Algorhythms (MOVAB = Monitor, 12 Lead, O2, Vitals & Vascular Access, Airway, Brearthing) Flashcards
(235 cards)
1
Q
What general considerations for universal approach
A
Everyone gets complete assessment
High level suspicion
Respect, dignity, privacy
2
Q
What the minimum number of vitals required, and what assessments are required in your vitals
A
Minimum x2
HR, SBP, RR, GCS, Pain scale
5 letters in “vital”
3
Q
What must you do you before and AFTER giving a controlled substance/sedative medication
A
4 lead
ETCO2
Vitals
4
Q
How often to get vitals for a red vs yellow vs green pt
A
Red - 5
Yellow - 10
Green - 15
5
Q
What should you do on a Ped pt if a ped protocol doesnt exist for the situation?
A
Use the adult protocol
6
Q
Can you disconnect a cardiac monitor to move the pt or upload/enter data mgmt mode?
A
No. No interruptions in “continuous cardiac monitoring”
7
Q
Minimum SPO2 to maintain
A
94%
8
Q
Is it pt abandonment to back out of a dangerous scene?
A
No
9
Q
Minimum time apart between vitals
A
5 minutes
10
Q
Rx for adult mild/partial obstructions
A
Don’t mess with it. Monitor, allow pt coughing, position of comfort
11
Q
Rx - adult severe / complete airway obstruction (responsive, unresponsive, unresponsive ALS)
A
Responsive = ab thrusts. Chest thrusts if unable
Unresponsive = CPR. Check for object each airway opening
ALS* laryngoscopy + magill forceps. No visualization = intubate > cric (last resort)
12
Q
Blind finger sweeps. Yes or no?
A
Never
13
Q
You intubate an unresponsive adult w/ airway obstruction, but still cant ventilate. What Rx?
A
*note the teeth mark
Deflate cuff > push all the way down > back to OG spot > reinflate and ventilate
14
Q
Sudden onset acute respiratory distress w/ coughing, gagging, stridor, or wheezing. What’s wrong?
A
Think choking
15
Q
How to tell if mild choking pt progresses to severe?
A
Silent cough w/ increased work of breathing or unresponsive
16
Q
Which priority in unresponsive choking adult pt?
Transport vs multiple intubation
A
Never delay transport
17
Q
asthma / COPD ALS Rx
A
MOVAB + ETCO2
Duoneb (2.5mg albuterol + 0.5mg Ipratropium) repeat x1
Subsequent 2.5mg albuterol PRN
Solu-medrol 125mg SIVP
All fails = CPAP + inline albuterol
All ELSE fails for *asthma= consider epi 0.3mg IM outer thigh, repeat x1 post 3-5min PRN - OLMC for epi drip
- BVM if resp failure
- mag sulfate 2g IV over 10min last resort
18
Q
What precaution for giving epi to asthma/COPD pt
A
> 35 yrs or Hx cardiac
19
Q
When to contact OLMC during asthma/COPD pt
A
Additional doses epi
Epi drip
Mag sulfate
20
Q
What should you ask every asthma/COPD pt? Why?
A
“Have you been intubated before?”
Yes = high risk rapid deterioration
21
Q
Your asthma /COPD pt suddenly has silent chest sounds from previous wheezing. What’s up?
A
Think pre-respiratory arrest
22
Q
You intubate or apply CPAP to your asthma/COPD pt and they suddenly decompensate. What’s up?
A
Think tension pneumo
23
Q
What QA measures for Asthma/COPD pt
A
lung sounds x2 (5 min apart)
Etco2
Soul-medrol
CPAP? Why or why not
24
Q
Should you give nitro to a pt who has already had a breathing treatment (albuterol)?
A
No
25
If anything fucks up (IV, vent, tube, monitor rhythm) what should you first think of before panicking?
DOPE - displacement, obstruction, Pneumo (airway-related), equipment failure
26
What to do if your vent pt is in resp distress and you can’t figure out what’s wrong?
Disconnect vent and bag
27
Trach obstruction Rx
1-3cc saline & suction PRN
28
You cant clear a trach with suction and can no longer ventilate. What next?
Replace tube if caretaker has a spare and knows how to do it
29
Trach pt cant be ventilated nor suctioned and there’s no caretaker to use a replacement tube. What next?
- insert ETT (similar size as stoma) and bags
If that fails = bag over stoma or pt’s mouth (cover stoma)
30
When can you, as a non CCT medic transport a vent pt?
When pt is on home ventilator and caretaker or family member can accompany to assist w/ operation
31
Your trach pt has excess secretions, no or decreased chest wall movement, cyanosis, accessory muscle use, and difficult ventilation. What’s up?
