ALS Emergencies Flashcards
Allergic Reaction Mild
Mild- Generalized Urticaria
Benadryl: 50mg IM
50mg Diluted 9ml Of Saline IV/IO
Allergic Reaction Moderate
Moderate- Airway Swelling/ Respiratory Distress/ Bronchospasm/ Tongue, Face Swelling
* Epinephrine 1:1000
0.3mg(0.3ml) IM lateral thigh x2 5min between
* Benadryl: 50mg IM
50mg diluted IV/IO
* Albuterol: 2.5mg Via nebulizer repeat as needed
Allergic Reaction Severe
Severe- Loss Of Radial Pulse
Push Dose Pressor Epinephrine
Maintain 100SBP
May repeat x2 max of 300mcg(30ml)
1 Liter Normal Saline May Repeat x1
Allergic Reaction Pediatric
- Benadryl: 1mg/kg IM Dilute with 9ml of Saline IV/IO
Contraindications: Neonates - EPI 1:1000- 0.01mg/kg IM Max Of .3
Precautions: Do Not Administer Within 5 Min Of Epi Pen - Albuterol- 2.5mg Via Nebulizer
Age Appropriate Hypotension - Epi Push Pressor
- Saline 20ml/kg May Repeat x2
Hypoglycemia Symptoms
AMS
Slurred Speech
Dilated Pupils
Seizures
Coma
Irritability
Hyperglycemia Symptoms With DKA
Nausea/Vomiting
Abdominal Pain
General Weakness
Kussmaul Respirations
AMS
Hypotension
Tachycardia
Acetone smell
Hypoglycemia Treatment
Less than 60mg/dl
Oral Glucose 15g may repeat x1
Contraindications Not Conscious to swallow
D10 100ml IV/IO Repeat x1
Retest Glucose
Hypoglycemia In Cardiac Arrest 250ml IV/IO Rapid Infusion
Hyperglycemia Treatment
BGL 300 mg/dl With Signs Of DKA
Normal Saline 1 Liter May Repeat x1
Precaution coronary heart Disease CHF renal failure
Hypoglycemia In Pediatrics
BGL Less Than 60
Oral Glucose 15g
Contraindications: Not Able to Swallow/ Under 2 Years
D10: 5ml/kg IV/IO
May Repeat x1
Hyperglycemia Treatment Pediatrics
BGL greater than 300 signs of DKA
Normal saline 20ml/kg IV/ IO
May repeat x2 If BGL is above 300
Dystonic Reaction Characterized As
Spasmodic or sustained involuntary contractions
face, neck, trunk, pelvis, extremities, larynx
can happen hours or days
What Meds Cause Dystonic Reactions
Antipsychotic (Haldol, Risperdal)
Antiemetic (Compazine, Reglan, Phenergan)
Antidepressants (Prozac, Paxil)
Dystonic Reaction
Benadryl: 50mg IV/IO with 9mL NS
Pediatric Diluted Benadryl 1mg/kg IV/IO
Max Of 50mg Contraindications - Neonates
Fluid Resuscitation/ Dehydration Treatment
Indications: Hypotension, Fatigue, Dark Urine, Dry Mouth, Headache, Prolonged Vomiting, Non-Traumatic Bleeding, Rhabdomyolysis, Paramedic Discretion
Treatment: 1 Liter
May Repeat x1
Pediatric: 20ml/kg Repeat x2 Per age hypotension
Hyperglycemic Medications
Glyburide, Glimepiride, Glipizide
If taken by the pt, must be transported if treated.
Hyperkalemia Indications
History Of Renal Failure/ Dialysis or Pre-Dialysis
Weakness
Cardiac Arrhythmias and ECG Abnormalities:
Peaked T-waves (early sign)
Sine Wave
Wide Complex QRS
Regular Really Wide Complex Tachycardia
Severe Bradycardia
High Degree AV Block
Hyperkalemia Treatment
- Calcium Chloride 1g IV/IO Over 2 minutes
- Albuterol 2.5mg Via Nebulizer
- Sodium Bicarbonate: 100 mEq IV/IO Over 2 minutes
Hypotensive:
Normal Saline 500ml IV/IO Repeat x1
Hyperkalemia Treatment Pediatric
- Calcium Chloride
20mg/kg IV/IO Over 2 Minutes - Albuterol 2.5mg Via Nebulizer
- Sodium Bicarbonate 1mEq/kg Over 2 minutes
Max Single Dose is 50mEq
May Repeat x1 In 5 Minutes Max Total Of 100mEq
Nausea/ Vomiting Treatment Adult
- NS 1Liter IV/IO Repeat x1
- Zofran 4mg IV/IO/IM/PO
Over 2 Minutes for IV/IO Repeat x1
Nausea/ Vomiting Treatment Pediatric
- NS 20ml/kg IV/IO Repeat x2 For Age-Appropriate
- Zofran
0.1mg/kg IV/IO/IM/PO
Over 2 minutes For IV/IO
Max Dose Of 4mg
COPD & Asthma Information
- Pts have prolonged exhalation secondary to bronchospasm, Causing air to be trapped resulting in hypercapnia High Co2
- SpO2 greater than 90 is most important
Auto Peep Definition
When air is forced into the lungs by BVM before the PT has fully exhaled risking a pneumothorax
COPD Pts with bad bag compliance or hypotension treatment
Discontinue to allow pt to fully exhale before continuing ventilation
Adults: 20-40 Seconds
Pediatrics: 10-20 Seconds
Bronchospasm secondary to COPD & Asthma treatment
