EMT Flashcards
ACETAMINOPHEN (Tylenol)
Indications & Contraindications
Indications: Treatment of fever in pediatrics
Contraindications: Previous hypersensitivity; Products containing alcohol, aspartame, saccharin, sugar,
or tartrazine (FDC yellow dye #5) should be avoided in patients who have
hypersensitivity or intolerance to these compounds; Severe hepatic
impairment/active liver disease.
ACETAMINOPHEN (Tylenol)
Administration
Administration:
* Adult Administer 15 mg/kg (max of 1000mg) oral with temperature > 102° F
* Pediatric Administer 15 mg/kg oral with temperature > 102° F
ALBUTEROL (Proventil®)
Indications & Contraindications
Indications:
* Bronchial asthma.
* Reversible bronchospasm associated with chronic bronchitis and emphysema.
* Anaphylactic respiratory distress.
* Crush syndrome [per MCP].
Contraindications:
* Hypertension
* Tachycardia (HR greater than 130 adult, HR greater than 150 child).
* Severe cardiac disease.
* Hypersensitivity to the drug
ALBUTEROL (Proventil®)
Administration
Using a small volume nebulizer, adjust the oxygen flowmeter to 8 to 10 L/minute to produce a steady, visible mist.
- Adult Give 2.5 mg (3 mL of 0.083% solution) with a mouthpiece, facemask, or CPAP.
- Pediatric Give 2.5 mg (3 mL of 0.083% solution) with a
mouthpiece, blow-by, or CPAP.
Adult - Bronchospasm Give 5 mg with a mouthpiece, blow-by, or CPAP.
ASPIRIN
Indications & Contraindications
Indications: Chest pain suggestive of an acute myocardial infarction.
Contraindications:
* Hypersensitivity to the drug, NSAIDS, and Tartrazine (FDC yellow dye #5).
* Bleeding disorders including GI hemorrhage and hemophilia.
* Hemorrhagic states.
ASPIRIN
Administration
Administer four (4) 81 mg chewable tablets (324 mg total dose) PO as soon as possible after the onset of chest pain.
DIPHENHYDRAMINE (Benadryl®)
Indications & Contraindications
Indications:
* Anaphylaxis, as an adjunct to Epinephrine.
* To treat dystonic reactions and extrapyramidal reactions caused by phenothiazines.
Contraindications:
* Bronchial asthma.
* Nursing mothers.
* Children less than 10 kg.
* Glaucoma.
* Hypersensitivity to the drug or other antihistamines.
DIPHENHYDRAMINE (Benadryl®)
Administration
- Adult Give 25 mg IM or slow IVP
- Pediatric Give 1 mg/kg up to 25 mg IM or slow IVP
EPINEPHRINE 1:1,000
Indications & Contraindications
Indications:
* Anaphylaxis.
* Bronchial asthma.
* Respiratory distress due to epiglottitis or croup [per MCP].
Contraindications: Epinephrine should be avoided in the following patients unless signs and symptoms are
severe:
* Hypertension
* Tachycardia
* Cardiovascular disease.
* Elderly
* Angle closure glaucoma.
EPINEPHRINE 1:1,000
Administration
- Adult Anaphylaxis/Bronchospasm:
Administer 0.3 mg IM. Repeat dose per MCP - Pediatric Anaphylaxis/Bronchospasm:
Administer 0.15 mg IM for patients <30 kg.
GLUCAGON (GlucaGen)
Indications & Contraindications
Indications: When unable to obtain IV access and give Dextrose, and:
* Altered mental status of unknown etiology (GCS less than or equal to 12).
* Hypoglycemia (less than 60 mg/dL) based on rapid glucose determination or
clinical judgment.
* Status epilepticus.
* Oral hypoglycemic agent overdose.
Contraindications: Hypersensitivity to the drug.
GLUCAGON (GlucaGen)
Administration
- Adult 1 mg IM (>25kg)
- Pediatric 0.5 mg IM (<25kg)
IPRATROPIUM (Atrovent)
Indications & Contraindications
Indications: * Bronchoconstriction in COPD, including chronic bronchitis and emphysema as
an adjunct to Albuterol.
* Bronchial asthma as an adjunct to Albuterol.
Contraindications: Hypersensitivity to the drug, or to Atropine and its derivatives.
Pediatric patients < 1 year old
IPRATROPIUM (Atrovent)
Administration
Using a small volume nebulizer, adjust the oxygen flowmeter to 8 to 10 L/minute to produce a steady, visible mist.
