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Medical Directives Flashcards

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USMLE® Step 1 flashcards
1
Q

Bronchoconstriction - contraindications

A

—-Salbutamol—-
allergy or sensitivity
—-Epinephrine—-
allergy or sensitivity

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2
Q

Analgesia - Treatment

A 
----Acetaminophen----
≥ 12 years to < 18 years
- 500-650 mg
- max of 1 dose
----Ibuprofen----
≥ 12 years old
- 400 mg
- max of 1 dose
----Ketorolac----
≥ 12 years old
- IM/IV
- 10-15 mg
- max of 1 dose
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3
Q

Cardiac Ischemia - Indications

A

Suspected cardiac ischemia

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4
Q

Suspected Adrenal crisis - Indications

A

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

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5
Q

Trauma Cardiac Arrest - Conditions

A
  • —–CPR——-
  • Altered LOA
  • Performed in 2-minute intervals
    - —Manual Defib—–
  • ≥ 30 days old
  • Altered LOA
  • VF or pulseless VT
    - —Trauma TOR—-
  • ≥ 16 years old
  • Altered LOA
  • no palpable pulse AND no defib delivered AND monitored HR = 0 OR Monitored HR >0 with closest ED ≥ 30 min transport time away
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6
Q

Nausea / vomiting - conditions

A
  • —Dimenhydrinate—-
  • ≥ 25kg
  • Unaltered
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7
Q

Foreign Body Airway Obstruction Cardiac Arrest - Indications

A

Cardiac arrest secondary to airway obstruction

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8
Q

Cardiac Ischemia - treatment

A

—-ASA—-
- 160-162 mg (PO-chew)
- max does of 1
—-Nitro—-
No STEMI
SBP ≥ 100
- 0.3mg or 0.4mg (SL)
- 5 Minute dosing interval
- Max of 6 doses
STEMI
SBP ≥ 100
- 0.3mg or 0.4mg (SL)
- 5 Minute dosing interval
- Max of 3 doses

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9
Q

Suspected Adrenal crisis - treatment

A
  • —Hydrocortisone—-
  • 2mg/kg IM (round to the nearest 10mg)
  • Max of 1 dose
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10
Q

Medical Cardiac arrest - Contraindications

A

——CPR——-
- Obviously dead
- DNR
—-Manual Defib—–
Rhythms other than VF or pulseless VT
—Epinephrine—-
- Allergy or sensitivity to epi
—-Medical TOR—-
Arrest thought to be of non-cardiac origin

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11
Q

Analgesia - Acetaminophen contraindications

A
  • Active vomiting
  • Allergy or sensitivity to acetaminophen
  • Prior use within the past 4 hours
  • Hx of liver disease
  • unable to tolerate oral medication
  • suspected ischemic chest pain
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12
Q

Continuous Positive Airway Pressure - treatment

A
  • 5cm H2O initial
  • 2.5cm increment
  • 5-minute titrating interval
  • Max of 15cm H2O
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13
Q

Nausea / vomiting - indications

A

Nausea or vomiting

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14
Q

Hypoglycemia- conditions

A
  • —Dextrose—-
  • ≥ 2years old
  • altered LOA
  • hypoglycemia
  • —Glucagon—-
  • altered LOA
  • hypoglycemia
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15
Q

Medical Cardiac Arrest - Indications

A

Non-traumatic cardiac arrest

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16
Q

Analgesia - Ketorolac contraindications

A
  • Pregnant
  • NSAID or Ibuprofen use within last 6 hours
  • Allergy or sensitivity to ASA or NSAIDS
  • Patient on anticoagulant therapy
  • Current active bleeding
  • Hx of peptic ulcer or GI bleen
  • If asthmatic, no prior use of ASA or other NSAIDS
  • CVA or TBI in the previous 24 hours
  • known renal impairment
  • Suspected ischemic chest pain
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17
Q

Acute Cardiogenic Pulmonary Edema - Treatment

A 
----Nitro----
SBP ≥ 100 to 140
- IV or prior history of nitro use
- 0.3mg or 0.4mg (SL)
- 5 Minute dosing interval
- Max of 6 doses
SBP ≥ 140
NO IV or prior history of nitro use
- 0.3mg or 0.4mg (SL)
- 5 Minute dosing interval
- Max of 6 doses
IV or prior history of nitro use
- 0.3mg or 0.8mg (SL)
- 5 Minute dosing interval
- Max of 6 doses
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18
Q

