Emt Flashcards
ACETAMINOPHEN (TYLENOL®)
SCOPE OF PRACTICE
EMT-Basic, EMT-Intermediate and EMT-Paramedic
CLASS OF DRUG
Analgesic, Antipyretic
PHARMACOLOGIC ACTION
May work peripherally to block pain impulse generation; may also inhibit prostaglandin synthesis in CNS.
INDICATIONS
1. Fever in pediatric patients
2. Pain management
CONTRAINDICATIONS
1. Hypersensitivity to the drug
2. Hepatic failure or impairment
DRUG INTERACTION
1. Phenothiazines - may produce hypothermia
2. Phenobarbital - increase hepatic toxicity
ADMINISTRATION
1. Pediatric: [10-15 mg/kg] orally
2. Not to exceed 50 mg/kg/24 hours
SPECIAL NOTES
1. There are multiple over-the-counter medications, as well as scheduled drugs, that include acetaminophen as an active ingredient.
ACETYLSALICYLIC ACID (ASA, ASPIRIN)
SCOPE OF PRACTICE
First Responder, EMT-Basic, EMT-Intermediate and EMT-Paramedic
CLASS OF DRUG
Antipatelet agent, non-steroidal anti-inflammatory drug (NSID) PHARMACOLOGIC ACTION
Inhibits synthesis of prostaglandin by cyclooxygenase; inhibits platelet aggregation; has antipyretic and analgesic activity.
INDICATIONS
1. For adults with suspected cardiac chest pain, including possible AMI patients.
CONTRAINDICATIONS
1. Hypersensitivity to aspirin or NSAIDS
2. Bleeding disorders
3. Aspirin-intolerant Asthma
ADMINISTRATION
1. Adult: [324 mg] orally for AMI (prefer chewable)
2. Pediatric: Should not be given to pediatric patients. Anything under the age of 6
3. 4 pills equal (324) 1 pill= 81
SPECIAL NOTES
1. All patients with suspected AMI and without contraindications should receive aspirin.
2. Multiple over-the-counter medications, as well as scheduled drugs, include aspirin as an active ingredient
ACTIVATED CHARCOAL (ACTIDOSE-AQUA®)
SCOPE OF PRACTICE
EMT-Basic, EMT-Intermediate and EMT-Paramedic
CLASS OF DRUG
Antidotes, other
PHARMACOLOGIC ACTION
Adsorbs a variety of drugs and chemicals (e.g. physical binding of a molecule to the surface of charcoal particles) desorption of bound particles may occur unless the ration of charcoal to toxin is extremely high.
INDICATIONS
Activated charcoal is used in the treatment of certain cases of poisoning and over-doses in the alert patient. Most commonly given in the hospital after gastric lavage, but it is appropriate to give in the pre-hospital setting before lavage if a long transport time is anticipated.
CONTRAINDICATIONS
1. Acids or alkali ingestion unless other drugs have ingested.
2. Gl obstruction
3. Unprotected airway (beware of aspiration)
DRUG INTERACTION
1. Contact MCEP before giving in acetaminophen OD’s. Charcoal interferes with the function of N-Acetylcysteine, an antidote for acetaminophen.
2. Milk products-decreases effectiveness.
ADMINISTRATION
1. Adult: [1 gm/kg] PO.
2. Pediatric: Same as adult
SPECIAL NOTES
1. The patient must be capable of protecting their airway over time.
ALBUTEROL (PROVENTIL®, VENTOLIN®, PROAIR®, ACCUNEB®)
SCOPE OF PRACTICE
First Responder, EMT-Basic, EMT-Intermediate and EMT-Paramedic
CLASS OF DRUG
Beta 2 agonist
PHARMACOLOGIC ACTION
Beta 2 receptor agonist with some beta-1 activity; relaxes bronchial smooth muscle with little effect on heart rate.
INDICATIONS
1. Albuterol is used to treat reversible airway obstruction caused by:
.Wheezing associated with asthma ii. COPD (emphysema) iii. Chronic bronchitis
CONTRAINDICATIONS
1. Hypersensitivity
2. Tachycardia secondary to heart condition.
DRUG INTERACTION
1. Beta adrenergic agents - potentiates the effects
2. MAO inhibitors - may lead to hypertensive crisis
3. Beta adrenergic blockers - decreases the effectiveness
Administration
1. Adult: [2.5-5.0 mgl (up to 10 mg) in 3 ml of sterile NS given as nebulized inhalation therapy over 5-15 minutes, may be repeated as necessary.
