Adults ALS (SD Protocols)

Question 1

Patients that are symptomatic of TIA/CVA. What is the window for hospital care?

Answer 1

< 24 hours

Question 2

For CVA/TIA patients. Maintain oxygen saturation at what levels?

Answer 2

94% to 98%

Question 3

For TIA/CVA patients. Keep head of bed (HOB) at what elevations?

Answer 3

15 degree elevation = if SBP is greater than 120

Flat = if SBP is less than 120 and patient tolerates it

Question 4

CVA and TIA patients. Who do you notify and when?

Answer 4

Notify the accepting Stroke Receiving Center early in the call

Question 5

CVA and TIA patients. What should be given to the ED staff on arrival?

Answer 5

Provide a list of all current medications, especially anticoagulants (blood thinners)

Question 6

What do we use as a BLS assessment tool to recognize, report, and document CVA and/or TIA patients?

Answer 6

BE-FAST

B = Balance
E = Eyes: (Bluured vision or loss of vision)
F = Face: (Unilateral facial droop)
A = Arms and/or legs: Unilateral weakness exhibited by a drift or droop
S = Speech: Slurred, inability to find words, absent
T = Time: Accurate Last Known Well Time

*****if any of this is positive, then what?

Question 7

CVA/TIA patients: If any of BE-FAST is positive, then what?

Answer 7

Calculate and report the FAST-ED to the MICN

Question 8

CVA/TIA patients: What is FAST-ED

Answer 8

FAST-ED

F = Facial palsy
A = Arm weakness
S = Speech changes
T = Time
E = Eye deviation
D = Denial/Neglect

Question 9

CVA/TIA patients: Get the LAST KNOWN WELL time in what hours?

Answer 9

Military time (hours: minute)

Question 10

Sudden severe headache with no known cause indicative of a stroke?

Answer 10

Yes

Question 11

CVA/TIA patients: Why do we bring a witness to the hospital?

Answer 11

To verify time of symptom onset. If witness cannot ride in the ambulance get their phone number

Question 12

Stroke/TIA patients with blood glucose of less than 60 mg/dl (BLS and ALS treatment)

Answer 12

Treat for hypoglycemia

BLS: give 3 oral glucose tabs or paste (patient is awake and able to swallow)

Patient may eat or drink, if able

ALS treatment:

Dextrose 25gm IV, MR, SO (No IV, then give glucagon 1 ml, SO, no repeat)

Question 13

CVA/TIA patients: ALS treatment?

Answer 13

• IV SO (large-bore in AC)
• Fluid bolus 250ml IV/IO to maintain BP 120 or greater if no rales SO, MR SO

Question 14

Chest Pain treatment: What do we keep the oxygen saturation levels at?

Answer 14

94% - 98%

Question 15

Chest Pain treatment: BLS treatment with nitro and ASA?

Answer 15

if SBP is 100 or greater, may assist patient with their nitro for a maximum of 3 doses, including those the patient has taken.

May assist with patients ASA up to max of 325 mg

Question 16

Chest Pain Treatment ALS: When do we repeat 12-leads?

Answer 16

After arrhythmia conversion or any change in patient status.

Question 17

Cardiac patient: What do we report on 12-leads?

Answer 17

LBBB, RBBB, or poor quality EKG

Question 18

Chest Pain: How much ASA do we give? Repeats? What order?

Answer 18

324 mg, SO, (no repeat)

Question 19

Chest Pain: If SBP is 100 or greater give what?

Answer 19

NTG 0.4 mg SL, SO, MR q3–5 min, SO

Pain medications

Question 20

Chest Pain: Discomfort/pain of suspected cardiac origin with associated shock

Answer 20

250 ml fluid bolus IV/IO with no rales SO, MR to maintain SBP 90 and greater, SO

Question 21

Chest Pain: If BP refractory to second fluid bolus

Answer 21

Push-dose epinephrine 1:100,000 (0.01mg/ml) 1ml, IV/IO, BHO, MR q3 minutes to SBP of 90 or greater

Question 22

Chest Pain: NTG is contraindicated in what patients?

Answer 22

Erectile dysfunction patients that have taken the following medications within 48 hours (viagra, cialis, levitra)

Pulmonary hypertension medications (Revatio, flolan, veletri)

Question 23

Chest Pain: If you do not give ASA what do you do?