Trauma Cardiac Arrest - treatment

A

——CPR——-
- Immediately
—-Manual Defib—–
≥ 30 day old to < 8 years
- 2 j/kg initial dose
- max of 1 dose
≥ 8 years
- 120 j
- max of 1 dose

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19
Q

Bronchoconstriction - Conditions

A 
----Salbutamol----
n/a
----Epinephrine----
- BVM ventilation required
- Hx of asthma
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20
Q

Bronchoconstriction - When shouldn’t you nebulize

A

Suspected fever or febrile respiratory illness

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21
Q

Opioid Toxicity - Treatment

A 
----Naloxone----
SC/IM/IN
- 0.8 mg
- 10-minute dosing interval
- Max of 3 doses
IV
- up to 0.4 mg
- immediate dosing interval
- max of 3 doses (Only to restore respiratory status)
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22
Q

Supraglottic Airway - Indications

A

Need for ventilatory assistance or airway control
AND
Other airway management is ineffective

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23
Q

Cardiac Ischemia - Conditions

A
  • —ASA—-
  • ≥ 18 years
  • Unaltered LOA
  • Able to chew and swallow
  • —Nitro—-
  • ≥ 18 years
  • Unaltered LOA
  • HR 60-159 bpm
  • SBP normotension
  • Prior history of nitro use OR IV access obtained
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24
Q

Continuous Positive Airway Pressure - indications

A

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

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25
Q

Hypoglycemia - Treatment

A 
----Dextrose----
D10W
- ≥ 2 years
- 0.2 g / kg (2ml/kg)
- 10g max single dose (100ml)
- 10 minute dosing interval
- max of 2 doses
D50W
- 0.5 g/kg (1ml/kg)
- 25g (50ml) max dose
- 10 minute dosing interval
- max of 2 doses
----Glucagon----
< 25kg
- 0.5 mg
- 20 minute dosing interval
- max of 2 doses
≥ 25kg
- 1 mg
- 20 minute dosing interval
- max of 2 doses
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26
Q

Analgesia - Ibuprofen contraindications

A
  • Active vomiting
  • Pregnant
  • NSAID or Ibuprofen use within last 6 hours
  • Allergy or sensitivity to ASA or NSAIDS
  • Patient on anticoagulant therapy
  • Current active bleeding
  • Hx of peptic ulcer or GI bleen
  • If asthmatic, no prior use of ASA or other NSAIDS
  • CVA or TBI in the previous 24 hours
  • known renal impairment
  • Unable to tolerate oral medications
  • Suspected ischemic chest pain
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27
Q

Continuous Positive Airway Pressure - contraindications

A
  • Unable to cooperate
  • Tracheostomy
  • suspected pneumothorax
  • Asthma exacerbation
  • Inability to sit upright
  • Major trauma or burns to head or torso
  • Unprotected or unstable airway
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28
Q

Moderate to severe Allergic reaction - Contraindications

A

—-Epi—-
- allergy or sensitivity to epinephrine
—-Diphenhydramine—-
allergy or sensitivity to diphenhydramine

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29
Q

Foreign Body Airway Obstruction Cardiac Arrest - Conditions

A
  • —–CPR——-
  • Altered LOA
  • Performed in 2-minute intervals
    - —Manual Defib—–
  • ≥ 30 days old
  • Altered LOA
  • VF or pulseless VT
30
Q

Foreign Body Airway Obstruction Cardiac Arrest - contraindications

A

——CPR——-
- Obviously dead
- DNR
—-Manual Defib—–
Rhythms other than VF or pulseless VT

31
Q

Hypothermic Cardiac Arrest - Indications

A

Cardiac arrest secondary to hypothermia

32
Q

Acute Cardiogenic Pulmonary Edema - Indications

A

Moderate to severe respiratory distress
-AND-
Suspected acute cardiogenic pulmonary edema

33
Q

Croup - Contraindications

A

—-Epi—-

Allergy or sensitivity to epi

34
Q

Continuous Positive Airway Pressure - conditions

A
  • ≥ 18 years old
  • RR tachypnea
  • SBP normotension
  • SpO2 < 90% OR accessory muscle use
35
Q

