ALS

Question 1

Bronco construction medical directive drugs

Answer 1

Salbutamol, epinephrine, dexamethasone

Question 2

Bronco construction medical directive conditions

Answer 2

Salbutamol: N/A
Epinephrine: BVM ventilation and History of asthma
Dexamethasone: history of asthma, or COPD, or 20 pack a year smoking history

Question 3

Bronco construction medical directive, contraindications

Answer 3

Salbutamol: allergy or sensitivity
Epinephrine: allergy or sensitivity
Dexamethasone: allergy or sensitivity and currently on PO or parenteral steroids

Question 4

Bronchoconstriction treatment

Answer 4

Salbutamol (MDI,NEB): < 25kg MDI 600mcg Every 5-15mins MAX 3 doses. NEB 2.5mg 5-15mins MAX 3 doses
>25kg MDI 800mcg Every 5-15mins MAX 3 doses. NEB 5mg 5-15mins MAX 3 doses
EPI (IM) : 0.01mg per/kg. MAX 0.5mg only one dose
DEX(PO,IM,IV): 0.5mg per/kg MAX 8mg only one dose

Question 5

Allergic reaction medical directive conditions

Answer 5

Epinephrine: anaphylaxis only
Diphenhydramine: >25 kg

Question 6

allergic reaction medical directive Contraindications

Answer 6

Epinephrine: allergy or sensitivity
Diphenhydramine: allergy sensitivity

Question 7

allergic reaction medical directive treatment

Answer 7

Epinephrine(IM): 0.01mg per/kg MAX 0.5mg. 2 doses wait 5 mins
Diphenhydramine(IV,IM,): >25kg <50kg = 25mg >50kg= 50mg

Question 8

Croup medical directive conditions

Answer 8

Epinephrine: >6 months < 8years HR < 200bpm and Strider rest
Dexamethasone: >6 months < 8years, LOA unaltered

Question 9

Croup medical directive conditions

Answer 9

Epinephrine: >6 months < 8years HR < 200bpm and Strider rest
Dexamethasone: >6 months < 8years, LOA unaltered

Question 10

Croup medical directive, contraindications

Answer 10

Epinephrine: allergy or sensitivity
Dexamethasone: allergy or sensitivity, steroids received within the last 48 hours, unable to tolerate oral medication.

Question 11

Croup medical directive treatment

Answer 11

Epinephrine(NEB): <10kg 2.5mg >10kg 5mg (one dose)
Dexamethasone(PO): 0.5mg per/kg max dose 8mg (one dose)

Question 12

ROSC medical directive treatment

Answer 12

Fluid bolus(IV) > 2 years - 12 years. 12+
Infusion 10ml/kg. 10ml/kg
Reassess every: 100ml. 250ml
Max. Volume: 1000 ml. 1000ml

Question 13

ROSC medical directive conditions

Answer 13

Fluid bolus: >2 years, hypertensive, clear chest auscillation.

Question 14

Cardiac ischaemia medical directive conditions

Answer 14

ASA: >18 years, unaltered LOA, Able to chew and swallow
Nitroglycerine: > 18 years old, LOA unaltered, HR 60-159bpm, normotension, prior of nitro or able to get IV access.

Question 15

Cardiac ischaemia medical directive contraindications

Answer 15

ASA: 1.allergy or sensitivity to NSAIDs,
2.asthmatic with no prior use of ASA,
3.current active bleeding,
4.CVA or TBI in the previous 24 hours.

Nitroglycerine: 1. allergy sensitivity to nitrates,
2.phosphodiesterase inhibitor use within the previous 48 hours,
3.systolic blood pressure drops 1/3 after use.
4.Right ventricular MI

Question 16

Cardiac ischemia medical directive (treatment)

Answer 16

ASA(PO): 160-162mg (2 tablets)
Nitroglycerine(SL): (BP has to be >100mmhg)
NO STEMI. STEMI
Dose: 0.3 - 0.4mg Dose: 0.3 - 0.4mg
Time: 5 mins Time: 5 mins
Max doses: 6. Max dose: 3

Question 17

Pulmonary edema medical directive conditions

Answer 17

Nitroglycerine: >18 years, HR 60-159, normotension,

Question 18

Pulmonary edema medical directive contraindications

Answer 18

Nitroglycerine: 1. Allergy or sensitivity to nitrates
2. Phosphodiesterase inhibitor use within the last 48 hours.
3. Systolic blood pressure drops 1/3 after use.

