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Core Medical Directives Flashcards

1
Q

What can Salbutamol be used for?

A

Bronchoconstriction

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2
Q

What are the conditions of Salbutamol?

A

Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: N/A

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3
Q

What are the contraindications of Salbutamol?

A

Allergy or sensitivity to Salbutamol

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4
Q

What is the treatment for someone under 25kg for salbutamol?

A

Route: MDI
Dose: Up to 600 mcg (6 puffs)
Max. Single Dose: 600 mcg
Dosing Interval: 5-15 min. PRN
Max. # of doses: 3
OR
Route: NEB
Dose: 2.5mg
Dosing Interval: 5-15 min. PRN
Max. # of doses: 3

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5
Q

What is the treatment for someone over or equal to 25kg for salbutamol?

A

Route: MDI
Dose: Up to 800 mcg (8 puffs)
Max. Single Dose: 800 mcg
Dosing Interval: 5-15 min. PRN
Max. # of doses: 3
OR
Route: NEB
Dose: 5 mg
Max. Single Dose: 5 mg
Dosing Interval: 5-15 min. PRN
Max. # of doses: 3

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6
Q

What can Epinephrine be used for?

A

Bronchoconstriction
Moderate to severe allergic reaction
Croup
Medical Cardiac Arrest

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7
Q

What are the conditions of Epinephrine for someone experiencing bronchoconstriction?

A

Age: N/A
LOA: N/A
HR: N/A
RR: BVM ventilation required
SBP: N/A
Other: Hx of asthma

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8
Q

What are the contraindications of Epinephrine? (Contraindications are the same for all directives)

A

Allergy or sensitivity to Epinephrine

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9
Q

What is the treatment for Epinephrine for someone experiencing bronchoconstriction or a medical cardiac arrest?

A

Route: IM
Concentration: 1mg/mL = 1:1,000
Dose: 0.01mg/kg
Max. Single Dose: 0.5 mg
Dosing Interval: N/A
Max. # of doses: 1
*The Epinephrine dose may be rounded to the nearest 0.05mg
*For medical cardiac arrest, only use if anaphylaxis is suspected as the causative event

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10
Q

What are the conditions of Epinephrine for someone experiencing moderate to severe allergic reaction?

A

Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: For anaphylaxis only

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11
Q

What is the treatment of epinephrine for someone experiencing moderate to severe allergic reaction?

A

Route: IM
Concentration: 1mg/mL = 1:1,000
Dose: 0.01mg/kg
Max. Single Dose: 0.5mg
Dosing Interval: Minimum 5 min.
Max. # of doses: 2
*The Epinephrine dose may be rounded to the nearest 0.05mg

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12
Q

What are the conditions of Epinephrine for croup?

A

Age: ≥ 6 months - <8 years
LOA: N/A
HR: <200 bpm
RR: N/A
SBP: N/A
Other: Stridor at rest

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13
Q

What is the treatment of Epinephrine for someone with croup who is <10kg?

A

Route: NEB
Concentration: 1mg/mL = 1:1,000
Dose: 2.5mg
Max. Single Dose: 2.5mg
Dosing Interval: N/A
Max. # of doses: 1

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14
Q

What is the treatment of Epinephrine for someone with croup who is ≥10kg?

A

Route: NEB
Concentration: 1mg/mL = 1:1,000
Dose: 5mg
Max. Single Dose: 5 mg
Dosing Interval: N/A
Max. # of Doses: 1

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15
Q

What are the conditions of Epinephrine for someone experiencing a medical cardiac arrest?

A

Age: ≥24 hours
LOA: Altered
HR: N/A
RR: N/A
SBP: N/A
Other: Anaphylaxis suspected as causative event

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16
Q

What can Dexamethasone be used for?

A

Bronchoconstriction
Croup

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17
Q

What are the conditions of Dexamethasone for someone with bronchoconstriction?

A

Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: Hx of asthma OR
COPD OR
20 pack-year history of smoking

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18
Q

What are the contraindications of Dexamethasone for someone with bronchoconstriction?

