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Medical Directives Flashcards

1
Q

What are the indications for Intravenous and Fluid Therapy?

A

Actual or potential need for intravenous medication or fluid therapy

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2
Q

What are the conditions for Intravenous and Fluid Therapy?

A

IV Cannulation

Equal to or greater than 2yrs old

0.9% NaCl Fluid Bolus

Equal to or greater than 2 yrs old
Hypotension

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3
Q

What are the contraindications of Intravenous and Fluid Therapy?

A

IV Cannulation

Suspected fracture proximal to the access site

0.9% NaCl Fluid Bolus

Fluid overload

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4
Q

What is the treatment for Intavenous and Fluid Therapy in terms of maintenance Infusion?

A

Equal to or greater than 2yrs old and <12yrs old.
Route. IV
Infusion. 15 ml/hr

Equal to or greater than 12 yrs old
Route. IV
Infusion. 30 - 60 ml/hr

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5
Q

What is the Mandatory Patch Point for Intravenous and Fluid Therapy?

A

Patch to BHP for authorization to administer 0.9% NaCl Fluid Bolus to hypotensive patients equal to or greater than 2yrs and less than 12 yrs with suspected Diabetic Ketoacidosis (DKA).

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6
Q

What is the treatment for Intravenous and Fluid Therapy in terms of fluid Bolus?

A 
Age equal to or greater than 2 yrs to <12 yrs
Route.                      IV     
Infusion                   20 ml/kg
Reasses every.       100 ml
Max. Vol.                 2000 ml
Equal to or greater than 12 yrs
Route.                      IV
Infusion.                  20 ml/kg
Reasses every.       250 ml
Max Vol*.                  2000 ml

*The Max. Vol. Of NaCl is lower for pts in cardiogenic shock and ROSC.

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7
Q

What are the clinical considerations of Intravenous and Fluid Therapy?

A

PCP assist IV authorizes a PCP to cannulate a peripheral IV at the request and under the direct supervision of an ACP. The pt must require a peripheral IV in accordance with the indications listed in this Medical Directive. PCPs authorized for PCP assist IV are not authorized to administer IV fluid or medication therapy.

Microchips and/or vol. Control administration sets shld be considered when IV access is indicated for pts <12 yrs of age.

An Intravenous fluid Bolus may be considered for a pt who does not meet trauma TOR criteria, where it does not delay transport and shld not be prioritized over management of other reversible causes.

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8
Q

What are the indications for CPAP?

A

Severe respiratory distress and Signs and/or symptoms of acute pulmonary edema or COPD

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9
Q

What are the conditions for CPAP?

A

Equal to orgreater than 18 yrs
RR. Tachypnea
SBP. Normotension
Other. SpO2 <90% or accessory muscle use

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10
Q

What are the contraindications for CPAP?

A 
Asthma exacerbation
Suspected pneumothorax
Unprotected or unstable airway
Major trauma or burns to the head or torso
Tracheostomy
Inability to sit upright
Unable to cooperate
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11
Q

What is the treatment for CPAP?

A

Initial Setting. 5cm H2O
Titration increment. 2.5 cm H2O
Titration interval. 5 min
Max. Setting. 15 cm H20

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12
Q

What are the indications for Acute Cardiogenic Pulmonary Edema?

A

Moderate to severe respiratory distress and suspected acute cardiogenic pulmonary edema.

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13
Q

What are the conditions for Acute Cardiogenic Pulmonary Edema?

A

Nitroglycerin
Equal to or greater than 18 yrs old
HR 60 - 159bpm
SBP. Normotension

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14
Q

What are the contraindications for Acute Cardiogenic Pulmonary Edema?

A

Nitroglycerin
Allergy or sensitivity to nitrates
Phosphodieterase inhibitor use within the previous 48 hrs
SBP drops by ⅓ or more of its initial value after nitro is administered.

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15
Q

What is the treatment for Acute Cardiogenic Pulmonary Edema?