Think trach obstruction. Consider DOPE
32
A ventilator alarm shows “low pressure or apnea”. What’s wrong
Possible loose/disconnected circuit or air leak > poor ventilations
33
A ventilator alarm shows “high pressure”. What’s wrong?
Possible plugged or obstructed airway or circuit tubing by coughing or by bronchospasm
34
CO poisoning Rx (what info does Hosp want to know?)
- Scene safe?
- Extricate pt > fresh air
- MOVAB
- CPAP (15 LPM NRB if unable)
- BVM PRN
- note & inform hospital of CO readings onscene
- seizure precaution
35
Mild vs severe CO poisoning SS
Mild = headache, nausea, vomit, fatigue
Severe = AMS, resp distress/arrest
36
What assessment is useless during CO poisoning
SPO2
37
You’re responding to a structure fire w/ smoke. What medical emergency to suspect?
Cyanide and CO poisoning
38
Pt pulled from smoke / industrial fire exposure is altered, lethargic, with abnormal respirations (tachy or Brady). What to suspect?
Cyanide poisoning
39
Cyanide poisoning/smoke inhalation Rx
- scene safety
- decon & extrication
- MOVAB & ETCO2 ( must have IV x2)
- hi flo O2
- severe (AMS or bad VS) = Cyanokit 5g IV over 15min (blood samples prior)
40
Initial Cardiac Arrest approach - when to do CPR first vs go straight to MRX rhythm analysis?
CPR first = >4min down or bad bystander CPR
MRX first = <4min down or good bystander CPR
41
Do you need to document bystander interventions (ex. CPR) prior to your arrival?
Yes, all of them.
42
Your pt achieves ROSC, nad goes in and out of it multiple times. How do you document this?
Document ALL occurrences of ROSC
43
When would you initiate transport on a cardiac arrest pt?
Only when ROSC unless scene dictates early extrication
44
Cardiac arrest - What joules to defib w/ the MRX?
150
45
What meds for asystole/PEA (concentration, dose, route, frequency/max)
1mg epi (0.1mg/mL) IV or IO every 3-5min - max 3 doses
46
What meds for Vfib/ pulseless Vtach (torsades?) (concentration, dose, route, frequency/max)
Epi 1mg (0.1 mg/mL) IO/IV - 3-5min - max 3 dose
Amio 300mg IV/IO - then 150mg 3-5min later OR…
… if torsades = mag sulfate 2g IV/IO
46
What meds for Vfib/ pulseless Vtach/torsades (concentration, dose, route, frequency/max)
Epi 1mg (0.1 mg/mL) IO/IV - 3-5min - max 3 dose
Amio 300mg IV/IO - then 150mg 3-5min later OR…
… if torsades = mag sulfate 2g IV/IO
47
What main assessment to monitor progress of cardiac arrest
EtCO2
48
What reversible causes? (H’s and T’s)
H - hermes the Ox drove to cali to play
volleyball and glyde
T - Thrombo the lesbo causes tension and trauma when she tox about her tampons
Hypothermia, hydrogen (acidosis), hyper/hypo K, hypovolemia, hypoglycemia, hypoxia
Thrombosis (PE or MI), tension pneumo, toxicity, tamponade, trauma
49
Cardiac arrest w/ suspected hyper K Rx?
Sodium bicarbonate 8.4% (100 mEq) + calcium chloride (1g) IV/IO
Flush lines between meds
50
Cardiac arrest w/ hypoglycemia Rx?
D10 - 25g IV/IO repeat x1 in 3-5min PRN
51
How much narcan for cardiac arrest with Opiate Overdose? How often/ how many times can you give it?
Narcan 2mg IV/IO - repeat PRN per 3-5min PRN until MAX 6mg (not including IN doses)
52
Cardiac arrest w/ suspected cyanide exposure Rx?
Cyanokit 5g IV/IO over 15min
53
Cardiac arrest w/ suspected tension pneumo Rx?
Needle decompress
54
What’s a vector change and when to do it?
Refractory V-fib after defib x3 = new pads in different position (ant/post or apex/sternum)
NO OLMC needed
55
When and how can you call a code in the field?
DNR, scene safety, or minimum 20min EMS resus attempt w/out response
56
What responses are you looking for when deciding to call a code?
Rhythm change, ETCo2, etc
57
When would you suspect hyper K on a cardiac arrest pt?
Dialysis/ESRD hx
Diabetes
K sparring diuretics or supplements
58
What QA measures for a cardiac arrest?
CPR w/in 1min
Supraglottic
EtCO2
No transport = <35 EtCO2 and OLMC
ROSC?
