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PARAMEDIC ALS PCS 5.0 > ALS PCS 5.0 > Flashcards

ALS PCS 5.0 Flashcards

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1
Q

When should you consider very early transport during a cardiac arrest?

A
  1. Pregnancy >20 weeks gestation
  2. Hypothermia
  3. Airway Obstruction
  4. Non-opioid drug overdose
  5. Reversible cause of arrest has not been addressed
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2
Q

When should you transport a pt. in refractory VF or pulseless VT?

A

After the third consecutive shock.
OR
after 20 minutes of resuscitation (and you have shocked)

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3
Q

At what age can you defibrillate a pt.?

A

≥24 hours old

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4
Q

How old must the pt. be in order to give EPI in an anaphylactic cardiac arrest?

A

≥24 hours

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5
Q

At what age you you obtain a medical TOR?

A

≥16 years old

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6
Q

What are the conditions in order to qualify for a Medical TOR?

A
  • ≥16 years
  • Not witnessed by paramedics
  • No ROSC after 20 minutes of resuscitation
  • No shocks delivered
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7
Q

When are you NOT starting CPR on a VSA?

A
  • Code 5
  • Valid DNR
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8
Q

When are you NOT going to call for a Medical TOR?

A

FHRNP
- FBAO
- Hypothermia
- Reversible cause has not been addressed
- Non-opiate overdose
- Pregnancy ≥20 weeks gestation

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9
Q

At what age are you using pediatric joule settings?

A

≥24 hours to <8 years

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10
Q

At what age are you using adult joule settings?

A

≥ 8 years

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11
Q

What is the initial pediatric dose for defibrillation?

A

2 J/kg

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12
Q

What is the subsequent dose setting for peds defibrillation?

A

4 J/kg

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13
Q

What is the dosing for EPI on an anaphylactic cardiac arrest?

A

0.01 mg/kg

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14
Q

What is the max # of doses of EPI on an anaphylactic cardiac arrest?

A

1

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15
Q

When might you consider patching early for a medical TOR?

A

following 4th analysis if there are extenuating circumstances
- egress
- prolonged transported, significant clinical limitations where resuscitation may be considered futile

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16
Q

How old must the pt. be in order to consider a trauma TOR?

A

≥16 years old

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17
Q

What criteria must be met in order to consider a trauma TOR?

A
  • ≥ 16 years old
  • No pulses
  • No shocks delivered
  • Asystole
  • No signs of life since fully extricated
  • Signs of life since fully extricated but closest ED ≥30 minute transport
  • PEA with closest ED ≥30 minutes away
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18
Q

What are contraindications for a Trauma TOR?

A
  • Age <16 years old
  • Shock delivered
  • Signs of life since fully extricated medical contact
  • PEA and closest ED is <30 minute transport time
  • Penetrating trauma to head/neck/torso and LTH <30 minute transport
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19
Q

What are signs of an obviously dead patient?

A

LORDDCPT
- Lividity
- Open head or torso wounds with outpouring cranial or visceral contents
- Rigor Mortis
- Decapitation
- Decomposition
- Charring (gross)
- Putrefaction
- Transection

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20
Q

How many doses of defibrillation is the patient receiving on a Trauma Cardiac Arrest?

A

1

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21
Q

What are considered signs of life when extricating on a trauma?

A
  • spontaneous movement
  • respiratory effort
  • organized electrical activity on ECG
  • reactive pupils
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22
Q

When do you provide PPV on a newborn?

A

HR <100bpm

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23
Q

What is the technical definition of a newborn pt?

A

<24 hours old

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24
Q

When do you provide CPR on a newborn?

A

HR <60 bpm or VSA

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25
Q

What should you do before you start CPR on a newborn patient?

A

PPV using room air for 30 seconds

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26
Q

What are contraindications for PPV?

A
  • Obviously Dead
  • Gestational age <20 weeks
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27
Q

What are the contraindications for CPR on a newborn patient?

A
  • Obviously Dead
  • Gestational age <20 weeks
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28
Q

What hand should you place the pulse oximeter on in newborn resuscitation?

A

Right

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29
Q

What are the conditions for the ROSC medical directive?

A
  • ≥2 years old
  • Hypotension
  • Chest auscultation is clear
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30
Q

What are the contraindications for ROSC medical directive?

A

Fluid overload

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31
Q

What is the treatment for ROSC medical directive?

