protocol what is a treatment option should a pt develop a dystonic reaction due to Reglan?
Benadryl
According to the Nausea/Vomiting protocol by what routes can Benadryl be given in the treatment of a dystonic reaction due to Reglan?
IV/IM/IO
According to the Nausea/Vomiting protocol what is the IV/IM/IO adult dose of Benadryl in the treatment of a dystonic reacion due to Reglan?
25mg
According to the Nausea/Vomiting protocol 3 signs of dehydration
Dry Mucosa
Tachycardia
Hypotension
According to the Non-traumatic Shock protocol what is the blood pressure measurement defining shock?
SBP<100
According to the Non-traumatic Shock protocol what are 4 other possible causes of Non-traumatic Shock?
- Hemorrhage not associated with trauma
- Hypovolemia
- Septic Shock
- Anaphylactic Shock
According to the Non-traumatic Shock protocol what is the first line treatment for Non-traumatic Shock?
NS fluid challenge
According to the Non-traumatic Shock protocol what is the adult dose given for a NS fluid challenge?
500cc
Repeat if needed
According to the Non-traumatic Shock protocol if pt is not responding to NS fluid challenge what is the next treatment option?
Epinephrine Push Dose Presser
According to the Non-traumatic Shock protocol by what routes can the Epinephrine Push Dose Presser be given?
IV
According to the Non-traumatic Shock protocol what is the IV adult dose of the Epinephrine Push Dose Presser?
0.5-2ml
May repeat every 2-5 minutes
According to the Non-traumatic Shock protocol what is the condition for giving the Epinephrine Push Dose Presser?
SBP<90 not responding to fluid challenge
How is the Epinephrine Push Dose Presser made in the field?
- Take 10ml syringe with 9ml NS
2.Draw 1ml Epinephrine 1:10,000 into this
Now you have 10ml Epinephrine(10mcg/ml)
According to the Sepsis/ Septic Shock protocol what are the 2 criteria when determining Sepsis/ Septic Shock?
- Presumed source of Infection
2. 2 or more of the SIRS Criteria are met
According to the Sepsis/ Septic Shock protocol what are the most common sources of infection?
Lung Skin Urine Abdomen CNS
According to the Sepsis/ Septic Shock protocol what are the SIRS Criteria?
- Temp >101 or <96.8
- HR >90
- RR >20
- Altered Mental Status (from baseline)
- Glucose >120mg/dl (non-diabetic)
According to the Sepsis/ Septic Shock protocol how many and of what kind IV should be started?
2 if able
Large Bore
According to the Sepsis/ Septic Shock protocol what is the mainstay of pre-hospital treatment?
IV Fluids
According to the Sepsis/ Septic Shock protocol what is the IV Fluid dose?
30 cc/kg NS Bolus
According to the Sepsis/ Septic Shock protocol what is the blood pressure criteria for continuing a fluid bolus?
SBP <100 until SBP >100
According to the Sepsis/ Septic Shock protocol if pt BP is not responding to fluid bolus what is the next treatment option?
Epinephrine Push Dose Presser
According to the Sepsis/ Septic Shock protocol by what route is the Epinephrine Push Dose Presser given?
IV
According to the Sepsis/ Septic Shock protocol what is the IV adult dose for the Epinephrine Push Dose Presser?
0.5-2ml
May repeat every 2-5 minutes
According to the Sepsis/ Septic Shock protocol what is the condition for giving the Epinephrine Push Dose Presser?
SBP <90mmHG not responding to fluid bolus
According to the Sepsis/ Septic Shock protocol what should you let the ER know prior to arrival?
“Sepsis Alert”
According to the Sepsis/ Septic Shock protocol what is the definition of Septic Shock?
Persisten SBP <90 after 30cc/kg fluids given
According to the Altered Mental Status (AMS) protocol what is the acronym for possible causes of AMS?
AEIOUTIPS
According to the Altered Mental Status (AMS) protocol what does the acronym AEIOUTIPS stand for?
A-Alcohol E-Endocrine, Electrolyte I-Insulin O-Overdose U-Uremia T-Trauma I-Infection P-Psychiatric S-Stroke
According to the Altered Mental Status (AMS) protocol what is the determining blood glucose for Hypoglycemia?
BG <70mg/dcl
According to the Altered Mental Status (AMS) protocol what is the determining blood glucose for Hyperglycemia?
BG >250mg/dcl
According to the Altered Mental Status (AMS) protocol what is the treatment option considered if pt is altered with respiratory depression?
Narcan
According to the Altered Mental Status (AMS) protocol by what routes can Narcan be given in the altered pt with respiratory depression?
IV/IM/ET/IO/IN
According to the Altered Mental Status (AMS) protocol what is the IV/IM/ET/IO adult dose of Narcan in the treatment of altered mentation with respiratory depression?
0.5-2 mg
Repeat every 10 minutes if improvement
According to the Altered Mental Status (AMS) protocol what is the IN adult dose of Narcan in the treatment of altered mentation with respiratory depression?
2mg
Repeat every 10 minutes if improvement
According to the Altered Mental Status (AMS) protocol what 3 criteria may lead EMS to RSI the altered pt?
- Gag depressed
- GCS <8
- Pt deemed unable to protect airway
According to the Mild and Moderate Allergic Reactions protocol what are signs/symptoms of a Mild Allergic Reaction?
Rash
Itching
Hives
According to the Mild and Moderate Allergic Reactions protocol what are signs/symptoms of a Moderate Allergic Reaction?
Dyspnea/Wheezing/Stridor
Mild/Moderate angioedema
According to the Mild and Moderate Allergic Reactions protocol what is the treatment option for a Mild Allergic Reaction?
Benadryl
According to the Mild and Moderate Allergic Reactions protocol by what routes can Benadryl be given.
IV/IM/IO
According to the Mild and Moderate Allergic Reactions protocol what is the IV/IM/IO adult dose of Benadryl for a Mild Allergic Reaction?
25mg
According to the Mild and Moderate Allergic Reactions protocol what are the treatment options for a Moderate Allergic Reaction?
Benadryl
Albuterol/Atrovent
Solumedrol
According to the Mild and Moderate Allergic Reactions protocol what is the IV/IM/IO adult dose of Benadryl for a Moderate Allergic Reaction?
50mg
According to the Mild and Moderate Allergic Reactions protocol when should Albuterol/Atrovent be considered for treatment of Moderate Allergic Reaction?
If wheezing/dyspnea
According to the Mild and Moderate Allergic Reactions protocol by what route can Albuterol/Atrovent be given?
Nebulized
According to the Mild and Moderate Allergic Reactions protocol what is the adult dose for Albuterol/Atrovent?
Albuterol 2.5mg with Atrovent 500mcg (duoneb)
May repeat twice
According to the Mild and Moderate Allergic Reactions protocol by what routes can Solumedrol be given?
