Drugs Flashcards
1
Q
Magnesium Sulfate
ACTION
A
depresses myoneural junctions, decreasing excitability of neural as
well as myocardial membranes. It is this depressant effect that is responsible for
depressing the central nervous system, potentially limiting seizure activity. The
depression of cardiac muscle activity is thought to be the mechanism by which
Magnesium Sulfate helps to control intractable V-Tach and other dysrhythmias
2
Q
Pediatric Seizure
What do we wanna check for as early as possible?
and how can we treat it if necessary?
A
Check blood glucose level early, and treat appropriately.
o For blood glucose < 70,
-Administer D25W 2mL/kg for children < 8 years old
-Administer D50 2mL/kg for children > 8 years old (maximum 50mL or 25g)
3
Q
in chest pain protocol, if Tachycardia (HR>100) present, we treat it with what?
A
Labetalol
5mg slow IV over 1-2 minutes.
may repeat in 5 minutes max of 20mg
4
Q
Sodium Bicarbonate
CONTRAINDICATIONS
A
- metabolic and respiratory alkalosis
- hypocalcemia
- hypokalemia
5
Q
Rocuronium
Zemuron
Onset of Action
and
Duration of Action
A
Onset
45-60 seconds
Duration
25-70 minutes
6
Q
Sodium Bicarbonate
DOSAGE AND ADMINISTRATION
Adults:
and Peds
(RTT)
A
• 1 mEq/kg, IV/IO bolus
• May be repeated, after 10 minutes, at 0.5 mEq / kg
• 25 mEq IV/IO for pre-treatment in a crush injury, prior to the release of the
trapped extremity; these patients may require a second dose of 25 mEq if
symptomatic of hyperkalemia
7
Q
Dextrose
DOSAGE AND ADMINISTRATION
Adults and Pedi
A
DOSAGE AND ADMINISTRATION
Adult:
• 25 grams IV slow
Pediatric:
• Preferentially use Dextrose 25% if age is <8 years old
• Refer to “Weight Based Resuscitation Tape” for pediatric dosing
8
Q
For altered patients, whats the best course of action?
A
check the BGL first
Naloxalone 0.5mg IV/IM/IO/IN
9
Q
Valium
Contraindications
A
CONTRAINDICATIONS
- Shock
- Coma
- Respiratory depression
- Substance abuse of CNS depressants
- Hypersensitivity to this medication
10
Q
Haloperidol
Haldol
ACTION
A
antipsychotic.
known to have effect on dopaminergic and
seritonergic receptors.
11
Q
Midazolam
Versed
CONTRAINDICATIONS
A
- known hypersensitivity to other benzodiazepines
- hypotension/shock
- respiratory distress
12
Q
Adenosine
Contraindications
A
- Heart Blocks
- AFlutter/Afib
- VTach
- Wolff Parkinsons
- Asthma
13
Q
Midazolam
Versed
DOSAGE / ADMINISTRATION
Adult:
Sedation after intubation or pre-treatment before cardioversion:
A
• 2 - 4 mg IV/IO
14
Q
Fentanyl
DOSAGE AND ADMINISTRATION
Sedation in a patient with an advanced airway
Adult
A
Sedation in a patient with an advanced airway
Adult:
- 100 to 250 mcg IV, may repeat to a maximum cumulative dose of 250mcg
- Discuss with online medical control if additional doses are needed
Pediatric:
• Please use weight-based dosing, administered IV or IO
15
Q
Midazolam
Versed
pedi
DOSAGE / ADMINISTRATION
Sedation after intubation or pre-treatment before cardioversion:
A
0.1 mg/kg IV/IO (max 2 mg)
16
Q
Albuterol
Side Effects
A
Headache Drowsiness Vertigo Nausea Hypertension
17
Q
In regards to Trauma, Pleural decompression for tension pneumothorax should only be performed
when all three of these criteria are present..???
If indicated, perform pleural
decompression at ___ intercostal space, ______ line.
A
-Severe respiratory distress with hypoxia
-Unilateral decreased or absent lung sounds (may see tracheal deviation away
from collapsed lung field)
-Evidence of hemodynamic compromise (shock, hypotension, tachycardia,
altered mental status)
decompression at 2nd intercostal space, midclavicular line.
18
Q
Methylprednisolone
SIDE EFFECTS
A
Nervousness
Dizziness
Headache
May raise serum glucose levels (hyperglycemia)
19
Q
Assess all trauma patients for Trauma Alert criteria. If criteria are met, begin transport to
Trauma Center within ____ minutes of arrival on scene whenever possible
A
10
20
Q
Hypotension/Shock (Non-Trauma)
Assess for _____ and signs of cardiogenic shock (auscultate for ___, ___ heart
sounds, assess for ___ and/or ___ edema).
o If absent:
Administer _______. May repeat as needed for continued
hypotension.
Consider _______mcg/kg/min IV
o If pulmonary edema present:
Consider starting with ______, and repeat
cautiously while monitoring respiratory status.
Administer ____mcg/kg/min IV
If BP improves consider ____ for treatment of pulmonary edema.
A
Assess for pulmonary edema and signs of cardiogenic shock (auscultate for rales, S3 heart
sound, assess for JVD and/or pedal edema).
o If absent:
Administer NS 500mL bolus. May repeat as needed for continued
hypotension.
Consider Dopamine 5-20mcg/kg/min IV
o If pulmonary edema present:
Consider starting with smaller fluid boluses (e.g. NS 250mL), and repeat
cautiously while monitoring respiratory status.
Administer Dopamine 5-20mcg/kg/min IV
21
Q
Epinephrine
Action
A
ACTION
Epinephrine is an endogenous catecholamine with beta-1, beta-2 (bronchodilation and
vasoconstriction of skeletal muscle) and alpha 1 (peripheral vasoconstriction)
adrenergic effects. It has positive inotropic, chronotropic and dromotropic effects, along
with increased SVR, increased coronary and cerebral perfusion and increased
automaticity. It causes an increase in myocardial oxygen demand.
22
Q
For Patients with crush injury or prolonged Administer _______ (maximum ____meq) just prior to
release of trapped extremity
• Administer _____ bolus
A
Administer Sodium Bicarbonate 1 mEq/kg slow IV push (maximum 25meq) just prior to
release of trapped extremity
• Administer normal saline 500mL bolus
23
Q
Sodium Bicarbonate
ACTION
A
Sodium bicarbonate is an alkalizing agent, which causes blood pH to rise
24
Q
Amiodarone
Other name?
A
Cordarone
25
Ondansetron
Zofran
SIDE EFFECTS
```
headache dizziness
drowsiness fatigue
weakness diarrhea
abdominal pain constipation
dry mouth extrapyramidal reactions
```
26
Ketamine
INDICATIONS
Indicated for induction in adults and children or management of agitated delirium
27
Organophospate poisoning treatment
may repeat how often and until when?
atropine 2mg IV
| may repeat every 5 minutes until secretions subside.
28
Glascow Coma Scale
EVM - 3-15
4Eyes 5Verbal 6Motor
Eye Opening
None 1 = Even to supra-orbital pressure
To pain 2 = Pain from sternum/limb/supra-orbital pressure
To speech 3 = Non-specific response, not necessarily to command
Spontaneous 4 = Eyes open, not necessarily aware
Verbal Response
None 1 = No verbalization of any type
Incomprehensible
2 = Moans/groans, no speech
Inappropriate
3 = Intelligible, no sustained sentences
Confused
4 = Converses but confused, disoriented
Oriented
5 = Converses and oriented
Motor Response
None
1 = To any pain; limbs remain flaccid
Extension
2 = Shoulder adducted and shoulder and forearm internally
rotated
Flexor response
3 = Withdrawal response or assumption of hemiplegic posture
Withdrawal
4 = Arm withdraws to pain, shoulder abducts
Localizes pain 5 = Arm attempts to remove supra-orbital/chest pressure
Obeys commands
6 = Follows simple commands
29
Labetalol
CONTRAINDICATIONS
PRECAUTIONS
```
hypersensitivity to the medication
• high degree AV block
• cardiogenic shock
• bradycardia
• hypotension
```
```
PRECAUTIONS
• heart failure
• hepatic disease
• diabetes
• asthma
```
30
EtCO2 rating needing to be managed for patient with sever head trauma
at least 40
31
Epinephrine
Precations
PRECAUTIONS
* hyperthyroidism
* diabetes mellitus
* glaucoma
* may exacerbate angina, hypertension, SVT and CHF
* protect solution from intense light sources
* is unstable in alkaline solutions
32
Dopamine
PRECAUTIONS
PRECAUTIONS
• Can cause an increase in myocardial oxygen consumption thus worsening the
cardiac status of the patient. Should be carefully monitored.
