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ALS PCS > CORE DIRECTIVES > Flashcards

CORE DIRECTIVES Flashcards

1
Q

supraglottic airway indications

A
  • need for ventilatory assistance or airway control,
    and
  • other airway management is ineffective
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2
Q

supraglottic airway conditions

A

absent gag reflex

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3
Q

supraglottic airway contraindications

A
  • airway obstructed by a foreign object,
  • known esophageal disease (varices)
  • trauma to the oropharynx
  • caustic ingestion
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4
Q

supraglottic airway treatment (insertion)

A

the max number of attempts is 2

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5
Q

supraglottic airway treatment (confirmation of placement)

A

primary: etco2 waveform capnography
secondary: etco2 non waveform, auscultation, chest rise

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6
Q

SGA clinical considerations

A
  • An attempt at supraglottic airway insertion is defined as the insertion of the supraglottic airway into the mouth.
  • Confirmation of supraglottic airway should use ETCO2 (Waveform capnography). If waveform capnography is not available or is not working, then at least 2 secondary methods must be used.
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7
Q

bronchoconstriction indications

A
  • respiratory distress and
  • suspected bronchoconstriction
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8
Q

bronchoconstriction conditions salbutamol

A

n/a

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9
Q

bronchoconstriction conditions EPI

A

rr- bvm ventilation required
other- hx of asthma

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10
Q

bronchoconstriction conditions dexamethasone

A

other: hx of asthma OR, COPD OR, 20 pack-year hx of asthma

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11
Q

bronchoconstriction contraindications salbutamol

A

allergy/sensitivity to salbutamol

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12
Q

bronchoconstriction contraindications EPI

A

allergy/ sensitivity to epi

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13
Q

bronchoconstriction contraindications dexamethasone

A
  • allergy or sensitivity to steroids
  • currently on PO or parenteral steroids
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14
Q

bronchoconstriction treatment salbutamol (weight <25kg)

A
  • MDI
    600 mcg
    5-15mins
    3 times
  • NEB
    2.5mg
    5-15 mins
    3 times
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15
Q

bronchoconstriction treatment salbutamol (weight >25kg)

A
  • MDI
    800 mcg
    5-15mins
    3 times
  • NEB
    5 mg
    5-15 mins
    3 times
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16
Q

bronchoconstriction epinephrine treatment

A
  • IM
    1mg/ml
    0.01mg/kg
    max 0.5mg
    1 time
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17
Q

bronchoconstriction dexamethasone treatment

A

-PO/IM/IV
0.5mg/kg
max 8mg
1 time

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18
Q

bronchoconstriction clinical considerations

A
  • epi should be the 1st medication administered if the patient is apneic. salbutamol may be administered subsequently using BVM MDI adapter
  • neb is contraindicated for pt with known or suspected fever or in setting of declared illness outbreak
  • MDI salbutamol administered every 4 breaths
  • spacer should be used when administering salbutamol MDI
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19
Q

moderate to severe allergic reaction indications

A

exposure to probable allergen and signs and symptoms of a mod- severe allergic reaction incl anaphylaxis

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20
Q

moderate to severe allergic reaction conditions epinephrine

A
  • for anaphylaxis only
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21
Q

moderate to severe allergic reaction conditions diphenhydramine

A
  • > 25kg
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22
Q

moderate to severe allergic reaction contraindications epinephrine

A

allergy or sensitivity to epinephrine

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23
Q

moderate to severe allergic reaction contraindications diphenhydramine

A

allergy or sensitivity to diphenhydramine

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24
Q

moderate to severe allergic reaction treatment epinephrine

A
  • IM
    1mg/ml
    0.01mg/kg
    max 0.5mg
    minimum 5 mins
    2 times
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25
Q

moderate to severe allergic reaction treatment diphenhydramine >25kg - <50kg

A
  • IV/IM
    25mg
    max 25mg
    1 time
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26
Q

moderate to severe allergic reaction treatment diphenhydramine >50kg

A
  • IV/IM
    50mg
    max 50mg
    1 time
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27
Q

moderate to severe allergic reaction clinical considerations

A
  • epi takes priority over IV access
  • iv administration of diphenhydramine applies only to PCP authorized for PCP autonomous IV
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28
Q

croup indications

A
  • current hx of a URTI
  • and barking cough or recent hx of a barking cough
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29
Q

croup conditions epinephrine

A

> 6mons - 8years
<200bpm
stridor at rest

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30
Q

croup conditions dexamethasone

A

> 6mons - 8years
unaltered
for moderate, mild or severe croup

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31
Q

croup contraindications epinephrine

A

allergy or sensitivity to epinephrine

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32
Q

croup contraindications dexamethasone

A
  • allergy or sensitivity to steroids
  • steroids received within the last 48 hours
  • unable to tolerate oral medications
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33
Q

