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ALS Flashcards

1
Q

When are you able to call for a medical TOR? When is it contraindicated?

A
  • you can call when they are 18 years or older, when the arrest was not witnessed by EMS (or fire), and NO shocks given
  • you can not call when death thought to be of non-cardiac origin
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2
Q

In terms of shocks during CPR, what is the dosing/interval?

A

If a person is 8 or older, they get 120, 150, 200, 200
- 4 times max, 2 minutes apart

If a person is under 8 years old, they get 2J/kg for the first shock, than after that can be given 3 more shocks at 4J/kg

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3
Q

In what cases is epi used in CPR?

A

Only when anaphylaxis is suspected cause of arrest
- 1 dose (0.01mg/kg up to a max of 0.5mg)

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4
Q

What situations would a “one and go” in terms of cardiac arrest be appropriate?

A
  • pregnancy over 20 weeks
  • hypothermia
  • airway obstruction
  • PE
  • toxicology/overdose
  • trauma
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5
Q

When must you patch to base hospital in a medical cardiac arrest?

A
  • after 3rd analysis (for TOR or for transport)
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6
Q

What are the most amount of shocks you can give a patient and how does that occur?

A

6
- FBAO gets relieved after 1 shock, if still pulseless - 4 shocks for medical directive, if pt ROSCs and re-arrests - 1 more shock

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7
Q

What are the conditions for manual defibrillation?

A

Age: >=30 days
LOA: altered
Other: VF or pulseless VT

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8
Q

What should be considered for tx in the medical cardiac arrest directive?

A
  • CPR
  • Supraglottic airway = where more than an OPA/NPA and BVM are required without interrupting CPR
  • Manual Defib
  • Epi = if anaphylaxis is suspected as causative event of cardiac arrest
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9
Q

When can you call for a trauma TOR? When can you not?

A
  • you can when they are 16 or older, NO shocks given, in asystole or if in PEA and closest hospital is 30 minutes or greater away
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10
Q

What are the steps for neonatal resuscitation?

A

Under 30 days of age
1. Term gestation AND good muscle tone AND breathing or crying (YES OR NO)
- if no provide warmth, position/clear airway and dry/stimulate for 30 seconds
- if yes provide warmth and clear airway as necessary (and then begin supportive care)
2. If you said NO to Step 1 - evaluate respirations and heart rate
3. Breathing and HR>=100?
- if yes provide supportive care
- if no continue neonatal resuscitation - for 30 seconds provide positive pressure ventilation (BVM) using room air
4. Reassess - is patients HR >= 60bpm
- if no begin CPR 3:1 ration making sure to plug oxygen to BVM
- continue CPR until HR above 60
- if HR is above 60 but less than 100 (or not breathing) then continue ventilations on room air until you reach 100 and can start supportive care

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11
Q

What 2 things should be placed on a neonate during resuscitation?

A
  • pulse oximetry
  • cardiac monitor
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12
Q

Normal SPO2 for neonate?

A

after 1 minute normal = 60-65%
by 5 minutes normal is 80-85%
by 10 minutes normal is 85-95%

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13
Q

What to do upon a ROSC?

A
  • get base vitals - restart primary
  • If >= 2 years, Hypotensive, and Chest auscultation is clear then provide fluid at a rate of 10ml/kg up to 1L. Reassessing every 100ml for someone someone less than 12, and every 250ml for someone >= 12
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14
Q

What is ROSC oxygen standard?

A
  • SpO2 = 94-98%
  • ETCO2 = 30-40mmHg
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15
Q

What are the conditions for insertion of a supraglottic airway?

A

Other: patient must be in cardiac arrest

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16
Q

What are the contraindications for insertion of a supraglottic airway?

A
  • active vomiting
  • inability to clear airway
  • airway edema
  • stridor
  • caustic ingestion
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17
Q

What are the indications for insertions of a supraglottic airway?

