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ALS Algorithms Flashcards

1
Q

Severe Agitation - Adult

A

Treatment: Sedation with Midazolam (2.5-5 mg IV/IO)

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1
Q

CHF

signs your looking for

treatment

A

Key Signs: Edema, Hypertension, PND, SOB, Wheezing, Crackles on Lung Auscultation.

Differentials: Rule out inferior STEMI with a 12-lead ECG.

Treatment: CPAP, Nitro 0.4 mg, Nitro Paste, Transport to Cardiac Center.

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2
Q

Mild Allergic Reation - Adult

signs for mild

treatment

A

Signs: Rash, Itching, Hives.

Treatment: Diphenhydramine 25-50 mg IV/IM).

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3
Q

Severe Allergic Reaction - Adult

signs for Severe

treatment

A

Signs: Respiratory Distress, Swelling.

Treatment: Epinephrine (0.3 mg IM) - may repeat every 5-15 minutes.

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4
Q

Anaphylaxis - Adult

signs for moderate

treatment

A

Possible Causes: Allergic reaction to food, insect sting.

Key Signs: Urticaria, angioedema, respiratory distress.

Vital Signs: Hypotension.

Treatment: Epinephrine 0.5 mg IM; consider diphenhydramine and Dexamethasone

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5
Q

Hypoglycemia - Adult

sign your looking for

treatment

A

Signs: Confusion, Sweating, Blood Glucose below 70 mg/dL.

Treatment: Dextrose 25 g IV/IO or Glucagon

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6
Q

Hyperkalemia - Adult

signs your looking for

treatment

A

Possible Causes: Renal failure, some meds cause it like Beta blockers, Sartans, Prills, diuretics.

Key Signs: Muscle weakness, peaked T waves on ECG.

Vital Signs: Bradycardia, hypotension.

Treatment: Cal Chloride 0.5-1gram slow 5 mins IVP flush then Sodium BiCarb 50 mEq IV over 5 mins

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7
Q

Severe Pain

treatment

A

Fentanyl 1mcg/kg

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8
Q

Seizures - Adult

signs

treatment

A

Midazolam/Versed 5mg IM

2.5mg if patient is over 69

check bgl

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9
Q

Seizures - Pregnancy

signs

treatment

A

Give 5mg IM Midazolam/Versed

then

4mg Mag Sulfate IV over 10mins mixed in 100mL LR

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10
Q

Hemorrhagic Shock - Adult

signs

treatment

A

Signs: Hypotension, Tachy, Cool Clammy, Long cap refill

Treatment:
Control bleed, Fluids

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11
Q

Hypovolemic Shock - Adult

signs

treatment

A

Signs: Hypotension, Tachy, Cool Pale, Weak Pulse

Treatment: Fluids

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12
Q

Neurogenic Shock - Adult

signs

treatment

A

Signs: Hypotension, Brady, Warm and Dry

Treatment: Fluids

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13
Q

Asthma Exacerbation

signs

treatment

A

Signs: Wheezing, accessory muscles, Shark fin capno

Treatment:

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14
Q

CHF

signs your looking for

treatment

A

Signs: Crackles, PND, Edema, HTN, capno might be norm. Check 12 lead

Treatment: IV, CPAP, SL Nitro 0.4, check bp 150

Note: Check for Inf Wall MI before Nitro

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15
Q

Croup - Peds

signs your looking for

treatment

A

Signs: Inspiratory Stridor, Barking Cough

Treatment: Neb Epi

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16
Q

Opioid Overdose

signs your looking for /possible drugs

treatment

A

Signs: Pinpoint, resp depress, AMS

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17
Q

Calcium Channel Blocker OD

signs/possible meds

treatment

A

Possible Causes: Overdose on medications like verapamil.

Key Signs: Hypotension, bradycardia, widened QRS complex.

Vital Signs: Hypotension, heart rate < 60 bpm.

Treatment: Calcium chloride 0.5 g-1 g SLOW IVP over 10 mins. (except digoxin)

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18
Q

(NA) Sodium Channel Blocker OD

signs/possible meds

treatment

A

Possible Causes: Overdose on medications like tricyclic antidepressants. TCA - Amitriptyline.

Key Signs: Wide QRS complex, seizures, hypotension.
Vital Signs: Hypotension, widened QRS complex.

Treatment: Sodium BiCarb 1 mEq/kg IV bolus; repeat 0.5mEq/kg every 10 mins to maintain narrow QRS

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19
Q

Beta Blocker OD

signs/possible meds

treatment

A

Possible Causes: Overdose on medications like Beta Blocker - propranolol (LOL)

Key Signs: Bradycardia, hypotension, altered mental status.