59
ROSC protocol
- 12-lead (call STEMI PRN)
- BP
- maintain ABCs & cardiac output
- transport to PCI
60
ROSC pt < 90 SBP Rx
Bolus 0.9% NS > max 2L (20ml/kg if <100kg)
- reassess lungs per 500mL
- push dose Epi - 10mcg every 1-2 min (max 5 doses)
- then norepi drip - 1mcg/min (w/ 2nd IV site) > titrate per 1min until SBP >90 or max 10mcg/min
61
ROSC pt w/ RONF fighting airway and ventilations. What Rx?
Versed (Midazolam) 2.5mg IV/IO and fentanyl 50mcg IV/IO - repeat x1 in 5min PRN
62
You’ve maxed your sedatives/pain meds on a ROSC pt w/ RONF. What next?
OLMC
63
ACS Rx
- MOVAB
- 12 Lead / declare STEMI alert & transmit PRN
- ASA 324-325mg
- Nitro 0.4mg SL per 3-5min PRN (pn resolves)
- SBP <90 = fluids 500mL > max 2L
- pn mgmt PRN
64
What qualifies as a STEMI
ST elevation >1mm in 2+ contiguous leads
65
What’s a preACT STEMI
ST elevation > 2mm in 2+ contiguous leads
HR <130
Age 30+
Decisional capacity
Onset <24hr
Narrow QRS
No DNR
No arrhythmia or pacer
SHADOQNN
66
When transmitting a 12-lead for STEMI/PreACT STEMI… what info required
Pt name and DOB w/ facility notification
67
Nitro contraindications
SBP < 90 mmHg
SLC 12-24-48
Stendra <12hr
Levitra, staxyn, viagra <24hr
Cialis < 48hr
68
What are angina equivalents
Chest (palpitations, SOB)
Head (syncope, anxiety, fatigue, diaphoresis)
Stomach (unexplained nausea, epigastric pain)
Shoulder/jaw pain
Tachypnea
Angina - think CHSSS (chessT)
69
What extra Rx for inferior wall MI
IV before nitro preferred
R side ECG (v4R)
70
ACS QA measures
12 lead w/in 5min pt side
STEMI = transmit 12 lead
Nitro and ASA?
Pn improvement?
71
Bradycardia Rx
MOVAB
Determine category and treat (stable-asymptomatic…. Stable -symptomatic… unstable)
72
Stable asymptomatic bradycardia Rx
MOVAB
Consider causes
73
Stable symptomatic bradycardia
MOVAB
SBP < 90 = NS bolus 500cc > max 2L (assess lungs per 500)
Atropine 1mg x 3 (every 3-5min PRN)
74
Unstable bradycardia Rx
MOVAB
Pace
Consider atropine 1mg but dont delay pace
Consider versed prior pacing (2.5mg IV/IM or 5mg -1/2 each nare… 2nd dose after 3-5min = same)
Epi drip last resort
75
Your bradycardic pt is still hypotensive despite fluids / atroping / pacing… what next?
OLMC to ask for…
Norepi drip 1-10mcg/min
Epi drip 2-5mcg/min
Calcium Chloride (if Ca channel blocker OD)
76
You suspect your bradycardic pt has a calcium channel blocker OD. What Rx?
OLMC > Calcium Chloride 1g SIV over 5min
77
When shouldn’t you give atropine to a bradycardic pt? why?
Suspected ACS ischemia or AMI. Atropine may overwork the heart and > more damage/infarct
78
Can you give atropine for blocks?
Type 2 and 3rd degree are ok w/ new wide QRS complex w/ no AMI/ischemia
79
Are there any precautions to versed and specific populations?
Consider lower dose for >60yr age or <60kg pts
80
QA measures for versed administration
VS before & after
EtCO2 after every dose
No Benzo and opiate mix
Waste documentation
81
Tachycardia Rx
MOVAB
- check pulse
- determine stable vs unstable - wide vs narrow
and follow Rx plan
82
What constitutes unstable tachycardia
Persistent tachyarrhythmia > Chest pain/discomfort, hypotension (SBP <90 mmHg), AMS, Pulmonary edema (Acute heart failure), shock signs
CHAPS
83
Stable - Wide tachycardia Rx (torsades?)
