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BSO EMS Protocols > Medical Emergencies > Flashcards

Medical Emergencies Flashcards

1
Q

Allergic Reaction

Information:

A

S/S: Allergic reactions are characterized by any of the following: urticaria, mild respiratory distress, difficulty swallowing, or swelling of the tongue and/or face.

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2
Q

Allergic Reaction

Adult: BLS Standard Requirements

A
  • Determine the source of the allergic reaction (insect, food, medications, etc.).
  • Assist patient with Epi Pen administration under the following circumstances:
  • Patient is prescribed the Epi Pen
  • Patient presents with respiratory distress and/or hypotension (shock)
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3
Q

Allergic Reaction

Adult: Mild

A

BENADRYL: 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage.

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4
Q

Allergic Reaction

Adult: Moderate

A

FOR MILD AIRWAY SWELLING/ MILD RESPIRATORY DISTRESS/ BRONCHOSPASM/ TONGUE AND/OR FACIAL SWELLING
• EPINEPHRINE: (1:1,000) 0.3mg (0.3mL) IM. May repeat 2x prn in five minute intervals. • Do not administer within 5 minutes of Epi-Pen administration
• BENADRYL: 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage.
• ALBUTEROL: For bronchospasm, 2.5mg via nebulizer, repeat prn.
• Solumedrol 125mg IV/IO/IM one dose

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5
Q

Allergic Reaction

Adult: Severe- Anaphylactic Shock

A

CHARACTERIZED BY THE SIGNS AND SYMPTOMS OF AN ALLERGIC REACTION, IN ADDITION TO THE LOSS OF A RADIAL PULSE AND/OR SBP OF LESS THAN 100mmHg
• Establish a second IV/IO.
• Push Dose EPINEPHRINE:
• NORMAL SALINE: 1L. Assess lung sounds and BP every 500 mL.
• Administer BENADRYL, SOLUMEDROL, and ALBUTEROL as noted above.

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6
Q

Altered Mental Status

Information

A

Consider the possible causes: AEIOU-TIPS, meningitis, and/or dehydration.

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7
Q

Altered Mental Status
Adult and Pediatric
Mental Status (AVPU)

A
  • Alert: to person, place, time, and event (AAOX4)
  • Verbal: responds only to verbal stimuli
  • Pain: responds only to painful stimuli
  • Unresponsive
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8
Q

Altered Mental Status
Adult and Pediatric
BLS Standard Requirements

A
  • Check and record BGL, if less than 60 mg/dL, follow the hypoglycemia protocol.
  • Identify possible causes: stroke, seizures, diabetic problem, drugs, EtOH, CO poisoning.
  • Place unresponsive patients in the recovery position (if no suspected spinal cord injury), and suction as needed.
  • Paramedic assist: Vitals, glucose, IV, ECG.
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9
Q

Altered Mental Status

AEIOU-TIPS

A 
A- Alcohol
E- Epilepsy
I- Insulin
O- Overdose
U- Uremia (Kidney Failure)

T- Trauma
I- Infection
P- Psychiatric
S- Stroke

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10
Q

Diabetic Emergencies

Symptoms of DKA include:

A

nausea/vomiting, abdominal pain, general weakness, Kussmaul Respirations, AMS, hypotension, or tachycardia with an acetone smell on the patient’s breath.

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11
Q

Diabetic Emergencies

Adult- If Blood Glucose is Less Than 60 mg/dl

A
  • Check and record BGL, if less than 60 mg/dL, and patient is able to protect their airway/swallow, give oral glucose. Place unresponsive patients in the recovery position (if no suspected spinal injury), and suction as needed.
  • ORAL GLUCOSE: (15g) May be given if patient is able to swallow and follow commands. Repeat as needed for blood glucose less than 60mg/dL.
  • D10: 100 mL IV, retest glucose. If patient remains less than 60 mg/dL, administer another 100 mL of D10. Repeat as needed for blood glucose less than 60.
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12
Q

Diabetic Emergencies

Adult- If unable to Obtain IV Acciss

A

Perform Proximal Humerus IO and administer D10: 100mL, retest glucose. If patient remains less than 60 mg/dL administer another 100 mL of D10. Repeat as needed for blood glucose less than 60.