IV/IO/IM
According to the Mild and Moderate Allergic Reactions protocol what is the IV/IO/IM adult dose of Solumedrol?
125mg
According to the Severe Allergic Reaction protocol what are signs/symptoms of a Severe Allergic Reaction?
Severe dyspnea
Severe angioedema
Hypotension
Altered mental status
According to the Severe Allergic Reaction protocol what are the treatment options for upper airway involvement and/or stridor?
Racemic Epinephrine
Epinephrine 1:1,000
According to the Severe Allergic Reaction protocol by what route is Racemic Epinephrine given for upper airway involvement and/or stridor?
Nebulized
According to the Severe Allergic Reaction protocol what is the adult dose for Racemic Epinephrine for upper airway involvement and/or stridor?
0.5ml
According to the Severe Allergic Reaction protocol by what route is Epinephrine 1:1,000 given?
IM
According to the Severe Allergic Reaction protocol what is the IM adult dose of Epinephrine 1:1,000?
0.5mg
Repeat every 5-10 minutes if needed
According to the Severe Allergic Reaction protocol what is the IV/IM/IO adult dose of Benadryl?
100mg
According to the Severe Allergic Reaction protocol what are the treatment options for a Severe Allergic Reaction?
Racemic Epinephrine Epinephrine 1:1,000 Benadryl Albuterol/Atrovent Solumedrol Epinephrine Push Dose Presser
According to the Hypertensive Crisis Protocol at what point should pharmacological interventions be considered?
SBP>190 or DBP>100 with: Acute pulmonary edema Hypertensive encephalopathy Headache Nausea and vomiting Chest pain Blurred vision Altered mental status
According to the Hypertensive Crisis Protocol what is the goal blood pressure after treatment?
25% decrease in BP over the first hour and/or improvement of symptoms
According to the Hypertensive Crisis Protocol what are the treatment options for a Hypertensive Crisis?
Nitroglycerin/Nitrospray
Labetalol
According to the Hypertensive Crisis Protocol by what route is Nitroglycerin/Nitrospray given?
Sublingual
According to the Hypertensive Crisis Protocol what is the sublingual adult dose of Nitroglycerin/Nitrospray?
0.4mg
Repeat every 5 minutes to reach goals
According to the Hypertensive Crisis Protocol in what situation should Nitroglycerin/Nitrospray be avoided?
Right Ventricular Infarct
CVA symptoms
According to the Hypertensive Crisis Protocol by what route is Labetalol given?
IV
According to the Hypertensive Crisis Protocol what is the IV adult dose of Labetalol?
10-20mg
SLOW
If needed may double initial dose and give after 10 minutes
According to the Hypertensive Crisis Protocol in what situation is Labetalol recommended?
Pt with suspected intracranial hemorrhages or CVA
According to the Hypertensive Crisis Protocol what is the goal blood pressure for a pt with a high suspicion of an intracranial hemorrhage?
<140/90
According to the Intracranial Bleed/CVA/TIA protocol what should you try to determine from the pt?
Last time patient known to be normal
According to the Intracranial Bleed/CVA/TIA protocol how should the cot be positioned?
Head of bed >30 degrees if able
According to the Intracranial Bleed/CVA/TIA protocol what should be determined prior to completing a stroke scale?
Blood glucose level
According to the Intracranial Bleed/CVA/TIA protocol what stroke scale is used in assessing the pt?
Cincinnati Stroke Scale
According to the Intracranial Bleed/CVA/TIA protocol what is assessed within the Cincinnati Stroke Scale?
Facial Droop
Arm Drift
Speech
According to the Intracranial Bleed/CVA/TIA protocol for the Cincinnati Stroke Scale how do you assess Facial Droop?
Have the person smile or show their teeth
According to the Intracranial Bleed/CVA/TIA protocol what is a normal finding when assessing for Facial Droop during the Cincinnati Stroke Scale?
Both sides of face move equally
According to the Intracranial Bleed/CVA/TIA protocol what is an abnormal findings when assessing for Facial Droop during the Cincinnati Stroke Scale?
One side of face does not move as well as the other or at all
According to the Intracranial Bleed/CVA/TIA protocol for the Cincinnati Stroke Scale how do you assess Arm Drift?
Have the person close their eyes and hold his or her arms straight out in front for about 10 seconds
According to the Intracranial Bleed/CVA/TIA protocol what is a normal finding when assessing for Arm Drift during the Cincinnati Stroke Scale?
Both arms move equally or not at all
According to the Intracranial Bleed/CVA/TIA protocol what is an abnormal finding when assessing for Arm Drift during the Cincinnati Stroke Scale?
One arm does not move or one arm drifts down compared to the other side
According to the Intracranial Bleed/CVA/TIA protocol for the Cincinnati Stroke Scale how do you assess Speech?
Have the person say “You can’t teach an old dog new tricks,” or some other simple, familiar saying
According to the Intracranial Bleed/CVA/TIA protocol what is a normal finding when assessing Speech during the Cincinnati Stroke Scale?
Patient uses correct words with no slurring
According to the Intracranial Bleed/CVA/TIA protocol what is an abnormal finding when assessing Speech during the Cincinnati Stroke Scale?
Slurred or inappropriate words or mute
According to the Intracranial Bleed/CVA/TIA protocol if a pt has 1 of the 3 findings abnormal during the Cincinnati Stroke Scale what is the probability of an ischemic stroke?
72%
According to the Intracranial Bleed/CVA/TIA protocol if a pt has all 3 findings abnormal during the Cincinnati Stroke Scale what is the probability of an ischemic stroke?
More than 85%
According to the Intracranial Bleed/CVA/TIA protocol where should a probable stroke pt be transported?
Nearest stroke center
According to the Intracranial Bleed/CVA/TIA protocol although a pt is confused or comatose can they understand and hear all conversation?
Yes it is possible
According to the Intracranial Bleed/CVA/TIA protocol what is the treatment option for a ischemic stroke?
Labetalol
According to the Intracranial Bleed/CVA/TIA protocol by what route can Labetalol be given for an ischemic stroke?
IV
According to the Intracranial Bleed/CVA/TIA protocol what is the IV adult dose of Labetalol given for an ischemic stroke?
10-20mg
SLOW
May double initial dose and give after 10 minutes if needed
According to the Intracranial Bleed/CVA/TIA protocol what diagnostic criteria would lead to treatment with Labetalol in an ischemic stroke pt?
BP >200/100 on 2 consecutive measurements
According to the Intracranial Bleed/CVA/TIA protocol what is the goal blood pressure after treatment in the ischemic stroke pt?
185/110
According to the Intracranial Bleed/CVA/TIA protocol what is the treatment option for a suspected non-traumatic intracranial hemorrhage/ subarachnoid hemorrhage?
Labetalol
According to the Intracranial Bleed/CVA/TIA protocol what is the IV adult dose of Labetalol for a suspected non-traumatic intracranial hemorrhage/ subarachnoid hemorrhage?