• Use with caution in cardiogenic shock with accompanying CHF.
33
Opioid overdose symptoms
treatment
Respiratory depression, altered mentation (somnolence), possibly decreased blood pressure,
pinpoint pupils, possibly cardiac arrest
Treat with Naloxone 0.5mg via IV/IO/IM/IN route (whichever is easiest
34
Adenosine
| Other name for it?
Adenocard
35
For regular, wide complex tachycardias (most likely ______________),
administer _______mg over ___ minutes.
Follow by maintenance infusion of __mg/min for __hrs
For regular, wide complex tachycardias (most likely ventricular tachycardia),
administer Amiodarone 150mg over 10 minutes.
Follow by maintenance infusion of 1mg/min for 6hrs
36
Naloxone
Narcan
DOSAGE AND ADMINISTRATION
Adults:
• 0.5mg IV, IO, IM, IN (whichever is easiest) – may be dosed as a single 2mg dose
or may be given in increments of 0.5mg up to four times, depending on the
protocol and patient’s clinical presentation
• For severe respiratory depression (<6 breaths per minute) administer 2 mg.
37
Benadryl
Precautions
PRECAUTIONS
• Use caution in pregnant patients
• Benadryl may have additive effects when used with other CNS depressant
medications
38
Calcium Channel Blockers and Beta Blockers overdose symptoms
and overdose treatment?
bradycardia, hypotension, heart blocks, hypoglycemia, and pre-syncope or
altered mental status
calcium chloride
1G slow IV
39
Etomidate
COMPLICATIONS
COMPLICATIONS
• Anticipate that the patient will awaken rapidly and be left without residual
analgesia.
• Medicate with additional narcotics and neuromuscular blockers, as needed.
40
Benadryl
Indications
INDICATIONS
* anaphylaxis
* extrapyramidal reaction to phenothiazine medications
* mild to moderate allergic reactions
41
Midazolam
Versed
```
SIDE EFFECTS
agitation drowsiness
excess sedation apnea/respiratory depression
bronchospasm coughing
nausea and vomiting
```
agitation drowsiness
excess sedation apnea/respiratory depression
bronchospasm coughing
nausea and vomiting
42
Nitroglycerin
INDICATIONS
• Ischemic chest pain
• Hypertension
• Acute pulmonary edema which may be secondary to another process such as
congestive heart failure
43
Cardizem
SIDE EFFECTS / ADVERSE EFFECTS
SIDE EFFECTS / ADVERSE EFFECTS
```
epistaxis dyspnea dysrhythmias
CHF peripheral edema bradycardia
chest pain hypotension palpitations
syncope tachycardia nausea / vomiting
flushing diaphoresis urticaria
hyperglycemia muscle cramps paresthesia / tremor
```
44
Fentanyl
DOSAGE AND ADMINISTRATION
Pain Control
Pedi
Pain Control
Pediatric:
• 0.5 mcg/kg, IV push slowly over 1-2 minutes, not to exceed 100 mcg.
• 1.5mcg/kg via mucosal atomization device if IV access unsuccessful or not
otherwise needed.
• May repeat every 5 minutes to a total of three doses or a maximum cumulative dose of 250 mcg
• Recheck a pain score & vitals including a HR, RR, and BP between doses
45
```
ABDOMINAL PAIN
ALS:
• Male > __; female >__
(cardiac until proven otherwise).
• Female age __-__ who has fainted or
has systolic BP
```
```
ABDOMINAL PAIN
ALS:
• Male > 30; female > 45
(cardiac until proven otherwise).
• Female age 12-50 who has fainted or
has systolic BP <90 (ectopic)
• Not alert (not at normal baseline)
• VS not normal for age and size
```
46
Cardizem
Contraindications
CONTRAINDICATIONS
Hypersensitivity Sick Sinus Syndrome
2nd or 3rd degree AV block Hypotension (<90 mmHg systolic)
Recent myocardial infarction Pulmonary congestion
Wolff-Parkinson-White syndrome (WPW)
47
Aspirin
Dosage
324mg PO
| 4 baby aspirin
48
Adenosine
| Action?
Slows the conduction through the AV Node.
| Blocks re-entrant pathways in SVT
49
Remember that ___% of geriatric syncope is cardiac dysrhythmia based
25
50
For all other cases of symptomatic hypertension with SBP > ___ and diastolic BP > ____,
administer _____mg IV push over ___ minutes. May repeat x ___ in ____ minutes if BP is
unchanged.
Goal is to lower blood pressure no more than ___% initially.
o this drug is contraindicated in cases of _________. Use caution in patients with
history of _____ disease or recent (
For all other cases of symptomatic hypertension with SBP > 220 and diastolic BP > 120,
administer Labetalol 10mg IV push over 1-2 minutes. May repeat x 1 in 10 minutes if BP is
unchanged. Goal is to lower blood pressure no more than 25% initially.
o Labetalol is contraindicated in cases of bradycardia. Use caution in patients with
history of reactive airway disease or recent (<48hrs) cocaine use
51
Methylprednisolone
CONTRAINDICATIONS
• Known hypersensitivity to methylprednisolone sodium succinate
• Systemic fungal infections
USE WITH CAUTION
• Known tuberculosis infection
• Patients who have received steroids within the past 12 hours
52
Synchronized Cardioversion
Joules
Supraventricular tachycardia or atrial flutter
50 to100 J
53
Succinylcholine
Anectine
Via IV- Time to complete paralysis?
Duration?
effects fade time?
Via IM - time to paralysis?
duration?
IV injection, complete paralysis is obtained within 1 minute and persists
for approximately 2 – 4 minutes
• Effects start to fade within 4 - 10 minutes
IM effects start within 3 minutes and the duration can be from 10 – 30 minutes
54
6 criteria for termination of cardiac arrest
Pulseless, apneic, and no other signs of life present
o Lack of pupillary reflexes and spontaneous movement
o Asystole or agonal rhythm <20bpm on cardiac monitor and multiple lead EKG
o Patients who become pulseless after severe traumatic injury when transport to the
nearest ED cannot be accomplished within 15min (i.e. prolonged extrications)
provided that all other signs of life are absent and transport has not been initiated
o Perform needle decompression of the chest prior to declaring termination, as tension
pneumothorax is a potentially reversible cause of cardiac arrest in these patients
o Place call to Online Medical Control for discussion prior to termination of
resuscitation
55
Methylprednisolone
Solumedrol
ACTION
Methylprednisolone is a potent anti-inflammatory glucocorticoid, a type of steroid. Its
anti-inflammatory effect is used to control conditions of severe inflammation such as
anaphylaxis and severe allergic reactions, exacerbations of COPD and asthma, and
other diseases. Onset of effect can occur within an hour of administration, and last for
nearly twelve hours.
56
Fentanyl
DOSAGE AND ADMINISTRATION
Pain Control
Adult
Pain Control
Adult:
• 50 - 100 mcg, IV push slowly over 1-2 minutes, or IM injection, may repeat every
5 minutes to a total of three doses or a maximum cumulative dose of 250 mcg
• Recheck a pain score & vitals including a HR, RR, and BP between doses
57
Nitroglycerin
SIDE EFFECTS
transient headache diaphoresis
hypotension syncope
nausea and vomiting tachycardia
58
Dextrose
Action
ACTION
Dextrose is a carbohydrate (monosaccharide) in a hypertonic solution which, when
given intravenously, increases blood glucose levels.
59
Labetalol
DOSAGE AND ADMINISTRATION
Adult:
Symptomatic Hypertension
10 mg IV over 1-2 minutes
• May be repeated in 10 minutes, if no significant change in blood pressure
• The goal is to lower the blood pressure, but not by more than 25%
60
Consider possibility of ______ as etiology of wide-complex tachycardia
(especially in dialysis patients), and treat with _____ @ ___ IV/IO if
suspected
Consider possibility of hyperkalemia as etiology of wide-complex tachycardia
(especially in dialysis patients), and treat with Calcium chloride 1G IV/IO if
suspected
61
Ondansetron
Zofran
CONTRAINDICATIONS
• hypersensitivity
62
Pediatric Vomiting and Diarrhea
UPC
Utilize IV protocol if s/s of hypovolemia, give ___?
• Check ___?
For blood glucose < 8 ___, administer ___ @______ for children < ___ years old
Administer ___ @ ___ for children > 8 years old (maximum __mL or __ G)
• For symptomatic nausea/vomiting, administer _____.
o Administer ___mg/kg IV (max __mg) for children <40kg.
o Administer __mg ODT or IV for children > 40kg (oral route preferred if patient
does not require IV for other reason)
Utilize IV protocol if signs or symptoms of hypovolemia, and give NS 20cc/kg bolus
• Check blood glucose level
For blood glucose < 60, administer D25 2mL/kg for children < 8 years old.