MOVAB
vagal
irregular = amio 150mg over 10min (repeat x1 PRN)
Regular = OLMC (adenosine or amio)
Torsades = mag sulfate 2g IV over 10min
84
Stable narrow tachycardia Rx
MOVAB
Vagal
Regular = adenosine 6mg RIVP > 12mg > OLMC
Regular w/ Afib hx = diltiazem 0.25mg/kg SIVP > max single dose 20mg
Irregular = same as above (diltiazem)
85
Unstable tachycardia
MOVAB
Versed 2.5mg - 5mg IV/IO/IN - repeat x1 in 5min PRN
Regular (narrow or wide ) > sync cardiovert 100-120-150-170J
Irregular narrow > sync cardiovert 120-150-170j
Irregular (wide or polymorphic) > defib 150j
86
Pt has unstable regular, narrow tachy. What Rx?
Sync cardiovert 100-120-150-170j
87
Pt has unstable wide regular tachycardia, what Rx?
Sync Cardiovert
100-120-150-170J
88
Pt has unstable irregular, narrow tachycardia, what Rx?
Sync Cardiovert
120-150-170j
89
Pt has unstable irregular wide/polymorphic tachycardia, what Rx?
Unsynchronized defib = 150j
90
Pt has stable wide tachycardia, what Rx
MOVAB
Vagal
Irregular = Amio 150mg infusion over 10min > repeat x1 PRN
Regular = OLMC for adenosine or amio
91
Pt has torsades (stable wide irregular) tachycardia
Mag sulfate 2g IV over 10min
92
Pt has stable narrow but regular tachycardia, what Rx?
MOVAB
Vagal
Adenosine 6mg RIVP > 12mg > OLMC
93
Pt has stable narrow tachycardia with hx Afib, what Rx?
Diltiazem 0.25mg/kg SIVP > max single dose 25mg
94
Pt has stable, narrow, irregular tachycardia, what Rx?
Diltiazem 0.25mg/kg SIVP > max single dose 25mg
95
What HR is for primary vs secondary tachycardia?
Primary = Usually >150 BPM
Secondary = usually lower
96
Cardiogenic shock Rx
MOVAB
Maintain BP via ROSC protocol (fluids + push dose epi + norepi PRN)
Transport > closest PCI
97
CHF / Pulmonary Edema Rx
MOVAB (12-lead)
Nitro per 3-5min if…
- SBP >90 = 0.4mg SL
- SBP >120 = 0.8mg SL
- SBP >160 = 1.2mg SL
CPAP
98
QA measures - CHF/Pulm edema
Lung sounds x2 (5min apart)
ETCO2
Nitro <5min at pt?
No nitro & albuterol mix?
99
You’re not sure if pt has CHF or COPD… what can’t you mix?
Nitro and albuterol
100
Ab pain / Nausea & Vomiting Rx
MOVAB (12 lead)
Nausea/Vomit = zofran 4mg SIVP or oral tab (4mg) > repeat x1 in 15min PRN
Fluids = 500mL 0.9% NS
Pn mgmt if ACUTE onset
101
Why SIVP for zofran
Most side effects DT rapid push
102
What are some reasons why pt might feel nausea
Heat trauma, ACS, bowel obstruction, preggo, drug effects
103
When would you give pain meds to an abdominal pn pt?
First time acute onset
104
Allergic Reaction & Anaphylaxis Rx
Severe = 0.5mg epi (1mg/mL) IM mid anterolateral thigh > repeat per 3-5min x max 3 doses PRN (12 lead after every epi)
Fluids > 500 mL
Benadryl = 50mg IV/IM/IO
Solu-medrol (methylprednisolone sodium succinate) = 125mg IVP
Albuterol = 2.5mg nebulized > repeat x1
105
What happens if you throw the sink at an anaphylaxis/allergic reaction and it doesn’t work
OLMC > more epi or epi drip (1-4 mcg/min)
106
SS of allergic reaction
Skin (hive, swell, rash)
Swollen lips/tongu/throat
Wheeze, stridor, resp distress
Tachy & hypo
Bees sting but their honey is SSWT
107
Psych Rx
Confirm safety & PD
Restraints PRN
Rule out underlying (SNOT - sugar, seizure, stroke, narcs, oxygen, trauma, toxins)
MOVAB (EtCO2 & 12-lead)
Versed PRN (if no de-escalate)
108
SOP for using restraints
Check & Doc PMS before/after/every 10min
No prone position
109
What’s the versed (Midazolam) dose for psychs? What must you do always when giving this med?
If de-escalate not possible…
Potentially violent = 2.5mg IV/IM OR 5mg IN (split nares) > repeat PRN x1 in 3-5min
Actively violent w/ immediate threat = double the normal dose > repeat at normal dose x1 PRN in 3-5min
* monitor EtCO2 & 4-lead always
110
What are the precautions with Midazolam (Versed) for psychs?