A

Need for ventilatory assistance/airway control
AND
other airway management is ineffective

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18
Q

ASA conditions:

A

Age: >=18 years
LOA: unaltered
Other: able to chew and swallow

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19
Q

ASA Contraindications:

A
  • allergy or sensitivity
  • CVA or TBI in the previous 24 hours
  • active bleed
  • asthmatic with no use of ASA before
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20
Q

ASA dosage/route:

A

160-162mg by mouth (1 dose)
- can give even if they have already taken

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21
Q

Nitro conditions (cardiac ischemia)

A

Age: >= 18 years
SBP: normotensive
HR: 60-159bpm
Other: need hx of nitro use or IV obtained

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22
Q

Nitro Contraindications (cardiac ischemia)

A
  • allergy or sensitivity
  • phosphodiesterase use within 48 hours
  • SBP drops by 1/3 or more from its initial value after nitro is administered
  • 12 lead compatible with RVI
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23
Q

What is the dosage for nitro in cardiac ischemia with NO STEMI?

A

SL
Dose: 0.3 or 0.4mg
Dosing interval: 5 mins
Max # of doses: 6

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24
Q

What is the dosage for nitro in cardiac ischemia with STEMI?

A

SL
Dose: 0.3 or 0.4mg
Dosing interval: 5 mins
Max # of doses: 3

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25
Q

What is the treatment for a patient with pulmonary edema

A
  • Nitro
  • CPAP
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26
Q

What are the indications for acute cardiogenic pulmonary edema?

A
  • moderate to severe respiratory distress
    AND
  • suspected acute cardiogenic pulmonary edema
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27
Q

Nitro Conditions (ACPE):

A

Age: >=18 years
HR: 60-159bpm
SBP: normotension

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28
Q

Nitro Contraindications (ACPE):

A
  • allergy or sensitivity to nitrates
  • phosphodiesterase use within previous 48 hours
  • SBP drops by 1/3 or more of its initial value after nitro is administered
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29
Q

What is the dosage for nitro in ACPE when SBP is >=100 and <140 with IV or a history of nitro use?

A

SL
Dose: 0.3 or 0.4mg
Dosing interval: 5 mins
Max # of doses: 6

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30
Q

What is the dosage for nitro in ACPE when SBP is >=140 with IV or hx of nitro use?

A

SL
Dose: 0.6 or 0.8mg
Interval: 5 mins
Max # of doses: 6

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31
Q

What is the dosage for nitro in ACPE when SBP is >=140 with no IV or no hx of nitro use?

A

SL
Dose: 0.3 or 0.4mg
Interval: 5mins
Max # of doses: 6

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32
Q

Dextrose conditions/contraindications:

A

Conditions - hypoglycemic, >=2 years, altered

Contraindications - allergy

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33
Q

Dextrose dosing/route:

A

IV - 2 doses, 10 minutes apart

If D10 - 0.2g/kg (2ml/kg) up to a max of 10g (100ml)
If D50 - 0.5g/kg (1ml/kg) up to a max of 25g (50ml)

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34
Q

Glucagon conditions:

A

LOA: altered
Other: hypoglycemic

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35
Q

Glucagon Contraindications:

A
  • allergy or sensitivity
  • pheochromocytoma
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36
Q

What are the indications for hypoglycemia?

A
  • agitation
  • altered LOA
  • seizure
  • symptoms of stroke
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37
Q

what is the treatment for hypoglycemia with glucagon when a pt is <25kg?

A

IM
Dose: 0.5mg
Interval: 20 mins
Max # of doses: 2

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38
Q

What is the treatment for hypoglycemia with glucagon when a pt is >=25kg?

A

IM
Dose: 1mg
Interval: 20 mins
Max # of doses: 2

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39
Q

What are the indications for Bronchoconstriction Directive?

A
  • respiratory distress
    AND
  • suspected bronchoconstriction
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40
Q

What conditions need to be met in order to give Salbutamol in bronchoconstriction?

A

NONE

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41
Q

What conditions need to be met in order to give Epinephrine in bronchoconstriction?

A

RR: BVM ventilations required
Other: hx of asthma

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42
Q

What are the contraindications of Salbutamol?

A
  • allergy or sensitivity to salbutamol
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43
Q

What are the contraindications of Epi for bronchoconstriction?

A
  • allergy or sensitivity to epi
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44
Q

What is the dosage of Salbutamol for a pt <25kg?

