Advanced Life Support Patient Care Standards Flashcards
In a Medical Cardiac Arrest, what should you consider for early transport after 1st analysis?
Consider very early transport after the 1
st analysis (and defibrillation if indicated) in the following
settings: pregnancy presumed to be ≥20 weeks gestation (fundus above umbilicus, ensure manual
displacement of uterus to left), hypothermia, airway obstruction, suspected pulmonary embolus,
medication overdose/toxicology, or other known reversible cause of arrest not addressed.
What cardiac arrest directive should you follow for opioid overdose?
Is there a role for Naloxone during cardiac arrest?
In cardiac arrest associated with opioid overdose, continue standard medical cardiac arrest directive.
There is no clear role for routine administration of naloxone in confirmed cardiac arrest.
What are the 2 shockable rhythm during cardiac arrest
VF OR pulseless VT
Trauma TOR conditions:
Trauma TOR Age ≥16 years LOA Altered HR 0 RR 0 SBP N/A Other No palpable pulses AND No defibrillation delivered AND Monitored HR = 0 OR Monitored HR >0 with the closest ED ≥30 min transport time away.
Medical TOR conditions:
Medical TOR Age ≥18 years LOA Altered HR N/A RR N/A SBP N/A Other Arrest not witnessed by EMS AND No ROSC AND No defibrillation delivered
Contraindications Medical TOR
Medical TOR
Arrest thought to be of non-cardiac
origin
Contraindications Trauma TOR
Trauma TOR Age <16 years Defibrillation delivered Monitored HR >0 and closest ED <30 min transport time away
If the patient is in cardiac arrest following removal of a obstruction, Do you Still treat as a Foreign Body Airway Obstruction
Cardiac Arrest?
Following removal of the obstruction, initiate management as a
medical cardiac arrest.
What is considered a Neonatal patient?
<30 days of age
If a 7 days old newborn patient HR is under 60 but greater than 0. What should you do
If the patient’s HR is less than 60 bpm but
greater than ‘0’ you must still start with
effective PPV on room air prior to initiating
PPV with 100% O2 and chest compressions.
When a newly born patient is in cardiac
arrest (HR of 0) you must do what?
you must still start with
effective positive pressure ventilations
(PPV) on room air prior to initiating chest
compressions. In other words, follow the algorithm outlined in your medical directive
(without skipping any steps) regardless of
the newly born patient’s initial heart rate. In
MOST cases effective PPV/ventilation of
the lungs will increase the newly born
patient’s heart rate
what is MR SOPA
‘MR SOPA’ - adjusting Mask to assure good seal, Reposition airway to “sniffing” position, Suction mouth and nose of secretions if necessary, Open mouth using manual manoeuvres, increase Pressure to achieve adequate chest rise, consider an Alternate Airway if available (ACP should consider ETT as an alternate airway).
(ROSC) Medical Directive:
Conditions
Contraindications
0.9% NaCl Fluid Bolus Age ≥2 years LOA N/A HR N/A RR N/A SBP Hypotension Other Chest auscultation is clear
(ROSC) Medical Directive:What should you your target SPO2 and ETCO2
Consider optimizing ventilation and oxygenation
Titrate oxygenation 94-98%
Avoid hyperventilation and target ETCO2 to 30-40 mmHg with continuous waveform capnography
(if available)
Cardiac Ischemia Medical Contraindications ASA and NTG
ASA Allergy or sensitivity to ASA or NSAIDs If asthmatic, no prior use of ASA Current active bleeding CVA or TBI in the previous 24 hours
Nitroglycerin Allergy or sensitivity to nitrates Phosphodiesterase inhibitor use within the previous 48 hours SBP drops by one-third or more of its initial value after nitroglycerin is administered 12-lead ECG compatible with Right Ventricular MI
Do you need to do a 12 Lead before administering NTG?
12 Lead Acquisition: Considering 12 lead acquisition and interpretation for STEMI is now a defined step in the treatment of cardiac
ischemia and precedes Nitroglycerin consideration
A 12 lead acquisition should be performed under __ from the PT contact
The recommendation that a 12 lead be performed within the first 10 minutes of patient contact is a goal. Understanding that not all situations allow for a 12 lead to be performed within the first 10 minutes of patient
contact, the Paramedic should document barriers that did not allow for this goal to be achieved
PT presented with an inferior AMI should not receive NTG, WHY?
These patients are often preload dependent and the administration of
nitroglycerin to these patients may cause significant hypotension.
PT presenting with chest pain took 2 ASA at 2pm. Will you still give him more for the Cardiac Ischemia directive?
ASA is a safe medication with a wide therapeutic index (the effective dose without side effects can be from 80
– 1500 mg). The additional dose provided by Paramedics will not exceed the therapeutic dose while ensuring the correct administration of correct dose of the medication. Therefore, apply the cardiac ischemia medical
directive as if no care had been rendered prior to your arrival
PT presenting with CHF and is STEMI positive. What is the maximum number of doses of NTG should you give?
Many patients who are at risk of having a cardiac event (MI) may also have a history of CHF and it can
sometimes be difficult to determine what issue is driving the other. It is likely that the STEMI is causing, or
exacerbating the CHF, and as such, following the Cardiac Ischemia Medical Directive and administering a
maximum of 3 x 0.4mg doses of nitroglycerin is most appropriate. The reduced number of doses in STEMI
reduces adverse outcomes associated with liberal nitroglycerin use.
Phosphodiesterase Inhibitors, are used for what
The use of these medications has diversified to include treatment of pulmonary hypertension and congestive
heart failure (CHF).
The most appropriate categorization is as phosphodiesterase (PDE) 5 inhibitors.
Phosphodiesterase (PDE) 5 inhibitor list (many known as erectile dysfunction drugs [EDD])