2. Pediatric: [1.25-2.5 mg] (up to 5 mg) in 3 ml of sterile NS given as nebulized inhalation therapy over 5-15 minutes, may be repeated as necessary.
SPECIAL NOTES
1. Most side effects are dosage related.
2. May decrease arterial oxygen tension acutely by causing bronchodilation in areas of lung with poor blood perfusion
3. Care should be taken if patient is already using an inhalant due to possible development of severe paradoxical airway resistance with repeated excessive use.
ATROPINE SULFATE
SCOPE OF PRACTICE
First Responder, ‘EMT-Basic, ‘EMT-Intermediate and EMT-Paramedic
CLASS OF DRUG
Anticholinergio, toxicity antidote
PHARMACOLOGIC ACTION
Competitively inhibits action of acetylcholinesterase on autonomic effectors innervated by postganglionic nerves.
INDICATIONS
1. Symptomatic sinus bradycardia or A-V Blocks
2. Anticholinesterase poisonings - organophosphate, mushrooms (certain types), and nerve gases
3. Adjunct in the treatment of bronchial asthma
CONTRAINDICATIONS
1. No absolute contraindications for ACLS, documented hypersensitivity in non-ACLS/nerve agent/organophosphate scenarios
DRUG INTERACTION
Antihistamines, tricyclic antidepressants - additive affect
ADMINISTRATION
1. Cardiac Indications:
i. Adult:[0.5mg] IV/IO, every 3-5 minutes: Max dose 3 mg. (0.04 mg/kg) for bradycardia.
ii. Pediatric:0.02 mg/kg] |V/10 for 1 dose. Minimum of 0.1 mg and maximum of 0.5 mg.
[0.03 mg/kg] ET.
2. Anticholinesterase poisoning:
i. Adult: [2.0 mg] IV, ET, or IO repeated until symptoms abate ii. Pediatric:[0.05 mg/kg] IV, ET, or 10, repeated until symptoms abate
3. Mushroom Poisoning:
i. Adult: [2 mg] IV, repeated to doses sufficient enough to control parasympathomimetic signs
SPECIAL NOTES
1. Available evidence suggests that the routine use of Atropine during asystole is unlikely to have a therapeutic benefit. Atropine is no longer recommended for use in asystole or PEA.
2. May be not be effective with high degree A-V block (2nd degree type II, 3rd degree) - do not delay pacing.
3. Bradycardia in the setting of an acute MI is common and probably beneficial. Don’t treat the rate unless there are signs of poor perfusion (i.e. low blood pressure, mental confusion).
Chest pain could be due to an AMI or to poor perfusion caused by the bradycardia itself.
4. Atropine increases the workload and myocardial 02 consumption of heart. Beware of patients who have an ischemic myocardium. Administer supplemental oxygen.
5. Ineffective in hypothermic bradycardia
6. ‘IM injection for treatment of chemical and/or nerve agent exposure, via auto injector only
DEXTROSE ( oral glucose) (ORAL/V/I0 - 10%, 25% AND 50%)
SCOPE OF PRACTICE
‘First Responder, ‘EMT-Basic, EMT-Intermediate and EMT-Paramedic
^ Oral Glucose Preparations only
CLASS OF DRUG
Glucose-elevating agents; and a metabolic and endocrine, other
PHARMACOLOGIC ACTION
Parenteral dextrose is oxidized to carbon dioxide and water, and provides 3.4 kilocalories/gram of d-glucose
INDICATIONS
1. Symptomatic hypoglycemia
2. Unconsciousness with suspected hypoglycemia
3. Seizures (associated with decreased BGL) of:
i. Unknown etiology ii. New onset of seizures ili. Known diabetic actively seizing
CONTRAINDICATIONS
1. Hyperglycemia
2. Diabetic coma
3. Intra-cranial or intraspinal hemorrhage
4. Anuria
5. Dehydrated patients with delirium tremens
6. Unconscious (for oral dextrose)
DRUG INTERACTION
1. None
ADMINISTRATION
1. Oral:[12-25 gm] of paste, may be spread with a tongue depressor
2. IV:
Adult: [12.5 to 25 gm] slow IV/IO push into patent line, if patient is unable to protect
airway or tolerate oral fluids. May be repeated as needed. Be prepared to restrain.