Use lower dose for ETOH or drug ingestions. Monitor airway
111
Every time you give a sedative, you must…
Document and reassess Vitals before and after (ETCo2 and SPO2) & 4-lead
112
Stroke Rx
Gather info
MOVAB (12-lead, BGL, 20g IV R AC)
FAST-ED stroke assessment
Declare Stroke ALERT
Assess Complex Stroke criteria
Determine destination
113
QA for sedatives / Versed
VS(Etco2, spo2) , 4-lead before/after
Waste documented
No benzo & Opiate mix
114
When should you be concerned with ETCO2 and SPO2 on a sedated psych pt?
ETCO2 > 45 or SPO2 < 94% = decreased respiratory drive
115
What info to gather during a stroke?
Onset/discovery (exact time)
Last known normal
SS present upon awakening from sleep?
Seizure hx?
BGL
Witness name / contact
Stroke BLOWSS
116
What constitutes a stroke alert?
Positive stroke assessment AND
<24hrs (last normal if unwitnessed)
117
Criteria for complex stroke?
FASTED score 4+
Suspected current or hx cranial bleed, head trauma or aneurysm
Neuro surgery last 3 mo
Bleeding disorder or blood thinners
118
Where to take stroke pts? primary vs comprehensive center
Comprehensive = Complex or 3.5hr +
Primary = < 3.5hr and no complex
119
What to do if suspected intracranial bleed?
30 degree head elevation
120
QA measures for strokes
Stroke sceen & alert w/in 5min
BGL?
Scene time <15min
All info documented (onset, last normal, witness contact)
121
Diabetic emergency Rx?
MOVAB & BGL
Follow hypo (<60mg/ dL) or hyper ( >400 mg/dL) protocol
122
What is hypoglycemia criteria and what Rx?
Hypo < 60 mg/dL or symptomatic
15g Oral glucose if conscious w/ patent airway OR…
25g D10 (250mL) IV OR…
1mg glucagon IM (last option)
Reassess per 5-10min post Rx. Repeat x1 PRN
123
What is hyperglycemia and what Rx?
>400 mg/dL
1000ml fluids (check half way for pulm edema)
ETT PRN
124
You cant get a line on a hypoglycemic. What next?
Glucagon
OLMC > IO access permission
125
Drowning/ Submersion Rx
Consider Spinal precautions
Remove wet clothing (hypothermia)
MOVAB
- wheeze = duoneb x2 & albuterol PRN
- rales = CPAP
- resp failure = intubate
126
Cold Emergency Rx
Extricate
Remove wet clothing & warm pt (hot pack > groin /armpit *no direct skin contact)
MOVAB (fluids & intubate PRN)
Frostbite = pn mgmt & burn center
127
What if you can’t get an IV on a cold emergency pt?
IO
128
Which pt groups are susceptible to cold emergencies?
Geriatrics (less subQ fat)
Peds
Alcoholics & Druggies
129
Heat Emergency Rx
Extricate & remove excess clothing
fluids
AMS = rapid cooling w/ ice packs & cool/wet sheets
MOVAB
Treat symptoms (nausea, seizures, hypotensive)
130
Athletes w/ suspected heat stroke RX
Can delay transport max 15min if cooling / submersion treatment underway (<101.5F)
Aggressive cooling Enroute (ice water tarp wrap)
MOVAB
Treat symptoms (hypotension, seizure, nausea)
131
What meds can elevate a pt’s body temp?
Take of your TAAUPS (dont judge me)
Tricyclic antidepressants
Anticholinergics
Alcohol
Uppers
Phenothiazines
Salicylates (aspirin)
132
Can you rely on forehead/tympanic temperatures to guide care?
No they’re not accurate enough. Use rectal 1st, oral 2nd
133
Sepsis Rx
MOVAB (ETCO2 & BGL)
Confirm indicators
Issue SEPSIS alert
Same as cardiogenic shock Rx (5-5-5)
- Fluids 500cc (pressure infuser)
- Push dose epi (10mcg per 1-2 min > max 5 dose)
- Fluids 500cc
- Norepi 1mcg/min (titrate > max 10mcg/min via 18g separate IV) *Last resort
134
What are the indicators of SEPSIS
Suspected infection AND 2+ indicators below:
HR > 100
RR > 20 AND EtCO2 25 or less
SBP <90 OR cap refill >4s OR mottled skin
Acute AMS or GCS 12-
135
You want to give norepi but aren’t sure if your IV site is working. Yes or no and why?
if in doubt, NO. norepi is highly necrotic to tissue
136
What to do if you suspected infiltrated norepi line?
Check The pearls of SEPSIS protocol for antidote steps: they’ll need an adrenergic blocking agent to cover the area
137
What QA measures for sepsis
BGL?