Administer D50 2mL/kg for children > 8 years old (maximum 50mL or 25G)
• For symptomatic nausea/vomiting, administer ondansetron.
o Administer 0.1mg/kg IV (max 4mg) for children <40kg.
Administer Zofran 4mg ODT or IV for children > 40kg (oral route preferred if patient
does not require IV for other reason)
63
What are the 6 controlled substances?
```
Lorazepam
Diazepam
Midazolam
Fentanyl
Ketamine
Etomidate
```
64
Succinylcholine
Anectine
DOSAGE AND ADMINISTRATION
Adult:
Peds (RTT)
• 1.5 mg/kg IV/IO push
• In extreme circumstances: deep IM injection of 3 - 4 mg/kg; total dose not to
exceed 150 mg, however paralytics should ideally be given with IV access
65
What drug can we administer prior to cardioversion and at what dose?
Midazolam
Versed
1-2mg IV/IN
66
If hypertensive patient complains of ____, obtain____ and treat per protocol.
o What should be first line antihypertensive and analgesic agent in this group
If patient complains of chest pain, obtain 12-lead EKG and treat per Chest Pain Protocol.
o Nitroglycerine should be first line antihypertensive and analgesic agent in this group
67
Patients with crush injury or prolonged extrication are at risk for developing _____
Patients with crush injury or prolonged extrication are at risk for developing rhabdomyolysis
68
Epinepherine
DOSAGE AND ADMINISTRATION
Cardiac Arrest
Adult/Pedi
Cardiac arrest:
Adult
* 1 mg IV / IO of Epinephrine (1:10,000) push every 3-5 minutes
* Can be given via ET tube at 2 - 2.5 times the normal dose diluted in 10ml of NS
Pediatric
• Epinephrine (1:10,000) 0.01 mg/kg IV or IO every 3-5 minutes
69
Initial recommended dose is dependent on rhythm
- Narrow, regular:
- Narrow, irregular:
- Wide, regular:
- Wide, irregular:
Narrow, regular: 50-100J
Narrow, irregular: 120-200J
Wide, regular: 100J
Wide, irregular: defibrillation dose (NOT synchronized)
70
Etomidate
PRECAUTIONS
PRECAUTIONS
• Patients with renal or hepatic insufficiency
71
Atropine
CONTRAINDICATIONS
CONTRAINDICATIONS
tachycardia
• narrow angle glaucoma
• myasthenia gravis
72
Atropine
SIDE EFFECTS
palpitations tachycardia
headache vertigo
dry mouth blurred vision
urinary retentio
73
Calcium Chloride
DOSAGE AND ADMINISTRATION
Adult and Pedi
Hyperkalemia
Hyperkalemia:
Adult:
• 1 gram, IV/IO
Pediatric:
• 20 mg/kg, IV/IO, maximum dose 1 gram
• Refer to “Weight Based Resuscitation Tape” for pediatric dosing.
74
Treatment For chemical burns
remove clothing and brush off any visible dry chemicals or powder.
flush with water or NS for 10-15 minutes
75
Sepsis alert will be instituted for patients meeting the following 2 criteria?
1. Suspected infection
```
2. Two or more of the following:
• Temperature (100.4° F) OR < (96.8° F)
• Respiratory Rate > 20 breaths/min
• Heart Rate > 90 beats/min
• ETCO2 ≤ 25
```
76
Dopamine
DOSAGE AND ADMINISTRATION:
Hypotension/shock refractory to fluid resuscitation
and
Bradycardia w/ a pulse
Adult
Hypotension/shock refractory to fluid resuscitation
Adult:
Infusion rate 5-20 mcg/kg/min IV and titrate for response.
Bradycardia with a pulse
Adult
• Infusion rate 2-20 mcg/kg/min IV and titrate for response.
77
Epinepherine
DOSAGE AND ADMINISTRATION
Anaphylaxis:
Anaphylaxis:
Adult:
• 0.3mg of Epinephrine 1:1,000 via intramuscular injection
• May repeat if signs and symptoms of shock persist after the initial dose
• If patient appears to be nearing cardiac arrest or develops cardiac arrest, give
1mg IV of 1:10,000 epinephrine
Pediatric:
• Per weight-based tape, inject the 1:1,000 epinephrine intramuscularly
• May repeat if signs and symptoms of shock persist after the initial dose
• If patient develops cardiac arrest, give 1:10,000 epinephrine IV per weight-based
tape dosing
78
Dopamine
Action
ACTION
Dopamine is an endogenous catecholamine, which is a precursor to norepinephrine.
Primarily acts upon alpha-1 and beta-1 receptors. Low dose ranges <2mcg/kg/min
results in vasodilation of the renal, mesenteric and cerebral arteries. Dose ranges of 2-
10 mcg/kg/min cause beta stimulation which results in increased cardiac output with
minimal changes in SVR or preload. Dose ranges of 10-20 mcg/kg/min result in alpha
response with vasoconstriction of the renal, mesenteric and peripheral vasculature.
79
Calcium Chloride
Action
ACTION
Calcium chloride is an essential electrolyte for functional integrity of the nervous and
muscular system, cardiac contractility and coagulation of blood.
80
Adenosine
Indications
Treatment of SVT
81
All trauma patients who present with multi-systems trauma will be transported as
soon as possible with the transport goal being____ minutes or less
10
82
Albuterol
Indications?
Contraindications?
Indications
Bronchospasms
Asthma-COPD
Contraindications
Hypertension
83
Synchronized Cardioversion
sedation
Medication and Dose
consider sedation with
Midazolam/Versed
1 - 2 mg IV
84
treatment for patients with epistaxis
Firmly pinch the bridge of the nose for at least 10 minutes
| with the head tilted forward facing down
85
Albuterol
Adult
Pediatric
Both are 2.5mg in 3-6ml
86
hypothermia is regarded as temp below ____degrees?
95
87
Synchronized Cardioversion
Joules
Ventricular Tachycardia
100J
88
Disadvantage of using Bougie Tube
| Can only be used with a __ endotracheal tube or larger
6.0
89
which drugs can be given in the ET tube?
when delivered in an ET tube, what is the amended dose?
Epi
Narcan
Atropine
for ET tube, admin 2-2.5 times the IV dose diluted in 5-10ml or NS
90
Pediatric Pain Control
Drugs for pain management
Fentanyl 0.5mcg/kg IV (maximum dose 100mcg), slow IV push
May repeat every 5 minutes, to a maximum of 3 doses
May be administered via MAD Intranasal dose is 1.5mcg/kg
(maximum dose 100mcg)
91
For thermal burns, cover with ____ or sterile
dressings
o <10% TBSA?
o >10% TBSA, ?
o Leave blisters intact
```
cover with burn sheet or sterile
dressings
o <10% TBSA, wet dressings with normal saline
o >10% TBSA, 1L bolus NS
o Leave blisters intact
```
92
Succinylcholine
SIDE EFFECTS
Hypotension Tachycardia
Hypertension Cardiac arrest
Ventricular dysrhythmias Brief elevation of serum potassium
Bradycardia, especially with a repeat dose and in children under 5 years old
Increased intracranial, intraocular and intragastric pressure
Malignant hyperthermia (rare but life-threatening complication)
93
in trauma, If BP < ___, administer boluses of NS at ___mL until BP > ___
If BP < 90, administer boluses of NS at 250mL until BP > 90
94
Calcium Chloride
Calcium Channel Blocker Overdose/Toxicity:
Adult
1 gram, IV/IO slowly
Pediatric:
* 20 mg/kg (0.2 ml/kg), IV/IO slowly
* Refer to “Weight Based Resuscitation Tape” for pediatric dosing.
95
If preeclampsia is present (___/___)BP, administer ________mg IVP every ___minutes until SBP
If preeclampsia is present (160/110), administer Labetalol 10mg IVP every 10minutes until SBP <
130 and DBP < 100.
o Contraindicated if HR < 60
o Use with caution in patients with history of asthma
96
If suspected CVA, whats proper protocol?
Check BGL first
Establish when symptoms began to determine if window of stroke alert
IV access
FAST-ED
Keep head of stretcher 30-45 degrees
dont treat BP >220 of suspected CVA
97
Sodium Bicarbonate
SIDE EFFECTS
* metabolic alkalosis
* seizures
* electrolyte imbalance
98
Cardizem
Precautions
PRECAUTIONS
* patients with renal or hepatic insufficiency or CHF
* geriatric patients
* pregnancy, lactation or children
* history of serious ventricular dysrhythmias
99
Daily Glucometer Checks
Once the solutions and test strips have been opened they are good for __
days.