A

MDI:
- rate - 1 puff every 4 breaths
- dose - 600mcg (6 puffs)
- interval - 5 mins
- max # of doses - 3

NEB:
- dose - 2.5mg
- interval - 5 mins
- max # of doses - 3

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45
Q

What is the dosage of Salbutamol for a pt >=25kg?

A

MDI:
- rate - 1 puff every 4 breaths
- dose - 800mcg (8 puffs)
- interval - 5 mins
- max # of doses - 3

NEB:
- dose - 5mg
- interval - 5 mins
- max # of doses - 3

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46
Q

What is the proper dosage equation of Epinephrine?

A

IM
Concentration: 1mg/ml (1:1000)
Dose: 0.01mg/kg (rounded to nearest 0.05mg, to a max of 0.5mg)
Max # of doses: 1 for bronchoconstriction, 2 for anaphylaxis

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47
Q

What is a contraindication for the nebulizer?

A
  • fever
  • declared febrile respiratory illness outbreak
48
Q

What are the conditions that need to be met in order to give Epi in moderate to severe allergic reactions?

A

Other: for anaphylaxis only (2 body systems)

49
Q

What are the indications for moderate to severe allergic reactions?

A
  • exposure to a probable allergen
    AND
  • s&s of a moderate to severe allergic reaction
50
Q

What conditions need to be met in order to give Diphenhydramine (Benadryl) in moderate to severe allergic reactions?

A

Weight: >=25kg

51
Q

What are the contraindications for Diphenhydramine (Benadryl)?

A
  • allergy or sensitivity to diphenhydramine
52
Q

What is the dosage of Diphenhydramine (Benadryl) for a pt >=25kg and <50kg?

A

IV&IM
Dose - 25mg
Max # of doses - 1

53
Q

What is the dosage of Diphenhydramine (Benadryl) for a patient >=50kg

A

IV & IM
Dose - 50mg
Max # of doses - 1

54
Q

Epi Dosage in Anaphylaxis:

A

0.01mg/kg up to 0.5 (rounded to the nearest 0.05) x2 doses - at least 5 minutes apart

55
Q

What are the indications for Croup?

A

severe respiratory distress
AND
stridor at rest
AND
current hx of URTI
AND
barking cough or recent hx of barking cough

56
Q

What are the conditions for Epinephrine in Croup?

A

Age: >= 8 years
HR: <200bpm

57
Q

What are the contraindications for Epinephrine in Croup?

A

allergy or sensitivity

58
Q

What is the treatment for a patient with croup who is <1 year and <5kg via NEB?

A

Dose: 0.5mg
Max # of doses: 1

  • add 2ml of saline (minimum NEB volume must be 2.5ml)
59
Q

What is the treatment for a patient with croup who is <1 year and >=5kg via NEB?

A

Dose:2.5mg
Max # of doses: 1

60
Q

What is the treatment for a patient with croup who is >=1 year and <8 years old via NEB?

A

Dose:5mg
Max # of doses: 1

61
Q

What are the indications for Acetaminophen and Ibuprofen/Ketorolac?

A

Pain

62
Q

What are the conditions for Acetaminophen?

A

Age: >=12 years
LOA: unaltered

63
Q

What are the contraindications for acetaminophen?

A
  • use within the previous 4 hours
  • allergy or sensitivity
  • hx of liver disease
  • active vomiting
  • unable to tolerate oral meds
  • suspected ischemic chest pain
64
Q

What is the treatment for pain with acetaminophen for a pt >=12 years and <18 years?

A

PO
Dose: 500-600mg
Max # of doses: 1

65
Q

What is the treatment for pain with acetaminophen for a pt >=18 years?

A

PO
Dose: 960-1000mg
Max # of doses: 1

66
Q

What are the conditions for Ibuprofen?

A

Age: >=12 years
LOA: unaltered

67
Q

What are the contraindications for Ibuprofen?