* Adult Give 0.5 mg in 2.5 mL with a mouthpiece or facemask. Repeat doses per Medical Command.
* Pediatric Not Administered in patients < 1 years of age.
* Pediatric Bronchospasm
0.5 mg for children 6 – 12 years of age
0.25 mg for children < 6 years of age
NALOXONE (Narcan)
Indications & Contraindications
Indications:
* Respiratory depression caused by narcotics.
* Coma unknown etiology.
Contraindications: Hypersensitivity to the drug.
NALOXONE (Narcan)
Administration
IN: Administer 2 mg IN (1 mL in each nostril) or 4 mg IN (2 mL in each nostril).
NITROGLYCERIN (Nitrostat)
Indications & Contraindications
Indications:
* Chest pain suspected to be cardiac in origin.
* Severe Hypertension
* Cardiogenic pulmonary edema.
Contraindications:
* Hypotension (SBP less than 90 mm Hg).
* Bradycardia (HR less than 60).
* Increased intracranial pressure (i.e., CVA, head injury).
* Hypersensitivity to the drug.
* Patients who are using anti-impotence agents (Cialis, Levitra, Viagra) within the last 3 days
NITROGLYCERIN (Nitrostat)
Administration
- Chest Pain: Administer 0.4 mg SL. Repeat q 5 minutes, if needed, to a maximum of 3 doses.
- Pulmonary Edema: (SBP ≥ 110 mmHg): Administer 0.4 mg SL. Repeated q 5 minutes to a maximum of 3 doses if needed.
-
Severe
Hypertension: Administer 0.4 mg SL. Repeat q 5 minutes, if needed, to a maximum of 3 doses.
ONDANSETRON (Zofran)
Indications & Contraindications
Indications:
1. Severe vomiting or nausea.
2. Vertigo.
Contraindications:
1. Hypersensitivity to the drug.
2. Pregnancy (all trimesters).
3. Prolonged QT interval
ONDANSETRON (Zofran)
Administration
- Administer 4 mg ODT. Place tablet on patient’s tongue. The tablet dissolves quickly and can be swallowed with saliva. Repeat dose requires MCP order.
- Administer 4 mg IM.
ORAL GLUCOSE (Insta-Glucose)
Indications & Contraindications
Indications: Patient with altered mental status and a known history of diabetes controlled by
medication.
Contraindications:
* Unresponsive.
* Unable to swallow.
ORAL GLUCOSE (Insta-Glucose)
Administration
- Assure signs and symptoms of altered mental status with a known history of diabetes.
- Assure patient is conscious and can swallow and protect the airway.
- Administer glucose:
o Between cheek and gum.
o Place on tongue depressor between cheek and gum.
Tube contains 12.5 g, 15 g, or 25 g (varies per manufacturer).
TETRACAINE HCL
Indications & Contraindications
Indications: Tetracaine Hydrochloride Ophthalmic Solution 0.5%, an ester local anesthetic, is indicated for procedures requiring a rapid and short-acting topical ophthalmic
anesthetic
Contraindications: Hypersensitivity; Thromboembolic disorders (current, history of, or at risk for); Acquired defective color vision (IV); Subarachnoid hemorrhage; Concurrent use of
combination hormonal contraception (PO).
TETRACAINE HCL
Administration
Two (2) drop topically in the eye(s) as needed in conjunction with Morgan Lens insertion. Discard unused portion.
SAMPLE
S - Signs and Symptoms
A - Allergies
M - Medications
P - Past medical history
L - Last oral intake
E - Events leading up to the present illness or injury
OPQRSTA
O - Onset: When and how the symptoms began
P - Provocation/Palliation: What makes the symptoms better or worse
Q - Quality: Description of the symptoms (e.g., sharp, dull, burning)
R - Region/Radiation: Location of symptoms and if they spread
S - Severity: Intensity of symptoms, often on a scale of 0-10
T - Time: Duration of symptoms
A - Associated symptoms: Other symptoms occurring alongside the main complaint
AVPU
Alert: The patient is fully awake, has spontaneously open eyes, responds to voice, and has bodily motor function.
Verbal: The patient responds to verbal stimuli, which could be as minimal as a grunt, moan, or slight movement when spoken to.
Pain: The patient responds only to pain stimuli, such as a trapezius squeeze or other pressure-based techniques.