Vital Signs: Heart rate < 60 bpm, systolic blood pressure (SBP) < 90 mmHg.

Treatment: Glucagon 1mg every 5 mins IVP

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20
Q

Organophosphate Poisoning

signs/possible products

treatment

A

Possible Causes: Ingestion or exposure to pesticides, insecticides.

Key Signs: Salivation, lacrimation, urination, defecation; pinpoint pupils; muscle twitching.

Vital Signs: Increased heart rate (HR), normal or elevated blood pressure (BP).

Treatment: Atropine 2-4mg IV every 5 mins

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21
Q

Chest Pain

signs
&
treatment

A

S: chest pressure, discomfort, sob, diaphoretic (sys abv 90, hr 60-150)

T:
aspirin 325mg
12 lead EKG (asap)
IV access
Nitro 0.4mg SL
(may repeat 90 sys, hr 60-150bpm)
2 more tabs, max 1.2mg

note: watch for bp drop of 20
withhold nitro - Inf MI, ED drugs

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22
Q

ST Elevation - MI STEMI

signs
&
treatment

A

Signs:
sob, cp, arm/jaw pain, diaphoretic, nausea
(st elevation, 1mm in 2 leads)

Treatment:
IV-Aspirin/Nitro
Cardiac Ctr/Transmit, STEMI Alert

Inferior (R) - get V4r - if elevation do NOT give nitro

if hypotensive/clear lungs -
give LR 250mL IV

note: depression in v1-v3, get posterior EKG

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23
Q

signs difference between:

Mild

Moderate

Severe

Anaphylaxis

A

Mild -
local swell/itch (1)

Moderate -
hives and/or mild wheeze (2)

Severe -
diff breathing, stridor
low bp,
abnormal skin color
Wheeze all over - swelling, stridor, loss of pulses, dyspnea -

Anaphylaxis - (two or more of)
Swelling of the Tongue/Airway/lips
Hives, low bp
N/V ab pain, diarrhea
Resp Compromise