10-20mg
SLOW
May double the initial dose and give after 10 minutes
According to the Intracranial Bleed/CVA/TIA protocol what is the goal blood pressure after treatment in the suspected non-traumatic intracranial hemorrhage/ subarachnoid hemorrhage pt?
<140/90
According to the Diabetic Emergencies-Hyperglycemia protocol what is the blood glucose finding leading to treatment according to the Hyperglycemia protocol?
> 250mg/dcl
According to the Diabetic Emergencies-Hyperglycemia protocol what is the treatment option for a pt with Hyperglycemia?
1-2L NS
According to the Diabetic Emergencies-Hyperglycemia protocol what are 5 pertinent histories to obtain about the pt with Hyperglycemia?
- Diabetic? (taking medications/insulin?)
- Fever?
- Nausea/Vomiting?
- Polydipsia?
- Polyuria?
According to the Diabetic Emergencies-Hypoglycemia protocol what are the findings leading to treatment according to the Hypoglycemia protocol?
<70mg/dcl
Consider level of cosciousness
According to the Diabetic Emergencies-Hypoglycemia protocol if a pt is found to be Hypoglycemic and can control their airways what is the treatment option?
1 tube Oral Glucose
Repeat as needed
According to the Diabetic Emergencies-Hypoglycemia protocol if a pt is found to be Hypoglycemic and has altered mentation what is the treatment option?
Dextrose 50%
According to the Diabetic Emergencies-Hypoglycemia protocol by what route can Dextrose 50% be given?
IV
According to the Diabetic Emergencies-Hypoglycemia protocol what is the IV adult dose of Dextrose 50%?
25 grams
May repeat up to 2 times if subsequent BGL <70mg/dcl
According to the Diabetic Emergencies-Hypoglycemia protocol if unable to establish an IV what is the next treatment option?
Glucagon
According to the Diabetic Emergencies-Hypoglycemia protocol by what routes can Glucagon be given?
IM
IN
According to the Diabetic Emergencies-Hypoglycemia protocol what is the IM adult dose of Glucagon?
1mg
According to the Diabetic Emergencies-Hypoglycemia protocol what is the IN adult dose of Glucagon
2mg
According to the Diabetic Emergencies-Hypoglycemia protocol if unable to establish and IV and Glucagon is unsuccessful what is the next treatment option?
Establish an IO and put 25 grams Dextrose 50% into 1L NS bag and run as a bolus
According to the Diabetic Emergencies-Hypoglycemia protocol what treatment option should be considered for the malnourished or suspected alcoholic?
Thiamine
According to the Diabetic Emergencies-Hypoglycemia protocol by what route can Thiamine be given?
IV/IM/IO
According to the Diabetic Emergencies-Hypoglycemia protocol what is the IV/IM/IO adult dose of Thiamine?
100mg
According to the Environmental Emergencies-Hyperthermia protocol what is the definition of Hyperthermia?
Core Temperature greater than 102 degrees F
According to the Environmental Emergencies-Hyperthermia protocol what is the definition of Heat Stroke?
Hyperthermia with hypotension
Altered mental status
Hypotension
Tachycardia
According to the Environmental Emergencies-Hyperthermia protocol what are the treatment options of the Hyperthermic pt?
Move to a cooler environment
Remove excess clothing
Apply tepid compresses to forehead, neck, extremities
According to the Environmental Emergencies-Hyperthermia protocol what are the treatment options for a pt with Heat Stroke?
NS fluid bolus to maintain SBP>100mmHg
Aggressive cooling with wet sheets and cold packs to the neck, axilla, and femoral regions
According to the Environmental Emergencies-Hypothermia protocol what is the definition of Hypothermia?
Core temperature less than 95 degrees F
According to the Environmental Emergencies-Hyporthermia protocol what are the 8 treatment options for pt with Systemic Hypothermia?
- Appropriate dysrhythmia protocol
- Carefully remove wet clothing(cut dont pull)
- Insulate from cold. Keep vehicle warm
- Wrap in warm blankets
- Heat packs to head, neck, chest, axilla, and groin
- Use IV re-warming units if available
- Gentle handling and transport ASAP
- Consider 12 lead EKG, cardiac monitoring and capnography depending on severity
According to the Environmental Emergencies-Hypothermia protocol what are the 4 treatment options for pt with Localized (Frostbite)?
- Gently remove clothing from affected area (cut dont pull)
- Protect area from pressure or friction (do not rub frost bite areas)
- Rewarm with blankets and body heat
- Assess for systemic hypothermia
According to the Environmental Emergencies-Hypothermia protocol at what temperature may the body not respond to cardiac medications?
<86 degrees F
According to the Environmental Emergencies-Hypothermia protocol how should the Hypothermic pt be treated with ACLS drugs?
Only 1 course of ACLS drugs should be given prior to pt being warmd to 92 degrees F
According to the Hyperventilation protocol what are 7 possible causes of hyperventilation which should be considered?
- Diabetic Ketoacidosis
- Metabolic Acidosis
- Carbon Monoxide
- Pulmonary Embolus
- Pneumothorax
- Aspirin Overdose
- Toxic Alcohol Poisoning
According to the Hyperventilation protocol what 4 steps should be performed if sufficient improvement is not seen in 5 minutes of coached breathing?
- Re-evaluate respiratory function
- Ensure adequate oxygenation (pulse ox)
- Determine blood glucose level
- Establish IV
According to the Hyperventilation protocol if pt is known to be Hyperventilating from anxiety what is the treatment option?
Versed
According to the Hyperventilation protocol by what routes can Versed be given?
IV/IO
IN
IM
According to the Hyperventilation protocol what is the IV/IO adult dose of Versed?
1-2.5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Hyperventilation protocol what is the IN adult dose of Versed?
2.5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Hyperventilation protocol what is the IM adult dose of Versed?
2.5mg
May repeat every 10-15 minutes
Max 2 doses
According to the General Obstetrics Call protocol what are 10 pertinent history questions to answer?
- # previous pregnancies (gravida)
- # previous live births (para)
- Estimated date of conception
- Length of labor for previous pregnancy
- Frequency of contractions
- Maternal urge to push
- Crowning
- Prenatal Care
- # babies in current gestation
- Current or previous pregnancy complicatons
According to the General Obstetrics Call protocol what are 2 conditions requiring immediate transport?
- Prolonged rupture of membranes (PROM)
2. Abnormal presentation, breech or transverse
According to the Obstetrical Complications protocol what are the 8 possible presentations?
- Breech
- Prolapsed Cord
- Multiple births
- Uterine Rupture
- Uterine Inversion
- Placenta Abruption/Placenta Previa
- Ectopic Pregnancy
- Shoulder Dystocia
According to the Obstetrical Complications protocol how should you handle a breech delivery?