Croup - Conditions

A
  • —Epi—-
  • < 8 years old
  • HR < 200 bpm
36
Q

Supraglottic Airway - contraindications

A
  • active vomiting
  • inability to clear the airway
  • airway edema
  • strider
  • caustic ingestion
37
Q

Nausea / vomiting - contraindications

A
  • —Dimenhydrinate—-
  • Allergy or sensitivity to Dimenhydrinate or other antihistamines
  • Overdose on antihistamines or anticholinergics or tricyclic antidepressants
38
Q

Medical Cardiac arrest - When to consider early transport (6)

A
  • Pregnancy ≥ 20 weeks gestation
  • hypothermia
  • airway obstructions
  • suspected pulmonary embolus
  • medication overdose / toxicology
  • Any known reversible cause of arrest
39
Q

Medical cardiac arrest - treatment

A

——CPR——-
- Immediately
—-Manual Defib—–
≥ 30 day old to < 8 years
- 2 j/kg initial dose
- 4 j/kg subsequent doses
- max of 4 doses
- 2-minute dosing interval
≥ 8 years
- 120 j, 150 j, 200 j, 200 j
- max of 4 doses
- 2-minute dosing interval
—-Epinephrine——
- 1:1000 IM
- 0.01 mg/kg
- max dose of 0.5mg
- max of 1 dose

40
Q

Opioid Toxicity - Contraindications

A
  • —Naloxone—-
  • Allergy or sensitivity to naloxone
  • Uncorrected hypoglycemia
41
Q

Supraglottic Airway - conditions

A

Patient must be in cardiac arrest

42
Q

Foreign Body Airway Obstruction Cardiac Arrest - treatment

A

——CPR——-
- Immediately
—-Manual Defib—–
≥ 30 day old to < 8 years
- 2 j/kg initial dose
- max of 1 dose
≥ 8 years
- 120 j
- max of 1 dose

43
Q

Hypoglycemia - contraindications

A
  • —Dextrose—-
  • Allergy or sensitivity
  • —Glucagon—-
  • allergy or sensitivity
  • pheochromocytoma
44
Q

Suspected Adrenal crisis - conditions

A

—-Hydrocortisone—-
- Paramedics are presented with hydrocortisone for the identified patient
AND
- age-related hypoglycemia
OR
- GI symptoms (vomiting, diarrhea, abdominal pain)
OR
- Syncope
OR
- Temperature ≥ 38C or suspected/history of fever
OR
- age-related tachycardia
OR
- age-related hypotension

45
Q

Moderate to severe Allergic reaction - Treatment

A

—-Epi—-
- 0.01 mg / kg
- max of 0.5mg
- 5-minute dosing interval
- Max of 2 doses
—-Diphenhydramine—-
≥25 kg to <50kg
- 25 mg IV or IM
- Max of 1 dose
≥ 50kg
- 50 mg IV or IM
- Max of 1 dose

46
Q

Bronchoconstriction - Indications

A

Respiratory distress AND suspected bronchoconstriction

47
Q

Moderate to severe Allergic reaction - Indications

A

Exposure to a probable allergen
OR
Signs and symptoms of a moderate to severe allergic reaction (including anaphylaxis)

48
Q

Croup - Treatment

A 
----Epi----
< 1 year and < 5kg
- 0.5mg NEB
- max of 1 dose
< 1 year ≥ 5 kg
- 2.5 mg NEB
- max of 1 dose
≥ 1 year to < 8 years
- 5 mg NEB
- max of 1 dose
49
Q

Opioid Toxicity - Conditions

A
  • —Naloxone—-
  • ≥ 12 years old
  • Altered
  • RR < 10 breaths/min
50
Q

Supraglottic Airway - treatment

A
  • max of 2 insertion attempts
51
Q

Bronchoconstriction - treatment

A 
----Salbutamol----
< 25kg
- 600 mcg MDI (6 puffs every 4 breaths)
OR
- 2.5 mg NEB
- 5 - 15 minute dosing interval
- Max # of doses is 3
≥ 25kg
- 800mcg MDI (8 puffs every 4 breaths)
OR
- 5 mg NEB
- 5 - 15 minute dosing interval
- Max # of doses is 3
----Epinephrine----
- 0.01 mg / kg IM
- Max dose of 0.5 mg
- Max # of doses is 1
52
Q