A

Allergy or sensitivity to steroids
Currently on PO or parenteral steroids

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19
Q

What is the treatment of Dexamethasone for someone with bronchoconstriction?

A

Route: PO/IM/IV
Dose: 0.5mg/kg
Max. Single Dose: 8mg
Dosing Interval: N/A
Max. # of doses: 1

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20
Q

What are the conditions of Dexamethasone for someone with croup?

A

Age: ≥6 months to <8 years
LOA: Unaltered
HR: N/A
RR: N/A
SBP: N/A
Other: For mild, moderate and severe croup

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21
Q

What are the contraindications of Dexamethasone for someone with croup?

A

Allergy or sensitivity to steroids
Steroids received within the last 48 hours
Unable to tolerate oral medications

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22
Q

What is the treatment of Dexamethasone for someone with croup?

A

Age: ≥6 months to <8 years
Route: PO
Dose: 0.5 mg/kg
Max. Single Dose: 8 mg
Dosing Interval: N/A
Max. # of doses: 1

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23
Q

What can Diphenhydramine be used for?

A

Moderate to severe allergic reaction
Minor allergic reaction (special event)

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24
Q

What are the conditions of Diphenhydramine for someone with a moderate to severe allergic reaction?

A

Age: N/A
Weight: ≥25 kg
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: N/A