A 
SBP equal to or greater than 100 mmHg to <140 mmHg
IV or Hx*            Yes
Route.                 SL
Dose.                   0.3 mg or 0.4 mg
Max. Single dose.       0.4 mg
Dosing interval.            5 min
Max. # of doses.          6
SBP equal to or greater than 140 mmHg
IV or Hx*          No
Route.               SL
Dose.                 0.3 mg or 0.4 mg
Max. Single Dose.          0.4 mg
Dosing interval.               5 min
Max. # of doses.             6
IV or Hx*        Yes
Route.             SL
Dose.               0.6 mg or 0.8 mg
Max. Single Dose.       0.8 mg
Dosing interval.            5 min
Max. # of doses.          6

*Hx refers to a pt with a prior history or nitro use.

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16
Q

What are the indications for Bronchoconstriction?

A

Respiratory distress AND Suspected bronchoconstriction.

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17
Q

What are the conditions for Bronchoconstriction?

A

Salbutamol
N/A

Epinephrine
BVM ventilation required
Hx of asthma

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18
Q

What are the contraindications for Bronchoconstriction?

A

Salbutamol
Allergy or sensitivity to salbutamol

Epinephrine
Allergy or sensitivity to epinephrine

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19
Q

What is the treatment for Bronchoconstriction with Salbutamol?

A 
<25 kg
Route.          MDI*
Dose.           Up to 600 mcg (6 puffs)
Max. Singke dose.       600mcg
Dosing interval.            5 - 15 min PRN
Max. # of doses.          3
Route.                 NEB
Dose.                  2.5 mg
Max. Single dose.        2.5 mg
Dosing interval.            5 - 15 min PRN
Max. # of doses.          3
Equal to or greater than 25 kg
Route.                       MDI*
Dose.                         Up to 800 mcg (8 puffs)
Max singke dose.     800 mcg
Dosing interval.         5 - 15 min PRN
Max # of doses.        3
Route.                          NEB
Dose.                            5 mg
Max. Single dose.       5 mg
Dosing interval.           5 - 15 min PRN
Max. # of doses.         3

*1 puffs = 100 mcg

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20
Q

What is the treatment for Bronchoconstriction with Epinephrine?

A

Route. IM
Concentration. mg/mL = 1 : 1000
Dose. 0.01 mg/kg*
Max. Single dose. 0.5 mg
Max. # of doses. 1

*the Epinephrine dose may be rounded to the nearest 0.05 mg

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21
Q

What are the clinical considerations for Bronchoconstriction?

A

Epinephrine should be the 1st medication. Administered if the pt is apneic. Salbutamol MDI may be administered subsequently using BVM MDI adapter.

Nebulization is contraindicated in pts with known or suspected fever or in the setting of a declared febrile repiratory illness outbreak by the local medical officer of health.

When administering salbutamol MDI, the rate of administration shld be 100 mcg approximately every 4 breaths.

A spacer shld be used when administering salbutamol MDI.

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22
Q

What are the indications for moderate to severe allergic reaction?

A

Exposure to a probable allergen AND signs and/or symptoms of a moderate to severe allergic reaction (including anaphylaxis).

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23
Q

What are the conditions for moderate to severe allergic reaction?

A

Epinephrine
For anaphylaxis only

Diphenhydramine
Equal to or greater than 25 kg

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24
Q

What are the contraindications for moderate to severe allergic reaction?

A

Epinephrine
Allergy is sensitivity to Epinephrine

Diphenhydramine
Allergy or sensitivity to diphenhydramine

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25
Q

What is the treatment for moderate to severe allergic reaction?

A 
Epinephrine 
Route.                  IM
Concentration.    1 mg/mL = 1 : 1000
Dose.                    0.01 mg/kg*
Max. Single dose.     0.5 mg
Dosing interval.         Minimum 5 min
Max. # of doses.       2

*the Epinephrine dose may be rounded to the nearest 0.05 mg

Diphenhydramine
>25 kg to <50 kg
IV/IM
Dose. 25 mg
Max. Single dose. 25 mg
Max. # of doses. 1

> 50 kg
IV/IM
Dose. 50 mg
Max. Single dose. 50 mg
Max. # of doses. 1

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26
Q

What are the clinical considerations for moderate to severe allergic reaction?