Avoid delivery if possible
Elevate mothers hips
If delivery unavoidable assist with delivery
If head will not deliver and spontaneous respirations occur insert gloved hand with palm toward infants face, form a “V”, and gently push vaginal wall away from face to create an airway
According to the Obstetrical Complications protocol how should you handle a prolapsed cord?
Avoid delivery if possible
Place mother in “Knee/Chest” position
Insert 2 gloved fingers to raise presenting part of fetus off of the cord.
Do NOT attempt to push the cord back.
According to the Obstetrical Complications protocol how should you handle multiple births?
Deliver babies
Keep babies warm
Consider additional MICU
According to the Obstetrical Complications protocol how should you handle uterine rupture?
Pain Control
IV access
NS fluid bolus to maintain SBP>100
Non-traumatic shock protocol if needed
According to the Obstetrical Complications protocol how should you handle uterine inversion?
Cover uterus with moist sterile dressing Pain control IV access NS fluid bolus to maintain SBP>100 Non-traumatic shock protocol if needed
According to the Obstetrical Complications protocol how should you handle placenta abruption/ placenta previa?
Pain control
IV access
NS fluid bolus to maintain SBP>100
Non-traumatic shock protocol if needed
According to the Obstetrical Complications protocol how should you handle ectopic pregnancy?
Pain control
IV access
NS fluid bolus to maintain SBP>100
Non-traumatic shock protocol if needed
According to the Obstetrical Complications protocol how should you handle shoulder dystocia?
Flex pt thighs up towards abdomen
Have partner apply downward pressure to the pubic symphysis while you apply downward traction to the fetus
According to the Obstetrical Delivery protocol when preparing for deliver how should mother be placed?
Supine with head of bed at 30 degrees
According to the Obstetrical Delivery protocol what will prevent an explosive delivery?
Gentle pressure to the baby’s head
According to the Obstetrical Delivery protocol what should occur as soon as the baby’s head is delivered?
Suction the mouth and nose with bulb suction device
According to the Obstetrical Delivery protocol what should happen if the cord is found around baby’s neck during delivery?
Gently slip is over the head if possible
If too tight apply 2 umbilical clamps and cut
According to the Obstetrical Delivery protocol what should be noted when the baby is delivered?
Time of birth
According to the Obstetrical Delivery protocol how should the cord be clamped and cut?
First clamp: 4 inches from infant
Second clamp: 2 inches distal the first
Cut between first and second clamp
According to the Obstetrical Delivery protocol what should be done with the newly delivered infant?
Clean Dry Warm Position Stimulate
According to the Obstetrical Delivery protocol when should APGAR scores be assessed?
1 and 5 minutes
According to the Obstetrical Delivery protocol what does the acronym APGAR stand for?
A-Appearance P-Pulse rate G-Grimace A-Activity R-Respiratory Effort
According to the Obstetrical Delivery protocol what is the maximum APGAR score possible?
10
According to the Obstetrical Delivery protocol what is the minimum APGAR score possible?
0
According to the Obstetrical Delivery protocol how many points are possible in each category of the APGAR score?
0-2
According to the Obstetrical Delivery protocol what are the point criteria for Apprearance?
0-Body and Extremities blue, pale
1-Body pink, hands/feet blue
2-Completely pink
According to the Obstetrical Delivery protocol what are the point criteria for Pulse Rate?
0-Absent
1-<100/min
2->100/min
According to the Obstetrical Delivery protocol what are the point criteria for Grimace?
0-No response
1-Grimaces
2-Cough, sneeze, cries
According to the Obstetrical Delivery protocol what are the point criteria for Activity?
0-Limp
1-Some flexion of extremities
2-Active motion
According to the Obstetrical Delivery protocol what are the point criteria for Respiratory Effort?
0-None
1-Slow and irregular
2-Strong cry
According to the Obstetrical Delivery protocol how should the placenta be handled?
Allow to deliver
Place in a clean container for physician inspection
According to the Obstetrical Delivery protocol how should the uterine fundus be cared for?
Massage in a circular motion
According to the Pre-eclampsia/Eclampsia protocol what should be confirmed early?
History of pregnancy >20 weeks
According to the Pre-eclampsia/Eclampsia protocol how should the pt be positioned?
On left side and handled gently
According to the Pre-eclampsia/Eclampsia protocol what should be assessed early?
Blood glucose level
According to the Pre-eclampsia/Eclampsia protocol what are signs and symptoms of Pre-eclampsia?
Abdominal pain Mental or visual status change Pitting edema Hyper-reflexia BP>140/90
According to the Pre-eclampsia/Eclampsia protocol for Pre-eclampsia what are the criteria for treatment?
SBP>160 and/or DBP>110 and/or symptomatic
According to the Pre-eclampsia/Eclampsia protocol what is the first line of treatment for Pre-eclampsia?
Magnesium Sulfate
According to the Pre-eclampsia/Eclampsia protocol what by what route can Magnesium Sulfate be given?
IV/IO
According to the Pre-eclampsia/Eclampsia protocol what is the IV/IO adult dose of Magnesium Sulfate for Pre-eclampsia?
4 grams over 5-10 minutes
May mix in 100ml NS over 5-10 minutes
According to the Pre-eclampsia/Eclampsia protocol what is the next treatment option after Magnesium Sulfate if SBP still >160 and or DBP > 110 and or symptomatic?
Labetalol
According to the Pre-eclampsia/Eclampsia protocol what by what route can Labetalol be given?
IV
According to the Pre-eclampsia/Eclampsia protocol what is the IV adult dose of Labetalol?
10-20mg
SLOW
If needed may double the initial dose and give after 10 minutes
According to the Pre-eclampsia/Eclampsia protocol what is the sign/symptom of Eclampsia?
Actively Seizing
According to the Pre-eclampsia/Eclampsia protocol what are the treatment options for Eclampsia?
Versed
Magnesium Sulfate
Labetalol
According to the Pre-eclampsia/Eclampsia protocol what by what routes can Versed be administered in the Eclamptic pt actively seizing?
IV/IO
IN
IM
According to the Pre-eclampsia/Eclampsia protocol what is the IV/IO adult dose of Versed?
2.5-5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Pre-eclampsia/Eclampsia protocol what is the IN adult dose of Versed?
5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Pre-eclampsia/Eclampsia protocol what is the IM adult dose of Versed?
5mg
May repeat every 10-15 minutes
Max 2 doses
According to the Pre-eclampsia/Eclampsia protocol what is the IV/IO adult dose of Magnesium Sulfate for the Eclamptic pt?
4-6 grams over 5-10 minutes
May mix in 100ml NS over 5-10 minutes
According to the Opthalmic Emergencies protocol what is the treatment option for an Opthalmic Emergency?
Alcaine
According to the Opthalmic Emergencies protocol what is the dose of Alcaine?
1-2 drops in affected eye(s)
According to the Opthalmic Emergencies protocol when should alcaine not be administered in the Opthalmic Emergency?