90 days
100
For crushing trauma,
Administer _____ mEq ___ IV push just prior to release of trapped
extremity
• Administer normal saline ___mL bolus
For crushing trauma,
Administer Sodium Bicarbonate 25 mEq slow IV push just prior to release of trapped
extremity
• Administer normal saline 500mL bolus
101
Fentanyl
Alternate Name
Sublimaze
102
Benadryl
Alternate name
Diphenhydramine
103
For behavioral/Agitated delerium, admin which drugs?
If patient has dystonic reactions, then what?
Midazolam 5-10 mg IV
May also be given 5 and 5 in each nostril.
Haloperidol
5mg IV/IM
may repeat once in 10 minutes
Ketamine
2mg/kg IM/IV
Dystonic reactions are treated with
Diphenhydramine
1mg/kg
or 25-50mg
may repeat once after 10 minutes
104
Dextrose
Indications
INDICATIONS
* hypoglycemia
* altered levels of consciousness
* coma or seizure of unknown etiology
105
Amiodarone Drop ROSC
| recurrent Vfib
150mg IV over 10 minutes
106
Relationship between CO2 and respiratory rate (RR):
↑ RR= ↓CO2 =
↓ RR= ↑CO2 =
Normal range of ETCO2 is __-__ mmHg
↑ RR= ↓CO2 =HYPER-ventilation (ETCO2 <35) → respiratory alkalosis
↓ RR= ↑CO2 = HYPO-ventilation (ETCO2 >45) → respiratory acidosis
Normal range of ETCO2 is 35-45 mmHg
107
12 Lead Placement and Lead Groups
SALI
Septal
V1 and V2
Anterior
V3 and V4
Lateral
I, V5, V6, and aVL
Inferior
II, III, and aVF
```
V1
Right parasternum
4th ICS
V2
Left parasternum
4ICS
V3
In between V2 and v4
V4
Left Midclavicular
5th ICS
V5
In between V4 and V6
V6
Left Midaxillary
```
108
Fentanyl
Precautions
USE WITH PRECAUTION
* Head injury
* COPD history
* Respiratory difficulty
109
Cardizem
Action
ACTION
Diltiazem is a calcium channel blocker which inhibits transport of calcium into
myocardial and vascular smooth muscle cells resulting in inhibition of excitationcontraction
coupling and subsequent contraction. It causes systemic vasodilation with
resultant decrease in blood pressure and coronary vasodilation
110
Naloxone
Narcan
DOSAGE AND ADMINISTRATION
Pediatric:
* 0.1 mg/kg IV, IO, IM, IN
| * Refer to "Weight Based Resuscitation Tape" for pediatric dosing.
111
What is APGAR?
APGAR score should be obtained and recorded at _ minute and _ minutes after
delivery
0-10
Appearance
0 - Blue/Pale
1 - BodyPink/Extremities Blue
2 - Pink
Pulse
0- Absent
1- < 100 per minute
2- > 100 per minute
Grimace
0- No response
1- Some motion
2- Cry
Activity
0- Limp
1- Some Flexion
2- Good flexion
Respiration
0- Absent
1- Weak Cry
2- Strong Cry
1 MINUTE AND 5 MINUTE
112
For irregular tachycardias (most likely _______), administer __________
mg/kg (maximum ___mg) IV over ___ minutes
For irregular tachycardias (most likely atrial fibrillation), administer Diltiazem 0.25
mg/kg (maximum 20mg) IV over 2 minutes
113
6 Rights
```
Patient
Route
Time
Drug
Dose
Date
```
114
Pediatric Seizure
For patients WITH IV access already established, the preferred treatment is?
If drug shortage, whats a benzo alternative?
Lorazepam/Ativan
0.1mg/kg IV/IO slow push (maximum 4mg/dose)
```
Alternative agents (to be used only in cases of drug shortage): Diazepam 0.2mg/kg
IV/IO slow push (max 5mg/dose)
```
115
Atropine
Dosage and Admin
Pedi Organophosphate OD/Toxic Ingestion
Pediatrics:
• 0.02 mg/kg IV (minimum dose 0.1mg), repeat every 5 minutes until respiratory
secretions subside
116
Midazolam
Versed
ACTION
Midazolam is a short acting benzodiazepine. It acts at many levels of the CNS to
produce generalized CNS depression. Effects may be mediated by gammaaminobutyric acid (GABA), an inhibitory neurotransmitter.
117
Cardizem
DOSAGE AND ADMINISTRATION
DOSAGE AND ADMINISTRATION
Adult:
• Consider vagal maneuvers as first line for a regular, narrow complex tachycardia
suggestive of SVT (AVNRT)
• 0.25 mg/kg IV over 2 minutes, maximum of 20mg
• May be repeated in 15 min if initial dose is ineffective
Pediatrics
• Consider expert consultation; typical dose is 0.25 mg/kg IV over 2 minutes
• Avoid use in infants
118
Direct introduction of, or application of, a drug into or on the body of a patient by
injection, inhalation, ingestion or any other means and, where required by law, shall
occur only pursuant to a medical order
Administration
119
Capno Hypoventilation
↓RR; Prolonged waveform; typical ETCO2 >45 mmHg.
120
Indications for Bougie Airway Adjunc
Unable to pass an endotracheal tube through the vocal cords.
• Ability to visualize the epiglottis but not the vocal cords
⇒ Obesity, edema, trauma, anaphylaxis, tumor, blood, C-collar
121
for pain severity > 6/10, and/or other indication for IV exists,
we can admin _____ IV, slow.
may repeat every ___ min, to a max of ____ total dose.
contradindicated if SBP < ___
use with cation for PTs with
_____
history of______ or ______
If pain severity > 6/10, and/or other indication for IV exists:
o Fentanyl 50-100mcg IV, slow
May repeat every 5 minutes, to a maximum of 250mcg total dose
For repeat dosing above 250mcg, contact Online Medical Control.
Contraindicated if SBP < 100
Use with caution if patient has head injury, history of COPD, or
respiratory distress.
122
Epinipherine
SIDE EFFECTS
CNS stimulation anxiety
headache nausea, vomiting
palpitations tachycardia
dizziness hyperglycemia
123
Midazolam
Versed
pedi
DOSAGE / ADMINISTRATION
Seizure (preferred agent if there is not IV access)
0.2 mg/kg via MAD – half given in each nostril (max 10mg total, 5mg per nostril)
124
Benadryl
CONTRAINDICATIONS
CONTRAINDICATIONS
* asthma (relative contraindication)
* narrow angle glaucoma
* patients taking MAO inhibitors
125
Magnesium Sulfate
CONTRAINDICATIONS
symptomatic heart block (myocardial depressant)
| • use with caution in patients with renal impairment
126
Benadryl
DOSAGE AND ADMINISTRATION
DOSAGE AND ADMINISTRATION
Adults:
• 1 mg/kg (max 50 mg) IV, or IM if no IV access
• Dystonic reaction: give 25 – 50 mg IV/IM
Pediatric:
• 1 mg/kg (max 50 mg) IV, or IM if no IV access
127
Synchronized Cardioversion
| not used for
treatment of VF,
pulseless VT,
or unstable
polymorphic (irregular) VT.
These rhythms require delivery of high-energy,
unsynchronized shocks
128
Succinylcholine
Anectine
INDICATIONS
• Used after induction of anesthesia to produce skeletal muscle paralysis.
• To achieve temporary paralysis where endotracheal intubation is indicated and
where muscle tone or seizure activities prevent it.
• Patients who demonstrate a high probability of airway compromise during
transport.
129
Trauma Protocol
If BP < __, administer boluses of NS at ___mL until BP > ____
If BP < 90, administer boluses of NS at 250mL until BP > 90
130
always perform ____
| after cardioversion or administration of antiarrhythmic
always perform 12-lead EKG
| after cardioversion or administration of antiarrhythmic
131
Atropine
Dosage and Admin
Adult Bradycardia
Adults:
• 0.5mg IV push, rapidly
• May be repeated every 3 - 5 minutes
• Maximum dose is 3 mg.
132
Ketamine
DOSAGE AND ADMINISTRATION
Respiratory Failure – Induction Agent
Adult/Pediatric Dose
| • 2 mg/kg IV2 mg/kg IV
133
Amiodarone
Action
Antiarrhythmic medication
Calcium, potassium, and sodium channel blocker.
negative chronotropic, negative dromotropic, and vasodilator.