Unresponsive: The patient shows no response to voice or pain stimuli.
AEIOU-TIPS
*Assess and recall potential causes of altered mental status
*
A - Alcohol/Abuse of substances, Acidosis
E - Endocrine disorders, Epilepsy, Electrolyte imbalances, Environmental factors
I - Infection, Insulin (related to diabetes)
O - Overdose, Oxygen deficiency
U - Underdose, Uremia
T - Trauma
I - Infection (repeated for emphasis)
P - Psychiatric conditions, Poisoning
S - Stroke, Shock
Dyspnea
shortness of breath
Bradypena
Abnormally slow breathing rate
For adults, it is typically defined as fewer than 12 breaths per minute
Ecchymosis
commonly known as a bruise
Cardiac Tamponade
It occurs when fluid accumulates in the pericardial space, compressing the heart and impairing its ability to fill and pump blood effectively.
Cincinnati Prehospital Stroke Scale
Facial Droop: The patient is asked to smile or show their teeth. An abnormal result is when one side of the face does not move as well as the other or doesn’t move at all12.
Arm Drift: The patient is instructed to close their eyes and hold both arms straight out in front with palms up for about 10 seconds. An abnormal result is when one arm drifts downward or cannot be raised12.
Speech Abnormality: The patient is asked to repeat a simple phrase like “You can’t teach an old dog new tricks.” An abnormal result is slurred speech, incorrect words, or inability to speak12.
Normal Respiratory Rate
Adults and Children
Adults 12 to 20 breaths per minute
Children
* Infant (0-12 months): 30-60 breaths per minute
* Toddler (1-3 years): 24-40 breaths per minute
* Preschooler (4-5 years): 22-34 breaths per minute
* School age (6-12 years): 18-30 breaths per minute
* Adolescent (13-18 years): 12-16 breaths per minute
Normal Heart Rate/Pulse
Adults and Children
Adults 60 to 100 beats per minute (bpm) at rest
Children
* Newborns (0-1 month): 70-190 bpm
* Infants (1-11 months): 80-160 bpm
* Toddlers (1-2 years): 80-130 bpm
* Preschoolers (3-4 years): 80-120 bpm
* School-age (5-9 years): 70-110 bpm
* Adolescents (10-18 years): 60-100 bpm
Normal Blood Pressure
Adults and Children
Adults
Normal: Less than 120/80 mmHg
Elevated: 120-129/less than 80 mmHg
Stage 1 Hypertension: 130-139/80-89 mmHg
Stage 2 Hypertension: 140 or higher/90 or higher mmHg7
Children
* 0-28 days: Systolic BP of at least 60 mmHg
* 1 month to 1 year: Systolic BP of at least 70 mmHg
* 1-10 years: 70 + (2 × age in years) mmHg systolic
* 10+ years: Systolic BP of at least 90 mmHg
Normal Glucose
Adults and Children
Adults
Fasting: 70-100 mg/dL (3.9-5.6 mmol/L)
Before meals: 80-130 mg/dL (4.4-7.2 mmol/L)
2 hours after meals: Less than 180 mg/dL (10 mmol/L)
Children
* Infant (0-12 months): 40-90 mg/dL (2.2-5.0 mmol/L)
* Child < 2 years: 60-100 mg/dL (3.3-5.6 mmol/L)
* Child > 2 years to Adult: 70-105 mg/dL (3.9-5.8 mmol/L)
End-tidal CO2 (ETCO2)
capnography
Normal Values:
Adults: 35-45 mmHg
Children: Similar to adults, but may vary slightly based on age
Five Steps of Pharmacokinetics
- Absorption: The process by which a drug enters the bloodstream after administration.
- Distribution: The movement of the drug from the bloodstream to various tissues and organs in the body.
- Metabolism: The chemical transformation of the drug, usually in the liver, into active or inactive metabolites.
- Excretion: The elimination of the drug and its metabolites from the body, primarily through the kidneys.
- Bioavailability: The fraction of the administered dose that reaches systemic circulation unchanged.
Cushing’s Triad
Cushing’s triad is a set of clinical signs that indicate increased intracranial pressure (ICP) and potential brain herniation. It consists of three key components:
1. Hypertension (especially systolic)
2. Bradycardia
3. Irregular respirations (often Cheyne-Stokes breathing)
STEMI
is a critical cardiac emergency.