croup treatment epinephrine <10kg

A

-NEB
2.5 mg
max 2.5 mg
1 time

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34
Q

croup treatment epinephrine >10kg

A

-NEB
5mg
max 5 mg
1 time

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35
Q

croup treatment dexamethasone

A

> 6mons - 8 years
- PO
0.5mg/kg
max 8mg
1 time

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36
Q

trache suctioning and reinsertion indications

A
  • pt with and endotracheal or trache tube
  • AND airway obstruction or increased secretions
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37
Q

trache suctioning and reinsertion conditions suctioning

A

n/a

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38
Q

trache suctioning and reinsertion conditions trache reinsertion

A
  • pt with existing trache where the inner and/or outer cannulas have been removed from the airway AND
  • respiratory distress AND
  • inability to adequately ventilate AND paramedics are presented with a tracheostomy cannula for the identified patient
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39
Q

trache suctioning and reinsertion contraindications suctioning

A

n/a

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40
Q

trache suctioning and reinsertion contraindications trache reinsertion

A

inability to landmark or visualize

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41
Q

trache suctioning and reinsertion suction settings

A
  • <1 year: 60-100mmHg
  • > 1 year- <12 years: 100-120mmHg
  • > 12 years: 100-150mmHg
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42
Q

trache suctioning and reinsertion treatment trache reinsertion

A

max attempts at reinsertion is 2

43
Q

medical cardiac arrest indications

A

non traumatic cardiac arrest

44
Q

medical cardiac arrest primary clinical considerations

A
  • pregnancy >20 weeks gestation
  • hypothermia
  • airway obstruction
  • non opioid drug overdose/ toxicology
  • other known reversible cause of arrest

for patients in refractory VF or pulseless VT, transport should begin after the third consecutive shock

45
Q

medical cardiac arrest conditions CPR

A

altered
performed in 2 min intervals

46
Q

medical cardiac arrest conditions manual defibrillation

A
  • > 24 hrs
    altered
    VF or pulseless VT
47
Q

medical cardiac arrest conditions AED or SAED

A
  • > 24 hrs
    altered
    defibrillation indicated if not using manual defibrillation
48
Q

medical cardiac arrest contraindications CPR

A
  • obviously dead as per BLS PCS
  • meet conditions of the BLS PCS DNR standard
48
Q

medical cardiac arrest contraindications epinephrine

A

allergy or sensitivity to epinephrine

48
Q

medical cardiac arrest conditions medical TOR

A
  • > 16 years
    altered
    arrest not witnessed by EMS AND
    no ROSC after 20 mins of resuscitation AND
    no defibrillation delivered
49
Q

medical cardiac arrest conditions epinephrine

A
  • > 24 hrs
    altered
    anaphylaxis suspected as causative event
50
Q

medical cardiac arrest contraindications manual defibrillation

A

rhythms other than VF or pulseless VT

51
Q

medical cardiac arrest contraindications AED or SAED

A

non shockable rhythm

52
Q

medical cardiac arrest contraindications medical TOR

A
  • known reversible cause of the arrest unable to be addressed
  • pregnancy presumed to be > 20 weeks
  • hypothermia
  • airway obstruction
  • non opioid drug OD/ toxicology
53
Q

medical cardiac arrest treatment manual defibrillation >24 hrs - <8 years

A

initial dose 2J/kg
subsequent dose 4J/kg
every 2 mins

53
Q

trauma cardiac arrest indications

A

cardiac arrest secondary to severe blunt or penetrating trauma

53
Q

medical cardiac arrest treatment manual defibrillation >8 years

A

every 2 mins as normal

54
Q

medical cardiac arrest treatment epinephrine

A
  • IM
    1mg/ml
    0.01mg/ml
    max 0.5 mg
    1 time
55
Q

trauma cardiac arrest conditions CPR

A

altered
performed in 2 min intervals

56
Q

trauma cardiac arrest conditions manual defibrillation

A

> 24 hrs
altered
VF or pulseless VT

57
Q

trauma cardiac arrest conditions AED or SAED

A

> 24 hrs
altered
defibrillation indicated

58
Q

trauma cardiac arrest conditions trauma TOR

A

> 16 years
- no palpable pulses AND
- no defibrillation delivered AND
- rhythm asystole AND
- no SOL at any time since fully extricated OR
- SOL when fully extricated with the closest ED >30 min transport time away OR
- rhythm PEA with the closest ED > 30 min transport time away

59
Q

trauma cardiac arrest contraindications CPR

A

obviously dead as per the BLS PCS
meet conditions of the BLS PCS DNR standard

60
Q

trauma cardiac arrest contraindications manual defibrillation

A

rhythms other than VF or pulseless VT

61
Q

trauma cardiac arrest contraindications AED or SAED

A

non shockable rhythm

62
Q

trauma cardiac arrest contraindications trauma TOR

A

<16 years
- defibrillation delivered
- SOL at any time since fully extricated
- rhythm PEA and closest ED <30 min transport time away
- PT with penetrating trauma to the torso or head/neck and lead trauma hospital <30 mins away