IV & fluids?
Minimum 1000cc fluids if time w/ pt >20min
Nor epi used?
Sepsis alert declared?
Final SBP >90
138
Pre-Eclampsia / Eclampsia Rx
MOVAB (ETCO2)
Fluids PRN
Fast transport (L Lateral) > OB hosp
Seizure = mag sulfate 4g IV over 10min, versed 2.5mg IV/IO per 5min > max 10mg
OR 5mg IN repeat x1 per 5-10min
139
What SS of pre-eclampsia? When do preggos typically have it?
HTN, headache, vision change, RUQ pn, Peripheral edema, dark urine
After wk 20 to 2 wks postpartum
140
What extra thing can you do for a preggo that displays severe SS pre-eclampsia, but hasn’t seized yet?
OLMC > pre-emitve mag sulfate 4g over 10min
141
What questions to ask a preggo?
Gravidity & parity?
Prenatal acre/complications?
ETA delivery & gestation length
High risk pregnancy?
142
What to assess for during an OB emergency
Contractions (length and frequency)
Membrane rupture?
Vaginal bleeding?
143
When’s the only time you should check the perineum?
Mandatory to check if contracts present and regular in obviously pregnant female
144
What to do if prolapsed umbilical cord?
Elevate hips > trendelenburg position or knee-chest
Gloved hand into vagina
Wrap gently in moist gauze
Rapid transport
145
During OB emergency, Breech presentation Rx?
Pt into knee-chest position
Rapid transport
146
What to do if baby fails to deliver fully
Hyperflex hips
Try to deliver in all 4s position
Deliver >1-2min still = rapid transport
147
Your pt is in active labor but you see no crowning. What to do?
Rapid transport to nearest OB
148
Poisoning / OD Rx
MOVAB (BGL)
Understand what toxidrome and treat accordingly
149
What are the main toxidromes?
Sympathomimetic
Opioid / sedative
Cholinergic
Anticholinergic
Opiate/benzo/ETOH withdrawal
150
Someone OD’ed on an upper. What Rx
MOVAB + Supportive care
151
How much and what route narcan for an opiate/opioid OD?
MOVAB
Narcan 4mg IN, repeat x1 after 3min PRN
OR
Narcan 0.5mg IV/IO, repeat per 3min to max 6
152
Number one goal of pit crew model
CPR & early defib
153
Pt has immune response and rash of bumps on face and body. What new possible disease?
Monkey pox
154
Monkey pox transmission?
Droplet - 6 feet, mucous, direct contact
Starts 5 days prior to rash onset.
155
Monkey pox precautions
Gown, N95, gloves, eyes, face
156
In pitcrew model, where are the positions?
Head = airway
Side = CPR
Leg = meds & access
157
when should you suspect hyper K in a cardiac arrest?
Hx renal failure/dialysis or diabetes
Meds - K sparring diuretics or K supplements
158
What dose of push dose epi for a ROSC pt and when to give it?
If pt hypotensive after INITIAL 500ml NS bolus
10 mcg per 1-2min (max 5 doses) until SBP > 90 mmHg
159
What dose of norepi and when to give it for a ROSC pt?
If pt hypotensive after 1000cc fluids (or fluid overload)
1mcg/min (with secondary IV site) > titrate per 1min until SBP > 90 or max 10mcg/min
160
When to give fluids and how much for a ROSC pt?
If SBP < 90 mmHg
Continue giving it in conjunction to other interventions
Max 20ml/kg (or 2000cc) or until fluid overload (assess lungs every 500cc fluids)
161
What is classified as severe anaphylaxis
2+ affected organ systems
Or Shock
162
What’s your goal onscene time & max time for a stroke?
Goal <10min
Max <15min
163
Which types of pts get hypoglycemic really easily?
ETOH
Insulin pumps
164
Hypoglycemic emergency pt has an insulin pump running. Can you turn it off?
YES
165
What should you expect for drowning/submersion pts?
A lot of VOMITTING. Monitor airway
166
What to be carful if applying hotpack to a hypothermic pt?
No direct skin contact > trauma risk
167
Where to take extreme hot and cold emergencies?
Trauma center (burn center for extreme injury)
168
What EtCO2 are you trying to maintain on a SEPSIS pt
25 mmHG
169
How much fluids to give to a SEPSIS pt?
Aim for SBP 90
Max 2000cc or 20ml/kg for kids
170
What dose and when to give push dose epi on a SEPSIS pt? How many doses max?
If initial 500cc NS fluids dont work on BP…
10mcg per 1-2min (max 5 doses) until SBP > 90
171
What dose and when to give norepi on a sepsis pt?