A

Epinephrine administration takes priority over IV access.

IV administration of Diphenhydramine applies only to PCPs authorized.

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27
Q

What are the indications for hypoglycemia?

A

Suspected hypoglycemia

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28
Q

What are the conditions for hypoglycemia?

A

Dextrose
Equal to or greater than 2 yrs
Altered LOA
Hypoglycemia

Glucagon
Altered LOA
Hypoglycemia

29
Q

What are the contraindications of Hypoglycemia?

A

Dextrose
Allergy or sensitivity to Dextrose

Glucagon
Allergy or sensitivity to glucagon
Pheochromocytoma

30
Q

What is the treatment for hypoglycemia?

A 
Dextrose 10%
Equal to or greater than 2 yrs old
Route.                     IV
Dose.                      0.2 g/kg (2 ml/kg)
Max. Single dose  25 g (250 ml)
Dosing interval.     10 min
Max. # of doses.    2
Dextrose 50%
Equal to or greater than 2 yrs old
Route.                       IV
Dose.                        0.5 g/kg (1 ml/kg)
Max. Single dose.   25 g (50 ml)
Dosing interval.       10 min
Max. # of doses.     2
Glucagon
<25 kg
Route.                         IM
Dose.                          0.5 mg
Max. Single dose.     0.5 mg
Dosing interval.         20 min
Max. # of doses.       2
Equal to or >25 kg
Route.                         IM
Dose.                          1 mg
Max. Single dose.     1 mg
Dosing interval.         20 min
Max. # of doses.       2
31
Q

What are the clinical considerations of hypoglycemia?

A

If the pt responds to dextrose or glucagon, he/she may receive oral glucose or other simple carbohydrates.

If only mild signs or symptoms are exhibited, the pt may receive oral glucose or other simple carbohydrates instead of dextrose or glucagon.

If pt intiates an informed refusal of transport, a final set of vitals signs including blood glucometry must be attempted and documented.

IV administration of dextrose applies only to authorized PCPs.

32
Q

What are the indications for Cardiac Ischemia?

A

Suspected cardiac ischemia

33
Q

What are the conditions for cardiac ischemia?

A

ASA
Equal to or >18 yrs old
Unaltered LOA
Able to chew and swallow

Nitroglycerin 
Equal to or >18 yrs old
Unaltered LOA
HR.          60 - 159 bpm
SBP.         Normotension 
Prior history of Nitroglycerin use OR IV access obtained
34
Q

What are the contraindications of cardiac ischemia?

A 
ASA
Allergy or sensitivity to NSAIDs
If asthmatic, no prior use of ASA
Current active bleeding
CVA or TBI in the previous 24 hours

Nitroglycerin
Allergy or sensitivity to nitrates
Phosphodiesterase inhibitor use within the previous 48 hrs
SBP drops by ⅓ or more of its initial value after Nitroglycerin is administered
12 - lead ECG compatible with Tight Ventricular MI

35
Q

What is the treatment for cardiac ischemia?

A 
ASA
Route.             PO
Dose.              160 - 162 mg
Max. Single dose.    162 mg
Max # of doses.        1

Administer 12 - lead and interpret for STEMI

Nitroglycerin 
No STEMI
SBP.                        Equal to or >100
Route.                     SL
Dose.                      0.3 mg or 0.4 mg
Max. Single dose.       0.4 mg
Dosing interval.           5 min
Max. # of doses.         6

STEMI POSITIVE
SBP. equal to or >100
Route. SL
Dose. 0.3 mg or 0.4 mg
Max. Single dose. 0.4 mg
Dosing interval. 5 min
Max # of doses. 3

36
Q

What are the clinical considerations for cardiac ischemia?