May be given rectally (paramedic only)
ii. Pediatric: Dilute 1:1 with sterile saline to make 25% solution (0.25 mg/ml) Give [0.5
1.0 g/kg] slow IV push. May be given rectally (paramedic only)
iii. Neonates: Use a 10% Dextrose solution (dilute 50ml D50 in 500ml bag of D5W) at
[0.2 gm/kg]
SPECIAL NOTES
1. Attempts at documenting hypoglycemia via automatic glucometry should be made before administration
2. Must insure patent IV line, and recheck patency during administration
3. Do not administer through the same infusion set as blood.
EPINEPHRINE
SCOPE OF PRACTICE
¹First Responder, ¹EMT-Basic, EMT-Intermediate and EMT-Paramedic
¹1:1000, no single dose greater than 0.3 ml, subcutaneous or intramuscular injection with a
pre-measured syringe (including autoinjector) or 0.3 ml TB syringe for anaphylaxis or
status asthmaticus refractory to other treatments.
CLASS OF DRUG
Sympathomimetic, Alpha/beta adrenergic agonist
PHARMACOLOGIC ACTION
Strong alpha-adrenergic effects, which cause an increase in cardiac output and heart rate, a
decrease in renal perfusion and peripheral vascular resistance, and a variable effect on BP,
resulting in systemic vasoconstriction and increased vascular permeability. Strong beta-1- and
moderate beta-2-adrenergic effects, resulting in bronchial smooth muscle relaxation
Secondary relaxation effect on smooth muscle of stomach, intestine, uterus, and urinary bladder
INDICATIONS
1. Severe Bronchospasm
2. In the nebulized form for croup/bronchiolitis and IM form for refractory acute asthma
3. Anaphylaxis
4. Cardiac Arrest
5. Symptomatic bradycardia refractory to other treatments
6. Shock
CONTRAINDICATIONS
1. Hypersensitivity
2. Cardiac dilatation
3. Coronary insufficiency
DRUG INTERACTION
1. Reduced effects with Beta-adrenergic blocker
Epinephrine part 2
EPINEPHRINE (cont.)
ADMINISTRATION
1. Cardiac Arrest
i. Adult: 1 mg every 3 - 5 minutes IV/IO preferred, may be given ET (2 - 2
1/2 times IV dose)
ii. Pediatric: IV/IO 0.01 mg/kg (1:10,000) every 3-5 minutes. ET 0.1 mg/kg (1:1000)
2. Bradycardia
i. Adult: [1 mg/ 1:1,000] in 250 cc NS or D5W administered at 2 - 10 mcg/min
ii. Pediatric: [0.01 mg/kg] IV/IO every 3-5 minutes or; [0.1-0.2 mcg/kg/minute] (0.6 x
body weight (kg) equals milligrams to add to D5W to create a total volume of 100 m).
Infuse at 1mL/h
3. Bronchospasm/Anaphylaxis
i. Adult: [0.3 mg] (1:1,000) IM using a 0.3 ml syringe or pre-filled device.
ii. Adult: [0.1 mg] (1:10,000) IV/IO over 5 minutes. Infusion of [1-4 mcg/min]
(Paramedic only).
iii. Pediatric: [0.01 mg/kg (1:1000)], IM to a maximum dose of 0.3 mg/dose
4. Croup
i. Pediatric: Epi 1:1000 5ml (equivalent to 0.5ml 2.25% racemic epi) nebulized.
SPECIAL NOTES
1. When used for allergic reactions, increased cardiac workload can precipitate angina and/or
AMI in susceptible individuals.
2. Due to peripheral vasoconstriction, it should be used with caution on patients with peripheral
vascular insufficiency.
3. Consider pulmonary edema or pulmonary embolus in wheezing patients with a history of
RAD.
4. EMT-Intermediates and Paramedics are not required to use a pre-filled device or 0.3 cc
syringes.