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13
Q

Diabetic Emergencies

Adult- IF BLOOD GLUCOSE LEVEL IS GREATER THAN 300 mg/dL WITH S/S OF DKA

A
  • NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
  • ZOFRAN: 4mg IM or slow IV/IO/PO over 2 minutes for nausea/vomiting.
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14
Q

Diabetic Emergencies

Patients Taking Oral Hypoglycemic medications.

A

Patients taking oral hypoglycemic mediations should be transported to the ED regardless of post treatment glucose levels. (i.e. Glyburide, Glimepiride, and Glipizide)

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15
Q

Diabetic Emergencies

If Unable to Provide Standard Hypoglycemia Treatment.

A
  • GLUCAGON: 1mg IM if available.
  • Glucagon may cause nausea/vomiting.
  • ZOFRAN: 4mg IV/IM/PO for nausea/vomiting.
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16
Q

Diabetic Emergencies

Pediatric- If Blood Glucose Levels are Less Than 60 mg/dl

A
  • ORAL GLUCOSE: (15g) may be given to conscious patients with an intact gag reflex. Not recommended for patients less than 2 years old.
  • D10: 5ml/kg IV/IO (max of 100 mL), retest glucose. May repeat 1x prn. SEE PEDIATRIC MEDICATION TOOL
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17
Q

Diabetic Emergencies

Pediatric- If Blood Glucose Levels are Greater Than 300 mg/dl with S/S of DKA

A
  • NORMAL SALINE: 20mL/kg IV/IO. Assess lung sounds and blood pressure often.
  • ZOFRAN: 0.1mg/kg IM or slow IV/IO/PO for nausea/vomiting per the PEDIATRIC MEDICATION TOOL.
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18
Q

Diabetic Emergencies

Pediatric- If Unable to Provide the Standard Hypoglycemia Treatment

A
  • GLUCAGON: Less than 20kg (0.5mg IM ), greater than 20kg (1mg IM ) if available.
  • Glucagon may cause nausea/vomiting.
  • ZOFRAN: 0.1mg/kg IM or slow IV/IO/PO for nausea/vomiting per the pediatric medication tool.
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19
Q

Dystonic Reaction

Information

A

Dystonic reactions are characterized by intermittent spasmodic or sustained involuntary contractions of muscles in the face, neck, trunk, pelvis, extremities, and even the larynx. Typically, antipsychotic (Haldol, Lithium, etc.), antiemetic (Compazine, Reglan, etc.) or antidepressant (Prozac, Paxil etc.) medications are responsible. A dystonic reaction can occur immediately or be delayed for hours to days.

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20
Q

Dystonic Reaction

Adult

A

BENADRYL : 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage.

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21
Q

Dystonic Reaction

Pediatric

A

BENADRYL: 1mg/kg IV/IO/IM SEE PEDIATRIC MEDICATION

Max total dose 50mg. Administer over 2 minutes for IV/IO usage. BENADRYL IM: SEE PEDIATRIC MEDICATION

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22
Q

Fluid Resuscitation/ Dehydration

Information

A

For dehydration secondary to: prolonged vomiting and/or diarrhea, DKA, heat illness, pneumonia, non- traumatic bleeding (vaginal or GI), suspected Rhabdomyolysis, Paramedic discretion, or hypotension secondary to overdose/poisoning.

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23
Q

Fluid Resuscitation/ Dehydration

Adult

A

NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
* Precaution for patients with history of CHF and /or Renal Failure
• Consider sepsis for all dehydrated patients.
• Patients with a history of renal failure/dialysis or CHF are at increased risk for fluid overload. Monitor these patients carefully.

24
Q

Fluid Resuscitation/ Dehydration

Pediatric

A

NORMAL SALINE: 20mL/kg bolus IV/IO, may repeat 2x prn for continued hypotension. Assess lung sounds and blood pressure often.