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25
What are the contraindications of Diphenhydramine for someone with a moderate to severe allergic reaction?
Allergy or sensitivity to Diphenhydramine
26
What is the treatment of Diphenhydramine for someone with a moderate to severe allergic reaction that weighs ≥25 kg to <50 kg
Route: IV/IM Dose: 25 mg Max. Single Dose: 25 mg Dosing Interval: N/A Max. # of doses: 1
27
What is the treatment of Diphenhydramine for someone with a moderate to severe allergic reaction that weighs ≥50 kg
Route: IV/IM Dose: 50 mg Max. Single Dose: 50 mg Dosing Interval: N/A Max. # of doses: 1
28
What can a 0.9% NaCl fluid bolus be used for?
Return of spontaneous circulation (ROSC) Cardiogenic shock Intravenous and fluid therapy
29
What are the conditions of a 0.9% NaCl fluid bolus for ROSC?
Age: ≥2 years LOA: N/A HR: N/A RR: N/A SBP: Hypotension Other: Chest auscultation is clear
30
What are the contraindications of a 0.9% NaCl fluid bolus for ROSC?
Fluid overload
31
What is the treatment of a 0.9% NaCl fluid bolus for someone who is ≥2 years to <12 years for ROSC?
Route: IV Infusion: 10ml/kg Infusion Interval: Immediate Reassess Every: 100ml Max. Volume: 1,000ml
32
What can ASA be used for?
Cardiac ischemia
33
What is the treatment of a 0.9% NaCl fluid bolus for someone who is ≥12 years for ROSC?
Route: IV Infusion: 10ml/kg Infusion Interval: Immediate Reassess Every: 250ml Max. Volume: 1,000ml
34
What are the conditions of ASA?
Age: ≥18 years LOA: Unaltered HR: N/A RR: N/A SBP: N/A Other: Able to chew and swallow
35
What are the contraindications of ASA?
Allergy or sensitivity to NSAIDs If asthmatic, no prior use of ASA Current active bleeding CVA or TBI in the previous 24 hours
36
What is the treatment for ASA?
Route: PO Dose: 160-162 mg Max. Single Dose: 162 mg Dosing Interval: N/A Max. # of doses: 1
37
What can Nitroglycerin be used for?
Cardiac ischemia Acute cardiogenic pulmonary edema
38
What are the conditions of Nitroglycerin for cardiac ischemia?
Age: ≥18 years LOA: Unaltered HR: 60-159 bpm RR: N/A SBP: Normotension Other: Prior history of nitroglycerin use OR IV access obtained
39
What are the contraindications of Nitroglycerin for cardiac ischemia?
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
40
What is the treatment of Nitroglycerin for cardiac ischemia with no STEMI?
SBP: ≥100 mmHg Route: SL Dose: 0.3mg or 0.4mg Max. Single Dose: 0.4mg Dosing Interval: 5 min Max. # of doses: 6
41
What is the treatment of Nitroglycerin for cardiac ischemia with a positive STEMI?
SBP: ≥100 mmHg Route: SL Dose: 0.3mg or 0.4mg Max. Single Dose: 0.4mg Dosing Interval: 5 min Max. # of doses: 3
42
What are the conditions of Nitroglycerin for acute cardiogenic pulmonary edema?
Age: ≥18 years LOA: N/A HR: 60-159 bpm RR: N/A SBP: Normotension Other: N/A
43
What are the contraindications of Nitroglycerin for acute cardiogenic pulmonary edema?
Allergy or sensitivity to nitrates Phosphodiesterase inhibitor use within the previous 48 hours SBP drops by one-third or more if its initial value after nitroglycerin is administered
44
What is the treatment of Nitroglycerin for acute cardiogenic pulmonary edema for someone with a SBP ≥100 mmHg to <140 mmHg?
IV or Hx: Yes Route: SL Dose: 0.3mg or 0.4mg Max. Single Dose: 0.4mg Dosing Interval: 5 min Max. # of doses: 6
45
What is the treatment of Nitroglycerin for acute cardiogenic pulmonary edema for someone with a SBP ≥140 mmHg?
IV or Hx: No Route: SL Dose: 0.3mg or 0.4mg Max. Single Dose: 0.4mg Dosing Interval: 5 min Max. # of doses: 6 IV or Hx: Yes Route: SL Dose: 0.6mg or 0.8mg Max. Single Dose: 0.8mg Dosing Interval: 5 min Max. # of doses: 6
46
What can Dextrose be used for?
Hypoglycemia
47
What are the conditions of Dextrose?
Age: ≥2 years LOA: Altered HR: N/A RR: N/A SBP: N/A Other: Hypoglycemia
48
What are the contraindications of Dextrose?
Allergy or sensitivity to Dextrose
49
What is the treatment of Dextrose?