63
Q

trauma cardiac arrest treatment defibrilation >24 hrs - <8 years

A

initial dose 2J/kg
1 time

64
Q

trauma cardiac arrest treatment defibrilation > 8 years

A

1 defibrillation as normal

65
Q

trauma cardiac arrest clinical considerations

A
  • If no obvious external signs of significant blunt trauma, consider medical cardiac arrest and treat according to the appropriate medical cardiac arrest directive.
  • Signs of life: specifically any spontaneous movement, respiratory efforts, organized electrical activity on ECG, and reactive pupils.
  • An intravenous fluid bolus may be considered, where it does not delay transport and should not be prioritized over management of other reversible pathology.
66
Q

newborn resuscitation conditions CPR

A

<24 hrs
<60 bpm
after 30 seconds of PPV with room air

67
Q

newborn resuscitation conditions PPV

A

<24 hrs
<100bpm

67
Q

newborn resuscitation indications

A

newborn patient

68
Q

newborn resuscitation contraindications PPV

A
  • obviously dead as per the BLS PCS
  • presumed gestation age less than 20 weeks
69
Q

newborn resuscitation contraindications CPR

A
  • obviously dead as per the BLS PCS
  • presumed gestation age less than 20 weeks
70
Q

newborn resuscitation clinical considerations

A
  • If newborn resuscitation is required, initiate cardiac monitoring and right-hand pulse oximetry monitoring.
  • Infants born between 20-25 weeks gestation may be stillborn or die quickly. Initiate resuscitation and transport as soon as feasible.
  • If gestational age cannot be confirmed, initiate resuscitation and rapid transport.
  • If newborn is less than 20 weeks gestation, resuscitation is futile. Provide the newborn with warmth and consider patching to BHP for further direction.
71
Q

ROSC indications

A

pt with ROSC after the resuscitation was initiated

72
Q

ROSC conditions 0.9% NaCl fluid bolus

A

> 2 yrs
hypotension
chest auscultation is clear

73
Q

ROSC contraindications 0.9% NaCl fluid bolus

A

fluid overload

74
Q

ROSC treatment: consider optimizing ventilation and oxygenation

A
  • titrate oxygenation 94-98%
  • avoid hyperventilation and target ETCO2 to 30-40 mmHg with continuous waveform capnography
75
Q

ROSC treatment 0.9% NaCl fluid bolus >2yrs- <12 yrs

A

IV
10ml/kg
immediate
reassess every 100ml
max 1000 ml

76
Q

ROSC treatment 0.9% NaCl fluid bolus >12 yrs

A

IV
10ml/kg
immediate
reassess every 250ml
max 1000 ml

77
Q

ROSC clinical considerations

A
  • Consider initiating transport in parallel with the above treatment.
  • IV fluid bolus applies only to PCPs authorized for PCP Autonomous IV.
78
Q

cardiac ischemia indications

A

suspected cardiac ischemia

79
Q

cardiac ischemia conditions ASA

A

> 18 years
unaltered
able to chew and swallow

80
Q

cardiac ischemia conditions nitroglycerin

A

> 18 years
unaltered
60-159
normotension
prior history of nitroglycerin use OR iv access obtained

81
Q

cardiac ischemia contraindications ASA

A
  • allergy or sensitivity to NSAIDS
  • if asthmatic no prior use of ASA
  • current active bleeding
    -CVA or TBI in the previous 24 hrs
82
Q

cardiac ischemia contraindications nitroglycerin

A
  • Allergy or sensitivity to nitrates
  • Phosphodiesterase inhibitor use within the previous 48 hours
  • SBP drops by one-third or more of its initial value after nitroglycerin is administered
  • 12-lead ECG compatible with Right Ventricular MI
83
Q

cardiac ischemia treatment ASA

A
  • PO
    160-162 mg
    max 162mg
    1 time
84
Q

cardiac ischemia treatment nitroglycerin >100mmHg no STEMI

A

-SL
0.3 OR 0.4 mg
max 0.4 mg
5 mins
6 times

86
Q

cardiac ischemia treatment nitroglycerin >100mmHg yes STEMI

A

-SL
0.3 OR 0.4 mg
max 0.4 mg
5 mins
3 times

87
Q

cardiac ischemia clinical considerations

A
  • Suspect a Right Ventricular MI in all inferior STEMIs and perform at minimum V4R to confirm (ST-elevation ≥ 1mm in V4R).
  • Do not administer nitroglycerin to a patient with Right Ventricular STEMI.
  • IV condition applies only to PCPs authorized for PCP Autonomous IV.
  • Apply defibrillation pads when a STEMI is identified.
  • The goal for time to 12-lead ECG from first medical contact is < 10 minutes where possible.

ALS PCS (1 decks)

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