134
Methylprednisolone
DOSAGE AND ADMINISTRATION
Adults:
Pediatric:
DOSAGE AND ADMINISTRATION
Adults:
• 125mg IV (preferred) or IM
Pediatric:
• 2 mg/kg IV, maximum 60mg or
• Refer to “Weight Based Resuscitation Tape” for pediatric dosing
o Avoid intramuscular (IM) route in children)
135
Magnesium Sulfate
INDICATIONS
• cardiac arrest, only if torsade de pointes or suspected hypomagnesemia is
present.
• life threatening ventricular arrhythmias due to digitalis toxicity
• seizures from eclampsia
• bronchospasm secondary to COPD or status asthmaticus
136
S.T.A.R.T. Triage Algorithm
Green
Yellow
Red
Black
Green Tag
Able to walk
Minor injuries
Yellow
Victim transport can be delayed
Serious to potentially life threatening injuries but not expected to deteriorate over several hours.
Red
Victim can be helped by immediate intervention and transport
Req medical attention within minutes for survival (up to 60)
compromised ABC
Black
Unlikely to survive
palliative care and pain relief
Algorythm
If Jaw thrust is needed to get Resp
If PR >30
If radial pulse absent ot cap refill >2 seconds
If doesnt obey commands
all go to REd
137
Calcium Chloride
Precautions
PRECAUTIONS
* use caution in patients taking digitalis
* patients with renal disease
* calcium precipitates on contact with sodium bicarbonate
138
Labetalol
ACTION
Labetalol is an adrenergic blocking agent with selective alpha and non-selective beta
adrenergic blocking actions thus lowering blood pressure without reflexive tachycardia
139
Amiodarone
VTach with pulse and unstable PSVT
150mg in 100ml
| D5W over 10 minutes
140
Dopamine
Side Effects
SIDE EFFECTS
```
hypertension tachydysrhythmias (dose related)
headache nausea and vomiting
```
141
H's and T's
```
Hydrogen Ions
Hyperkalemia
Hypovolemia
Hypothermia
Hypoxia
```
Thrombosis
Toxins
Tension PNeumo
Tamponade
142
Fentanyl
CONTRAINDICATIONS
CONTRAINDICATIONS
* Patients currently taking MAO inhibitors
* Hypersensitivity to this medication
* Hypotension
* Abnormalities in lead V4R or other indications of inferior wall myocardial infarct
143
Self-rehab (rest and hydration) should last at least ___ minutes following the depletion of a
____ SCBA cylinder or following __ minutes of intense work that does not
require an SCBA
Self-rehab (rest and hydration) should last at least 10 minutes following the depletion of a
single 30-minute SCBA cylinder or following 20 minutes of intense work that does not
require an SCBA
144
For patients with bleeding dialysis fistula
Firm pressure with one finger may be enough to stop bleeding from a dialysis fistula,
particularly if bleeding results from recent dialysis access
o Large lacerations in dialysis fistulas may require direct pressure with hemostatic
gauze
o Tourniquets should be utilized only as a last resort as these will likely destroy the
fistula or graft
145
Dopamine
CONTRAINDICATIONS
CONTRAINDICATIONS
* tachydysrhythmias
* patients with Pheochromocytoma
* hypovolemic shock prior to fluid replacement
146
Personnel should report to rehab for evaluation after __ minutes
45
147
Ketamine
DOSAGE AND ADMINISTRATION
Agitated Delirium
Adult/Pediatric Dose
• 2 mg/kg IV/IM –
o Utilize only in extreme cases of excited delirium, as studies show that as many as 30-
40% of patients treated with ketamine in the prehospital environment may require
intubation in the emergency department for sedation and respiratory depression. If
respiratory depression occurs, treat per Respiratory Failure Protocol.
148
Cardizem
Alternate Name
Diltiazem
149
Haloperidol
Haldol
INDICATIONS
INDICATIONS
• For prompt control of the acute agitated delirium patient with moderately severe to
severe symptoms.
• used in the setting of an acute psychiatric episode
150
Atropine
Action?
parasympatholytic drug that inhibits the actions of acetylcholine at
the postganglionic parasympathetic neuroeffector sites. Effects include dilation of the
pupils, relaxation of the bronchioles, decreased gastric motility and increased heart rate.
It produces both positive chronotropic and positive dromotropic effects.
151
Amiodarone
Indications
V fib
PVtach
Adjunct to elecrical cardioversion of SVT and PSVT
152
Calcium Chloride
Indications
INDICATIONS
* hypocalcemia
* hyperkalemia
* calcium channel blocker toxicity
* magnesium sulfate overdose
* cardiac resuscitation
153
Seizure (preferred agent if there is not IV access)
* Patients <50kg: 5 mg via MAD
| * Patients >50kg: 10 mg via MAD (5 mg per nostril)
154
Haloperidol
Haldol
CONTRAINDICATIONS
Severe, toxic CNS depression or comatose states from any cause.
• Hypersensitivity
• Known prolonged QT
PRECAUTIONS
• Use cautiously for patients with severe cardiovascular disorder because of the
possibility of transient hypotension and / or angina.
• Use carefully for patients on anti-convulsive therapy or with a history of seizures
because haloperidol may lower the convulsive threshold.
• Known hypersensitivity.
• Use with caution in patients >50 years old.
• Haloperidol is capable of potentiating the effects of CNS depressants such as
alcohol, opiates, and anesthetics.
155
Pediatric Seizure
what is the preferred
treatment before placement of peripheral
IV??
Dose??
preferred
treatment is midazolam/versed via mucosal atomizer device (MAD), before placement of peripheral
IV
Midazolam 0.2mg/kg (max 10mg, 5mg to each nare) via MAD
156
It is the policy of Tampa Fire Rescue to change out expired medications at______ for those medications with dates listed with month and year
only, i.e., 11/10
the end of
| the month of expiration
157
Suspect preeclampsia if the following conditions are met:
o Gestational age > __ weeks
o Elevated blood pressure > __/__
o Symptoms are present such as edema, visual disturbance, headache, epigastric
pain.
Suspect preeclampsia if the following conditions are met:
o Gestational age > 20 weeks
o Elevated blood pressure > 160/110
o Symptoms are present such as edema, visual disturbance, headache, epigastric
pain.
158
Age greater than __ years or less than __ years in the presence of significant
mechanism of injury are recommended to wear C collars
>65 or <5
159
Magnesium Sulfate
INCOMPATIBILITIES
```
IV Alcohol Bicarbonates
barium Calcium
Clindamycin Dobutamine
Hydrocortisone Hyperalimantation
Polymyxin Procain
solutions containing soluble phosphates
```
160
Rocuronium
Zemuron
INDICATIONS
• Rocuronium is used for skeletal muscle paralysis, following an induction agent, in
rapid sequence intubation. Paralysis may also facilitate chest wall compliance
during mechanical ventilation
161
Albuterol
Action?
Bronchodilator
| Beta 2 Smooth Muscle relaxer
162
For patients with GI bleed that are nauseous treat with what drug for N/V?
Ondenastron 4mg IV
163
3 leading causes of secondary brain injury
hypotension, hypoxia, hyperventilation
164
Ondansetron
Zofran
DOSAGE AND ADMINISTRATION
Pediatric:
• 0.1 mg/kg IV for children <40kg
• 4 mg/kg IV or a 4mg oral dissolving tablet sublingual for children >40kg
o Oral route is preferred if the child does not otherwise require an IV
• Refer to "Weight Based Resuscitation Tape" for pediatric dosing as needed
165
Fentanyl
INDICATIONS
• Pain control
• Sedation of the intubated patient
INDICATIONS
* Pain control
* Sedation of the intubated patient
166
Ketamine
SIDE EFFECTS
```
SIDE EFFECTS
• hypertension
• tachycardia
• respiratory depression
• laryngospasm
• nausea
• vomiting
```
167
CPAP
Indications
Moderate respiratory distress with at least two of the following:
_____ or _____ use
RR > __
SpO2 < __%
and
Contraindications
_____ and / or cardiac arrest
• ______ trauma
• Severe hypotension (SBP
\indications
Moderate respiratory distress with at least two of the following:
Retractions or accessory muscle use
RR > 25
SpO2 < 92%
• May be used and may prevent need for intubation in patients with exam
consistent with pulmonary edema (rales, JVD, hypoxia) or bronchospasm
(wheezing, hypoxia, tachypnea)
Contraindications
Respiratory and / or cardiac arrest
• Penetrating chest trauma
• Severe hypotension (SBP<90)
• Persistent nausea / vomiting or active GI bleed.