25
Q

Hyperkalemia

Information

A

Consider hyperkalemia in patients with a history of renal failure/dialysis who are pre- dialysis and present with: general weakness, hypotension, paresthesia, tall peaked T-waves (most prominent early sign), or arrhythmias (sine wave, wide complex QRS, V-Tach (with rate lower than 120 bpm), severe bradycardia, or high degree AV blocks)

26
Q

Hyperkalemia

Adult (for patients presenting with arrhythmias indicative of hyperkalemia)

A

• CALCIUM CHLORIDE: 1 gram, slow IV/IO over 2 minutes.
• ALBUTEROL: 10 mg via nebulizer, (4 * 2.5mg) continuous treatments.
* If patient is intubated, administer Albuterol via in line nebulization.
• SODIUM BICARBONATE: 50 mEq, slow IV/IO over 2 minutes.

IF PATIENT IS HYPOTENSIVE
Administer NORMAL SALINE: 500mL, may repeat 1x prn. Check lung sounds after each fluid bolus.

27
Q

Hyperkalemia

Pediatric ( for patients presenting with arrhythmias indicative of hyperkalemia)

A
  • CALCIUM CHLORIDE: 20 mg/kg, slow IV/IO over 2 minutes. (AS PER PEDS MED TOOL)
  • ALBUTEROL: 10mg via nebulizer, (4 * 2.5mg) continuous treatments.
  • Sodium Bicarbonate: SEE PEDIATRIC MEDICATION TOOL
28
Q

Nausea/ Vomiting

Information

A

Consider differential diagnosis: MI, Stroke, Diabetic, Head Injury, heat illness, G.I., etc.
• Perform 12 LEAD EKG
• Consider 15 LEAD EKG

29
Q

Nausea/ Vomiting

Adult

A

• NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
• ZOFRAN: 4mg IM or slow IV/IO/PO. Can be administered prn
ZOFRAN ADMINISTRATION:
If IV access is unobtainable, it is acceptable to administer the IV formulation of Zofran via the PO route to the patient.

30
Q

Nausea/ Vomiting

Pediatric

A

• NORMAL SALINE: 20mL/kg bolus. Assess lung sounds often. May repeat 2x prn
• ZOFRAN: 0.1mg/kg IM or slow IV/IO/PO
• Can be administered prn. Max dose 4mg.
ZOFRAN ADMINISTRATION:
If IV access is unobtainable, it is acceptable to administer the IV formulation of Zofran via the PO route to the patient.

31
Q

Respiratory Distress
Information

AUTO-PEEP

A

Respiratory Distress
Patients with COPD & Asthma have prolonged exhalation secondary to bronchospasm, which causes air trapping resulting in hypercapnia (high levels of CO2). Therefore, EtCO2 guidelines should be disregarded for these patients, as it is more important to maintain SpO2 levels at 90%. Trying to maintain normal EtCO2 levels in these patients puts them at risk for developing Auto PEEP, which can result in a pneumothorax or hypotension. Auto PEEP occurs during assisted ventilations when air goes in before the patient is allowed to fully exhale. This causes the lungs to expand like a balloon, putting the patient at risk for a pneumothorax. In addition, increasing intrathoracic pressure decreases venous return to the heart which can result in hypotension. COPD or Asthma patients who develop poor bag compliance or hypotension during positive pressure ventilations should have positive pressure ventilations discontinued (if intubated, disconnect BVM from ETT) for 20- 40 seconds (10-20 seconds for pediatrics) to allow the patient to completely exhale before resuming positive pressure ventilations.

32
Q

Respiratory Distress

C-Pap

A

Immediately remove CPAP for the asthmatic patient whose condition worsens after applying the CPAP

33
Q

Respiratory Distress

BLS care

A
  • Position of comfort is preferred.
  • Apply oxygen, maintain SpO2at 95% or 90% for COPD and asthma patients “blow by” Oxygen for pediatrics.
  • Adult: Assist ventilations with a BVM and an airway adjunct (NPA/OPA) for a respiratory rate of less than 10 or greater than 29 with shallow respirations. If ventilation is required for more than 2 minutes and the patient is unconscious with no gag reflex, insert an advanced airway.
  • Consider differential diagnosis (i.e. CHF, allergic reaction, etc.).
  • Monitor EtCO2
  • CPAP (10 cm H2O) is indicated for moderate/severe respiratory distress, including: COPD, asthma and pneumonia patients.
  • Contraindicated for patients without spontaneous respirations
  • Contraindicated for patients with a decreased LOC (lethargic)
  • Relative Contraindication for SBP< 100
34
Q

