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Paramedic > ALS Algorithms > Flashcards

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
Q

Sync Cardio Vert

signs of when

and how

A

Hr over 150

UnStable

SVT - NARROW- 100, 200, 300, 360

Afib/Aflutter - 200, 300, 360

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25
Q

Working Code

what do you do first

when do you

A

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)

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26
Q

Cardiogenic Shock

A

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.

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27
Q

Sepsis

A

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.

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28
Q

Eclampsia

A

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

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29
Q

Cyanide Poisoning

A

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
Q

Ped patient is defined as

A

up to 40kg or up to 14 years of age

Appear, Wob, Circulation

31
Q

Geriatric is defined as

A

over 65 years old, poss reduced meds

32
Q

GCS M, V, E

A

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
Q

Stable SVT (nat registry)

A

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
Q

Stable Brady (nat registry)

A

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
Q

Stable Tachy - Afib, AFlutter

A

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
Q

Wide Complex Tachy - Stable

A

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
Q

Wide Complex Tachy - unstable

A

Synchronized cardiovert 100j

38
Q

BVM Rate:

  • Adult
  • Ped
  • Head Trauma
A

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
Q

Compression depth for

Less than 1

Everyone else

A

less than 1 - 1 1/2 inches

everyone else - 2

40
Q

Check pulse and defib every

Give epi every

A

2 mins

5 mins

41
Q

What are the H’s and T’s

A

Hypovolemia
Hypoxia
Hydrogen Ions
Hyper/hypoKalemia
Hypothermia

Tension Pneumo
Cardiac Tamp
Toxions
Pulm Thromb
Coronary Thromb

42
Q

ROSC Protocol

A

Obtain 12 lead
10 breaths a min
Titrate Fluids and or Vasopressors to 90 systolic / map 65
TARGET TEMP MANAGEMENT
H and Ts

43
Q

Dopamine and Epi Infusion

A

Dopamine - 5-20 mcg/kg/ min

Epi 2-10 mcg/min

44
Q

Name beta blockers and calcium channel blockers

A

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
Q

SVT hr and Tach hr

A

SVT - over 150

tachy - over 100

46
Q

Steps for Pacing

A

unstable under 50 bpm

set rate to 80
set CURRENT till both electrical capture and mechanical

47
Q

CP

A

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
Q

Bradycardia how much Atropine can you give?

A

1mg IV Atropine

every 3-5 mins (total 3mg)

note: with hold on type II 2nd degree and 3rd degree

49
Q

Organophosphate poisoning how much Atropine

A

2-4 mg or higher (extremely large doses)

50
Q

When is Digoxin used?

A

to slow ventricular rate in A fib or A flutter

51
Q

2nd line drug for brady cardia

A

Dopamine

(after atropine)

5-20 mcg/kg/min

taper slowly

after fluids
hypotension signs of shock bp less than 70

52
Q

When else do you give Glucagon?

A

beta blocker OD

53
Q

What do you give for TCA over dose

what are signs

name some TCA drugs

A

give Sodium Bicarb

signs:
ams, seizures, wides QRS, hypotension, Dry, dilated

Amitriptyline

54
Q

normal adult pupil size

A

2-4 mm in bright light

55
Q

What is the Ped dose for Dextrose D10

A

5 mL/kg IV

56
Q

what is the Ped dose for Benadryl

A

1mg /kg IV SLOWQ

57
Q

What is the Ped dose for Epi for anaphylaxis

A

0.01 mg/kg. 1:1,000 max of 0.3mg IM

58
Q

What is the Ped dose for Albuterol and Atrovent

A

2.5mg and 500mcg

59
Q

What is the Ped dose for Neb Epi and when

A

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
Q

For PED what hr do you start CPR

A

less than 60

61
Q

Whats the compression rate for PED

A

30:2 - 1 person

15:2 - 2 people

62
Q

What do you give for PED brady

and what hr unstable

A

unstable under 120ish

Epi 0.01

Atropine 0.02mg/kg may repeat once

63
Q

What is the dose for Amio in a PED code

A

amio IV/IO 5mg/kg may repeat 3 doses VF, pulseless VT

64
Q

What is the Defib J setting for PED code

A

2, 4, 6, 8, 10

65
Q

PED svt, what is the bad hr for infant and Child

what is the J setting for cardioversion

what is the Drug and dose

A

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
Q

what is the PED dose of Dexamethasone

A

for croup 0.6mg/kg IM/IV (max 16)

for asthma 0.6mg/kg IM/IV (max 16)

67
Q

PED dose of EPI for anapyhlaxis

A

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
Q

Asthma, COPD, Bronchospasm

A

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
Q

CHF treatment

A

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
Q

What is the Min age for CPAP

A

13 years old

71
Q

What is the goal of Nitro for CHF

A

To reduce the pressure of blood returning to the heart (preload) and the resistance that the left ventricle must pump against (after-load).

72
Q

What is the treatment for Hypotensive CHF

A

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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