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24
Sync Cardio Vert signs of when and how
Hr over 150 UnStable SVT - NARROW- 100, 200, 300, 360 Afib/Aflutter - 200, 300, 360
25
Working Code what do you do first when do you
CPR, Pads, O2 Asystole/PEA - EPI asap VFib/pVTach - Shock asap (200) CPR - 2mins w IO/IV (1st pulse check) CPR - for 2 mins then pulse check w/ iGel/capno (2nd pulse check)
26
Cardiogenic Shock
Possible Causes: Acute myocardial infarction, heart failure. Key Signs: Hypotension, cool/clammy skin, pulmonary edema. Vital Signs: Hypotension, tachycardia. Treatment: Nitroglycerin 0.4 mg SL; consider fluid bolus; dopamine infusion.
27
Sepsis
Possible Causes: Infection, pneumonia, urinary tract infection. Key Signs: Fever, altered mental status, hypotension. Vital Signs: Fever > 100.4°F, heart rate > 90 bpm. Treatment: Antibiotics; crystalloid fluid resuscitation; vasopressors if hypotensive.
28
Eclampsia
Possible Causes: Severe preeclampsia (high bp) Key Signs: Seizures in pregnant woman after 20th week, hypertension. Vital Signs: Hypertension. Treatment: Magnesium sulfate 4 g IV over 15 mins
29
Cyanide Poisoning
Possible Causes: Inhalation or ingestion of cyanide. Burning materials (plastics, rubber) Key Signs: Altered mental status, seizures. Vital Signs: Elevated heart rate. Treatment: Hydroxocobalamin (B12)
30
Ped patient is defined as
up to 40kg or up to 14 years of age Appear, Wob, Circulation
31
Geriatric is defined as
over 65 years old, poss reduced meds
32
GCS M, V, E
M (6) Motor Localizes - 5 withdraw - 4 core - 3 V (5) voice confused - 4 inappropriate - 3 incomprehensible - 2 E (4) eyes to speech - 3 to pain - 2 none - 1
33
Stable SVT (nat registry)
Perform vagal maneuvers Adenosine 6 mg IV (proximal site) followed by 10 mL fluid bolus If tachycardia continues, give adenosine 12 mg IV A third dose of adenosine, 12 mg IV, can be given Diltiazem 0.25 mg/kg slowly IV over 2 minutes fter 15 minutes, a second dose of diltiazem 0.35 mg/kg IV may be given For patients older than 65 years old, recommend maximum initial dose of diltiazem 10 mg IV and a maximum second dose of 20 mg Metoprolol 5 mg IV given over 1–2 minutes. May repeat as needed q 5 minutes for a total of 3 doses Verapamil 2.5–5 mg IV given over 2 minutes. May repeat with verapamil 5–10 mg after 15–30 minutes
34
Stable Brady (nat registry)
HR less than 60 bpm with CP, AMS, CHF, Seizure, syncope, diaphoretic VOMIT O2 over 94% 12 lead IV BGL Atropine 1 mg IV q 3–5 minutes (maximum total dose of 3 mg)  then if that doesn't work Epinephrine IV drip 0.02–0.2 mcg/kg/min titrated to a MAP greater than 65 mmHg
35
Stable Tachy - Afib, AFlutter
HR over 100, palpitations, dyspnea, syncope, ams, cp O2 over 94%, 12 lead, IV (vomit) Diltiazem (Cardizem) 0.25 mg/kg slowly IV over 2 minutes After 15 minutes, a second dose of diltiazem 0.35 mg/kg IV may be given if needed For patients older than 65 years old, recommend maximum initial dose of 10 mg IV and a maximum second dose of 20 mg Metoprolol 5 mg IV given over 1–2 minutes. May repeat as needed q 5 minutes for a total of 3 doses
36
Wide Complex Tachy - Stable
Amiodarone 150 mg IV over 10 minutes. May repeat once as needed Procainamide 20–50 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases greater than 50%, or maximum dose 17 mg/kg given Maintenance infusion: 1–4 mg/min, Avoid if prolonged QT or CHF Lidocaine 1–1.5 mg/kg IV May be repeated at 5-minute intervals for a maximum dose of 3 mg/kg IV Adenosine 6 mg IV (proximal site) followed by 10 mL fluid bolus, If monomorphic tachycardia continues, give adenosine 12 mg IV
37
Wide Complex Tachy - unstable
Synchronized cardiovert 100j
38
BVM Rate: - Adult - Ped - Head Trauma
Adult - 1 breath every 6 seconds. 10 per min normal 35-45 capno Ped - 1 breath every 3 seconds 20 per min Head Trauma (cushings) - 1 breath every 3 seconds, 20 breaths per min 30-35 capno - cush - hypertension, brady, Irreg Resp ICP
39
Compression depth for Less than 1 Everyone else
less than 1 - 1 1/2 inches everyone else - 2
40
Check pulse and defib every Give epi every
2 mins 5 mins
41
What are the H's and T's
Hypovolemia Hypoxia Hydrogen Ions Hyper/hypoKalemia Hypothermia Tension Pneumo Cardiac Tamp Toxions Pulm Thromb Coronary Thromb
42
ROSC Protocol
Obtain 12 lead 10 breaths a min Titrate Fluids and or Vasopressors to 90 systolic / map 65 TARGET TEMP MANAGEMENT H and Ts
43
Dopamine and Epi Infusion
Dopamine - 5-20 mcg/kg/ min Epi 2-10 mcg/min
44
Name beta blockers and calcium channel blockers
Beta Blockers: Atenolol Metoprolol Propranolol Carvedilol Calcium Channel Blockers: Amlodipine Nifedipine Verapamil Diltiazem (may give for SVT) Beta Blockers (e.g., Metoprolol): Decrease heart rate and contractility. Calcium Channel Blockers (e.g., Diltiazem): Dilate vessels and slow AV node conduction.
