Directives Flashcards
Contraindications for adenosine
Allergy
Sinus tach, a fib, a flutter
Taking carbamazepine (Tegretol) or dipyridamole (persantine)
Broncho construction on exam
Amiodarone dose for tachydysthymia
150mg q10 mins
2 doses
Lidocaine dose for tachydysrhytmia
1.5mg/kg
Subsequent dose 0.75mg/kg
3 doses q10 mins
Dopamine contraindications for ROSC
Allergy
Pheochromocytoma
Tachydysrhythmia
Mechanical shock
Morphine dose for cardiac ischemia vs pain
2mg q5 minutes (5 doses)
Vs
0.05-0.1mg/kg (>1- <18), Max 5mg, q15, max 10mg
2-10mg (>18yo), q15, max 20mg
What age do you have to patch for dose verification in pain medication?
Less than 12 years old.
What are the indications for needle thoracostomy in traumatic arrest?
Age N/A
LOA N/A
HR N/A
RR N/A
SBP N/A
Other: suspected tension pneumothorax AND absent or severely diminished breath sounds on affected side.
What are the indications and conditions for needle thoracostomy in the tension pneumothorax medical directive?
Indications: pre-arrest or VSA AND absent or diminished breath sounds on affected side
Age N/A
LOA N/A
HR N/A
RR N/A
SBP: hypotension or VSA
Other N/A
What are the contraindications for dopamine in cardiogenic shock?
Allergy
Tachydysrhymias
Mechanical shock
Hypovolemia
Pheochcomocytoma
What are the contraindications for dopamine in cardiogenic shock?
Allergy
Tachydysrhymias
Mechanical shock
Hypovolemia
Pheochcomocytoma
What are the routes for fentanyl in procedural sedation directive?
IV, IO, CVAD, IN
What are the routes for fentanyl in procedural sedation directive?
IV, IO, CVAD, IN
What are the routes for Midazolam in procedural sedation?
IV, IO, CVAD, IN
Can you give fentanyl and midazolam for procedural sedation if hypotension was present but corrected?
Yes
What are the routes of administration for calcium gluconate?
IV, IO, CVAD
What is the ETT epi dose in neonate resus?
1:10,000
0.1mg/kg
Max dose 0.3mg (3ml)
Max # of doses 1
What are the indications for tension pneumothorax directive?
Pre-arrest or VSA
AND
Absent or severely diminished breath sounds
What are the routes for fentanyl for pain?
IV/IN
What are the routes for morphine for the pain directive?
IV/SC
What is the route for dopamine in ROSC medical directive?
IV
What is the route if administration for midazolam in combative directive?
IV/IM/IN
What is the route of administration for ketamine in combative patient directive?
IM
What are the indications for pediatric/adult IO
Need for fluid/meds
AND
IV unobtainable
AND
Pre arrest or VSA
What are the routes for midazolam in seizure activity?
IV, IO, IM, IN, Buccal
Double dose for IM, IN, Buccal
What are the indications for cricothyrotomy?
Need to advanced airway management
AND
Intubation and supraglottic airway unsuccessful
AND
Unable to ventilate
What are the indications for CVAD access
Actual or potential need for fluid/meds
And
IV unsuccessful
AND cardiac arrest or prearrest
What are the contraindications for CVAD
Inability to confirm patency
Inability to flush or aspirate
Injury or fracture proximal
Swelling of involved limb
Bleeding at insertion site
What is the route of admin for atropine?
IV
What is the route of administration for dopamine in bradycardia?
IV
What type of medication is atropine?
Antimuscarinic
How does atropine work?
Works through the inhibition of post synaptic acetylcholine receptors. Blocks the parasympathetic response and allows sympathetic drive to take over.
How does dopamine work?
Dopamine is a catecholamine that works on the alpha and beta receptors. 5mcg is beta dose increasing heart rate and contractility. Alpha dose causes vasoconstriction.
What is the route of administration for amiodarone in cardiac arrest?
IV/IO/CVAD
What is the route of administration of lidocaine in cardiac arrest?
IV/IO/CVAD/ETT
What are the contraindications of intubation?
Age <50 AND asthma AND not in or near cardiac arrest
What are the routes of administration of amiodarone in tachydysrhythmia directive?
IV
What is the classification of adenosine? And how does it work?
Purine nucleoside
Across on purinergic adenosine receptors which are located in AV node.
Drives K+ outside of cells and inhibits Ca+ influx leading to HYPERpolarization.
What is the classification and effect of amiodarone?
Class III antiarryhtmic
Works by inhibiting influx of Na+, as well as Ca+
Has alpha and beta ANTAGONIST effects
Blocks K+ during phase 3 of cardiac action potential (repolarization)
Prolongs refractory period of cardiac myocytes
What is the classification of lidocaine and what is its effect?
Class 1B antiarrythmic
Binds to sodium channels and slows down influx of Na+ into cardiac myocytes.