When laceration or global penetrations are present or suspected
According to the Opthalmic Emergencies protocol once anesthetized what should EMS prevent from pt.
Rubbing Eyes as it may exacerbate existing injuries
According to the Opthalmic Emergencies protocol what other treatment option should be considered other than Alcaine?
Slowly irrigate using NS with IV tubing or sterile water flush
According to the Opthalmic Emergencies protocol how should foreign bodies be handled?
Do not attempt to remove
If large stabilize in position
According to the Hyperkalemia/Renal Dialysis protocol what should not be done while assessing blood pressures or attempting IV sticks?
Do not take BP or attempt IV access in the same area as a dialysis access
According to the Hyperkalemia/Renal Dialysis protocol if after several IV attempts access has not been successful what may be considered?
IV access in a dialysis access
According to the Hyperkalemia/Renal Dialysis protocol due to a predispotion to hyperkalemia what should each of these pt have as part of their assessment?
12 lead EKG
Continuous cardiac monitoring
According to the Hyperkalemia/Renal Dialysis protocol what are treatment options for the brady-arrhythmic with wide QRS and a pulse pt?
Calcium gluconate
Sodium bicarbonate
Albuterol (or Duoneb)
Lasix
According to the Hyperkalemia/Renal Dialysis protocol by what routes can Calcium gluconate be given?
IV/IO
According to the Hyperkalemia/Renal Dialysis protocol what is the IV/IO adult dose of Calcium gluconate?
1 gram
According to the Hyperkalemia/Renal Dialysis protocol by what routes can Sodium bicarbonate be given?
IV/IO
According to the Hyperkalemia/Renal Dialysis protocol what is the IV/IO adult dose of Sodium bicarbonate?
1meq/keg
May repeat every 5 minutes
According to the Hyperkalemia/Renal Dialysis protocol by what route can Albuterol (or Duoneb) be given?
Nebulized
According to the Hyperkalemia/Renal Dialysis protocol what is the adult dose of Albuterol (or Duoneb)?
2.5mg
May repeat every 5 minutes
According to the Hyperkalemia/Renal Dialysis protocol by what routes can Lasix be given?
IV/IO
According to the Hyperkalemia/Renal Dialysis protocol what is the IV/IO adult dose of Lasix?
40mg
According to the Hyperkalemia/Renal Dialysis protocol what is the BP requirement prior to giving Lasix?
SBP>100
According to the Hyperkalemia/Renal Dialysis protocol if all medication treatments fail in the brady-arrhythmic pt with wide QRS and a pulse what should be considered?
Transcutaneous Pacing
According to the Hyperkalemia/Renal Dialysis protocol if the patient is in cardiac arrest other than following the cardiac arrest protocol what are the treatment options?
Calcium Gluconate
Sodium Bicarbonate
Albuterol
According to the Overdose/Poisoning protocol what is the phone number for poison control?
1-800-222-1222
According to the Overdose/Poisoning protocol what medication should be considered if the pt has altered mentation with respiratory depression?
Narcan
According to the Overdose/Poisoning protocol by what routes can Narcan be given?
IV/IM/ET/IO
IN
According to the Overdose/Poisoning protocol what is the IV/IM/ET/IO adult dose of Narcan?
0.5-2mg
May continue to repeat every 10 minutes if improvement
According to the Overdose/Poisoning protocol what is the IN adult dose of Narcan?
2mg
May continue to repeat every 10 minutes if improvement
According to the Overdose/Poisoning protocol what is the acronym describing symptoms of a possible Cholinergic poisoning?
SLUDGE
According to the Overdose/Poisoning protocol what does the acronym SLUDGE stand for?
S-Salivation L-Lacrimation U-Urination D-Defecation G-G.I. Distress E-Emesis
According to the Overdose/Poisoning protocol what is the treatment option for a possible Cholinergic Poisoning?
Atropine
According to the Overdose/Poisoning protocol by what routes can Atropine be given?
IV/ET/IO
According to the Overdose/Poisoning protocol what is the IV/ET/IO adult dose of Atropine?
2-3mg
May repeat every 5 minutes until secretions diminished
Suction as needed
According to the Overdose/Poisoning protocol what is the first warning sign of a possible Tricyclic Antidepressant overdose?
Increased HR
According to the Overdose/Poisoning protocol other than the first warning sign of an Increased HR what other signs point to a possible Tricyclic Antidepressant overdose?
Increased BP- worsening Decreased BP (with possible ectopy, seizures, and cardiac arrest)
According to the Overdose/Poisoning protocol what are the treatment options for a Tricyclic Antidepressant Overdose?
Hyperventilate in assisting respiration
Treat hypotension with fluid challenge
If Tachycardia, dysrhythmias or widening QRS (>0.1 sec) administer Sodium Bicarbonate
Intubate if needed for unstable vitals or to protect airway
According to the Overdose/Poisoning protocol what is the treatment option if a possible Tricyclic Antidepressant Overdose presents with tachycardia, dysrhythmias or widening QRS (>0.1 sec)?
Sodium Bicarbonate
According to the Overdose/Poisoning protocol by what routes can Sodium Bicarbonate be given in the Tricyclic Antidepressant Overdose presenting with tachycardia, dysrhythmias or widening QRS (>0.1 sec)?
IV/IO
According to the Overdose/Poisoning protocol what is the IV/IO adult dose for the Tricyclic Antidepressant Overdose presenting with tachycardia, dysrhythmias or widening QRS (>0.1 sec)?
1meq/kg
According to the Overdose/Poisoning protocol what are 2 common Tricyclic Antidepressants that begin with the letter A?
Amitriptyline (Elavil, Tryptizol, Laroxyl)
Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)
According to the Overdose/Poisoning protocol what is 1 common Tricyclic Antidepressants that begins with the letter B?
Butriptyline (Evadyne)
According to the Overdose/Poisoning protocol what are 1 common Tricyclic Antidepressants that begins with the letter C?
Clomipramine (Anafranil)
According to the Overdose/Poisoning protocol what are 6 common Tricyclic Antidepressants that begin with the letter D?
Demexiptiline (Deparon, Tinoran) Desipramine (Norpramin, Pertofrane) Dibenzepin (Noveril, Victoril) Dimetacrine (Istonil, Istonyl, Miroistonil) Dosulepin/Dothiepin (Prothiaden) Doxepin (Adapin, Sinequan)
According to the Overdose/Poisoning protocol what are 2 common Tricyclic Antidepressants that begin with the letter I?
Imipramine (Tofranil, Janimine, Praminil)
Imipaminoxide (Imiprex, Elepsin)
According to the Overdose/Poisoning protocol what are 2 common Tricyclic Antidepressants that begin with the letter M?
Melitracen (Deanxit, Dixeran, Melixeran, Trausabun)
Metapramine (Timaxel)
According to the Overdose/Poisoning protocol what are 3 common Tricyclic Antidepressants that begin with the letter N?
