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STPP NYS Protocols > Meds per Protocol > Flashcards

Meds per Protocol Flashcards

1
Q

Arrest: PEA/Asystole

A
  • NS 500 ml
  • Epi 1:10,000 1 mg/3-5 min
  • Suspected Acidosis or Hyperkalemia: 50 mEq BiCarb, 1 g CaCl
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2
Q

Arrest: V-Fib/Pulseless V-Tach

A
  • Defib
  • NS 500 ml
  • Epi 1:10,000 1 mg/3-5 min
  • Ami 300 mg/20 ml NS, after 5 min 150 mg more
  • Torsades: 2 g Mag
  • 50 mEq BiCarb, 1 g CaCl

MC: Lido 1.5 mg/kg, Ami drip 150 mg/100ml/10 min

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3
Q

Arrest: ROSC

A
  • 2 IVs
  • Retain SBP > 100 MAP > 65: 2 mcg/min titrated to 20mcg/min if needed Norepi

MC:

  • Ami 150 mg/100 ml/10 min and Lido 1.5 mg/kg for dysrrhythmia
  • Metoprolol 5 mg/5 min up to 4 doses for HTN
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4
Q

Asthma

A
  • Albuterol 2.5 mg/3ml and Ipratropium 0.5 mg/2.5 ml together up to 3 doses (MC for more)
  • 10 mg Dex
  • Epi 1:1,000 0.3 mg IM for severe
  • Mag 2g/100ml/20 min (MC for more)

MC:
-3 mg Epi Neb

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5
Q

Chest Pain

A
  • ASA 324 mg
  • Nitro 0.4 mg SL/5 min w/ SBP > 120 MAP > 90 as needed
  • if SPB < 100, 500 ml bolus NS
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6
Q

Agitated Pt

A

-2.5 mg IV - 5 mg IM (may repeat up to 10 mg) Versed

MC:

  • Additional Versed
  • 2.5-5 mg IV/IM Haldol
  • 250 mg IM loading, 0.5-2 mg/kg IV/IM Ketamine
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7
Q

Ax Rxn

A
  • if SBP < 90 MAP < 60, 500 ml NS
  • 0.3 mg IM Epi 1:1,000 if wheezing/ 5 min as symptoms persist
  • DuoNeb up to x3 for wheezing
  • 50 mg IV/IM Benadryl
  • 10 mg PO/IM/IV Dex
  • if after NS SBP < 100 MAP <65, consider 2-20 mcg/min Norepi

MC:
-1 mg/1000 ml Epi at 5 mcg/min

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8
Q

Brady/Symptomatic Brady

A
  • Atropine 0.5 mg IV/3 min up to 3 mg
  • NS bolus up to 2 L
  • Transcutaneous Pacing
  • Consider 2-20 mcg/min Norepi after NS to get SBP > 100 MAP > 65
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9
Q

Cardiogenic Shock

A

to be used with STEMI confirmed

  • ASA 324 mg
  • 500 ml NS
  • if unstable or pulm edema: 2-20 mcg/min Norepi to get MAP > 65 SBP > 100
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10
Q

COPD/Bronchospasm

A
  • DuoNeb up to x3 (MC for more)
  • Consider 10 mg Dex
  • Consider CPAP

MC:
-2 g/100 ml/10 min Mag

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11
Q

Crush Injury

A

-If 1 ext crushed > 2 hr or 2 ext crushed > 1 hr: 50 mEq BiCarb/30 min, 1 dose 1 min prior to extrication

MC:
-if hyperkalemia w/EKG changes: 1 g/5 min CaCl, repeat in 5 min if no resolution

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12
Q

Eye Injury

A

-Tetracaine 0.5% 2 drops per eye/3 min as needed

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13
Q

Excited Delerium

A
  • 10 mg Versed or 250 mg Ketamine
  • can give another 250 mg Ketamine after either one of those

MC:

  • 2.5-5 mg Haldol
  • 2.5-10 mg more Versed
  • 0.5-2 mg/kg IV or 3-5 mg/kg IM more Ketamine
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14
Q