Respiratory Distress
Adult
BRONCHOSPASM SECONDARY TO COPD

A
  • ALBUTEROL: 2.5mg via nebulizer Repeat prn for bronchospasm. ( Pure B Agonist)
  • SOLUMEDROL:125mgIV/IM one dose
  • CPAP (May be administered simultaneously)
35
Q

Respiratory Distress
Pediatric
ASTHMA/ BRONCHOSPASM:

A

1ST BUNDLE - ASTHMA
• Oxygenate and/or ventilate prn to maintain SpO2 at 95% and EtCO2 levels between 35-45 mmHg. Treatment for asthma patients is based on maintaining an SpO2of 90%.
• ALBUTEROL: 2.5mg via nebulizer. Repeat prn for bronchospasm.
• Solumedrol: 2mg/kg over 2 minutes SEE PEDIATRIC MEDICATION TOOL

IF BRONCHOSPASM ( ASTHMA) WORSENS OR DOESN’T IMPROVE AFTER ABOVE TREATMENT, DO 2ND BUNDLE

2nd BUNDLE - ASTHMA
• Oxygenate and/or ventilate prn to maintain SpO2 at 95% and EtCO2 levels between 35-45 mmHg. Treatment for asthma patients is based on maintaining an SpO2of 90%.
• Assist ventilations via BVM prn with appropriate airway adjunct.
• ALBUTEROL: 2.5mg via nebulizer. Repeat prn for bronchospasm.
• EPINEPHRINE: (1:1,000) 0.01mg/kg (0.01mL/kg) IM. Max single dose 0.3mg.
May repeat 2x prn, in five minute intervals.
• MAGNESIUM SULFATE: SEE PEDIATRIC MEDICATION TOOL
• Solumedrol: 2mg/kg over 2 minutes SEE PEDIATRIC MEDICATION TOOL

36
Q

Respiratory Distress

Pediatric (Croup and Epiglottis)

A

FOR CROUP/EPIGLOTTITIS
• EPINEPHRINE: (1:1,000) 3mL (3mg total) delivered via nebulizer.
• (Yes, 3ml is the dose!)
• DO NOT STRESS THE PATIENT!
• DO NOT ATTEMPT INTUBATION OR PLACE AN OPA OR NPA. VENTILATE VIA BVM AS NEEDED.
• Expedite transport to closest approved Pediatric EMERGENCY DEPARTMENT.

Croup
• Usually less than 3 y/o
• “Sick” for a couple of days
• Low grade fever
• Not “toxic” appearing
Epiglottitis
• Usually 3-6 y/o
• Sudden Onset
• Tripod Position
• High grade fever
• Poor general impression
• Drooling
*** Both will have stridor and/or a “barky” cough.
37
Q

Seizures
Information
Possible Causes

A

Consider the possible causes: meningitis, head trauma, hemorrhagic stroke, diabetic, drugs, alcohol, poisoning, fever, and eclampsia.

38
Q

Seizures

Adult

A

IF ACTIVELY SEIZING
VERSED: 5 mg IV/IO/IN/IM. May repeat 1x prn. *Max total dose of VERSED 10 mg IV/IO/IN/IM
• Contraindication - Hypotension
• Precaution - Monitor for respiratory depression

FOR STATUS EPILEPTICUS:
* If no effect with Versed after 2 doses then add
Ketamine: 100 mg IV/IO/IM -IF THE PATIENT NEEDS INTUBATION GIVE ADDITIONAL 100 MG (200MG AS PER FACILITATED INTUBATION DOSE)
*be prepared to manage the airway!

