Core Medical Directives Flashcards
What can Salbutamol be used for?
Bronchoconstriction
What are the conditions of Salbutamol?
Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: N/A
What are the contraindications of Salbutamol?
Allergy or sensitivity to Salbutamol
What is the treatment for someone under 25kg for salbutamol?
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
What is the treatment for someone over or equal to 25kg for salbutamol?
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
What can Epinephrine be used for?
Bronchoconstriction
Moderate to severe allergic reaction
Croup
Medical Cardiac Arrest
What are the conditions of Epinephrine for someone experiencing bronchoconstriction?
Age: N/A
LOA: N/A
HR: N/A
RR: BVM ventilation required
SBP: N/A
Other: Hx of asthma
What are the contraindications of Epinephrine? (Contraindications are the same for all directives)
Allergy or sensitivity to Epinephrine
What is the treatment for Epinephrine for someone experiencing bronchoconstriction or a medical cardiac arrest?
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
What are the conditions of Epinephrine for someone experiencing moderate to severe allergic reaction?
Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: For anaphylaxis only
What is the treatment of epinephrine for someone experiencing moderate to severe allergic reaction?
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
What are the conditions of Epinephrine for croup?
Age: ≥ 6 months - <8 years
LOA: N/A
HR: <200 bpm
RR: N/A
SBP: N/A
Other: Stridor at rest
What is the treatment of Epinephrine for someone with croup who is <10kg?
Route: NEB
Concentration: 1mg/mL = 1:1,000
Dose: 2.5mg
Max. Single Dose: 2.5mg
Dosing Interval: N/A
Max. # of doses: 1
What is the treatment of Epinephrine for someone with croup who is ≥10kg?
Route: NEB
Concentration: 1mg/mL = 1:1,000
Dose: 5mg
Max. Single Dose: 5 mg
Dosing Interval: N/A
Max. # of Doses: 1
What are the conditions of Epinephrine for someone experiencing a medical cardiac arrest?
Age: ≥24 hours
LOA: Altered
HR: N/A
RR: N/A
SBP: N/A
Other: Anaphylaxis suspected as causative event
What can Dexamethasone be used for?
Bronchoconstriction
Croup
What are the conditions of Dexamethasone for someone with bronchoconstriction?
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
What are the contraindications of Dexamethasone for someone with bronchoconstriction?
Allergy or sensitivity to steroids
Currently on PO or parenteral steroids
What is the treatment of Dexamethasone for someone with bronchoconstriction?
Route: PO/IM/IV
Dose: 0.5mg/kg
Max. Single Dose: 8mg
Dosing Interval: N/A
Max. # of doses: 1
What are the conditions of Dexamethasone for someone with croup?
Age: ≥6 months to <8 years
LOA: Unaltered
HR: N/A
RR: N/A
SBP: N/A
Other: For mild, moderate and severe croup
What are the contraindications of Dexamethasone for someone with croup?
Allergy or sensitivity to steroids
Steroids received within the last 48 hours
Unable to tolerate oral medications
What is the treatment of Dexamethasone for someone with croup?
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
What can Diphenhydramine be used for?
Moderate to severe allergic reaction
Minor allergic reaction (special event)
What are the conditions of Diphenhydramine for someone with a moderate to severe allergic reaction?
Age: N/A
Weight: ≥25 kg
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: N/A
What are the contraindications of Diphenhydramine for someone with a moderate to severe allergic reaction?
Allergy or sensitivity to Diphenhydramine
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
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
What can a 0.9% NaCl fluid bolus be used for?
Return of spontaneous circulation (ROSC)
Cardiogenic shock
Intravenous and fluid therapy
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
What are the contraindications of a 0.9% NaCl fluid bolus for ROSC?
Fluid overload
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
What can ASA be used for?
Cardiac ischemia
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
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
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
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
What can Nitroglycerin be used for?
Cardiac ischemia
Acute cardiogenic pulmonary edema
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
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
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
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
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
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
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
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
What can Dextrose be used for?
Hypoglycemia
What are the conditions of Dextrose?
Age: ≥2 years
LOA: Altered
HR: N/A
RR: N/A
SBP: N/A
Other: Hypoglycemia
What are the contraindications of Dextrose?
Allergy or sensitivity to Dextrose
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
What can Glucagon be used for?
Hypoglycemia
What are the conditions of Glucagon?
Age: N/A
LOA: Altered
HR: N/A
RR: N/A
SBP: N/A
Other: Hypoglycemia
What are the contraindications of Glucagon?
Allergy or sensitivity to Glucagon
Pheochromocytoma
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
What can Naloxone be used for?
Opioid toxicity and withdrawal
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
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
What are the contraindications of Naloxone?
Allergy or sensitivity to Naloxone
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
What can Buprenorphine/Naloxone be used for?
Opioid toxicity and withdrawal
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
What are the contraindications of Buprenorphine/Naloxone?
Allergy or sensitivity to buprenorphine
Taken methadone in the past 72 hours
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
What can Hydrocortisone be used for?
Suspected adrenal crisis
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
What are the contraindications of Hydrocortisone?
Allergy or sensitivity to Hydrocortisone
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
What can Acetaminophen be used for?
Analgesia
Musculoskeletal pain (Special Event)
Headache (Special Event)
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
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
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
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
What can Ibuprofen be used for?
Analgesia
What are the conditions of Ibuprofen?
Age: ≥12 years
LOA: Unaltered
HR: N/A
RR: N/A
SBP: N/A
Other: N/A
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
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
What can Ketorolac be used for?
Analgesia
What are the conditions of Ketorolac?
Age: ≥12 years
LOA: Unaltered
HR: N/A
RR: N/A
SBP: Normotension
Other: N/A
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
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
What can Ondansetron be used for?
Nausea/Vomiting
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
What are the contraindications of Ondansetron?
Allergy to Ondansetron
Prolonged QT syndrome (known to patient)
Apomorphine use
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
What can Dimenhydrinate be used for?
Nausea/vomiting
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
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
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
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
What can Oxytocin be used for?
Emergency childbirth
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
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
What is the treatment of Oxytocin?
Route: IM
Dose: 10 units
Max. Single Dose: 10 units
Dosing Interval: N/A
Max. # of doses: 1
What drugs can be used for Bronchoconstriction?
Salbutamol
Epinephrine
Dexamethasone
What drugs can be used for Moderate to Severe Allergic Reaction?
Epinephrine
Diphenhydramine
What drugs can be used for Croup?
Epinephrine
Dexamethasone
What drugs can be used for Medical Cardiac Arrest?
Epinephrine
What drugs can be used for ROSC?
0.9% NaCl Fluid Bolus
What drugs can be used for Cardiac Ischemia?
ASA
Nitroglycerin
What drugs can be used for Acute Cardiogenic Pulmonary Edema?
Nitroglycerin
What drugs can be used for Hypoglycemia?
Dextrose
Glucagon
What drugs can be used for Opioid Toxicity and Withdrawal?
Naloxone
Buprenorphine/naloxone
What drugs can be used for Suspected Adrenal Crisis?
Hydrocortisone
What drugs can be used for Analgesia?
Acetaminophen
Ibuprofen
Ketorolac
What drugs can be used for Nausea/Vomiting?
Ondansetron
Dimenhydrinate
What drugs can be used for Emergency Childbirth?
Oxytocin