• Questionable ability to protect airway, i.e. stroke, obtunded, etc
168
Capno HYPERVENTILATION:
↑RR, shortened waveform; typical ETCO2 <35 mmHg
169
Methylprednisolone
INDICATIONS
* Acute bronchospasm (asthma or COPD)
| * Allergic reactions including anaphylaxis
170
Benadryl
Side Effects
SIDE EFFECTS
drowsiness sedation
hypotension tachycardia
palpitations drying of bronchial secretions
dry mouth urinary retention
171
Valium
Action
ACTION
Diazepam is a sedative-hypnotic benzodiazepine. It acts on the limbic, thalamic and
hypothalamic regions of the CNS to potentiate the effects of inhibitory
neurotransmitters. It raises the seizure threshold and produces sedation and amnesia
172
Ondansetron
Zofran
PRECAUTIONS
* liver impairment (use single doses not to exceed 8 mg)
* pregnant or lactating females
* children <3 years of age (safety not established)
173
Midazolam
Versed
pedi
DOSAGE / ADMINISTRATION
Agitated Delirium:
5-10 mg IV/IO or 10 mg MAD (5mg per nostril via mucosal atomized device)
174
Atropine
Dosage and Admin
Pedi Bradycardia
Pediatric:
• 0.02 mg/kg, minimum dose 0.1 mg, maximum dose 0.5 mg
• May repeat for a second dose
• Refer to “Weight Based Resuscitation Tape” for pediatric dosing.
175
Naloxone
Narcan
ACTION
Naloxone is a synthetic opioid antagonist. It competes at opiate receptor sites resulting
in reversal of respiratory depression, sedation and pupillary effects.
176
Etomidate
SIDE EFFECTS / ADVERSE EFFECTS
SIDE EFFECTS / ADVERSE EFFECTS
* Transient venous pain at injection site
* Transient skeletal muscle spasms/ twitching (myoclonus).
177
Ondansetron
Zofran
ACTION
Ondansetron is an anti-emetic. It blocks the effects of serotonin located in vagal nerve
terminals and the chemoreceptor trigger zone in the central nervous system.
178
Dystonic Reaction described as what?
treatment?
Acute uncontrollable muscle contractions
| • Diphenhydramine 25-50mg IV/IM
179
For regular, narrow complex tachycardias (most SVT if
rate >____), attempt vagal maneuvers, then treat with _____ if vagal maneuvers are
unsuccessful
Diltiazem ___mg/kg
max of ___mg
may be given if SBP > ____and vagels/adenosine are ineffective.
For regular, narrow complex tachycardias (most likely supraventricular tachycardia if
rate > 160), attempt vagal maneuvers, then treat with adenosine 6mg rapid IV push followed by a rapid NS flush.
second dose 12mg rapid IV push followed by a saline flush.
Diltiazem .25mg/kg
max of 20mg
may be given if SBP > 100 and vagels/adenosine are ineffective.
180
for carbon monoxide exposure, the normal range when measuring SpCO is less than what?
If greater than what %, consider CPAP
3%
25%
181
Ondansetron
Zofran
INDICATIONS
• Prevention and treatment of nausea and vomiting
182
Labetalol
DOSAGE AND ADMINISTRATION
Sinus Tachycardia in the setting of acute chest pain
• 5 mg IV over 1-2 minutes, observe for adverse response.
• If no adverse response and patient is still in sinus tachycardia, then repeat 5 mg
dosage in 5 minutes to a maximum of 20mg if tachycardia persists. Repeat and
document vital signs between doses.
• Maximum effect occurs usually within five minutes of administration.
183
Pacing
Set pacer RATE - set pacer rate at _ bpm above the patient's intrinsic rate
Set pacer RATE - set pacer rate at 20-30 bpm above the patient's intrinsic rate
184
Synchronized Cardioversion
| is indicated to treat
```
• unstable tachyarrhythmias associated with an organized QRS complex and a
perfusing rhythm (pulses).
```
• unstable SVT due to reentry,
atrial fibrillation,
and
atrial flutter.
• unstable, monomorphic ventricular tachycardia.
The unstable patient demonstrates signs of poor perfusion, including altered mental
status, ongoing chest pain, hypotension, or other signs of shock (eg, pulmonary edema)
185
in heat emergency pt thats experiencing shivers due to cooling procedures, admin this drug
Prolonged heat exposure may result in significant fluid losses which may be treated with ______ if hypovolemia symptoms are present
Lorazepam 2mg IV/IM
186
Etomidate
Alternate name
Amidate
187
Rocuronium
Zemuron
action
ACTION
Rocuronium is a non-depolarizing, neuromuscular blocker that competitively blocks
acetylcholine receptors without stimulation
188
Per syncope,
if BGL is
always perform 12-lead EKG
| after cardioversion or administration of antiarrhythmic
189
Amiodarone
Dose in Cardiac Arrest?
300 mg IV/IO push followed by 20-30ml flush.
second dose 150mg IV/IO push followed by 20-30ml flush
190
Magnesium Sulfate
ADVERSE EFFECTS
```
cardiac arrest at high serum concentrations. diaphoresis
severe bradycardia flushing
respiratory paralysis hypotension
depressed reflexes hypothermia
hypotonia prolonged PR interval
sweating widened QRS complex
```
191
For seizure patients without IV access, the preferred
treatment is ___ @ mg via mucosal atomizer device (MAD), before placement of peripheral
IV.
for less than 50kg
admin ___
for more than 50kg
admin ___ in this way?
For patients with IV access already established, the preferred treatment is _____
@ this dosen and these routes at this speed.
For patients without IV access, the preferred
treatment is midazolam via mucosal atomizer device (MAD), before placement of peripheral
IV. For patients with IV access already established, the preferred treatment is Lorazepam 2-
4mg IV/IO slow push
192
Formal rehab and medical evaluation with __ minutes of rest and hydration should occur
following any of these:
o The depletion of __ __-minute SCBA cylinders;
o The depletion of one __- or __-minute SCBA cylinder;
o Whenever encapsulating chemical protective clothing is worn; or
o Following __ minutes of intense work without an SCBA
Formal rehab and medical evaluation with 20 minutes of rest and hydration should occur
following any of these:
o The depletion of two 30-minute SCBA cylinders;
o The depletion of one 45- or 60-minute SCBA cylinder;
o Whenever encapsulating chemical protective clothing is worn; or
o Following 40 minutes of intense work without an SCBA
193
Calcium Chloride
Contraindications
CONTRAINDICATIONS
* ventricular fibrillation during arrest
* hypercalcemia
* digitalis toxicity
194
Aspirin
Contraindications
Hypersensitivity
Ulcers
Diabetice Meds
GI Bleeds
195
Rocuronium
Zemuron
DOSAGE AND ADMINISTRATION
Adult
and Peds
• 1 mg/kg IV
Peds:
Refer to Weight Based Tape
196
For seizure in pregnant patient (__ trimester or
For seizure in pregnant patient (3rd trimester or <4wks postpartum), consider eclampsia and
treat with Magnesium Sulfate 4G in 100mL D5W IV/IO over 15 minutes
o Monitor for respiratory depression when giving magnesium.
197
Labetalol
INDICATIONS
Acutely symptomatic hypertension ( >220 / >120 mmHg)
• May be used in presence of CVA symptoms
• May be used for sinus tachycardia in the setting of chest pain
• Pregnant or recently (<6 weeks) delivered hypertensive patient (>140 systolic or
>100 diastolic, or a relative increase of +30 systolic and +20 diastolic from the
patient’s normal, pre-pregnancy blood pressure) especially if acutely
symptomatic for pre-eclampsia/eclampsia
198
If patient has respiratory failure or needs intubation for airway protection, be mindful that
____, _____, and ________ are the leading causes of _____ _____ injury.
If patient has respiratory failure or needs intubation for airway protection, be mindful that
hypotension, hypoxia, and hypoventilation are the leading causes of secondary brain
injury
199
Tourniquet
at least _
cm proximal to the injury
Tourniquet time > _ hours is associated with distal tissue loss
5 CM proximal
6 HOURS
200
Fentanyl
Action
ACTION
Fentanyl is an opioid analgesic. It binds to opiate receptors in the CNS, altering the
response to and the perception of pain. It may produce CNS and/or respiratory
depression in higher doses
201
Glucose, Oral
DOSAGE AND ADMINISTRATION
Adults:
15g PO for patients with an intact gag reflex and who are able to handle their own
secretions.
Pediatrics:
5-15g PO for patients with an intact gag reflex and who are able to handle their own
secretions
202
Patients who have regained capacity after naloxone administration and who wish
to refuse treatment are allowed to sign a refusal only if the following criteria are
all 4 instances are present
Patient did not overdose on medication/drugs as part of a suicide attempt
Patient used heroin, and not other synthetic long acting opioid (such as
fentanyl, methadone, extended release morphine, etc). Please call medical
control if concern exists about the duration of effect of the medication that
was used.