IPRATROPRIUM (ATROVENT®)
SCOPE OF PRACTICE
EMT-Basic, EMT-Intermediate and EMT-Paramedic
CLASS OF DRUG
Anticholinergic, respiratory
PHARMACOLOGIC ACTION
Anticholinergic (parasympatholytic) agent; inhibits vagally mediated reflexes by antagonizing acetylcholine action; prevents increase in intracellular calcium concentration that is caused by interaction of acetylcholine with muscarinic receptors on bronchial smooth muscle.
INDICATIONS
1. Bronchial asthma
2. Reversible bronchospasm associated with chronic bronchitis and emphysema.
CONTRAINDICATIONS
1. Hypersensitivity to the drug, especially with Atropine products, soy and peanuts
DRUG INTERACTION
1. Oxivent and Spiriva
ADMINISTRATION
1. Should be administered in conjunction with beta agonist therapy.
i. Adult:[1 - 2 inhalations] via metered dose inhaler
1250-500mcg via nebulization ii. Not recommended for pediatrics
SPECIAL NOTES
1. The vital signs must be monitored during therapy.
2. Caution should be used when administering it to elderly patients and those with cardiovascular disease or hypertension.
LEVALBUTEROL (XOPENEX®)
SCOPE OF PRACTICE
First Responder, EMT-Basic, EMT-Intermediate and EMT-Paramedic
CLASS OF DRUG
Isomer, Beta 2 Agonist
PHARMACOLOGIC ACTION
Xopenex (levalbuterol HCI) inhalation solution binds to human beta-adrenergic receptors on the gron monster alains. This relaxes the airways, which protects against
INDICATIONS
1. Xopenex is used to treat reversible airway obstruction caused by:
i. Wheezing associated with asthma ii. COPD (emphysema) ili. Chronic bronchitis
CONTRAINDICATIONS
1. Hypersensitivity to the drug class.
2. MAO inhibitor use w/in 14 days.
3. Hypersensitivity to peanuts.
DRUG INTERACTION
1. Phenothiazines
ADMINISTRATION
1. Nebulizer
i. Adult:[1.25 mg] in 3 ml of sterile NS given as inhalation therapy over 5-15 minutes, may be repeated as necessary
ii. Pediatric: [0.63-1.25 mg] in 3 ml of sterile NS given as inhalation therapy over 5-15
minutes, may be repeated as necessary.
SPECIAL NOTES
1. Drug of choice for patients that you are concerned with having an increased myocardial oxygen demand. However this drug can still cause an increase in Heart Rate and BP.
2. It is not recommended that this drug be mixed with Atrovent.
NALOXONE (NARCAN®)
SCOPE OF PRACTICE
*First Responder, EMT-Basic, EMT-Intermediate and EMT-Paramedic
‘Via nasal mucosal atomizer, or [IM delivery system (if patient’s own medication)]
CLASS OF DRUG
Opioid reversal agent
PHARMACOLOGIC ACTION
Competitive opioid antagonist; synthetic congener of oxymorphone
INDICATIONS
1. Reversal of narcotic effects, particularly respiratory depression, due to narcotic drugs, whether ingested, injected, or administered in the course of treatment. Narcotic drugs include agents such as morphine, Demerol®, heroin, Dilaudid®, Percodan®, codeine, Lomotil®, propoxyphene (Darvon®), pentazocine (Talwin®).
CONTRAINDICATIONS
1. Hypersensitivity
2. Absences of indication
DRUG INTERACTION
1. Administration of naloxone can result in the sudden onset of opiate withdrawal (agitation, tachycardia, pulmonary edema, nausea, vomiting, and, in neonates, seizures)
ADMINISTRATION
1. Adult: [2mg (1 mg per naris)] IN, [0.4 mg - 2.0 mg] IV/10 (2.0 mg total dose) - [0.4 - 2.0 mg] if IM, SQ, ET. Titrate to respiratory effort/rate. May be repeated at 2 - 3 minutes, if needed.
2. Pediatric:[0.1 mg/kg|< 5 yrs or ≤ 20 kg, [2 mg] ≥5 yr or > 20kg IV, ET, IM, SQ, 10, May be repeated at 0.1 mg/kg if no response.
3. Neonate: [0.1 mg/kg| cow IVR, ET, IM, SQ, IQ; ropeat in 2-3 minutes, if needed (mix 1 ml of naloxone, 0.4 mg in 9 ml of D5W, which gives 0.04 mg/ml)
Note: Much higher doses should be given to patients with suspected propoxyphene (Darvon®), pentazocine (Talwin®), and fentanyl overdoses.