- Albuterol:
2.5mg VIA Nebulizer may be administered with CPAP
Repeat as needed
Severe Asthma Not Responding to Nebulizer Treatment Adult
- Epi (1:1000) .3mg IM Repeat x2 5 Min Intervals
- Magnesium Sulfate Dilute 2g in a 50ml bag D5W
Administer over 10 minutes IV/IO 10 Drop Set 1 gtt/sec
Moderate Or Severe COPD, Asthma, Pneumonia Treatment
CPAP 10 cm H20
Pediatric Bronchospasm
Albuterol 2.5mg Via Nebulizer
May Repeat As Needed
Pediatric Severe Asthma
- Epinephrine 1:1000
0.01mg x2 5 min Intervals - Mag Sulfate
Dilute 40mg/kg in a 50ML Bag Of D5W
Administer over 25 Min IV/IO Max Dose 2G
Pediatric Croup, Epiglottitis
- Epinephrine 1:1000
3mg (3ml Total) Delivered Via Nebulizer
Precaution do not stress the patient
Do not Intubate, OPA, NPA Pt
BVM as needed
Croup Signs and symptoms
- Less than 3 years old
- Sick for couple days
- Low grade fever
- Not toxic appearing
- Stridor / Barky cough
Epiglottitis
Usually 3-6 Years Old
Sudden Onset
High Grade Fever
Poor General Impression
Drooling
Tripod Position
Stridor/ Barky Cough
Seizure Causes
Meningitis Drugs
Fever Alcohol
Head Trauma Diabetic
Hemorrhagic Stroke Poisoning
Adult Seizure Treatment
Versed 5mg IV/IO/IN/IM
x1 in 5 minutes
Contraindications Hypotensive
Precaution Monitor Respirations
Adult Patient Seizure Not Responding to Versed
- Ketamine
Dilute 100mg into a 50ml bag of D5W
IV/IO With 60gtt Set, Wide Open
Precaution: Pregnant, Penetrating eye injury
Non-Traumatic Chest Pain
Seizure with no Vascular Access
Ketamine 100mg IN/IM
Pediatric Seizures
Febrile Seizure, Active Cooling, Actively Seizure
Versed 0.1mg/kg IV/IO Max of 5mg
Versed 0.2mg/kg IN/IM Max of 5mg
Contraindications: Hypotension
Ketamine 1mg/kg IN/IM
Repeat x1 In 5 Min
Sepsis Symptoms
- Temperature Greater than 100.4 or Less than 96.8
- UTI
- Pneumonia
- Wounds that look infected
- PT on Antibiotics
- Recent Surgery
- AMS or Poor Oral Intake
- Bed Sores
- All Sepsis PTS are priority 2
Sepsis Criteria
Adult & Not Pregnant
Suspected or Documents Infection
H- Hypotension less than 100
A- Altered Mental status new onset
T- Tachypnea respirations greater than 22 Or ETCO2 less than 25
Sepsis Precations
Keep Pt from becoming Hypotensive - Increases Morbidity Rates
Pneumonia pts with rales still require fluids
Adult: Sepsis treatment
- Normal Saline 1L MUST repeat if time permits
- Ceftriaxone(Rocephin) 2g mixed with 20ml of NS
Into a 50ml Bag 10gtt set over 10 minutes 1gtt a sec
Ancef, Ceclor, Cefdinir, KeflexArtificial Heart Valve Replacement - Gentamicin 80mg IM ONLY
Paromycin, Tobramycin, Neomycin Artificial Heart Valve Replacement
Hypotensive - Push dose Epi
Contraindications: Allergy to Aminoglycoside Antibiotics
Pediatric Sepsis Treatment
- Normal Saline 20ml/kg IV/IO
Regardless of Bp Repeat x2 - Push-Dose Epi 1ml
Stroke Assessment
Symptoms within 24 Hours
Cincinnati Srtoke Assessment
Race Score Greater Than 0
Witnessed (24hrs) Unwitnessed Unknown Time
Stroke Alerts
Race Score
MAX of 11
0 Is Perfect
0-1-2 scoring
Facial - Smile
Arm Motor- Hold Arm
Leg Motor- Hold Leg
Cortical PLUS Encode
Head and Eyes
Stroke Treatment Adult
BGL
Position- 30 Degrees Head Elevation
Oxygen 2lpm NC
IV Access 18g Antecubital Unaffected Side
Normal Saline 500 IV/IO Regardless Of BP
Stoke Treatment Pediatric
BGL
Position- 30 Degrees Head Elevation
Oxygen 2lpm NC
IV
10ml/kg IV/IO max dose of 250ML
Sickle Cell Anemia Adult Treatment
- SpO2 95 or Greater
- Normal Saline 500ml IV/IO Repeat x1
- Pain Management Protocol
If Hypotension Occurs During Fentanyl limit saline to 500ml
Pediatric: Sickle Cell Anemia treatment
- SpO2 95 Or Greater
- Normal Saline 20ml/kg x2
- Pain Management
Taser Protocol
Stabilize Probe if above the clavicles, genitalia, areola
Transport for:
Excited Delirium
Drug Use
Cardiac History
Altered Mental
Hyperthermia
Any Chief Complaint
Pregnancy
Blood thinners
Aphasia
understands but difficulty expressing
Agnosia
Inability to recognize
CPAP Contraindications
- SBP< 90
- No Spontaneous Respirations
- Decreased LOC
- Patients < 30kg