Patient does not have any other medical complaints that would warrant
further medical evaluation
Patient has a family member or caregiver present who is able to call EMS
if symptoms recur
203
Midazolam
Versed
DOSAGE / ADMINISTRATION
Agitated Delirium:
• 5-10 mg IV/IO or 10 mg MAD (5mg per nostril via mucosal atomized device)
204
Succinylcholine
Anectine
ACTION
```
Succinylcholine is a short acting, motor nerve depolarizing, skeletal muscle
relaxant. It binds to cholinergic receptors in the motor neuron end plate to cause
muscle depolarization (fasciculations) followed by paralysis
```
205
Epinepherine
DOSAGE AND ADMINISTRATION
Severe respiratory distress/bronchospasm secondary to asthma/COPD:
Severe respiratory distress/bronchospasm secondary to asthma/COPD:
Adult:
• 0.3mg of 1:1000 via intramuscular injection
o Discuss with online medical control prior to use if >55 years old or known
use of beta blockers
Pediatric:
• Per weight-based tape, inject the 1:1,000 epinephrine intramuscularly
206
If OB seizure activity is present, administer ____ at this dose___ IV in ___mL D5W over
___ minutes
o Monitor for signs of magnesium toxicity: hyporeflexia, respiratory depression,
hypotension
If seizure activity is present, administer Magnesium Sulfate 4G IV in 100mL D5W over
15 minutes
o Monitor for signs of magnesium toxicity: hyporeflexia, respiratory depression,
hypotension
207
Air transport should be considered if any of the following criteria apply:
• high priority patient with > __ minute transport time
Air transport should be considered if any of the following criteria apply:
• high priority patient with > 20 minute transport time
208
FAST-ED score
```
Facial Palsy
Arm Drift
Speech
Eye Deviation
Denial
```
209
Approximately __% of the following life-threatening conditions present with
syncope: subarachnoid hemorrhage, acute coronary syndrome, aortic dissection,
leaking aortic aneurysm, and ruptured ectopic pregnancy
15
210
Ondansetron
Zofran
DOSAGE AND ADMINISTRATION
Adult:
* 4 mg IV or IM
* Administer over at least 30 seconds, preferably over 2-5 minutes
* Peak effects: (IV) in 15 – 30 minutes, duration of 4 hours
211
Valium
Side Effects
SIDE EFFECTS
* Hypotension
* Respiratory depression
* Ataxia
* Confusion
* Nausea
* CNS depression
212
The failure to use a medication, in a situation where it has been shown to be of proven
benefit to the patient
Underuse
213
Etomidate
CONTRAINDICATIONS
CONTRAINDICATIONS
* hypersensitivity
* pregnancy or lactation
* patients under 3 months of age
214
Epinephrine
Indications
INDICATIONS
* cardiac arrest
* acute bronchospasm from asthma or COPD
* anaphylaxis
215
Tricyclic Antidepressant
symptoms
overdose
treatment
may be repeated in ___ minutes
hypotension, arrhythmias, wide QRS complex (>0.09sec)
Sodium Bicarbonate
50meq IV
10 minutes
216
Etomidate
INDICATIONS
INDICATIONS
* induction prior to use of neuromuscular blocking agents and/or analgesics
* supplement to use of neuromuscular blocking agents and/or analgesics
217
Nitroglycerin
CONTRAINDICATIONS
and Precautions
• Hypotension
• Head injury or other concern for intracranial hemorrhage
• Use of a phosphodiesterease-5 inhibitor (such as sildenafil/Viagra or
vardenafil/Levitra) in the past 24 hours, or past 48 hours if tadalafil/Cialis
• acute coronary syndrome/myocardial infarction if there are abnormalities of lead
V4R, or other signs of right ventricular infarct
PRECAUTIONS
• patients with glaucoma as it may increase intraocular pressure
218
Ketamine
CONTRAINDICATIONS
```
Known hypersensitivity
• Patients in whom a significant elevation of blood pressure would constitute a
serious hazard.
• Hemorrhagic stroke
• B/P > 240 / 120
• Children less than 3 months of age
```
219
Haloperidol
Haldol
DOSAGE AND ADMINISTRATION
5 mg IV/IM, may repeat x1 in 10 minutes
220
If BGL is higher than 200, treat how?
500cc bolus
221
Haloperidol
Haldol
Side effects
```
tachycardia hypotension
hypertension ventricular arrhythmias
nausea / vomiting dry mouth
blurred vision diaphoresis
laryngo / bronchospasm
```
222
When a medication, not immediately necessary for a particular situation, is utilized
anyway or when a medication is used to treat the side effect of another medication
without withdrawing that medication
Overuse
223
Synchronized Cardioversion
Joules
Atrial fibrillation
Biphasic dose :
| 100J
224
Labetalol
SIDE / ADVERSE EFFECTS
postural hypotension
• diaphoresis
• vertigo, nausea and vomiting
225
Nitroglycerin
DOSAGE AND ADMINISTRATION
* 0.4 mg tablet, sublingually or one metered dose spray of 0.4 mg, sublingually
* May be repeated every 3 – 5 minutes up to 3 times
226
Treatment for high or low voltage injuries
1000ml bolus
12 - lead
monitor for cardiac issues
227
original DNR order (or high-quality photocopy) must be signed by _____and _____
o DNR orders or copies MUST be on _____ to be considered valid
original DNR order (or high-quality photocopy) signed
by the patient (or surrogate) and his/her physician
o DNR orders or copies MUST be on yellow paper to be considered valid
228
Aspirin
Indications
Myocardial Infarction
Unstable Angina
Chest Pain
229
Succinylcholine
Anectine
CONTRAINDICATIONS
• Known hypersensitivity to the drug.
• Penetrating eye injuries, history of glaucoma and malignant hyperthermia
(consider using Rocuronium.)
230
Naloxone
Narcan
SIDE EFFECTS
* tachycardia
* hypertension
* hypotension
* nausea and vomiting
231
when random services are rendered, If HR >___, or there are signs of hypertension or respiratory compromise, recommend
transport for evaluation. Obtain a signed refusal if patient declines transport.
110
232
Ketamine
ACTION
rapid acting general anesthetic
profound analgesia, normal pharyngeal-laryngeal reflexes, normal or
slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and
occasionally a transient and minimal respiratory depression.
233
Amiodarone
Side effects
Bradycardia
Nausea
AV block
Vasodilation/Hypotension
234
Pleural decompression for tension pneumothorax should only be performed
when all three of these criteria are present
where should it be done?
Severe respiratory distress with hypoxia
(O2 sat < 90%)
Unilateral decreased or absent lung sounds (may see tracheal deviation away
from collapsed lung field)
Evidence of hemodynamic compromise (shock, hypotension, tachycardia,
altered mental status)
2nd |CS midclavicular
235
S.T.A.R.T. Triage Algorithm
Green
Yellow
Red
Black
Green Tag
Able to walk
Minor injuries
Yellow
Victim transport can be delayed
Serious to potentially life threatening injuries but not expected to deteriorate over several hours.
Red
Victim can be helped by immediate intervention and transport
Req medical attention within minutes for survival (up to 60)
compromised ABC
Black
Unlikely to survive
palliative care and pain relief
Algorythm
If Jaw thrust is needed to get Resp
If PR >30
If radial pulse absent ot cap refill >2 seconds
If doesnt obey commands
all go to REd
236
Labetalol
DOSAGE AND ADMINISTRATION
Pre-eclampsia/eclampsia
10 mg IV over 1-2 minutes
• May be repeated in 10 minutes, if no significant change in blood pressure
• The goal is to lower blood pressure to SBP <130 and DBP <100
237
Sodium Bicarbonate
INDICATIONS
• Overdose of tricyclic antidepressant, aspirin, cocaine, or diphenhydramine.
• Prolonged resuscitation with effective ventilation; on return of spontaneous
circulation after long arrest interval.
• Severe acidosis, either diagnosed or suspected (as in PEA arrest)
• Hyperkalemia, either diagnosed or suspected (as in PEA arrest)
• Pre-treatment prior to the release of a trapped extremity with a serious crush
injury
238
Pediatric Tachycardia w/Pulse
And Poor Perfusion
synchronized
cardioversion.
o Begin with ___J/kg; if not effective, increase to __J/kg.
o May administer _____mg/kg (max of ____mg) prior to cardioversion if time
allows.
Begin with 0.5-1J/kg; if not effective, increase to 2J/kg.
o May administer Midazolam 0.1mg/kg (max of 1-2mg) prior to cardioversion if time
allows.
239
Pacing
Conscious patients requiring pacing may be given __ (drug) @ __ mg / kg, IV push.
Titrate to patient comfort, up to a maximum dose of _ mg or a systolic blood
pressure of > _ mm/Hg
Set amperage approximately _ milliamps above capture point
When mechanical capture is obtained:
• Adjust the heart rate to maintain a systolic BP > __ mm/Hg.