45
SVT hr and Tach hr
SVT - over 150 tachy - over 100
46
Steps for Pacing
unstable under 50 bpm set rate to 80 set CURRENT till both electrical capture and mechanical
47
CP
if o2 is less than 90% give 4ltrs nc no nitro if systolic less than 90 hr less than 50 Inferior wall MI Right sided involvement PD drugs within 24 hrs give nitro then give Morphine: 2-4mg IV then 2-8mg after 5 mins
48
Bradycardia how much Atropine can you give?
1mg IV Atropine every 3-5 mins (total 3mg) note: with hold on type II 2nd degree and 3rd degree
49
Organophosphate poisoning how much Atropine
2-4 mg or higher (extremely large doses)
50
When is Digoxin used?
to slow ventricular rate in A fib or A flutter
51
2nd line drug for brady cardia
Dopamine (after atropine) 5-20 mcg/kg/min taper slowly after fluids hypotension signs of shock bp less than 70
52
When else do you give Glucagon?
beta blocker OD
53
What do you give for TCA over dose what are signs name some TCA drugs
give Sodium Bicarb signs: ams, seizures, wides QRS, hypotension, Dry, dilated Amitriptyline
54
normal adult pupil size
2-4 mm in bright light
55
What is the Ped dose for Dextrose D10
5 mL/kg IV
56
what is the Ped dose for Benadryl
1mg /kg IV SLOWQ
57
What is the Ped dose for Epi for anaphylaxis
0.01 mg/kg. 1:1,000 max of 0.3mg IM
58
What is the Ped dose for Albuterol and Atrovent
2.5mg and 500mcg
59
What is the Ped dose for Neb Epi and when
Croup treatment 0.01mg/kg EPI IM (max 0.5mg) Dexamethasone 0.5mg/kg IV (max 10mg) then neb epi 2.5mL of 1mg - 2.5mg stridor, labored Transport to the closest medical - neb epi
60
For PED what hr do you start CPR
less than 60
61
Whats the compression rate for PED
30:2 - 1 person 15:2 - 2 people
62
What do you give for PED brady and what hr unstable
unstable under 120ish Epi 0.01 Atropine 0.02mg/kg may repeat once
63
What is the dose for Amio in a PED code
amio IV/IO 5mg/kg may repeat 3 doses VF, pulseless VT
64
What is the Defib J setting for PED code
2, 4, 6, 8, 10
65
PED svt, what is the bad hr for infant and Child what is the J setting for cardioversion what is the Drug and dose
infant - over 220 child - over 180 J setting - 1j/kg, then 2j/kg Adenosine - 0.1mg/kg rapid then 0.2 mg/kg rapid (max dose 12mg) Regular Narrow Complex Tachycardia – Stable (SVT) 1. Perform vagal maneuvers 2. Adenosine 0.1 mg/kg (maximum of 6 mg) a. If unsuccessful, may repeat with 0.2 mg/kg (maximum of 12 mg) ii. Regular Narrow Complex Tachycardia – Unstable 1. Deliver a synchronized shock: 0.5–1 J/kg for the first dose 2. Repeat doses should be 2 J/kg iii. Regular, Wide Complex Tachycardia — Stable 1. Consider adenosine 0.1 mg/kg (maximum of 6 mg) for SVT with aberrancy 2. Otherwise give amiodarone 5 mg/kg IV (maximum of 150 mg) over 10 minutes iv. Regular, Wide Complex Tachycardia – Unstable 1. Synchronized cardioversion 0.5–1.0 J/kg
66
what is the PED dose of Dexamethasone
for croup 0.6mg/kg IM/IV (max 16) for asthma 0.6mg/kg IM/IV (max 16)
67
PED dose of EPI for anapyhlaxis
0.15mg IM less than 5 y/o 0.5mg IM over 5 y/o 2 or more symptoms - or known allergen with hypotension Get IV Then albuterol less than 1 year old - half dose 1.25mg NO atrovent 2 years old - 1.25 and 250mcg atrovent Over 2 regular dose Benadryl 1mg/kg slow IV max of 50mg Fluid for hypotension 20mL/kg titrate Dexamethasone 0.5mg/kg max of 10mg
68
Asthma, COPD, Bronchospasm
Wheezing and SHarkfin NRB Neb CPAP Albuterol Atrovent Dex Mags Epi CPAP (Continuous Positive Airway Pressure): Signs: Key Differential: Respiratory distress with bilateral crackles. Rapid, labored breathing. Use of accessory muscles. Cyanosis. History of chronic lung disease. Vitals: Key Differential: Respiratory rate > greater 25/min. Pulse > greater 100/min. Oxygen saturation < less 90%. Treatment: Initiate CPAP at 5-10 cm H2O. Titrate to improve oxygenation. Consider BVM if deteriorating contra jvd rales peripheral edema
69
CHF treatment
12 lead ekg (if inferior wall MI consult first) IV O2 less than 94% give O2 BP before each dose nitro 0.4mg q 3-5mins max 1.2mg and 1 inch nitro paste CPAP if systolic drops below 90 give 250mL bolis may repeat once if hypo still give 1mg of epi in 100mL 60 drops/min titrate to 90sys geriatric, hypertension, sob, resp dis, wheezing,
70
What is the Min age for CPAP
13 years old
71
What is the goal of Nitro for CHF
To reduce the pressure of blood returning to the heart (preload) and the resistance that the left ventricle must pump against (after-load).
72
What is the treatment for Hypotensive CHF
Still CPAP but withhold Nitro if SBP below 90mmHg Give 250 mL of Ringers and Epi Infusion (1mg), 60gtts/min

Paramedic (24 decks)

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