Age: ≥2 years Concentration: 10% Dextrose Route: IV Dose: 0.2g/Kg (2ml/Kg) Max. Single Dose: 25g (250ml) Dosing Interval: 10 min Max. # of doses: 2 Concentration: 50% Dextrose Route: IV Dose: 0.5g/Kg (1ml/Kg) Max. Single Dose: 25g (50ml) Dosing Interval: 10 min Max. # of doses: 2 *Titrate Dextrose to a level of awareness where the patient can safely consume complex carbohydrates
50
What can Glucagon be used for?
Hypoglycemia
51
What are the conditions of Glucagon?
Age: N/A LOA: Altered HR: N/A RR: N/A SBP: N/A Other: Hypoglycemia
52
What are the contraindications of Glucagon?
Allergy or sensitivity to Glucagon Pheochromocytoma
53
What is the treatment of Glucagon for someone who is <25 kg?
Age: N/A Route: IM Dose: 0.5mg Max. Single Dose: 0.5mg Dosing Interval: 20 min Max. # of doses: 2
54
What can Naloxone be used for?
Opioid toxicity and withdrawal
54
What is the treatment of Glucagon for someone who is ≥25 kg?
Age: N/A Route: IM Dose: 1mg Max. Single Dose: 1mg Dosing Interval: 20 min Max. # of doses: 2
55
What are the conditions of Naloxone?
Age: ≥24 hours LOA: Altered HR: N/A RR: <10 breaths/min SBP: N/A Other: Inability to adequately ventilate OR Persistent need to assist ventilations
56
What are the contraindications of Naloxone?
Allergy or sensitivity to Naloxone
57
What is the treatment of Naloxone?
Route: IV Dose: Up to 0.4mg * Max. Single Dose: 0.4mg Dosing Interval: 5 min Max. # of doses: 3 *For the IV route, titrate naloxone only to restore the patients respiratory status Route: IM Dose: 0.4mg Max. Single Dose: 0.4mg Dosing Interval: 5 min Max. # of doses: 3 Route: IN Dose: 2-4mg Max. Single Dose: 2-4mg Dosing Interval: 5 min Max. # of doses: 3 Route: SC Dose: 0.8mg Max. Single Dose: 0.8mg Dosing Interval: 5 min Max. # of doses: 3
58
What can Buprenorphine/Naloxone be used for?
Opioid toxicity and withdrawal
59
What are the conditions of Buprenorphine/Naloxone?
Age: ≥16 LOA: Unaltered HR: N/A RR: N/A SBP: N/A Other: Received naloxone for current opioid toxicity episode AND Patient is exhibiting acute withdrawal with a COWS score ≥8
60
What are the contraindications of Buprenorphine/Naloxone?
Allergy or sensitivity to buprenorphine Taken methadone in the past 72 hours
61
What is the treatment for Buprenorphine/Naloxone?
Route: BUC/SL Initial Dose: 16mg Subsequent Dose(s): 8mg Dosing Interval: 10 minutes Max. Cumulative Dose: 24mg
62
What can Hydrocortisone be used for?
Suspected adrenal crisis
63
What are the conditions of Hydrocortisone?
Age: N/A LOA: N/A HR: N/A RR: N/A SBP: N/A Other: Paramedics are presented with a vial of hydrocortisone for the identified patient AND Age related hypoglycemia OR GI symptoms (vomiting, diarrhea, abdominal pain) OR Syncope OR Temperature ≥38°C or suspected/history of fever OR Altered level or awareness OR Age-related tachycardia OR Age-related hypotension
64
What are the contraindications of Hydrocortisone?
Allergy or sensitivity to Hydrocortisone
65
What is the treatment for Hydrocortisone?
Route: IM/IV Dose: 2mg/kg* Max. Single Dose: 100mg Dosing Interval: N/A Max. # of doses: 1 *Dose should be rounded to the nearest 10mg
66
What can Acetaminophen be used for?
Analgesia Musculoskeletal pain (Special Event) Headache (Special Event)
67
What are the conditions of Acetaminophen for analgesia?
Age: ≥12 years LOA: Unaltered HR: N/A RR: N/A SBP: N/A Other: N/A
68
What are the contraindications of Acetaminophen for analgesia?
Acetaminophen use within previous 4 hours Allergy or sensitivity to Acetaminophen Hx of liver disease Active vomiting Unable to tolerate oral medication Suspected ischemic chest pain
69
What is the treatment of Acetaminophen for analgesia for someone who is ≥12 years to <18 years of age?
Route: PO Dose: 500-650mg Max. Single Dose: 650mg Dosing Interval: N/A Max. # of doses: 1
70
What is the treatment of Acetaminophen for analgesia for someone who is ≥18 years old?
Route: PO Dose: 960-1,000mg Max. Single Dose: 1,000mg Dosing Interval: N/A Max. # of doses: 1
71
What can Ibuprofen be used for?
Analgesia
72
What are the conditions of Ibuprofen?
Age: ≥12 years LOA: Unaltered HR: N/A RR: N/A SBP: N/A Other: N/A