Answer 23

Document the reason why you withheld it (ASA can be withheld if a healthcare provider has given an equivalent amount)

Question 24

BLS Adult compressions: how many continuous compressions?

Answer 24

100-120/minute, but 110 is optimal

Question 25

BLS Adult ventilation rate?

Answer 25

10-12/minute

Question 26

Adult CPR: What are we looking for with capnograpgy (End Tidal CO2)

Answer 26

Wave form and number value

Question 27

Adult CPR: NG/OG is what order?

Answer 27

SO, PRN

Question 28

Adult CPR: Minimize compressions to what?

Answer 28

Less than 5 seconds (SD County)

Question 29

Adult CPR: May intubate if end tidal CO2 reads what?

Answer 29

Greater than “0”

Question 30

Adult CPR: If End Tidal CO2 rises quickly, what do you do?

Answer 30

Pause CPR and check for a pulse for no more than 5 seconds. (Femoral or carotid)

Question 31

Adult Unstable Bradycardia: Treatment

Answer 31

12-lead
Atrophine 1 mg IV/IO SO, MR q3-5 minutes to max 3 mg SO
250 ml NS bolus to maintain SBP of 90 or greater w/ clear lung sounds. MR, SO, IV/IO

Question 32

Adult Unstable Bradycardia: Rhythm unresponsive to atrophine

Answer 32

Versed 1-5mg IV/IO (pre-pacing) SO
Pacing, SO
If capture occurs and SBP is 100 or greater, treat with Pain Management

Question 33

Adult Unstable Bradycardia: If SBP is less than 90 after atrophine or initiation of pacing

Answer 33

• 250 ml NS bolus IV/IO, MR X1, SO
• Push Dose EPI, 1 ml, BHO, repeat q3 minutes, titrate to SBP of 90 or greater (BHO)

Question 34

Adult Unstable Bradycardia: What qualifies as unstable?

Answer 34

SBP of less than 90 and any of the following symptoms:

AlOC
Pallor
Diaphoresis
Significant Chest Pain of Cardiac Origin
Severe SOB

Question 35

Cardiac Pacing Adult: What rate do we begin at?

Answer 35

60/min

Question 36

Adult Cardiac Pacing: After setting the rate, what do you do?

Answer 36

Dial up until capture occurs. Usually capture occurs between 50 and 100 mA

Question 37

Adult Cardiac Pacing: Do we increase capture?

Answer 37

Usually about 10 percent for ongoing pacing

Question 38

Adult SVT (Stable-symptomatic); Treatment

Answer 38

IF SBP <90 mm Hg and no rales, 250 ml NS bolus IV/IO, MR SO
VSM, SO
Adenosine 6mg rapid IV/IO followed by 20ml NS rapid IV/IO, SO
Adenosine 12 mg rapid IV/IO followed by 20ml NS rapid IV/IO SO, MR x 1, SO

Question 39

What pain medications do we give for pacing under “pain management?”

Answer 39

Ketamine and Fentanyl

Question 40

What would be a scenario where Ketamine would be withheld from a patient being “paced?”

Answer 40

Drug or alcohol intoxication

GCS less than 15

Question 41

Unstable Bradycardia:

If SBP <90 mmHg after atropine OR initiation of pacing?

Answer 41

• 250ml fluid bolus IV/IO SO, MR x 1, SO
• Push-dose epinephrine 1:100,000 (0.01mg/mL) 1mL IV/IO, BHO, MR q3minutes, titrate to SBP 90 or greater, BHO

Question 42

Cardiac arrest: VAD patients

Answer 42

• CPR
• contact BH for additional instructions

Question 43

Cardiac arrest: TAH

Answer 43

• contact BH for instructions

Question 44

What is the synch cardiovert energy settings?

Answer 44

70, 120, 150 (S0),,,,,,200 (BHO)

Question 45

A-FIB/Flutter treatment

Answer 45

Rate 180 and greater
Consider midazolam 1-5 mg IV/IO pre-cardioversion SO
Synch cardiovert 70,120,150 (SO) and 200 (BHO)

After successful cardioversion:
Give fluids—250 mL bolus w/clear lungs if SBP is less than 90, MR, SO
- 12 lead

Question 46

If patient is unstable V-Tach, then what?

Answer 46

Go directly to synch cardioversion

Versed pre-cardioversion SO (BP doesn’t matter)

*****no pain management for synch cardioversion