Nitroxazepine (Sintamil)
Nortriptyline (Pamelor, Aventyl, Norpress)
Noxiptiline (Agedal, Elronon, Nogedal)
According to the Overdose/Poisoning protocol what are 3 common Tricyclic Antidepressants that begin with the letter P?
Pipofezine (Azafen/ Azaphen)
Propizepine (Depressin, Vagran)
Protriptyline (Vivactil)
According to the Overdose/Poisoning protocol what is 1 common Tricyclic Antidepressants that begin with the letter Q?
Quinupramine (Kevopril, Kinupril, Adeprim, Quinuprine)
According to the Overdose/Poisoning protocol what are common signs/symptoms over Cocaine ingestion?
Hypertension Hyperthermia Mental status changes Seizures Agitation Chest pain Diaphoresis
According to the Overdose/Poisoning protocol what is the treatment option of a symptomatic Cocaine ingestion?
Versed
According to the Overdose/Poisoning protocol what by what routes can Versed be given?
IV/IO
IN
IM
According to the Overdose/Poisoning protocol what is the IV/IO adult dose of Versed?
1-2.5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Overdose/Poisoning protocol what is the IN adult dose of Versed?
1-2.5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Overdose/Poisoning protocol what is the IM adult dose of Versed?
2.5mg
May repeat every 10-15 minutes
Max 2 doses
According to the Overdose/Poisoning protocol what is 1 common Calcium Channel Blocker that begins with the letter A?
Amlodipine
According to the Overdose/Poisoning protocol what are 2 common Calcium Channel Blockers that begin with the letter C?
Cardene
Cardizem
According to the Overdose/Poisoning protocol what is 1 common Calcium Channel Blocker that begins with the letter D?
Diltiazem
According to the Overdose/Poisoning protocol what are 3 common Calcium Channel Blockers that begin with the letter N?
Nicardipine
Nifedipine
Norvasc
According to the Overdose/Poisoning protocol what is 1 common Calcium Channel Blocker that begins with the letter P?
Procardia
According to the Overdose/Poisoning protocol what is 1 common Calcium Channel Blocker that begins with the letter V?
Verapamil
According to the Overdose/Poisoning protocol what is 1 common Beta Bocker that begins with the letter A?
Atenolol
According to the Overdose/Poisoning protocol what are 2 common Beta Bockers that begin with the letter C?
Carvedilol
Coreg
According to the Overdose/Poisoning protocol what are 2 common Beta Bockersthat begin with the letter L?
Labetalol
Lopressor
According to the Overdose/Poisoning protocol what is 1 common Beta Bocker that begins with the letter M?
Metoprolol
According to the Overdose/Poisoning protocol what is 1 common Beta Bocker that begins with the letter P?
Propanolol
According to the Overdose/Poisoning protocol what is 1 common Beta Bocker that begins with the letter S?
Sotalol
According to the Overdose/Poisoning protocol what are 2 common Beta Bockers that begin with the letter T?
Toprol
Timolol
According to the Psychiatric/ Behavioral Emergencies protocol what are 7 tactics to dealing with a Non-Violent pt with no evidence of immediate danger?
- Approach pt in a calm manner
- Show self-confidence and concern for pt
- Reassure pt that they should and will be taken to a hospital where people are interested in helping
- Transport pt as quickly as possible to appropriate facility without causing harm
- If pt appearing to have significant mental disorder refuses transport consider police assistance
- Never stay alone with psychiatric pt
- One crew member should establish rapport and deal with pt.
According to the Psychiatric/ Behavioral Emergencies protocol what are 3 tactics to dealing with a Violent and/or Suicidal/Homicidal pt with evidence of immediate danger to self or EMS?
- Protect patient, yourself, and others at the scene
- Always have enough help to restrain the violent pt
- Summon law enforcement for assistance when necessary
According to the Psychiatric/ Behavioral Emergencies protocol what should be assessed on every pt?
Blood Glucose Level
According to the Psychiatric/ Behavioral Emergencies protocol what should be considered for violent pts judged as unsafe for transport?
Physical Restraint
Chemical Restraint
According to the Psychiatric/ Behavioral Emergencies protocol what is the treatment option for chemical restraint of a violent pt?
Versed
According to the Psychiatric/ Behavioral Emergencies protocol by what routes can Versed be given?
IV/IO
IN
IM
According to the Psychiatric/ Behavioral Emergencies protocol what is the IV/IO adult dose of Versed?
2.5-5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Psychiatric/ Behavioral Emergencies protocol what is the IN adult dose of Versed?
2.5-5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Psychiatric/ Behavioral Emergencies protocol what is the IM adult dose of Versed?
5mg
May repeat every 10-15 minutes
Max 2 doses
According to the Psychiatric/ Behavioral Emergencies protocol if after treatment with Versed the pt continues to be violent what is the next treatment option?
Haldol
According to the Psychiatric/ Behavioral Emergencies protocol by what routes can Haldol be given?
IV/IM/IN/IO
According to the Psychiatric/ Behavioral Emergencies protocol what is the IV/IM/IN/IO adult dose of Haldol?
2-5mg
According to the Psychiatric/ Behavioral Emergencies protocol what should be considered if the pt does not have an intact airway or is at high risk of injuring him/herself and/or staff despite treatments?
RSI
According to the TASER Barb Removal protocol what should be confirmed prior to any treatment?
The TASER has been shut off and the barb cartridge has been disconnected from the TASER device.
According to the TASER Barb Removal protocol what reasons should be considered for the pts violent and combative behavior?
Intoxication Psychosis Hypoxia Hypoglycemia Overdose CNS infection
According to the TASER Barb Removal protocol if the pt is over 40 what should be assessed?
12 Lead
According to the TASER Barb Removal protocol what 4 locations of barb puncture are considered High Risk/Sensitive Zones?
- Face or neck
- Groin/ Genitals
- Spinal column
- Imbedded in a bone or joint
According to the TASER Barb Removal protocol what should be done if the barb puncture is in what is considered a High Risk/Sensitive Zone?
DO NOT attempt to remove
Transport to medical facility for removal
According to the TASER Barb Removal protocol how many barbs can be removed at a time from the pt?
One at a time
According to the TASER Barb Removal protocol what are the 3 steps for removing the barb?
- Stabilize the skin surrounding the barb
- Firmly grasp the barb
- With one smooth hard jerk remove the barb
According to the TASER Barb Removal protocol after removing the barb what 3 things should be done with the barb?
- Visually examine the barb tip to ensure it is fully intact
- Avoid needle stick and place in an appropriate container
- Return barb/container to the law enforcement officer
According to the TASER Barb Removal protocol what should happen if any part of the barb remains in the pt?
Transport to a medical facility for removal
According to the TASER Barb Removal protocol how should the wound be treated?
Cleanse the affected area with antiseptic
Cover with an adhesive bandage
According to the TASER Barb Removal protocol what 2 things should EMS inform pt of?