A

Suspect a Right Ventricular MI in all inferior STEMIs and perform at minimum V4R to confirm (ST-elevation equal to or >1mm in V4R).

Do not administer Nitroglycerin to a pt with Right Ventricular STEMI.

IV condition applies only to PCPs authorized.

Apply defibrillation pads when a STEMI is identified.

The goal time to 12-lead ECG from first medical contact is <10 min where possible.

37
Q

What are the indications for Croup?

A

Severe respiratory distress AND strider at rest AND current history of URTI, AND barking cough or recent history of a barking cough.

38
Q

What are the conditions of Croup?

A

<8 yrs old

HR <200 bpm

39
Q

What are the contraindications of Croup?

A

Allergy or sensitivity to epinephrine

40
Q

What is the treatment for Croup?

A 
<1 year
<5 kg
NEB
1 mg/mL = 1: 1000
Dose.                             0.5 mg
Max single dose.         0.5 mg
Max # of doses.           1
Equal to or >5 kg
NEB
1 mg/mL = 1:1000
Dose.                            2.5 mg
Max single dose.        2.5 mg
Max # of doses.          1
Equal to or >1 to <8
NEB
1 mg/mL = 1:1000
Dose.                        5 mg
Max single dose.    5 mg
Max # of doses.      1
41
Q

What are the clinical considerations for Croup?

A

The minimum initial volume for nebulization is 2.5 mL.

42
Q

What are the indications for Analgesia?

A

Pain

43
Q

What are the conditions for Analgesia?

A

Acetaminophen
Equal to or >12 yrs old
Unaltered LOA

Ibuprofen
Equal to or >12 yrs old
Unaltered LOA

Ketorolac
Equal to or >12 yrs old
Unaltered LOA
SBP. Normotension

44
Q

What are the contraindications for Acetaminophen?

A 
Acetaminophen use with previous 4 hours
Allergy or sensitivity to Acetaminophen
Hx of liver disease 
Active vomiting 
Unable to tolerate oral medication 
Suspected Ischemia chest pain
45
Q

What are the contraindications of Ibuprofen?

A 
NSAID use within previous 6 hours
Allergy or sensitivity to NSAIDs
Pt on anticoagulation therapy
Current active bleeding
Hx of peptic ulcer disease or GI bleed
Pregnant
If asthmatic, no prior use of ASA or other NSAIDs
CVA or TBI in the previous 24 hours
Known renal impairment 
Active vomiting 
Unable to tolerate oral medications
Suspected ischemia chest pain
46
Q

What are the contraindications of ketorolac?

A 
NSAID use within previous 6 hours
Allergy or sensitivity to NSAIDs
Pt on anticoagulation therapy
Current active bleeding 
Hx of peptic ulcer disease or GI bleed
Pregnant
If asthmatic, no prior use of ASA or other NSAIDs
CVA ot TBI in the previous 24 hours
Known renal impairment 
Suspected ischemic chest pain
47
Q

What is the treatment for Analgesia using acetaminophen?

A 
Equal to or >12 yrs old to <18 yrs old
PO
Dose.                    500-650 mg
Max single dose. 650 mg
Max # of doses.   1
Equal to or >18 yrs old
PO
Dose.                      960-1000 mg
Max single dose.  1000 mg
Max # of doses.    1
48
Q

What us the treatment for Analgesia using Ibuprofen?

A 
Equal to or >12 yrs old
PO
Dose.                         400mg
Max single dose.     400 mg
Max # of doses.       1
49
Q

What is the treatment for Analgesia using ketorolac?

A 
Equal to or >12 yrs old
IM/IV
Dose.                       10-15 mg
Max single dose.    15 mg
Max # of doses.      1
50
Q

What are the clinical considerations of Analgesia?

A

Whenever possible, consider co-administration of acetaminophen and Ibuprofen.

Suspected renal colic pts should routinely be considered for Ibuprofen or ketorolac.

IV administration of ketorolac applies only to authorized PCPs.

51
Q

What are the indications for opioid toxicity?