Key points for EMS management of STEMI include:
Rapid Assessment: Obtain a 12-lead ECG within 10 minutes of first medical contact for patients with suspected cardiac symptoms.
STEMI Alert Activation: If ECG shows ST elevation ≥ 1 mm in 2 contiguous leads or machine interpretation indicates “Acute Myocardial Infarction,” activate a STEMI alert.
Transport Decision: Determine if transport time to a PCI-capable hospital is ≤ 60 minutes. If so, transport directly to the PCI facility. If not, consider transport to the nearest appropriate non-PCI hospital for possible fibrinolytic therapy1.
(ST-Elevation Myocardial Infarction)
Hypertension / Hypotension
High or Low BP
Hypotension: <90/<60 mmHg
Hypertension is consistently ≥130/80 mmHg
Tachycardia
Typically defined as more than 100 beats per minute while at rest.
Bradycardia
Typically defined as fewer than 60 beats per minute in adults
Hypoperfusion
Hypoperfusion is a state of inadequate blood flow to organs and tissues, resulting in insufficient oxygen and nutrient delivery.
Common signs and symptoms:
* Tachycardia
* Tachypnea
* Hypotension
* Cool/clammy skin
* Altered mental status
* Reduced urine output
Beck’s Triad
Beck’s triad is a collection of three clinical signs associated with acute cardiac tamponade:
* Hypotension (low blood pressure)
* Jugular venous distention (JVD)
* Muffled heart sounds
JVD
Jugular vein distention (JVD) is a clinical sign characterized by the bulging or swelling of the jugular veins in the neck.
Common causes of JVD include:
* Right-sided heart failure
* Left ventricular failure
* Pulmonary hypertension
* Tricuspid valve stenosis
* Superior vena cava obstruction
* Constrictive pericarditis
* Cardiac tamponade
* Tension pneumothorax
* Pulmonary embolism
Edema
swelling caused by fluid buildup in bodily tissues
Drug Administration Routes
Intravenous (IV): Delivers medication directly into the bloodstream for rapid onset.
Intramuscular (IM): Injection into muscle tissue.
Subcutaneous (SC): Injection into the fatty tissue beneath the skin, commonly used for insulin.
Oral: Administration by mouth, such as aspirin for suspected heart attacks.
Sublingual: Placement under the tongue for rapid absorption, often used for nitroglycerin.
Intranasal (IN): Delivery through the nose using an atomizer device, used for naloxone.
Inhaled: Administration via inhalers or nebulizers for respiratory medications.
Endotracheal: Delivery of medication directly into the trachea through an endotracheal tube.
Intraosseous (IO): Injection into the bone marrow, used when IV access is difficult.
Hypovolemia
is a condition characterized by abnormally low extracellular fluid volume in the body, often due to blood or fluid loss
Right Upper Quadrant (RUQ)
- Liver
- Gallbladder
- Right kidney
- Right adrenal gland
- Duodenum
- Part of the stomach
- Parts of ascending and transverse colon
Left Upper Quadrant (LUQ)
- Spleen
- Left kidney
- Left adrenal gland
- Stomach
- Part of the liver
- Pancreas
- Parts of transverse and descending colon
Right Lower Quadrant (RLQ)
- Cecum
- Appendix
- Right ovary and fallopian tube (in females)
- Right ureter
- Parts of small and large intestine
Left Lower Quadrant (LLQ)
- Sigmoid colon
- Left ovary and fallopian tube (in females)
- Left ureter
- Parts of small and large intestine
DCAP-BTLS
Deformities: Is there an abnormality in the shape of a body part or organ compared to the normal shape?
Contusions: Do you notice bruising? In extreme cases, this can cause blood to seep, hemorrhage or extravasate into surrounding tissues.
Abrasions: How severe is the abrasion? Your treatment will vary depending on the severity, but be sure to always clean and remove any debris.
Punctures/penetrations: Penetrating trauma suggests an object didn’t pass through, while perforating trauma is associated with an entrance and exit wound.
Burns: Treatment depends on the severity of the burn.
Tenderness: This shouldn’t be confused with pain. Tenderness is triggered by discomfort when an affected area is touched.
**Lacerations: **Treatment depends on the type, cause and depth of the wound. Minor wounds heal on their own, while puncture wounds are more prone to infection.
Swelling: This is an abnormal enlargement of a body part or area. Swelling may occur in response to infection, injury or disease.
CPAP
8L/Min
Normal spO2
94-99%