SPECIAL NOTES
1. The patient may quickly become conscious and combative.
NITROGLYCERIN
SCOPE OF PRACTICE
‘EMT-Basic, ‘EMT-Intermediate and EMT-Paramedic
‘Patients own medication with on line medical control only.
2 Must have intravenous access established prior to administration or approval of online medical control if IV/IO access is unavailable.
CLASS OF DRUG
Nitrates, anti-anginal agent/vascular dilating agent
PHARMACOLOGIC ACTION
Organic nitrate which causes systemic venodilation, decreasing preload. Cellular mechanism: nitrate enters vascular smooth muscle and converted to nitric oxide (NO) leading to activation of cyclic guanosine monophosphate (CGMP) and vasodilation. Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial 02 demand. Also improves coronary collateral circulation. Lower BP, increases heart rate, occasional paradoxical bradycardia.
INDICATIONS
1. Chest pain, anginal pain
2. Congestive heart failure with severe pulmonary edema
CONTRAINDICATIONS
1. Hypersensitivity
2. Hypotension (SBP < 100 mm Hg or ≥30 mm Hg below baseline)
3. Increased intra-cranial pressure
4. Severe anemia
5. Extreme bradycardia (<50 bpm)
6. Tachycardia in the absence of heart failure (> 120 bpm)
7. Confirmed right ventricular infarction
DRUG INTERACTION
1. Additive hypotension with beta-adrenergic blockers, antihypertensives, calcium channel blockers, and phenothiazines.
2. Tricyclic antidepressants and antihistamines may interfere with buccal absorption.
3. Can cause a lethal drop in blood pressure in patients taking Sildenafil citrate (Viagra) within
24 hours of ingestion, tadalafil (Cialis®) within last 48 hours, vardenafil (Levitra®) within last
48 hours, or other phopsphodiesterase-5 inhibitors.
ADMINISTRATION
1. Adult:
i. Sublingual: [0.3 - 0.4 mg] tablet. Repeat at 3 - 5 minutes as needed to a total of three tabs (or more by MCEP order).
i. Line or so sprays my - mit destora otal dintey sprays to onu by Mitral
NITROGLYCERIN (cont.)
ili. Infusion: [5 - 20 mcg/min] the infusion may be increased by 5 mcg/min every 3 - 5 minutes to 50 - 200 mcg/min. The infusion dose is leveled off when desired effect is reached or a decrease in blood pressure of more than 10 mm Hg over baseline or less than 90 mm Hg systolic is observed. (Infusions may be initiated or monitored by Paramedics Only)
Note: The most common method for mixing Nitroglycerin is 50 mg nitroglycerin in 250 ml of normal saline. This yields a concentration of 200 mcg/ml (0.2 mg/ml) in glass or non-absorbable container and non-PVC tubing.
2. Pediatric:Not recommended for pre-hospital use.
SPECIAL NOTES
1. Common side effects may include: throbbing headache, flushing, dizziness, and burning under the tongue (if these side effects are noted, the pills may be assumed potent, not outdated).
2. Less common effect: marked hypotension, particularly orthostatic.
3. Paramedics should use their supply of nitroglycerin, not the patient’s.
4. Use with caution with patient not previously receiving nitroglycerin.
5. Generalized vasodilation may cause profound hypotension and reflex tachycardia.
6. NTG tablets loose potency easily, should be stored in a dark glass container with a tight lid, and not exposed to heat. NTG spray does not have this problem.
7. Use only with Medical Control on patients with systolic BP below 100 mm Hg.
NONSTEROIDAL ANTI-INFLAMMATORY (NSAIDS) (ibuprofen)
SCOPE OF PRACTICE
*EMT-Basic, EMT-Intermediate and EMT-Paramedic
“ ibuprofen PO in pediatric or adults to treat fever or pain ibuprofen PO to pediatrics and adults for pain or fever; IV or IM
CLASS OF DRUG
Non-steroidal anti-inflammatory drug (NSAID)
PHARMACOLOGIC ACTION
Inhibits synthesis of prostaglandins in body tissues
INDICATIONS
For the acute management of pain or as an antipyretic for children >6months and adults.