A

Altered LOC AND respiratory depression AND inability to adequately ventilate OR persistent need to assist ventilations AND suspected opioid overdose.

52
Q

What are the conditions for opioid toxicity?

A

Equal to or >24 hours
Altered LOA
RR. <10 breaths/min

53
Q

What are the contraindications of opioid toxicity?

A

Allergy or sensitivity to naloxone.

54
Q

What is the treatment for opioid toxicity?

A 
IV
Dose up to 0.4 mg*
Max single dose 0.4 mg
Dosing interval is 5 min
Max # of doses is 3
IM
Dose 0.4 mg
Max single dose 0.4 mg
Dosing interval is 5 min
Max # of doses is 3
IN
Dose 2-4 mg
Max single dose 2-4 mg
Dosing interval is 5 min
Max # of doses is 3
SC
Dose 0.8 mg
Max single dose is 0.8 mg
Dosing interval is 5 min
Max # of doses is 3

*for the IV route, Titration naloxone only to restore the pts repiratory status.

55
Q

What are the clinical considerations for opioid toxicity?

A

IV administration of naloxone applies only to PCPs authorized.

Upfront aggressive management of the airway is paramount and the initial priority.

If no response to initial treatment; consider patching for further doses.

If the pt does not respond to airway management and the administration of naloxone, glucometry should be considered.

Combative behavior shld be anticipated following naloxone administration and paramedics shld protect themselves accordingly, thus the importance of gradual Titration to desired clinical effect: repiratory rate equal to or >10, adequate airway and ventilation, not full alertness.

56
Q

What are the indications for suspected adrenal crisis?

A

A pt with primary adrenal failure who is experiencing clinical signs of an adrenal crisis.

57
Q

What are the conditions for suspected adrenal crisis?

A

Paramedics are presented with a vial of hydrocortisone for the identified pt AND age-related hypoglycemia OR GI symptoms OR syncope OR temp equal to or >38C or suspected/history of fever OR altered LOA OR age-related tachycardia OR age-related hypotension

58
Q

What are the contraindications of suspected adrenal crisis?

A

Allergy or sensitivity to hydrocortisone

59
Q

What is the treatment for suspected adrenal crisis?

A

IM/IV
Dose 2 mg/kg*
Max single dose 100 mg
Max # of doses is 1

*Dose shld be rounded to the nearest 10 mg

60
Q

What are the indications for Nausea/vomiting?

A

Nausea or vomiting

61
Q

What are the conditions for nausea/vomiting?

A

Weight equal to or >25 kg

Unaltered LOA

62
Q

What are the contraindications of nausea/vomiting?

A

Dimenhydrinate
Allergy or sensitivity to dimenhydrinate or other antihistamines.
Overdose on antihistamines or anticholinergics or tricyclic antidepressants.

63
Q

What is the treatment for nausea/vomiting?

A 
Weight equal to or >25 kg to <50 kg
Route           IV/IM       
Dose.                               25 mg                         
Max single dose.           25 mg
Max # of doses.             1
Weight equal to or >50 kg
Route.          IV/IM
Dose.                          50 mg
Max single dose.      50 mg
Max # of doses.        1
64
Q

What are the clinical considerations for nausea/vomiting?

A

IV administration of dimenhydrinate applies to authorized PCPs only.
Prior to IV administration, dilute dimenhydrinate 1:9 with normal saline or sterile water. If administered IM do not dilute.

65
Q

What are the indications for cardiogenic shock?

A

STEMI-positive 12-lead ECG AND cardiogenic shock

66
Q

What are the conditions for cardiogenic shock?

A

Equal to or >18 yrs old
SBP Hypotension
Chest auscultation is clear

67
Q

What are the contraindications for cardiogenic shock?

A

Fluid overload

SBP equal to or >90 mmHg

68
Q

What is the treatment for cardiogenic shock?

A 
Equal to or >18
IV
Infusion 10 ml/kg
Reasses every 250 ml
Max volume 1000 ml

Medical Directives (4 decks)

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