A
  • titrate oxygen to 94-98%
  • avoid hyperventilation
  • target ETCO2 to 30-40mmHg
  • Fluid bolus
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32
Q

What is the fluid bolus directive for a ROSC?

A
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33
Q

What are the conditions for ASA (cardiac ischemia)?

A
  • ≥18 years old
  • Unaltered
  • Able to chew and swallow
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34
Q

What are the conditions for Nitro (cardiac ischemia)?

A
  • ≥18 years old
  • Unaltered
  • HR 60-159 bpm
  • Normotensive
  • Hx. of Nitro use OR IV access obtained
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35
Q

Contraindications for ASA?

A

AAAS
- Allergy or sensitivity
- Asthmatic, no prior history of using ASA
- Active bleeding (peptic ulcers)?
- CVA or TBI in previous 24 hours

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36
Q

Contraindications for Nitroglycerin?

A

APSR
- Allergy or sensitivity to nitrates
- Phosphodiesterase inhibitor use within last 48 hours
- SBP drops by 1/3 or more of its initial value
- 12-lead shows Right Ventricular MI

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37
Q

Nitro Treatment for Cardiac Ischemia

A
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38
Q

Indications for Acute Cardiogenic Pulmonary Edema

A
  • Moderate to severe respiratory distress
  • Suspected cardiogenic pulmonary edema
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39
Q

Conditions for Nitro for Acute Cardiogenic Pulmonary edema?

A
  • ≥18 years old
  • HR 60-159 bpm
  • Normotensive
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40
Q

Contraindications for Nitro for Acute Cardiogenic Pulmonary Edema?

A

APS
- Allergy or sensitivity to nitrates
- Phosphodiesterase inhibitor use within the last 48 hours
- SBP drops by 1/3 or more of its initial value

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41
Q

Treatment for Nitro for acute cardiogenic pulmonary edema?

A
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42
Q

Conditions for Dextrose?

A
  • ≥2 years old
  • Altered
  • Hypoglycemic
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43
Q

Conditions for Glucagon?

A
  • Altered
  • Hypoglycemic
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44
Q

Contraindications for Dextrose?

A

Allergy or sensitivity to dextrose

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45
Q

Contraindications for Glucagon?

A
  • Allergy or sensitivity to glucagon
  • Pheochromocytoma
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46
Q

Dextrose Treatment

A
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47
Q

Glucagon Treatment

A
48
Q

Indications for Bronchoconstriction Medical Directive?

A

Respiratory Distress AND Suspected Bronchoconstriction

49
Q

What are the conditions for EPI for broncoconstriction?

A
  • BVM ventilation
  • Hx of asthma
50
Q

What are the conditions for Dexamethasone for bronchoconstriction?

A
  • Hx of Asthma OR;
  • COPD OR;
  • 20 pack-year history of smoking
51
Q

Contraindications for Bronchoconstriction medical directive?

A
52
Q

Salbutamol Treatment (Bronchoconstriction)

A
53
Q

Epinephrine Treatment (Bronchoconstriction)

A
54
Q

Dexamethasone Treatment

A
55
Q

When is nebulization contraindicated?

A
  • when the pt. has a fever
  • respiratory illness outbreak
56
Q

Indications for Moderate to severe allergic reaction medical directive?

A
  • exposure to probable allergen
  • S/S of moderate to severe allergic reaction
57
Q

Conditions for moderate to severe allergic reaction medical directive?

A
58
Q

Contraindications for moderate to severe allergic reaction medical directive?

A
59
Q

EPI treatment for moderate to severe allergic reaction medical directive?

A
60
Q

Diphenhydramine treatment for moderate to severe allergic reaction medical directive?

A
61
Q

Indications for Croup medical directive?

A
  • Current history of URTI
  • Barking cough or Hx. of barking cough
62
Q

Conditions for Epi (Croup medical directive)

A
63
Q

Conditions for dexamethasone (Croup medical directive)

A
64
Q

Contraindications for Epi for Croup Medical Directive

A
65
Q

Contraindications for Dexamethasone for Croup Medical Directive

A
66
Q

Epi Treatment for Croup

A
67
Q

Dexamethasone Treatment for Croup

A
68
Q

Indications for Supraglottic Airway Medical Directive

A

Need for Ventilatory Assistance
AND
Other airway management is ineffective

69
Q

Conditions for Supraglottic Airway Medical Directive

A

Absent gag reflex

70
Q

Contraindications for Supraglottic Airway

A
71
Q

What is the max # of supraglottic airway insertion attempts?