Suspected Adrenal crisis - contraindications

A
  • —Hydrocortisone—-

- Allergy or sensitivity to hydrocortisone

53
Q

Analgesia - Indications

A

Pain

54
Q

Cardiac Ischemia - contraindications

A
  • —ASA—-
  • Allergy
  • Asthma, no prior use of ASA
  • Bleeding
  • CVA (TBI) in the last 24 hours
  • —Nitro—-
  • Right ventricular MI
  • Allergy
  • SBP drops 1/3 or more of its initial value after nitro administered
  • Phosphodiesterase inhibitor use within 48 hours
55
Q

Trauma Cardiac Arrest - Contraindications

A

——CPR——-
- Obviously dead
- DNR
—-Manual Defib—–
Rhythms other than VF or pulseless VT
—-Trauma TOR—-
- < 16 years old
- Defib delivered
- Monitored HR > 0 and closest ED < 30 minutes away

56
Q

Hypothermic Cardiac Arrest - conditions

A
  • —–CPR——-
  • Altered LOA
  • Performed in 2-minute intervals
    - —Manual Defib—–
  • ≥ 30 days old
  • Altered LOA
  • VF or pulseless VT
57
Q

Croup - Indications

A 
Severe respiratory distress
AND
Stridor at rest
AND
Current Hx of URTI
AND Barking cough or recent Hx of barking cough
58
Q

Medical Cardiac arrest - Conditions

A
  • —–CPR——-
  • Altered LOA
  • Performed in 2-minute intervals
  • —Manual Defib—–
  • ≥ 30 days old
  • Altered LOA
  • VF or pulseless VT
  • –Epinephrine—-
  • Altered LOA
  • Anaphylaxis suspected as the causative event
  • —Medical TOR—-
  • ≥ 18 years old
  • Altered LOA
  • Arrest not witnessed by EMS -AND- No ROSC -AND- No defib delivered
59
Q

Nausea / vomiting - treatment

A 
----Dimenhydrinate----
≥ 25kg to < 50kg
- 25mg IV/IM
- max of 1 dose
≥ 50kg
- 50mg IV/IM
- max of 1 dose
60
Q

Acute Cardiogenic Pulmonary Edema - Nitro conditions

A
  • ≥ 18 years
  • HR 60-159 bpm
  • SBP normotension
61
Q

Return of spontaneous circulation - conditions

A
  • —0.9% NaCl Fluid Bolus—-
  • ≥ 2 years
  • SBP - hypotension
  • chest auscultation is clear
62
Q

Opioid Toxicity - Indications

A 
Altered LOC
AND
Respiratory depression
AND
Inability to adequately ventilate
AND
Suspected Opioid overdose
63
Q

Analgesia - What condition requires Ketorolac as the elective drug?

A

Renal colic

64
Q

Analgesia - Conditions

A
  • —Acetaminophen—-
  • ≥ 12 years old
  • Unaltered
  • —Ibuprofen—-
  • ≥ 12 years old
  • Unaltered
  • —Ketorolac—-
  • ≥ 12 years old
  • Unaltered
  • Normotension
  • Restricted to those who are unable to tolerate oral medications
65
Q

Hypoglycemia - Indications

A 
Agitation
-or-
Altered LOA
-or-
Seizure
-or-
Symptoms of stroke
66
Q

Acute Cardiogenic Pulmonary Edema - Nitro contraindications

A
  • Allergy or sensitivity
  • Phosphodiesterase inhibitor use with 48 hours
  • SBP drops by 1/3 or more of initial value after nitro administered
67
Q

Hypothermic Cardiac Arrest - treatment

A

——CPR——-
- Immediately
—-Manual Defib—–
≥ 30 day old to < 8 years
- 2 j/kg initial dose
- max of 1 dose
≥ 8 years
- 120 j
- max of 1 dose

68
Q

Trauma Cardiac Arrest - Indications

A

Cardiac arrest secondary to severe blunt or penetrating trauma

69
Q

Hypothermic Cardiac Arrest - contraindications

A

——CPR——-
- Obviously dead
- DNR
—-Manual Defib—–
Rhythms other than VF or pulseless VT

70
Q

Supraglottic Airway - placement confirmation

A
  • ETCO2
  • auscultation
  • chest rise
71
Q

Moderate to severe Allergic reaction - Conditions

A

—-Epinephrine—-
- For anaphylaxis only
—-Diphenhydramine—-
weight is ≥ 25kg

BLS and Medical Directives (2 decks)

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