CONTRAINDICATIONS
1. Allergy to aspirin, ketorolac, or other NSAIDS
2. Perioperative pain in setting of coronary artery bypass graft (CABG) surgery
3. Preterm infants with untreated proven or suspected infection
4. Bleeding with active intracranial hemorrhage or GI bleed
5. Thrombocytopenia
6. Coagulation defects
7. Proven or necrotizing enterocolitis
8. Significant renal impairment
DRUG INTERACTION
1. Coumadin
2. Plavix
3. ASA
4. Other NSAIDs or anticoagulants
ADMINISTRATION
1. Adult: [10mg/kg] up to 800mg PO [400-800mg] IV over 30 minutes
2. Pediatrics: [10mg/kg] PO, not to exceed 800 mg. Dosing must be six (6) hours apart.
[10mg/kg] IV over 30 minutes
SPECIAL NOTES:
1. Febrile seizures occur in normal children between 6months and 6 years. Such seizures are usually short, lasting less than 5 minutes, generalized, and usually do not require anti-seizure drug therapy.
2. Oncology patients should not receive Ibuprofen or other NSAIDS due to the risk of increased bleeding associated with these medications.
3. Fever may be the result of a toxic ingestion such as Benadryl and other anticholinergics.
Risk of toxic ingestion should be considered in all febrile pediatric patients.
4. Ibuprofen should not be utilized to facilitate treat and release situations. Administration should only be performed if transport is initiated.
OVER THE COUNTER MEDICATIONS (OTC)
SCOPE OF PRACTICE
First Responder, EMT-Basic, EMT-Intermediate, & EMT-Paramedic
CLASS OF DRUG
Drugs not classified as controlled or dangerous substances
PHARMACOLOGIC ACTION
Drug and dose dependent
INDICATIONS
Dependent on patient needs and condition
CONTRAINDICATIONS
Dependent on patient needs and condition
DRUG INTERACTION
Drug and dose dependent
ADMINISTRATION
Dependent on patient needs and condition and physician orders
SPECIAL NOTES
1. A physician medical director may approve a list of over the counter (OTC) medications and products (i.e. NSAID’s, antihistamines, anti-diarrheal, laxatives, antacids, vitamin supplements, hygiene products and other products) for distribution by an EMS caregiver working under medical direction to a requesting individual during scheduled stand-by situations.
2. Examples include:
2. Long term wildfire responses
3. Public events (concerts, rodeos, etc), various industry situations such as movie production
4. Ski Patrol
5. Long term construction & manufacturing projects
6. Long term search and rescue or tactical operations
7. Other situations where scheduled stand-by EMS is provided.
3. The OTC medication/product must be properly labeled in individual dose packaging when distributed to the patient. Distribution from a bulk or multi-dose container is not permitted by this scope of practice as well as other state and federal laws and regulations; medications will be distributed per manufacturer recommendations and labeling directions.
4. The agency/EMS caregiver will maintain a written guideline that contains the list of physician approved OTC medications/products and the conditions for which they may be distributed.
Specific dosing information and indications for pediatric patients must be included.
5. The EMS agency/EMS caregiver must develop a method of documentation for the appropriate distribution of the OTC medications/products. This documentation shall include the OTC medication documentation and appropriate patient care report, per 7.27.10.12 (Records and Data Collection, NMAC) and 7.27.11.11 (NMAC). PRC certified ambulance agencies shall complete patient care documentation per 18.3.14.24 (NMAC).
Oxygen
SCOPE OF PRACTICE
First Responder, EMT-Basic, EMT-Intermediate and EMT-Paramedic
CLASS OF DRUG
Class III Gas, Oxidizer
PHARMACOLOGIC ACTION
Appropriate levels of oxygen are vital to support cell respiration. Oxygen plays an important role in the energy metabolism of living organisms.
INDICATIONS
1. Suspected hypoxia or respiratory distress from any cause
2. Acute chest pain in which myocardial infarction is suspected
3. Shock (decreased oxygenation of tissue) from any cause
4. Trauma
5. Carbon monoxide poisoning
CONTRAINDICATIONS
1. None
DRUG INTERACTION
1. None
ADMINISTRATION
1. Adult & Pediatric:
Low flow (1-2L/min)
Medium flow (4-6L/min)
- Both by Nasal cannula (NC)
High Flow
(10-15L/min)
- Through non- breathable Mask (NRB)