A
  • NSAID use within the previous 6 hours
  • allergy or sensitivity to NSAIDs
  • pt on anticoagulation therapy
  • current active bleed
  • hx of peptic ulcer disease or GI bleed
  • Pregnant
  • if asthmatic, no prior use of ASA or NSAIDs
  • CVA or TBI in the previous 24 hours
  • known renal impairment
  • active vomiting
  • unable to tolerate oral meds
  • suspected ischemic chest pain
68
Q

What is the treatment for pain with Ibuprofen for a pt >=12 years?

A

PO
Dose: 400mg
Max # of doses: 1

69
Q

What are the conditions for Ketorolac?

A

Age: >=12 years
LOA: unaltered
SBP: normotension

70
Q

What are the contraindications for Ketorolac?

A
  • NSAID use within previous 6 hours
  • allergy or sensitivity to NSAIDs
  • pt on anticoagulation therapy
  • current active bleed
  • hx of peptic ulcer disease or GI bleed
  • pregnant
  • if asthmatic, no prior use of ASA or NSAIDs
  • CVA or TBI in the previous 24 hours
  • known renal impairment
  • suspected ischemic chest pain
71
Q

What is the treatment for pain with Ketorolac?

A

IM/IV
Dose: 10-15mg
Max # of doses: 1

72
Q

What is the preferred method of pain control?

A

Co-administration of Tylenol/Ibuprofen if possible
- in cases of renal colic, Ketorolac is preferred

73
Q

What are the indications for Opioid Toxicity Medical Directive?

A

altered LOA
AND
respiratory depression
AND
inability to adequately ventilate
AND
suspected opioid overdose

74
Q

What are the conditions for Naloxone for opioid toxicity?

A

Age: >=24 hours
LOA: altered
RR: <10 breaths/min

75
Q

What are the contraindications for naloxone?

A

allergy or sensitivity to naloxone

76
Q

What is the treatment for Naloxone in opioid toxicity?

A

IV
Dose: up to 0.4mg (titrate)
Interval: 5 min
Max # of doses: 3

IM
Dose: 0.4mg
Interval: 5 min
Max # of doses: 3

IN
Dose: 2-4mg
Interval: 5 min
Max # of doses: 3

SC
Dose: 0.8mg
Interval: 5 min
Max # of doses: 3

77
Q

When would you disconnect a home dialysis machine?

A

Patient needs to be transported and they can not disconnect it AND no family/caretaker there to disconnect
- follow directions that come with machine
- make sure patient and machine side of connection are clamped before disconnecting anything

78
Q

Indications for suspected adrenal crisis medical directive?

A

A patient with primary adrenal failure who is experiencing clinical signs of an adrenal crisis

79
Q

Conditions for adrenal crisis directive?

A
  • Paramedics are presented with a vial of hydrocortisone for the identified pt AND
  • Age-related hypoglycemia OR
  • GI symptoms (vomiting, diarrhea, abdo pain) OR
  • Syncope OR
  • Temp >= 38C or suspected/hx of fever OR
  • Altered LOA OR
  • Age-related tachycardia OR
  • Age-related hypotension
80
Q

Contraindications for adrenal crises directive?

A

allergy or sensitivity to hydrocortisone

81
Q

Tx with hydrocortisone for adrenal crisis directive?

A

IM/IV
Dose: 2mg/kg (rounded to nearest 10mg)
Max Dose: 100mg
Max # of doses: 1

82
Q

Indications for Endotracheal and Tracheostomy Suctioning & Reinsertion Directive:

A
  • patient with endotracheal and tracheostomy tube
    AND
  • airway obstruction or increased secretions
83
Q

Conditions for tracheostomy suctioning:

A

NONE

84
Q

Conditions for emergency tracheostomy reinsertion:

A
  • pt with an existing trach where the inner and/or outer cannula(s) have been removed from the airway
    AND
  • respiratory distress
    AND
  • inability to adequately ventilate
    AND
  • paramedics are presented with a trach cannula for the identified pt
85
Q

Contraindications for Trach Reinsertion:

A

inability to landmark or visualize

86
Q

treatment guidelines for trach suctioning:

A

<1 year
Dose: 60-100mmHg
Max single dose: 10sec

> =1 year to <12 years
Dose: 100-120mmHg
Max single dose: 10sec

> =12 years
Dose: 100-150mmHg
Max single dose: 10sec

87
Q

Steps for suctioning a trach?