When pt hypotensive after 1000cc fluids
1mcg/min (w/ second IV 18g AC)
Titrate per 1min till SBP > 90 or max 10 mcg/min
172
Why shouldn’t you try to reposition a prolapsed cord
Severe compression = hypoperfusion to fetus
173
What ALS treatment on an OB emergency . What sbp should you give fluids? How much initially?
MOVAB
IV fluids TKO
SBP < 100 mmHg = 250cc bolus
174
What’s a cholinergic and what treatment?
Cholinergic = pesticides, neurotoxin
Atropine 2mg IV, repeat per 2min until secretions dry
OLMC for duodote kit
175
What’s an Anticholinergic and what RX?
Red as a beet, blind as a bat, dry as a hare, mad as a hatter
Supportive care & MOVAB
176
What Rx for pt in withdrawals (drugs, benzos, alcohol)
HR > 120 or SBP > 140mmHg = versed 2.5mg IV/IM, repeat per 3-5min x1
Seizing = seizure protocol
177
What causes acute dystonic reation and what Rx?
Psych and nausea drugs
Rx = benadryl 50mg IV, versed 2.5mg IV/IM repeat x1 per 3-5min
178
Pepper spray Rx?
Remove contaminated stuff
Flush w/ saline
179
What drugs would cause a widened QRS? What phenomenon is that called? What Rx?
Sodium Channel Blockade
Anticholinergics, antihistamines, tricyclic antidepressants
Sodium Bicarb 1 mEq/kg IV
180
Pain MGMT protocol
MOVAB (EtCO2 & SPO2)
Moderate = ketorolac or Acetaminophen
Severe = Fentanyl
181
Ketorolac contraindications?
No active/recent bleed risk
Kidney disease
Cardiac ACS/active disease
Pregnant/nursing mom
NSAID <8hr
Allergy
182
Ketorolac dose and indication
Moderate acute pain
15mg IV/IM x1 (no repeat)
183
Acetaminophen contraindications
Liver disease
Previous Tylenol < 6hrs
Allergy
184
Acetaminophen indications and dosage
Moderate acute pain
>50kg = 1g IV over 15min (no repeats)
<50kg = 15mg/kg IV over 15min (no repeats)
185
Indication and dose for fentanyl
Severe acute pain
1mcg/kg IV/IO to max SINGLE dose of 100mcg
Repeat per 10 min to max total of 3mcg/kg OR
1mcg/kg IN (max single dose 100mcg). Repeat per 5 min to max of 3mcg/kg
186
What other med should you avoid mixing with opioids? Why?
Benzodiazepines > increase risk resp. Depression
187
Pn mgmt QA
Vitals & pn scale before & after each admin
ETCO2
Waste documented
188
Seizure Rx
MOVAB (15lpm, EtCO2)
Protect pt from trauma
BGL
Versed (2.5mg IV/IM or 5mg IN… repeat per 3-5min until max dose 10mg)
189
When should you call PD on a seizure?
If they were driving prior
190
Impaled objects Rx
Stabilize in place ( DONT remove)
191
Wet or dry dressings for burns? For eviscerations?
Burns = dry
Eviscerations = wet
192
What to do with amputated body parts
Moist sterile inner packaging, ice/cold outer
193
When to do needle decompress
suspected TENSION pneumo
194
What to do for active herniation of head
Hyperventilate 20 BPM to maintain 30-35 mmHG EtCO2
195
What SBP to maintain for trauma?
Depends:
Major/multi-system = SBP 80-90mmHg
Major head = SBP 100-110 mmHg
196
What are the H-bombs of TBI’s? What’s the significance?
Hypoxia, hypotension, hyperventilation/hypocarbia
Short period of any of these = increased mortality
197
Which traumas specifically need OLMC contact
Replant services
Crush/compartment syndrome mgmt
198
General Trauma QA
Scene time < 10min
Trauma alert < 5min
O2 & IV
199
Traumatic arrest Rx
XABCDE
Chest decompress if chest trauma
Fluids
ACLS
200
How much fluids for a trauma arrest?
Adult = 2000cc
14-15 = 1500cc
13 - = handtevy
201
Where do you take a traumatic arrest
NOT a free standing
202
Electrocution / lightning strike (not in arrest) Rx
Consider spinal & burns
MOVAB
203
Electrical / lightening burn Rx
Significant = Fluids
Adults = 2000cc
14-15 years = 1500
13- = handtevy
204
Cardiac arrest from lightning/electrocution Rx.