39
Q

Seizures

Pediatric

A

• Actively cool the patient by removing the clothing and fanning, being careful not to induce shivering.
• DO NOT cover patient with a wet towel/sheet.
• DO NOT apply ice/cold packs to the patient’s body.
IF NOT ACTIVELY SEIZING AND FEBRILE (ABLE TO TOLERATE PO) ACETAMINOPHEN/ TYLENOL
SUSPENSION:
-15MG/KG PO single dose:
IF ACTIVELY SEIZING, FEBRILE OR NON-FEBRILE
1. VERSED SEE PEDIATRIC MED TOOL (may repeat 1x prn)
2. KETAMINE: SEE PEDIATRIC MED TOOL

40
Q

Sepsis

Information

A

Recognition and treatment of sepsis is the key to the successful management of sepsis. It is imperative that once sepsis is identified, that the patient is kept from becoming hypotensive, as an episode of hypotension significantly increases morbidity and mortality. Sepsis is most common in the elderly, very young, patients confined to bed (bed sores, abscesses, cellulitis, or immobile) and patients with a recent history of surgery or invasive medical procedure.

41
Q

Sepsis

Sources and Signs

A
  • FEVER: Temp>100.4or<96.8
  • Urinary Frequency, Dysuria, Cloudy or Bloody Urine
  • Cough
  • Skin Wounds
  • Abdominal Pain
  • Vomiting/Diarrhea
  • AMS
  • Medical Equipment:: Dialysis ports/fistulas, Foley catheters. Nephrostomy tubes, Biliary tubes,
  • Hx of IVDA
42
Q

Sepsis Alert Criteria

A
  • Adult
  • AND
  • Suspected or documented infection
  • AND
  • At least 2/3 criteria: (QSOFA)
  • Hypotension SBP < 100
  • Altered Mental status
  • Tachypnea: respirations greater than 22 and/or ETCO2 <25
43
Q

Sepsis
Adult

SEPSIS TREATMENT

A
  • Call a Sepsis Alert and limit on - scene time
  • Monitor EtCO2
  • BGL
  • Maintain SpO2 at 95% or 90% for COPD and asthma patients.
  • NORMAL SALINE: 1L, regardless of blood pressure. Assess lung sounds every 500mL.
  • If patient develops rales OR is unable to tolerate the fluid challenge:

For Septic Shock NOT RESPONDING TO FLUIDS
• Push Dose EPINEPHRINE

Patients with a history of renal failure or CHF may not tolerate fluids. These patients should be monitored carefully for the development of rales.

44
Q

Sepsis

Pediatric

A

• NORMAL SALINE: 20mL/kg IV/IO bolus. Assess lung sounds and blood pressure often. May Repeat 2X

45
Q

Stroke

Information

A

CRITERIA FOR STROKE ALERT: RACE 1 OR GREATER AND ONSET/LAST KNOWN WELL LESS THAN 24 HOURS

R.A.C.E. (Risk Assessment of Cerebrovascular Events) IF ANY SCORE greater than a zero is found during the assessment, call a stroke alert, expedite transport, notify the hospital ASAP and advise that this is a “Stroke Alert” and include the R.A.C.E exam score. Determine to the best of your ability the exact time of stroke onset or the last known well time of the patient. Obtain witness information to include: names, phone numbers, and medications. Then relay the information to the ED. Onset of Stroke symptoms must be within 24 hours to call a Stroke Alert. RACE predicts the probability of LVO

46
Q

Stroke

Criteria for Stroke Alert

A

A. RACE 1 or greater within 24 hours
B. Slurred Speech present and clinically suspected to be related to central brain etiology within 24 hours
C. Severe sudden onset Headache concerning for SAH ( Thunder Clap and worst headache of their life)
D. Sudden onset of AMS or dizziness suspected to be related to central brain etiology
Consider differential diagnosis: Must check BGL, Inspect for Head Trauma, Bell’s Palsy, etc..

47
Q

Stroke

Adult

A
  • Transport patient in a 30 degrees elevation position (the supine position may be considered if the patient will tolerate).
  • 2 Lpm NC for O2 sat < 95%. Increase oxygen therapy as needed.
  • An 18g catheter in the antecubital is preferred.
  • Normal Saline: 500mL bolus (Regardless of BP).
  • All Stroke Alerts shall be transported to a Comprehensive Stroke Center.
  • The time of onset is determined to be the time that the patient was last seen to be normal (without stroke signs and symptoms).
  • Any patient who awakens with stroke symptoms or when it is not able to be determined when stroke symptoms began shall be transported to Comprehensive Stroke Center as a stroke alert.
48
Q