- Basic wound care and the need to seek additional care in the event that signs of infection appear
- The need for a tetanus shot if they have not had one in the last 5 years
According to the TASER Barb Removal protocol what 5 reasons necessitate the transport of the pt to the hospital?
- Barb lodged in a High Risk/Sensitive Zone
- Pt has previous cardiac history
- Pt appears intoxicated or non-compliant with direct instructions
- Pt has any symptoms, abnormal vitals, or abnormal 12 Lead
- If pt does not meet consent/refusal of transport guidelines
According to the TASER Barb Removal protocol is complete medical documentation required of EMS whether or not the pt is transported?
Yes
According to the TASER Barb Removal protocol if ED evaluation is necessary which hospital should the pt be taken to?
Closest appropriate hospital
According to the Respiratory Distress (Mild and Moderate) protocol what are 6 signs/symptoms of Mild Respiratory Distress?
Shortness of Breath Wheezes Cough Tachypnea Increased respiratory effort Decreased air movement
According to the Respiratory Distress (Mild and Moderate) protocol other than the 6 signs/symptoms of Mild Respiratory Distress how will the pts O2 saturation and capnography present?
Both present as normal
According to the Respiratory Distress (Mild and Moderate) protocol what are the 4 signs/symptoms of Moderate Respiratory Distress?
Abnormal O2 saturations (90-94%)
Capnography CO2 <50
Accessory muscle use/ retractions
Difficult to complete sentences
According to the Respiratory Distress (Mild and Moderate) protocol what 3 assessments should be considered?
12 Lead
Capnography
Cardiac monitoring
According to the Respiratory Distress (Mild and Moderate) protocol what should be considered as a possible cause of the Respiratory Distress?
Upper airway obstruction
According to the Respiratory Distress (Mild and Moderate) protocol if an Upper Airway Obstruction is found to be causing the respiratory distress how should this be handled?
BLS choking maneuvers
Magill forceps removal
According to the Respiratory Distress (Mild and Moderate) protocol if the clinical picture suggests asthma or COPD, wheezing or poor air movement what are the treatment options?
Albuterol/Atrovent (Duoneb)
Solumedrol
According to the Respiratory Distress (Mild and Moderate) protocol by what route can Albuterol/Atrovent (Duoneb) be given?
Nebulized
According to the Respiratory Distress (Mild and Moderate) protocol what is the adult dose of Albuterol/Atrovent (Duoneb)?
Albuterol 2.5mg with Atrovent 500mcg (Duoneb)
May repeat 2 times
According to the Respiratory Distress (Mild and Moderate) protocol by what routes can Solumedrol be given?
IV/IO/IM
According to the Respiratory Distress (Mild and Moderate) protocol what is the IV/IO/IM adult dose of Solumedrol?
125mg
According to the Respiratory Distress (Mild and Moderate) protocol what is the goal O2 saturation from treatment?
> 94%
According to the Respiratory Distress (Mild and Moderate) protocol what is the goal O2 saturation from treatment for a pt with COPD?
> 92%
According to the Respiratory Distress (Mild and Moderate) protocol what is the NS bolus dose which should be considered?
500cc
Then TKO
According to the Respiratory Distress (Mild and Moderate) protocol when should the NS bolus dose not be considered for a pt?
Suspicion of CHF
According to the Respiratory Distress (Mild and Moderate) protocol what should occur if after treatment there has been no improvement?
Proceed to the Severe Respiratory Distress Protocol
According to the Respiratory Distress (Severe) protocol what are the 7 signs/symptoms of Severe Respiratory Distress?
- Impending respiratory failure
- Abnormal O2 saturations (<90%)
- Capnography CO2>50mmHg
- 1-3 syllable phrases
- Cyanosis
- Decreased LOC
- Hypotension (SBP>100)
According to the Respiratory Distress (Severe) protocol what 3 assessments should be performed?
12 Lead
Capnography
Cardiac monitoring
According to the Respiratory Distress (Severe) protocol what should be considered as a possible cause of the Severe Respiratory Distress?
Upper airway obstuction
According to the Respiratory Distress (Severe) protocol if the clinical picture suggests asthma or COPD, wheezing or poor air movement what are the treatment options?
Albuterol/Atrovent (Duoneb)
Solumedrol
According to the Respiratory Distress (Severe) protocol along with the medication treatment options what treatment should be considered if the clinical pictures suggests asthma or COPD, wheezing or poor air movement?
CPAP
According to the Respiratory Distress (Severe) protocol can Albuterol/Atrovent (Duoneb) be given to a pt who has been placed on CPAP
Yes
Inline
According to the Respiratory Distress (Severe) protocol what is the NS fluid bolus dose which should be considered?
500cc to maintain SBP >100
According to the Respiratory Distress (Severe) protocol what treatment option should be considered if the pt presents with Respiratory Distress with Stridor?
Racemic Epinephrine
According to the Respiratory Distress (Severe) protocol by what route is Racemic Epinephrine given?
Nebulized
According to the Respiratory Distress (Severe) protocol what the adult dose for Racemic Epinephrine?
0.5ml
According to the Respiratory Distress (Severe) protocol if after initial treatment options have been used and symptoms persist what further treatment options are there?
Magnesium Sulfate
Epinephrine 1:1,000
According to the Respiratory Distress (Severe) protocol by what routes can Magnesium Sulfate be given?
IV/IO
According to the Respiratory Distress (Severe) protocol what is the IV/IO adult dose of Magnesium Sulfate?
2 grams
SLOW
Over 20 minutes (may mix in 100ml NS over 20 minutes)
According to the Respiratory Distress (Severe) protocol by what route can Epinephrine 1:1,000 be given?
IM
According to the Respiratory Distress (Severe) protocol what is the IM adult dose of Epinephrine 1:1,000?
0.5mg
May repeat once in 10 minutes
According to the Respiratory Distress (Severe) protocol what are the 3 conditions for using Epinephrine 1:1,000?
ONLY for asthma
Age <50
No history of cardiac disease
According to the Respiratory Distress (Severe) protocol what should occur if all treatment options have been exhausted without improvement?
RSI
According to the Seizures protocol what 5 things should be obtained?
IV access Cardiac Monitoring Capnography 12 Lead EKG (if new onset seizure or age >40) Blood glucose level
According to the Seizures protocol what 5 things should you consider as possible causes?
Head injury Overdose Fever Hypoxia Recurrent seizure
According to the Seizures protocol what treatment option should be considered?
Spinal immobilization
According to the Seizures protocol if a pt is experiencing febrile seizures what should be ensured?
That the pt is not excessively dressed
According to the Seizures protocol what are the treatment options?
Versed
According to the Seizures protocol by what routes can Versed be given?
IV/IO
IN
IM
According to the Seizures protocol what is the IV/IO adult dose of Versed?
2.5-5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Seizures protocol what is the IN adult dose of Versed?
