ALS PCS 5.0 Flashcards
When should you consider very early transport during a cardiac arrest?
- Pregnancy >20 weeks gestation
- Hypothermia
- Airway Obstruction
- Non-opioid drug overdose
- Reversible cause of arrest has not been addressed
When should you transport a pt. in refractory VF or pulseless VT?
After the third consecutive shock.
OR
after 20 minutes of resuscitation (and you have shocked)
At what age can you defibrillate a pt.?
≥24 hours old
How old must the pt. be in order to give EPI in an anaphylactic cardiac arrest?
≥24 hours
At what age you you obtain a medical TOR?
≥16 years old
What are the conditions in order to qualify for a Medical TOR?
- ≥16 years
- Not witnessed by paramedics
- No ROSC after 20 minutes of resuscitation
- No shocks delivered
When are you NOT starting CPR on a VSA?
- Code 5
- Valid DNR
When are you NOT going to call for a Medical TOR?
FHRNP
- FBAO
- Hypothermia
- Reversible cause has not been addressed
- Non-opiate overdose
- Pregnancy ≥20 weeks gestation
At what age are you using pediatric joule settings?
≥24 hours to <8 years
At what age are you using adult joule settings?
≥ 8 years
What is the initial pediatric dose for defibrillation?
2 J/kg
What is the subsequent dose setting for peds defibrillation?
4 J/kg
What is the dosing for EPI on an anaphylactic cardiac arrest?
0.01 mg/kg
What is the max # of doses of EPI on an anaphylactic cardiac arrest?
1
When might you consider patching early for a medical TOR?
following 4th analysis if there are extenuating circumstances
- egress
- prolonged transported, significant clinical limitations where resuscitation may be considered futile
How old must the pt. be in order to consider a trauma TOR?
≥16 years old
What criteria must be met in order to consider a trauma TOR?
- ≥ 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
What are contraindications for a Trauma TOR?
- 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
What are signs of an obviously dead patient?
LORDDCPT
- Lividity
- Open head or torso wounds with outpouring cranial or visceral contents
- Rigor Mortis
- Decapitation
- Decomposition
- Charring (gross)
- Putrefaction
- Transection
How many doses of defibrillation is the patient receiving on a Trauma Cardiac Arrest?
1
What are considered signs of life when extricating on a trauma?
- spontaneous movement
- respiratory effort
- organized electrical activity on ECG
- reactive pupils
When do you provide PPV on a newborn?
HR <100bpm
What is the technical definition of a newborn pt?
<24 hours old
When do you provide CPR on a newborn?
HR <60 bpm or VSA
What should you do before you start CPR on a newborn patient?
PPV using room air for 30 seconds
What are contraindications for PPV?
- Obviously Dead
- Gestational age <20 weeks
What are the contraindications for CPR on a newborn patient?
- Obviously Dead
- Gestational age <20 weeks
What hand should you place the pulse oximeter on in newborn resuscitation?
Right
What are the conditions for the ROSC medical directive?
- ≥2 years old
- Hypotension
- Chest auscultation is clear
What are the contraindications for ROSC medical directive?
Fluid overload
What is the treatment for ROSC medical directive?
- titrate oxygen to 94-98%
- avoid hyperventilation
- target ETCO2 to 30-40mmHg
- Fluid bolus
What is the fluid bolus directive for a ROSC?
What are the conditions for ASA (cardiac ischemia)?
- ≥18 years old
- Unaltered
- Able to chew and swallow
What are the conditions for Nitro (cardiac ischemia)?
- ≥18 years old
- Unaltered
- HR 60-159 bpm
- Normotensive
- Hx. of Nitro use OR IV access obtained
Contraindications for ASA?
AAAS
- Allergy or sensitivity
- Asthmatic, no prior history of using ASA
- Active bleeding (peptic ulcers)?
- CVA or TBI in previous 24 hours
Contraindications for Nitroglycerin?
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
Nitro Treatment for Cardiac Ischemia
Indications for Acute Cardiogenic Pulmonary Edema
- Moderate to severe respiratory distress
- Suspected cardiogenic pulmonary edema
Conditions for Nitro for Acute Cardiogenic Pulmonary edema?
- ≥18 years old
- HR 60-159 bpm
- Normotensive
Contraindications for Nitro for Acute Cardiogenic Pulmonary Edema?
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
Treatment for Nitro for acute cardiogenic pulmonary edema?
Conditions for Dextrose?
- ≥2 years old
- Altered
- Hypoglycemic
Conditions for Glucagon?
- Altered
- Hypoglycemic
Contraindications for Dextrose?