Stroke

Pediatric

A

DEFINITIONS OF A PEDIATRIC STROKE (Less than 18 years of age)
• All Pediatric Stroke Alerts shall be transported to a Pediatric Comprehensive ED/Comprehensive Stroke Center ( BHMC or JDCH)
• Transport patient in a 30 degrees elevation position (the supine position may be considered if the patient will tolerate).
• 2 Lpm NC for O2 sat <95%. Increase oxygen therapy as needed.
• An appropriately sized IV catheter. Antecubital preferred
• Normal Saline: 20 mL/kg bolus (max 500 mL) (Regardless of BP).
• Transport All suspected Pediatric Strokes to Pediatric Comprehensive Stroke Center.
• The time of onset is determined to be the time that the patient was last seen to be normal (without stroke signs and symptoms).
• Communication TO HOSPITAL:
1. LKW
2. RACE SCORE and Neurologic Deficits
3. Is patient on Coumadin, Xarelto, Eliquis, or Pradaxa
4. Blood Pressure
5. Blood Sugar

49
Q

Allergic Reaction

Pediatric: Mild

A

Benadryl: 1mg/kg IV/IO or IM (See Pediatric Medication if unable to obtain IV access). Max total dose 50mg. Administer over 2 minutes for IV/IO usage.

50
Q

Allergic Reaction

Pediatric: Moderate

A

(airway swelling, respiratory distress, Bronchospasm, tongue and/ or Facial Swelling)

  • Epinephrine IM: (1:1000) 0.01mg/kg (0.01 ml/ kg). Max single dose 0.3mg. May repeat 2x prn, in 5 minute intervals. (See Pediatric Medication Tool).
  • Benadryl: 1mg/kg IV/IO (diluted) (See Pediatric Medication tool.)
  • Benadryl IM: Do not dilute (see pediatric medication tool)
  • Albuterol: For bronchospasm, 2.5mg via nebulizer, repeat prn.
  • Solumedrol: 2mg/kg as per Pediatric medication tool
51
Q

Allergic Reaction

Pediatric: Severe - Anaphylactic Shock

A

Characterized by the signs and symptoms of an allergic reaction, in additions to the loss of distal pulses.

  • Establish a second IV/IO but do not delay treatment
  • Push Dose Epinephrine
  • Normal Saline: 20ml / kg bolus IV/ IO, may repeat 2x prn for hypotension. Check lung sounds often
  • Administer Benadryl, Solumedrol, and Albuterol as noted above.
52
Q

Criteria for Hypoglycemia resolution and refusal:

A

Insulin only and no pills, total return to baseline mental status, direct access to food, family member to monitor.

53
Q

Consider: Hypoglycemia in many cases is a result of

A

severe systemic illness

54
Q

Diabetic Emergencies:

Symptoms of hypoglycemia

A

AMS, Focal Neuro Def, Abnormal Breathing, Diaphoresis

55
Q

Respiratory Distress
Adult
BRONCHOSPASM SECONDARY TO ASTHMA

A

-Initial Treatment-1ST BUNDLE
• ALBUTEROL: 2.5mg via nebulizer. Repeat prn for bronchospasm.
• SOLUMEDROL 125 mg IV/IM one dose

FOR SEVERE ASTHMA NOT RESPONDING TO ABOVE TREATMENT
– 2ND BUNDLE
• CPAP (5-10 CM H2O) Remove immediately if symptoms worsen
• ALBUTEROL: 2.5mg via nebulizer. Repeat prn for bronchospasm.
• EPINEPHRINE (1:1,000) 0.3mg IM.
May repeat 2x given EVERY five minutes concurrently with Magnesium
• MAGSULFATE: InfusionProtocol
• SOLUMEDROL 125 mg IV/IM one dose

ADMINISTER IN-LINE NEBULIZED ALBUTEROL TO ALL INTUBATED ASTHMA PATIENTS WITH BRONCHOSPASM.

56
Q

Stroke Alert

• Communication TO HOSPITAL:

A
  1. LKW
  2. RACE SCORE and Neurologic Deficits
  3. Is patient on Coumadin, Xarelto, Eliquis, or Pradaxa
  4. Blood Pressure
  5. Blood Sugar

BSO EMS Protocols (13 decks)

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