Fluids (adult 2000, 14-15 = 1500, younger = handtevy)
MOVAB
ACLS
205
Eye injury Rx
Help pt remove contacts PRN
Stabilize impaled objects
Irrigate PRN
IV & pn mgmt
206
Pt has eye injury after using power tools or welding… why shouldn’t they sign a refusal?
These appear ok at first, but can actually be super severe
207
Stingray Rx
Control bleed
Hot water (w/ soap or ammonia) or hot pack to wound
Look for a barb (DONT remove)
Pn mgmt
208
Jellyfish / man-o-war Rx
HAZARD, beware contamination
Script w/ rigid edge & rinse w/ seawater or NS fluid (baking soda/fluid to water)
a lot of rubbing alcohol
Pn mgmt
209
Snakebite Rx
Identify/photograph snake
Remove constricting clothes/jewelry
Mark area
Splint below heart level
Pn mgmt
210
Insect sting Rx
Identify / photograph
Rigid edge for stinger (no tweezer)
Cold pack
Pn mgmt
211
What shouldn’t you do for a snake bite?
NO tourniquet of cold pack
212
Burns Rx
1. Stop burning/decon (undress contaminated)
2. Cover burns (dry dressing)
3. MOVAB (prep adv airway & EtCO2)
4. Fluids
5. Consider pn mgmt, Cyanokit, Co poisoning
213
What to do for chemical burns
Brush it off then flush generously
214
How to determine burn destination
1. 2nd or 3rd degree >15% BSA w/ multisystem trauma = trauma alert > Tampa general if equidistant to closest trauma center
2. 2nd or 3rd degree at high risk (hands, feet, face, airway, circumferential = trauma alert > Tampa General
3. Isolated 2nd or 3rd degree >15% = trauma alert > Tampa General
215
A burn pt has 2nd and/or 3rd degree burn > 15% BSA but no trauma. What destination?
Tampa General w/ trauma alert
216
Burn pt with 2nd or 3rd degree burn to face/airway, hands, feet, perineum, circumferential chest/extremities… what destination?
Trauma alert to Tampa General hospital
217
What BSA % and what burn degree qualifies someone to go to a burn center?
15% and 2nd or 3rd degree burns
218
How much fluids to give to a burn pt?
Adult = 20ml/kg (max 2000cc)
14-15 = 20ml/kg (max 1500cc)
13 years minus = handtevy
219
Barotrauma / diving injury Rx
MOVAB (high flo O2, EtCO2)
Fluids
Nausea = zofran (12-lead before)
220
What history to obtain on a dive/ barotrauma injury?
“D’FAC is barotrauma?”
Depth / length of dive
Frequency in <24 hrs
Air travel in <24 hrs
Compressed air type
221
How much fluids to give to a barotrauma or diving injury pt?
Adult = 2000cc
14-15 = 1500cc
13 younger = handtevy
222
How long after a dive can SS of a diving injury occur?
Up to 48 hrs after
223
How does barotrauma affect the body
Ears = ruptured drum, vertigo, tinnitus
Lungs = Pneumothorax, mediastinal emphysema
stomach = nausea / vomiting
224
What’s decompression sickness and how does it affect the body?
Gas bubbles block blood flow = joint pain, headache, vision, clots (PE, MI, CVA)
225
Restrictive vs Obstructive lung disease
Restrictive = mechanically cant get air in (fibrosis, chest wall, amyloidosis)
Obstructive = cant expel CO2 (COPD/asthma)
226
What lung disease interfere with gas exchange (diffusion) in the alveoli?
Pneumonia
Edema/CHF
227
What do reverse shark fin capno’s mean?
Leak in a vent circuit
228
Great ways to differentiate COPD vs CHF
CHF pts will present with…
Cool pale diaphoretic
Pedal / sacral edema
Square (not shark fin) capno
Higher blood pressure
Rales
229
Quick way to know push dose epi
Sepsis, ROSC hypotension, Cardiogenic shock
5-5-5
500 fluids > 5 push dose epi’s > 500 fluids > norepi (last resort)
230
How to draw push dose epi
1. Waste 1cc of a 10cc NS flush
2. Inject 1cc of 1:10,000 into the flush via 3way stopcock
3. Use the saline flush @ 10mcg/ml
231
What is the trauma triad of death ? Why is it important?
These 3 factors compound each other during a trauma > high mortality rate:
Coagulopathy
Hypothermia
Acidosis
232
What examples of coagulopathy in the trauma triad of death?
Bleeding
Saline dilutes blood
Blood thinners
Drugs/alcohol
233
What can cause hypothermia in trauma pts?
Cold pavement
Saline infusions
Bleeding
234
What causes acidosis in trauma pts
Hypoperfusion to organs > lactate acids build up in body