Allergy or sensitivity to dextrose
Contraindications for Glucagon?
- Allergy or sensitivity to glucagon
- Pheochromocytoma
Dextrose Treatment
Glucagon Treatment
Indications for Bronchoconstriction Medical Directive?
Respiratory Distress AND Suspected Bronchoconstriction
What are the conditions for EPI for broncoconstriction?
- BVM ventilation
- Hx of asthma
What are the conditions for Dexamethasone for bronchoconstriction?
- Hx of Asthma OR;
- COPD OR;
- 20 pack-year history of smoking
Contraindications for Bronchoconstriction medical directive?
Salbutamol Treatment (Bronchoconstriction)
Epinephrine Treatment (Bronchoconstriction)
Dexamethasone Treatment
When is nebulization contraindicated?
- when the pt. has a fever
- respiratory illness outbreak
Indications for Moderate to severe allergic reaction medical directive?
- exposure to probable allergen
- S/S of moderate to severe allergic reaction
Conditions for moderate to severe allergic reaction medical directive?
Contraindications for moderate to severe allergic reaction medical directive?
EPI treatment for moderate to severe allergic reaction medical directive?
Diphenhydramine treatment for moderate to severe allergic reaction medical directive?
Indications for Croup medical directive?
- Current history of URTI
- Barking cough or Hx. of barking cough
Conditions for Epi (Croup medical directive)
Conditions for dexamethasone (Croup medical directive)
Contraindications for Epi for Croup Medical Directive
Contraindications for Dexamethasone for Croup Medical Directive
Epi Treatment for Croup
Dexamethasone Treatment for Croup
Indications for Supraglottic Airway Medical Directive
Need for Ventilatory Assistance
AND
Other airway management is ineffective
Conditions for Supraglottic Airway Medical Directive
Absent gag reflex
Contraindications for Supraglottic Airway
What is the max # of supraglottic airway insertion attempts?
2
What is the primary method to confirm supraglottic airway placement?
ETCO2 (waveform capnography)
What are secondary methods to confirm supraglottic airway placement?
ETCO2 (non-waveform)
Auscultation
Chest Rise
Indications for Analgesia
Pain
Conditions for Acetaminophen
- > 12 years old
- Unaltered
Conditions for Ibuprofen
- > 12 years old
- Unaltered
Conditions for Ketorolac
- > 12 years old
- Unaltered
- Normotension
Contraindications for Acetaminophen
IVALUU
- Ischemic chest pain
- Vomiting
- Allergy or sensitivity
- Liver disease
- Unable to tolerate PO meds
- Use within previous 4 hours
Contraindications for Ibuprofen
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
Ketorolac contraindications
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
Acetaminophen Doses
Ibuprofen Treatment
Ketorolac Treatment
Indications for Nausea/Vomiting Medical Directive
Nausea or Vomiting
Conditions for Ondansetron
Conditions for Dimenhydrinate (Gravol)
Contraindications for Ondansetron
Contraindications for Dimenhydrinate
65 years+
Ondansetron Treatment
Dimenhydrinate Treatment
Clinical Consideration for Nausea/Vomiting
If pt has received Ondansetron and has no relief after 30 mins, Dimenhydrinate may be considered.
Indications for Opioid Toxicity Medical Directive
Conditions for Opioid Toxicity
Contraindications for Naloxone
Allergy or sensitivity
Treatment for Naloxone
Adrenal Crisis Medical Directive Indications
A pt with primary adrenal failure who is experiencing clinical signs of adrenal crisis
Adrenal Crisis Conditions (Hydrocortisone)
Contraindications for Hydrocortisone
Allergy or sensitivity
Hydrocortisone Treatment
Emergency Childbirth Medical Directive Indications
- Pregnant pt experiencing labour
OR - Post-partum pt immediately following delivery and/or placenta
Conditions for Delivery (Emergency Childbirth)
Conditions for Umbilical Cord Management (Emergency Childbirth)
Conditions for External Uterine Massage (Emergency Childbirth)
Conditions for Oxytocin (Emergency Childbirth)
Contraindications for Emergency Childbirth Medical Directive
Treatment for Shoulder Dystocia
Treatment for Breach Delivery
Management of Prolapsed Cord
Umbilical Cord Management
Oxytocin Treatment
Endotracheal and Tracheostomy Suctioning and Reinsertion Medical Directive
- Pt with endotracheal or tracheostomy tube
AND - Airway obstruction or increased secretions
Conditions for tracheostomy suctioning
Conditions for emergency trach reinsertion
Contraindications for emergency trach suctioning/reinsertion
inability to landmark or visualize
Treatment for emergency trach suctioning / reinsertion