A

2

72
Q

What is the primary method to confirm supraglottic airway placement?

A

ETCO2 (waveform capnography)

73
Q

What are secondary methods to confirm supraglottic airway placement?

A

ETCO2 (non-waveform)
Auscultation
Chest Rise

74
Q

Indications for Analgesia

A

Pain

75
Q

Conditions for Acetaminophen

A
  • > 12 years old
  • Unaltered
76
Q

Conditions for Ibuprofen

A
  • > 12 years old
  • Unaltered
77
Q

Conditions for Ketorolac

A
  • > 12 years old
  • Unaltered
  • Normotension
78
Q

Contraindications for Acetaminophen

A

IVALUU

  • Ischemic chest pain
  • Vomiting
  • Allergy or sensitivity
  • Liver disease
  • Unable to tolerate PO meds
  • Use within previous 4 hours
79
Q

Contraindications for Ibuprofen

A

PARIBUS AAVPU

  • Pregnancy
  • Allergy or sensitivity
  • Renal impairment
  • Ischemic chest pain
  • Bleeding
  • Use within the last 6 hours
  • Stroke or TBI
  • Asthma, and no Hx. of using NSAIDS
  • Anticoagulation therapy
  • Vomiting
  • Peptic Ulcers
  • Unable to tolerate PO medications
80
Q

Ketorolac contraindications

A

PARIBUS AAP

  • Pregnancy
  • Allergy or sensitivity
  • Renal impairment
  • Ischemic chest pain
  • Bleeding
  • Use within the last 6 hours
  • Stroke or TBI
  • Asthma, and no Hx. of using NSAIDS
  • Anticoagulation therapy
  • Peptic Ulcers
81
Q

Acetaminophen Doses

A
82
Q

Ibuprofen Treatment

A
83
Q

Ketorolac Treatment

A
84
Q

Indications for Nausea/Vomiting Medical Directive

A

Nausea or Vomiting

85
Q

Conditions for Ondansetron

A
86
Q

Conditions for Dimenhydrinate (Gravol)

A
87
Q

Contraindications for Ondansetron

A
88
Q

Contraindications for Dimenhydrinate

A

65 years+

89
Q

Ondansetron Treatment

A
90
Q

Dimenhydrinate Treatment

A
91
Q

Clinical Consideration for Nausea/Vomiting

A

If pt has received Ondansetron and has no relief after 30 mins, Dimenhydrinate may be considered.

92
Q

Indications for Opioid Toxicity Medical Directive

A
93
Q

Conditions for Opioid Toxicity

A
94
Q

Contraindications for Naloxone

A

Allergy or sensitivity

95
Q

Treatment for Naloxone

A
96
Q

Adrenal Crisis Medical Directive Indications

A

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

97
Q

Adrenal Crisis Conditions (Hydrocortisone)

A
98
Q

Contraindications for Hydrocortisone

A

Allergy or sensitivity

99
Q

Hydrocortisone Treatment

A
100
Q

Emergency Childbirth Medical Directive Indications

A
  • Pregnant pt experiencing labour
    OR
  • Post-partum pt immediately following delivery and/or placenta
101
Q

Conditions for Delivery (Emergency Childbirth)

A
102
Q

Conditions for Umbilical Cord Management (Emergency Childbirth)

A
103
Q

Conditions for External Uterine Massage (Emergency Childbirth)

A
104
Q

Conditions for Oxytocin (Emergency Childbirth)

A
105
Q

Contraindications for Emergency Childbirth Medical Directive

A
106
Q

Treatment for Shoulder Dystocia

A
107
Q

Treatment for Breach Delivery

A
108
Q

Management of Prolapsed Cord

A
109
Q

Umbilical Cord Management

A
110
Q

Oxytocin Treatment

A
111
Q

Endotracheal and Tracheostomy Suctioning and Reinsertion Medical Directive

A
  • Pt with endotracheal or tracheostomy tube
    AND
  • Airway obstruction or increased secretions
112
Q

Conditions for tracheostomy suctioning

A
113
Q

Conditions for emergency trach reinsertion

A
114
Q

Contraindications for emergency trach suctioning/reinsertion

A

inability to landmark or visualize

115
Q

Treatment for emergency trach suctioning / reinsertion

A

PARAMEDIC ALS PCS 5.0 (1 decks)

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