ema protocols Flashcards
Indications for initiating a N/S IV?
to replace fluids for hypovolemia(bleeding, diarrhea, vomiting) ((burns))
Administer Medication
suspected shock or TBI
DO NOT DELAY TRANSPORT OF UNSTABLE PATIENT TO START AN IV
Indications for hypovolemia protocol?
evidence of significant fluid loss (bleeding, diarrhea, vomit)
Systolic BP <90mmHg
anticipated shock or signs of shock
2nd and 3rd degree burns >20% TBSA
maintain rate for N/S?
75ml/hr X 10gtts/min / 60mins/hr = 12.5 gtts/min
what should be completed before initiating an IV of N/S?
Complete primary
load and transport
SAMPLE history
obtain baseline vitals
auscultate the lungs (looking for crackles=edema)
verify indications and contraindications
Six rights (check fluid -expiry, dose..etc)
Contraindications for N/S?
None
Rate for N/S with a SBP > 90?
75ml/hr = approx 1 drop every 5 sec
bolus amount for N/S?
500ml with a BP <90
cautions for hypovolemic protcol
shortness of breath
Max dose of N/S
2000ml Must auscultate and do vitals between each 500ml bolus
nausea and vomiting protocol indications
pt. experiencing N/V or vertigo
Contraindications for Dimenhydrinate
Known hypersensitivity or allergy to Gravol (dimenhyrinate)
Dimenhydrinate Cautions
Glaucoma (increased intraocular pressure)
Asthma/COPD
cardiovascular disease (htn, ischemic heart disease)
Prostatic hyperplasia/urinary obstruction
Elderly (frail)
Pregnancy
Dimenhydrinate Doses
1mg/kg to a max of 50mg
phone if patient is <25kg
12.5 mg in the frail and elderly
Routes of administration for dimenhydrinate?
IM 50mg/ml
IV slow push over 2 mins, 50mg/ml + 9ml N/S
TXA indications
Trauma suggesting occult bleeding >16 y/o SBP <90mmHG Heart rate>110 within 3hrs from time of injury and on route to hospital
TXA contraindications
Known hypersensitivity to TXA
Doesn’t meet indications, ie, time is greater then 3 hrs after injury, Patient is under 16
tranexamic acid TXA dose
1g/10ml TXA infused in 50ml N/S (piggy back) 60gtts/min = 1 gtts/sec
OR slow IV push 1g/10ml TXA over 10mins
txa Cautions
hypotension if administered to quickly
indications for Salbutamol
SOB with a Hx of asthma or COPD
Broncospasms and wheezing
contraindications for Salbutamol
hemodynamically significant tachyarrhythmias
allergy to salbutamol
Neb dose for salbutamol
> 15kg 5mg/5ml
<15kg 2.5ml/2.5mg
Ventolin Drug class
Sympathomimetic
bronchodilator
What is meant by a staged approach to SOB protocol
start with o2 in primary
include chest exam and auscultation after RBS
transport
obtain Hx and vitals
If patient meets criteria for treatment admin. Salbutamol
if not explore other causes and SOB consider CPAP?
CPAP Indications
>13 y/o in respiratory distress maintain a patent airway Exhibits ALL the following: RR>24 SpO2 <94% on O2 Acessory Muscle use
CPAP Contraindications
Low LOC'S RA Vomiting unable to fit the mask <12y/o Traumatic cause of SOB Pneumothorax and SBP <90mmHg
Glucagon Indications
Hypoglycemia when IV access attempts have been unsuccessful
Glucagon Dose
0.5-1mg IM (0.5mg <20kg)
D10W maintaince rate
100ml/hr 16 gtts/min (1gtts/3sec)
D10W indications
Diabetic Pt. with decreased LOC’s and Bgl <4mmol
how many bolus’s of D10W can we administer without medical directions
2 bolus’s of 100ml, access vitals for improvement inbetween bolus’s
ASA indications
Chest Pain or atypical symptoms assoiciated with cardiac ischemia/AMI
ASA contraindications
Allergy to ASA
Asthma
Cautions for ASA
Recent internal bleeding (GI, peptic ulcers) known bleeding diseases anticoagulants recent surgery pregnancy
EPI Dose
0.01mg/kg max dose 0.5mg
Diphenhydramine DOSE
Pt >12 y/o 25-50mg
Pt 6-11 y/o 25mg
pt 2-5 y/o 12.5mg
NOT for neonates
At what point in a call do you give EPI?
you must complete:
your primary survey and sencondary Hx by then you should have info to warrant Anaphalxis protocol.
Get a baseline set of vitals, go over 6 rights and contraindications.
give epi, give diphenhydramine
TRANSPORT