73
What are the contraindications of Ibuprofen?
NSAID use within previous 6 hours Allergy of sensitivity to ASA or NSAIDs Patient on anticoagulation therapy Current active bleeding Hx of peptic ulcer disease or GI bleed Pregnant If asthmatic, no prior use of ASA or other NSAIDs CVA or TBI in the previous 24 hours Known renal impairment Active vomiting Unable to tolerate oral medication Suspected ischemic chest pain
74
What is the treatment of Ibuprofen?
Age: ≥12 years Route: PO Dose: 400mg Max. Single Dose: 400mg Dosing Interval: N/A Max. # of doses: 1
75
What can Ketorolac be used for?
Analgesia
76
What are the conditions of Ketorolac?
Age: ≥12 years LOA: Unaltered HR: N/A RR: N/A SBP: Normotension Other: N/A
77
What are the contraindications of Ketorolac?
NSAID use within previous 6 hours Allergy or sensitivity to ASA or NSAIDs Patient on anticoagulation therapy Current active bleeding Hx of peptic ulcer disease or GI bleed Pregnant If asthmatic, no prior use of ASA or other NSAIDs CVA or TBI in the previous 24 hours Known renal impairment Suspected ischemic chest pain
78
What is the treatment for Ketorolac?
Age: ≥12 years Route: IM/IV Dose: 10-15 mg Max. Single Dose: 15 mg Dosing Interval: N/A Max. # of doses: 1
79
What can Ondansetron be used for?
Nausea/Vomiting
80
What are the conditions of Ondansetron?
Age: N/A Weight: ≥25kg LOA: Unaltered HR: N/A RR: N/A SBP: N/A Other: N/A
81
What are the contraindications of Ondansetron?
Allergy to Ondansetron Prolonged QT syndrome (known to patient) Apomorphine use
82
What is the treatment of Ondansetron?
Weight: ≥25 kg Route: PO Dose: 4 mg Max. Single Dose: 4 mg Dosing Interval: N/A Max. # of doses: 1
83
What can Dimenhydrinate be used for?
Nausea/vomiting
84
What are the conditions of Dimenhydrinate?
Age: 65 years Weight: ≥25 kg LOA: Unaltered HR: N/A RR: N/A SBP: N/A Other: N/A
85
What are the contraindications of Dimenhydrinate?
Allergy or sensitivity to dimenhydrinate or other antihistamines Overdose on antihistamines or anticholinergics or tricyclic antidepressants Co-administration of diphenhydramine
86
What is the treatment of Dimenhydrinate for someone that weighs ≥25kg to <50kg?
Route: IV/IM Dose: 25mg Max. Single Dose: 25mg Dosing Interval: N/A Max. # of doses: 1
87
What is the treatment of Dimenhydrinate for someone that weighs ≥50kg?
Route: IV/IM Dose: 50 mg Max. Single Dose: 50 mg Dosing Interval: N/A Max. # of doses: 1
88
What can Oxytocin be used for?
Emergency childbirth
89
What are the conditions of Oxytocin?
Age: Childbearing years LOA: N/A HR: N/A RR: N/A SBP: <160 mmHg Other: Postpartum delivery AND/OR Placental delivery
90
What are the contraindications of Oxytocin?
Allergy or sensitivity to Oxytocin Undelivered fetus Suspected or known pre-eclampsia with current pregnancy Eclampsia (seizures) with current pregnancy ≥4 hours post placenta delivery
91
What is the treatment of Oxytocin?
Route: IM Dose: 10 units Max. Single Dose: 10 units Dosing Interval: N/A Max. # of doses: 1
92
What drugs can be used for Bronchoconstriction?
Salbutamol Epinephrine Dexamethasone
93
What drugs can be used for Moderate to Severe Allergic Reaction?
Epinephrine Diphenhydramine
94
What drugs can be used for Croup?
Epinephrine Dexamethasone
95
What drugs can be used for Medical Cardiac Arrest?
Epinephrine
96
What drugs can be used for ROSC?
0.9% NaCl Fluid Bolus
97
What drugs can be used for Cardiac Ischemia?
ASA Nitroglycerin
98
What drugs can be used for Acute Cardiogenic Pulmonary Edema?
Nitroglycerin
99
What drugs can be used for Hypoglycemia?
Dextrose Glucagon
100
What drugs can be used for Opioid Toxicity and Withdrawal?
Naloxone Buprenorphine/naloxone
101
What drugs can be used for Suspected Adrenal Crisis?
Hydrocortisone
102
What drugs can be used for Analgesia?
Acetaminophen Ibuprofen Ketorolac
103
What drugs can be used for Nausea/Vomiting?
Ondansetron Dimenhydrinate
104
What drugs can be used for Emergency Childbirth?
Oxytocin

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