Als pcs flash cards
bronchoconstriction med directive
indications: respiratory distress & suspected bronchoconstriction
conditions:
- salbutamol=none
-epi= rr-bvm required, other=hx of asthma
-dex: other=hx of asthma, copd, or 20 pack yr
contraindications:
allergy/sensitivity ( all)
dex= currently on PO or parental steriods.
TX:
salbutamol
weight= <25kg
route: MDI
dose=600mcg 6 puffs ( max)
dose int= 5-15mins
max #=3
route= NEB
dose=2.5mg (max
dose int: 5-15min
max #=3
Weight: >=25kg
route: MDI. NEB
dose: up to 800 (8puffs) (max) 5mg ( max)
dosing int: 5-15min
max #=3
epi: im, 0.01mg/kg, 0.5mg, 1 (first administered if pt=apneic)
dex: PO/im, Max single 8mg, 1 dose
Supraglottic airway medical directive
indications:
need for ventilatory assistance or a/w control
&
other management is ineffective
conditions: other= absent gag reflex
contraindications:
a/w obstruction, known esophageal varices, trauma to mouth, caustic ingestion
Tx:
max # of attempts=2
confirm placement w/-1) ETCO2-2)auscultation, chest rise, ETCO2
moderate to severe allergic reaction medical directive
indications: exposure to probable allergen & s/s of moderate to severe allergic reaction ( anaphylaxis)
conditions:
epi: for anaphylaxis only
Diphenhydramine:
weight=>25kg
contraindications:
Epi & diphenhydramine:
- allergy or sensitivity
TX:
Epi ( rounded to nearest 0.005mg)
- route: IM
-Concentratio: 1;1000
- DOSE: 0.01MG/Kg
- dose int: min 5 mins
max # dose=2
diphenhydramine
weight: >/=25kg-<50kg
route: IV/IM
dose: 25mg
max=25mg
max#=1
weight:>/=50kg
route: iv/im
Dose= 50mg
max=1
clinical considerations:
- epi admin takes priority over IV access.
- iv admin of diphen= pcp authorized
Croup medical directives
indications: current hx of urti/ barking cough, recent hx of barking cough
conditions:
epi:
- age: >/=6months-8yrs
-hr<200bpm
-other: stridor at rest
dex:
-age:>/= 6months=8yrs
-other: for mild-moderated& severe croup
contraindications:
- allergy or sensitivity to both, dex: steriods within the last 48hrs, unable to tolerate oral meds
tx:
epi
=<10kg, NEB, 2.5mg, 1 dose
=>10kg, NEB, 5mg, 1 dose
dex:
age= >=6mths-<8yrs
route=po
dose= 0.5mg/kg
max= 8mg, 1 dose
IV & fluid therapy medical directive auxiliary ( PCP)
Indications: actual or potential need for IV meds or fluid therapy
iv cannulation:
Conditions: >2 yrs old
0.9% NaCl fluid maintenance
conditions: >2yrs
SBP= hypotensive
Contraindications:
iv cannulation: possible fracture proximal to IV site
0.9% Nacl maintenance:
- fluid over load
treatment:
age: <= 2-<12. >= 12
Route: IV
Infusion: 15ml/hr 30-60ml/hr
*Mandatory provincial Patch Point for fluid bolus to hypotensive pt>= 2yrs old w suspected DKA
Fluid Bolus directive
Consider 0.9% NaCl Bolus:
AGE: >2-<12. >12
route: IV
infusion: 20ml/hr. 20ml/hr
reassess: 100ml. 250ml
MAX VOL: 2000ml/hr
*micro drops/vol control for peds use
* considered for trauma pt that do not meet the TOR as long as it does not delay transport & should not be prioritized over management of reversible causes.
Rosc med directives
indications: pt with rosc after resuscitation was initiated
conditions:
0.9% NaCl fluid bolus
Age: >2yrs
SBP: hypotension
other: chest auscultation= clear
contraindications: fluid overload
Tx:
- consider optimizing ventilation & oxygenation
- titrate O2, 94%-100%
- consider 0.9% NaCl bolus
age: >2yrs-<12. >12yrs
route: IV
infusion: 10ml/hr. 10ml/hr
reassess: 100ml/hr. 250ml/hr
max vol: 1000ml/Hr
- consider 12 lead ecg acquisition and interpretation.
clinical considerations:
initiate transport inline with tx
Cardiogenic shock med directive:
indications: STEMI + 12-lead ECG & cardiogenic shock
conditions:
0.9% NaCl fluid Bolus
age: >18yrs
sbp: hypotension
other chest auscultation clear
contraindications:
fluid overload & SBP>90mmHG
Tx:
consider 0.9% NaCl fluid Bolus
age: >18yrs
route: IV
infusion: 10ml/kg
reassess every: 250ml
max vol: 1000ml
Clinical considerations: N/a