A
  • pre-oxygenate with 100% O2
  • only suction for 10 seconds at a time and on the way out only
  • oxygenate between suction attempts
88
Q

How many attempts can be made to reinsert a trach?

A

2

89
Q

Indications for IV and Fluid Therapy Medical Directive

A
  • actual or potential need for intravenous medication OR fluid therapy
90
Q

Conditions for IV fluid therapy:

A

Age: >=2 years
SBP: hypotensive
(if only cannulating than they don’t need to be hypotensive)

91
Q

Contraindications for IV fluid therapy:

A
  • suspected fracture proximal to the access site
  • fluid overload symptoms (or BP >= 90mmHg)
92
Q

What is the rate of fluid in an IV for TKVO?

A
  • For pts >=2 years to <12 years = 15ml/hr
  • For pts >=12 years = 30-60ml/hr
93
Q

Rate of fluid for IV therapy for pts >=2 years and <12 years

A

20ml/kg
reassess every 100ml to a max of 2000ml

94
Q

Rate of fluid for IV therapy for pts >=12 years

A

20ml/kg
reassess every 250ml to a max of 2000ml

95
Q

When must you patch before giving fluids?

A

If the patient >=2 years and <12 years with suspected DKA

96
Q

Indications for Cardiogenic shock medical directive:

A
  • STEMI positive 12-lead ECG
    AND
  • cardiogenic shock
97
Q

Conditions for fluid therapy in cardiogenic shock?

A

Age: >=18 years
SBP: hypotension
Other: chest auscultation clear

98
Q

Contraindications for fluid therapy in cardiogenic shock?

A
  • fluid overload
  • SBP >=90mmHg
99
Q

What is the fluid rate for someone in cardiogenic shock?

A

10ml/kg
reassess every 250ml to a max of 1000ml

100
Q

Indications for CPAP directive?

A
  • severe respiratory distress
    AND
  • signs and/or symptoms of ACPE or COPD
101
Q

What are the conditions for CPAP?

A

Age: >=18 years
RR: tachypnea
SBP: normotension
Other: SPO2 <90% or accessory muscle use

102
Q

What are the contraindications for CPAP?

A
  • asthma exacerbation
  • suspected pneumo
  • unprotected or unstable airway
  • tracheostomy
  • inability to sit upright
  • unable to cooperate
103
Q

What is the initial setting when treating a pt with CPAP?

A

5cm H2O

104
Q

What is the titration increment when treating a pt with CPAP?

A

2.5cm H2O

105
Q

What is the titration interval when treating a pt with CPAP?

A

5 min

106
Q

What is the max setting when treating a pt with CPAP?

A

15cm H2O

107
Q

When would you increase FIO2 when treating a pt with CPAP?

A

If SPO2 <92% despite treatment and/or 10cm H2O pressure

108
Q

What are the indications for nausea/vomiting?

A

nausea
OR
vomiting

109
Q

What conditions need to be met in order to give Dimenhydrinate (Gravol) for nausea/vomiting?

A

Weight: >=25kg

110
Q

What are the contraindications for Dimenhydrinate (Gravol)?

A
  • allergy or sensitivity to dimenhydrinate or other antihistamines
  • overdose on antihistamines, anticholinergics or tricyclic antidepressants
111
Q

What is the dosage of dimenhydrinate (gravol) for a pt >=25kg and <50kg?

A

IV & IM
Dose: 25mg
Max # of doses: 1

112
Q

What is the dosage of dimenhydrinate (gravol) for a pt >=50kg?

A

IV & IM
Dose: 50mg
Max # of doses: 1

113
Q

In order to administer dimenhydrinate (gravol) through IV what must you do first?

A

dilute the dimenhydrinate with normal saline or sterile water with a ratio of 1:9

114
Q

Probe Removal Directive Indications:

A

Age: >=18 years
LOA: unaltered

115
Q

Probe removal contraindications:

A

probe embedded above the clavicles, in the nipple(s), or in the genital area

Exam Prep (10 decks)

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