EMS chemical control Flashcards
How shall restrained pt’s be positioned?
Supine, semi-fowlers, or lateral position.
Pt shall be restrained when?
only if its necessary to protect the pt or personnel from harm.
What is the dose for ketamine in excited delirium?
4mg/kg IV or IM to a max of 400mg
What types of adverse reactions are possible with ketamine?
hypersalivation and laryngospasm
How is hypersalivation treated with regards to ketamine?
Atropine 0.5mg IV IM IO.
How is laryngospasms treated with regards to Ketamine?
Hi Flow 02
BVM
RSI
After administration of ketamine what are the next treatments?
Upon arrival to ED Versed 2.5mg IV or IO
5.0mg IN
obtain IV access if not already done
Obtain temperature.
What is the treatment for temperatures greater than 103F with excited delirium? Adults
ice packs to groin and axilla
saline 30mg/kg wide open max of 2L
Sodium Bicarb 50meq IV IO
What is the treatment for cardiac arrest with regards to excited delirium?
treat as SECONDARY Arrest
sodium bicarb 100meq IV IO
saline 30mg/kg max 2L
ACLS protocols
What is the treatment for pediatrics, cardiac arrest in excited delirium?
There is none.
What is the treatment for Violent/ combative pt’s?
The same as Excited delirium. If there is no chance of Ketamine being administered during pt care then:
Versed 2.5mg IV IO
5.0mg IN IM
What are the contraindications with regards to fentanyl and pain mgt?
pregnant females greater than 32 weeks
To reverse fentanyl reactions what is the treament?
0.5mg narcan IV, IO, IM
or
2mg narcan IN
What are the side effects from fentanyl?
chest wall rigidity
respiratory depression
what is the dose of fentanyl in an adult for pain mgt?
50mcg IV, IM, IO max dose is 150mcg IV IO IM
or
100mcg IN max dose 200mcg IN
what is the pediatric dose of fentanyl in pain mgt?
1 mcg/kg IV, IM, IO max of 50mcg
or
1.5mcg/kg IN max of 150mcg
What is the contraindication with fentanyl and pain mgt for the pediatric pt?
Must be greater than 6mo.
What is the treatment to reverse fentanyl in pediatrics for pain mgt?
Narcan 0.5mg IV, IO, IM
or
1.0mg IN
What is the dose for zofran in pediatrics with regards to pain mgt?
0.1mg/kg IM ONLY
Who is responsible for ensuring an airway is obtained after paralytics are adminsitered?
District captain.
IF there are multiple pts who should the district captain accompany?
the most critical.
What are the indications for paralytics?
- Status epilepticus
- multi system trauma
- head injuries with GCS < 8
- trismus, lock jaw or clenched teeth
- burn injuries to the upper airway
- District captain disrection
What are the contraindications for Succinylcholine?
Predicted difficult intubation- obesity, short neck, small mouth
thyromental distance of < 3 finger widths
Major facial or laryngeal trauma
Pt that cannot be BVM’d
Penetrating Eye injuries or glaucoma
organophosphate poisoning
renal failure- dialysis / hyperkalemia
hypersensitivity or malignant hyperthermia
pre-existing nu-euromuscular ds.
chronic paralysis
in the advanced airway protocol what type and when should 02 be applied?
NC 15L/min after giving sedation or pre-sedation for paralytics
What is the dose of ketamine in the advanced airway protocol for severe asthma?
2mg/kg IV IO IM may repeat 1x max 400mg
What is the does of etomidate for adults and children in advanced airway?
20mg IV IO over 30-60sec. May repeat 1x.
0.3mg/kg IV IO max single dose 20mg may repeat 1x.
What is the dose for Succinylcholine in adult and children?
adults 100mg IV IO
pedi < 2: 2mg/kg IV IO max 100mg
pedi >3: 1mg/kg IV IO max 100mg
Once inutbated what are the doses of norcuron for adults and pedi?
adult: 0.1mg/kg max dose 10mg
pedi: 0.1mg/kg max dose 10mg
Once intubated and if the pt is HYPOtensive what can be given and how much?
ketamine
adult : 2mg/kg IV IO IM max dose is 400mg
pedi: 1mg/kg IV IO IM max dose is 400mg
The provisions for the advanced airway protocol for pediatrics applies to which age and is affected by what medications?
greater than 3mo and applies to Etomidate, ketamine, norcuron.