• Do not exceed a paced rate of __ bpm
Conscious patients requiring pacing may be given Ativan 0.05 mg / kg, IV push.
Titrate to patient comfort, up to a maximum dose of 4 mg or a systolic blood
pressure of > 100 mm/Hg.
Set amperage approximately 5 milliamps above capture point
When mechanical capture is obtained:
• Adjust the heart rate to maintain a systolic BP > 100 mm/Hg.
• Do not exceed a paced rate of 90 bpm
240
This occurs when a medication is used inappropriately; i.e. incorrect dose or route,
medication contraindicated
Misuse
241
Any preventable event that may cause or lead to inappropriate medication use, or
patient harm, while the medication is in the control of the health care provider or patient
Medication error
242
For bradycardia, which drugs can we use?
Atropine .5 IV
can repeat every 3-5 minutes up to a max of 3mg
second line therapy,
Pacing
Dopamine 2-10mcg/kg/min
or Epi 2-10 mcg/min IV
243
Etomidate
DOSAGE AND ADMINISTRATION
Adult/Pediatrics Dose:
• 0.3 mg/kg IV
• Administered IV, the onset of action is usually within 1 minute with duration of
action of 5 minutes
• Patient is usually fully awake within 7-14 minutes
244
Rule of Nines
Adult
```
Head and Neck 9%
Trunk
Anterior 18%
Posterior 18%
Arms (Each) 9%
Legs (Each) 18%
Genitals 1%
```
245
Nitroglycerin
ACTION
Nitroglycerin is a peripheral vasodilator which reduces preload and to a lesser extent,
after-load, thus decreasing myocardial oxygen demand.
246
Midazolam
Versed
INDICATIONS
* Sedative effects for agitation or following intubation
| * Treatment of seizure
247
```
BACK PAIN (NON-TRAUMATIC)
ALS:
• Fainting, age __ (rule out aortic aneurism)
• Not alert
• Abnormal VS
```
```
BACK PAIN (NON-TRAUMATIC)
ALS:
• Fainting, age ≥50 (rule out aortic aneurism)
• Not alert
• Abnormal VS
```
248
Place clamps on umbilical cord ___-___ inches from abdomen, __ inch(es) apart, and cut cord between clamps
Place clamps on umbilical cord 10-12 inches from abdomen, one inch apart, and
cut cord between clamps
249
Calcium Chloride
Side effects
SIDE EFFECTS
bradycardia hypotension
peripheral vasodilation tissue sloughing (following accidental IM
administration or secondary to extravasation of
medication)
250
Atropine
Dosage and Admin
Notes and
Warnings
Note:
• Atropine may be given via E.T. tube, by adding 2 - 2.5 times the IV dose, mixed
with 5 to 10 mL of sterile water or saline, and injected directly into the ETT.
• Use caution in patients with MI history or myocardial ischemia due to increased
myocardial oxygen consumption
251
Valium
Indications
INDICATIONS
* Seizure control
* Acute anxiety
* Muscle relaxant
* Pre-medication prior to cardioversion
252
Etomidate
Action
ACTION
Etomidate is a hypnotic drug without analgesic or muscle relaxing properties. It usually
causes myoclonus on injection; for this reason, it is usually given concomitantly with
neuromuscular blocking agents and analgesics
253
Torsades de pointes, or polymorphic VT, should be treated with _________ @______ (in ___mL D5W), slow infusion over ____ minutes
```
Torsades de pointes, or polymorphic VT, should be treated with Magnesium
Sulfate 2G (in 100mL D5W), slow infusion over 15 minutes
```
254
If chance of reimplantation, ____________________.
Place on ice if available (do not freeze).
Transport to _______Hospital
If chance of reimplantation, wrap amputated part in sterile dressing soaked in NS.
Place on ice if available (do not freeze).
Transport to Tampa General Hospital
255
Atropine
Dosage and Admin
Adult Organophosphate OD/Toxic Ingestion
Adults:
| • 2 mg every 5 minutes until symptoms controlled, no maximum dose
256
Epinepherine
DOSAGE AND ADMINISTRATION
Bradycardia with a pulse
Bradycardia with a pulse
Adult
• Epinephrine 2-10 mcg/min IV is one option (alternatives are transcutaneous
pacing and Dopamine)
Pediatric (if refractory to chest compressions/oxygenation)
• Epinephrine (1:10,000) 0.01 mg/kg IV or IO every 3-5 minutes
257
Aspirin
Action
Interferes with platelet aggregation and is known as an anti-platelet medication
258
Dopamine
Indications
INDICATIONS
• Hypotension with signs and symptoms of shock, which do not respond to volume
replacement
• Second line drug for symptomatic bradycardia
259
Valium
DOSAGE AND ADMINISTRATION
DOSAGE AND ADMINISTRATION
Adult:
• 5 mg IV/IO or MAD. May repeat as needed after 5 minutes, up to max dose of
10mg
Pediatric:
• 0.2 mg/kg IV/IO or MAD (maximum 5 mg dose), may repeat as needed after 5
minutes to a maximum of 10mg
260
Release of the trapped extremity can lead to arrhythmias from _____ and ______
Release of the trapped extremity can lead to arrhythmias from hyperkalemia and acidosis
261
Fentanyl
Side Effects
SIDE EFFECTS
```
apnea laryngospasm
respiratory depression arrhythmia
bradycardia circulatory depression
hypotension nausea and vomiting
skeletal and thoracic muscle rigidity
```
262
Midazolam
Versed
USE CAUTIOUSLY IN
* pulmonary disease
* CHF
* renal impairment
* severe hepatic impairment
* geriatric or debilitated patients
263
Magnesium Sulfate
DOSAGE AND ADMINISTRATION
Respiratory Distress
Eclampsia
Respiratory Distress
• 2gm mixed in a 100ml bag of D5W given over 10-20min
Eclampsia
• 4gm mixed in a 100ml bag of D5W given over 15min
264
Moderate smoke inhalation exposure may be recognized by the presence of soot in the
___/____/____, along with the presence of _____ and/or _____.
Treat such with
Moderate exposure may be recognized by the presence of soot in the
nose/mouth/oropharynx, along with the presence of altered mental status and/or hypotension.
IV established
Admin 500 bag
admin cyanokit 5G IV
265
Rocuronium
Zemuron
SIDE EFFECTS
Transient hypertension or hypertension
266
Naloxone
Narcan
INDICATIONS
* acute CNS depression
| * decreased level of consciousness from opiate overdose or unknown etiology
267
Atropine
Indications
INDICATIONS
• symptomatic bradycardia
• organophosphate poisoning
268
If mother is in ___ trimester, place in lateral recumbent position.
• If gestational age known to be < 20 weeks, transport to ______
• If gestational age known to be >20 weeks, transport to _____.
If mother is in 3rd trimester, place in lateral recumbent position.
• If gestational age known to be < 20 weeks, transport to closest hospital.
• If gestational age known to be >20 weeks, transport to closest OB receiving facility.
269
Rocuronium
Zemuron
CONTRAINDICATION
PRECAUTIONS
CONTRAINDICATIONS
Known hypersensitivity to the drug or to bromides.
PRECAUTIONS
Use caution in patients with liver disease – duration of action in these patients is about
1.5 times longer
270
Valium
| alternate names
Diazepam
and
Diastat
271
Amiodarone
Contraindications
Cardiogenic shock
sinus bradycardia
high degree AV block
272
Adequate Capno Reading during CPR
| andthe waveform shape one would see\?
“Square box” waveform baseline CO2 = 0; ETCO2= 10-15 mmHg (possibly higher) with
adequate CPR
273
Cardizem
Indications
INDICATIONS
* management of supraventricular tachycardia
* rapid ventricular rates in atrial flutter or fibrillation
274
Treatment of Sepsis
When possible, notify the receiving ED of incoming Sepsis Alert prior to arrival
• IV en route
Administer 250mL boluses until SBP > 90mmHg
do not exceed 2000mL
o Boluses may be given in rapid succession if SBP remains < 90mmHg
• If systolic BP remains < 90mmHg after 4th fluid bolus (1000mL):
o Dopamine infusion at 5-20mcg /kg/min titrated to maintain systolic BP >
90mmHg
275
for seizures, Benzodiazepine dose may be repeated every __ minutes x __ (maximum __mg lorazepam, maximum diazepam __mg).
Do not repeat ___?.
every 5 minutes
8mg max lorazepam
10mg max diazepam
dont repeat MAD dose for midazolam
276
Treatment for hypervalemia during CA
Sodium Bicarb
1meq/kg
Calcium Chloride 1G