2.5-5mg
May repeat every 2-3 minutes
Max 3 doses
According to the Seizures protocol what is the IM adult dose of Versed?
5mg
May repeat every 10-15 minutes
Max 2 doses
According to the Syncope protocol what 4 things should be obtained?
IV access
12 lead EKG
Cardiac monitoring
Blood glucose level
According to the Syncope protocol what treatment option should be considered?
NS fluid bolus to maintain SBP>100
According to the Syncope protocol can a NS fluid bolus be used to treat the CHF pt?
Yes but with caution
According to the Syncope protocol what are the 5 most common causes of Syncope?
- Dysrhythmias
- Decreased cardiac output
- Hypovolemia
- Vagal response
- Orthostasis
According to the Syncope protocol what are 6 pertinent histories to obtain?
- Circumstances of occurrence (pt position)
- Duration of episode
- Any symptoms before episode
- Other associated symptoms
- Previous episodes of syncope
- Past medical history
According to the Carbon Monoxide/ Cyanide Poisoning protocol what are 7 possible causes of Carbon Monoxide/ Cyanide Poisoning?
- Space heaters/stoves
- Water heaters
- Grills
- House fires
- Cigarette smoke
- Gas/Propane exhaust fumes
- Paints/Solvents/Degreasers
According to the Carbon Monoxide/ Cyanide Poisoning protocol what are the 10 symptoms of Carbon Monoxide/ Cyanide Poisoning?
- Tachycardia
- Hyper/hypotension
- Tachypnea
- Headache
- Dizziness
- Nausea/Vomiting
- Pallor/”cherry-red skin”
- Pulmonary Edema
- Memory disturbances/amnesia/confusion
- Seizures
According to the Carbon Monoxide/ Cyanide Poisoning protocol what are the 3 levels of Carbon Monoxide Poisoning?
Mild
Moderate
Severe
According to the Carbon Monoxide/ Cyanide Poisoning protocol what would the Carbon Monoxide level be in a pt suffering from Mild Carbon Monoxide Poisoning?
5-15%
According to the Carbon Monoxide/ Cyanide Poisoning protocol what symptoms would a pt suffering from Mild Carbon Monoxide Poisoning exhibit?
Headache
Dyspnea on exertion
Dizziness
According to the Carbon Monoxide/ Cyanide Poisoning protocol what would the Carbon Monoxide level be in a pt suffering from Moderate Carbon Monoxide Poisoning?
15-25%
According to the Carbon Monoxide/ Cyanide Poisoning protocol what symptoms would a pt suffering from Moderate Carbon Monoxide Poisoning exhibit?
Fatigue Visual Changes Nausea/Vomiting Palpitations Tinnitus
According to the Carbon Monoxide/ Cyanide Poisoning protocol what would the Carbon Monoxide level be in a pt suffering from Severe Carbon Monoxide Poisoning?
> 25%
According to the Carbon Monoxide/ Cyanide Poisoning protocol what symptoms would a pt suffering from Severe Carbon Monoxide Poisoning exhibit?
Altered mental status
Angina/MI
Seizures
According to the Carbon Monoxide/ Cyanide Poisoning protocol if a pt has altered mental status what else should be assessed?
Blood glucose level
According to the Carbon Monoxide/ Cyanide Poisoning protocol what is the first treatment option for a pt suffering from Carbon Monoxide/ Cyanide Poisoning?
Non-rebreather mask at 15lpm (100% O2)
According to the Carbon Monoxide/ Cyanide Poisoning protocol if pt symptoms are not improved with high flow O2 what possible cause should be considered?
Cyanide Toxicity
According to the Carbon Monoxide/ Cyanide Poisoning protocol in what situations should Cyanide Toxicity be considered?
Pt not improving after high flow O2
Cyanide detected on fire scene
Manufacturing facility
Drug house (meth-lab)
According to the Carbon Monoxide/ Cyanide Poisoning protocol if Cyanide Toxicity is suspected what is the treatment option?
Cyanokit Administration (Hydroxocobalamin)
According to the Carbon Monoxide/ Cyanide Poisoning protocol what are the 4 steps in a Cyanokit Administration?
- Place vial in an upright position
- Add 200ml of NS to vial using transfer spike (fill to line)
- Invert/rock vial for 60 seconds (do not shake)
- Infuse 5 grams IV over 15 minutes (Pediatric Dose 70mg/kg)
According to the Carbon Monoxide/ Cyanide Poisoning protocol by what route is a Cyanokit administered after it has been made?
IV
According to the Carbon Monoxide/ Cyanide Poisoning protocol what is the IV adult dose of a Cyanokit after it has been made?
5 grams
Over 15 minutes
According to the Carbon Monoxide/ Cyanide Poisoning protocol what is the IV pediatric dose of a Cyanokit after it has been made?
70mg/kg
Over 15 minutes
According to the Carbon Monoxide/ Cyanide Poisoning protocol what is the guideline for administering and IV fluid bolus?
Maintain SBP>100mmHg
According to the Carbon Monoxide/ Cyanide Poisoning protocol if pt blood pressure is not responding to fluid bolus what treatment option should be considered?
Epinephrine Push Dose Presser
According to the Carbon Monoxide/ Cyanide Poisoning protocol by what route is the Epinephrine Push Dose Presser given?
IV
According to the Carbon Monoxide/ Cyanide Poisoning protocol what is the IV adult dose of the Epinephrine Push Dose Presser?
0.5-2ml every 2-5 minutes for SBP<90mmHg
According to the Carbon Monoxide/ Cyanide Poisoning protocol if a pt has chest pain, dyspnea, or altered mental status what other assessment tools should be utilized?
12 Lead EKG
Cardiac Monitoring
According to the Carbon Monoxide/ Cyanide Poisoning protocol where should all symptomatic Carbon Monoxide pts be transported?
Closest appropriate hospital
According to the Carbon Monoxide/ Cyanide Poisoning protocol what is often a late and unreliable sign of Carbon Monoxide poisoning?
“Cherry red skin”
According to the Carbon Monoxide/ Cyanide Poisoning protocol what assessment is un-reliable and often misleading in the Carbon Monoxide poisoning pt?
Pulse oximetry
According to the Snake Bites protocol what 3 pertinent histories are important to obtain?
Type of snake
Any field treatment
Previous anti-venom exposure
According to the Snake Bites protocol how should the pt and their belongings be handled?
Keep pt calm
Remove all jewelry
According to the Snake Bites protocol how should the pt blood pressure be maintained?
IV access
NS fluid bolus to maintain SBP>100
According to the Snake Bites protocol how should the wound be handled?
Mark the wound size with time of marking
Keep wound clean
According to the Snake Bites protocol what kind of transport is necessary for the Snake Bite pt?
Rapid
According to the Snake Bites protocol what 4 things should never be done when treating the Snake Bite pt?
- Use ice
- Wrap
- Tourniquet
- Apply suction to the wound