Question 19

Pulmonary edema medical directive treatment

Answer 19

Nitro(SL) >100 <140 SBP. >140mmhg. >140mmhg
IV or Hx: YES. NO Yes
Dose: 0.3-0.4mg 0.3-0.4mg 0.3 - 0.4mg
Dosing time: 5mins 5mins 5mins
MAX#: 6 6 6

Question 20

Hypoglycaemia medical directive conditions

Answer 20

Dextrose: > 2 years, altered LOA, hypoglycaemia
Glucagon: altered LOA, hypoglycaemia

Question 21

Hypoglycaemia medical directive contraindications

Answer 21

Dextrose: allergy or sensitivity
Glucagon: allergy or sensitivity, pheochromocytoma (tumour above the adrenal glands)

Question 22

Hypoglycaemia medical directive treatment

Answer 22

Dextrose(IV) 10% 50%
Dose. 2ml/kg 1ml/kg
Max dose 250ml 50ml
Dosing interval 10mins 10mins
Max# dose: 2 2

Glucagon(IM): <25kg >25kg
Dose: 0.5mg 1mg
Dosing interval: 20min 20min
Max # dose 2 2

Question 23

Opioid toxicity medical directive Conditions and contraindications

Answer 23

Naloxone: >24 hours old, altered LOA, <10 breaths/min, inability to ventilate or persistent need to assist ventilations

Naloxone contraindications: allergy or sensitivity

Question 24

Opioid toxicity medical directive treatment

Answer 24

Naloxone:
Route: IV. IM. IN. SC
Dose: Up to 0.4mg. 0.4mg. 4mg. 0.8mg
Dosing interval: 5mins. 5min. 5min. 5min
Max# doses: 3. 3. 3. 3.

Question 25

Analgesia medical directive Conditions

Answer 25

Acetaminophen: > 12 years old, LOA unaltered. Ibuprofen: > 12 years old, LOA unaltered Ketorolac: >12 years old, LOA unaltered, Normotension

Question 26

Analgesia medical directive contraindications for acetaminophen

Answer 26

1. acetaminophen use within the previous four hours. 2. Allergy or sensitivity 3. History of liver disease. 4. Active vomiting. 5. Unable to tolerate oral medication. 6. Suspected ischaemic chest pain. “All Adults Hate Active Upset Stomachs”

Question 27

Analgesia, medical directive counter indications for ibuprofen

Answer 27

1. NSAID use within previous six hours. 2. Allergy or sensitivity to ASA or NSAID 3. Patient on anticoagulation therapy 4. Current active bleeding. 5. History of peptic ulcer disease or G.I. bleed 6. Pregnant 7. If asthmatic no prior use of ASA or other NSAID 8. CVA or TBI in the previous 24 hours 9. Known renal impairment. 10. Active vomiting. 11. Unable to tolerate oral medication. 12. Suspected ischemic chest pain

Question 28

Analgesia medical directive contraindications for Ketorolac

Answer 28

1. NSAID use within previous six hours. 2. Allergy or sensitivity to ASA or NSAID 3. Patient on anticoagulation therapy 4. Current active bleeding. 5. History of peptic ulcer disease or G.I. bleed 6. Pregnant 7. If asthmatic no prior use of ASA or other NSAID 8. CVA or TBI in the previous 24 hours 9. Known renal impairment. 10. Suspected ischemic chest pain

Question 29

Analgesia medical directive treatment

Answer 29

Acetaminophen(PO): Age: >12 - <18 18+ Dose: 500-650mg 960-1000mg Max # doses 1 1 Ibuprofen(PO): >12 years old Dose: 400mg give only once Ketorolac(IM/IV): Age: >12 years old Dose: 10-15 mg Max # doses: 1

Question 30

Nausea/vomiting medical directive conditions

Answer 30

Ondansetron: >25kg, LOA unaltered Dimenhydrinate: <65 years, >25kg, LOA unaltered.

Question 31

Nausea/vomiting medical directive Contraindications

Answer 31

Ondansetron: 1. allergy 2.Prolonged QT syndrome (known to pt) 3. Apomorphine use Dimenhydrinate: 1.allergy or sensitivity to Dimenhydrinate or other antihistamines 2. Overdose on antihistamines or anticholinergics or tricyclic antidepressants 3. Co-administration of diphenhydramine

Question 32

Nausea/vomiting medical directive treatment

Answer 32

Ondansetron: >25kg Dose: 4mg Max# dose: 1 Dimenhydrinate(IV/IM): Weight: >25kg <50kg >50kg 25mg 50mg

Question 33

Suspected adrenal crisis medical directive conditions

Answer 33

Hydrocortisone Other: 1.paramedics are presented with a vile of hydrocortisone for the identified patient 2. Age related hypoglycemia. OR G.I. symptoms.(vomiting, diarrhoea abdominal pain.) OR syncope OR temperature >38c or suspected fever OR altered LOA OR age related tachycardia OR age related hypotension

Question 34

Suspected adrenal crisis medical directive contraindications

Answer 34

Hydrocortisone: allergy or sensitivity

Question 35

Suspected adrenal crisis medical directive treatment

Answer 35

Hydrocortisone(IM/IV): Dose: 2mg/kg Max single dose: 100mg Max# doses: 1

Question 36

EMRG child birth oxytocin conditions

Answer 36

1. Childbearing years 2. SBP <160 mmhg 3. Postpartum delivery and/or placental delivery

Question 37

EMRG child birth oxytocin contraindications

Answer 37

1. Allergy or sensitivity 2. Undelivered fetus 3. Suspected or known pre-eclampsia with current pregnancy 4. Eclampsia (seizures) with current pregnancy 5. >4 hours post placenta delivery

Question 38

EMRG child birth oxytocin treatment

Answer 38

10 units only given once