Hyperglycemia

A

-BGL > 400 mg/dL: 500 ml NS, may repeat once

MC for more

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15
Q

Hyperkalemia

A
  • 500 ml NS
  • Cardiac Arrest/Rhythm changes during RSI: 50 mEq BiCarb, 1 g CaCl if QTc prolong or QRS widening

MC:

  • Albuterol 2.5 mg/3 ml Neb every 10 min
  • The BiCarb and CaCl in Pts that don’t meet standing order criteria
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16
Q

Hypoglycemia

A
  • 15-24 g oral glucose
  • BGL < 60: D10 up to 25 g, can be redosed (MC for more)
  • if no IV, 1 mg IM Glucagon
17
Q

Nausea/Vomiting

A
  • 4 mg Zofran, can repeat in 10 min
  • 25 mg Benadryl for motion sickness

MC:
-Versed

18
Q

Opioid Overdose

A

-2 mg doses IN/IV/IM if hypoventilation or resp arrest

19
Q

Organophosphate Exposure

A
  • Symptomatic Pts: Atropine 2 mg per dose IV / 5 min until secretions dry
  • 5 mg IV/IN/IM Versed for seizures
20
Q

Pain Management

A

MC for More:

  • Morphine 0.05 mg/kg IV or 0.1 mg/kg IM, can repeated up to 10 mg
  • Fentanyl 1-1.5 mcg/kg IN/IV/IM, can be repeated up to 200 mcg

MC:

  • Ketamine 25 mg IV/5min or 50 mg IM OR 0.1-0.3 mg/kg IV
  • Versed IV/IM/IN
  • Ketorolac 20 mg IV or 30-60 mg IM
21
Q

Post-Intubation Management

A
  • Fentanyl 100 mcg IV once then 50 mcg IV/5 min, as needed

- Versed up to 5 mg IV/10 min as needed -can substitute Ketamine up to 100 mg/5 min as needed

22
Q

Procedural Sedation

A
  • Versed 2.5 mg IV or 5 mg IM, can be repeated / 5 min SBP > 100 MAP > 65
  • Fentanyl 1-1.5 mcg/kg IN/IV/IM, can be repeated / 5 min up to 200 mcg

MC:

  • Morphine
  • Ketamine 0.5-2 mg/kg IV or 3.5 mg/kg IM
  • Etomidate 0.1 mg/kg IV ONCE, 0.3 mg/kg for induction
23
Q

Pulmonary Edema

A

-CPAP as needed
-Nitro 0.4 mg SL:
x1/5 min if SBP 120-160
x2/5 min if 160-200
x3/5 min if > 200
-if wheezes, DuoNeb, MC for more albuterol after

24
Q

Seizures

A
  • Versed 5 mg IV/IN/IM, may repeat once (MC for more)

- Mag 4 g IV over 20 min if Pt is pregnant

25
Q

Sepsis

A

-NS so MAP > 65

MC:
-Norepi to help MAP: 2-20 mcg/min to keep MAP > 65 SBP > 100

26
Q

Shock

A
  • NS
  • Norepi 2-20 mcg/min for MAP > 65 SBP > 100

MC:
-Decadron 10 mg PO/IM/IV

27
Q

Stroke

A
  • maintain SBP > 120 MAP > 90
  • if SBP > 220 or DBP > 120, contact MC

MC:
-Metoprolol 5 mg slow IV push

28
Q

STEMI

A
  • ASA 4x81 mg
  • Nitro 0.4 mg SL as needed/5 min (SBP > 120 MAP > 90)
  • Consider NS if SBP < 100

MC:
-Metoprolol 5 mg slow IV (HR > 80 BP > 120 or MAP > 90) up to 4 doses

29
Q

Narrow Complex Tachy

A
  • NS
  • Unstable and Reg: Sedation, synchronized cardioversion starting at 100 J or equivalent biphasic
  • Unstable and Irreg: same but start at 200 J
  • Stable and Reg: Adenosine 6 mg then 12 mg IV (MC for another 12 mg IV)
  • Stable and Irreg: Cardizem 0.25 mg/kg (max 25 mg) IV/2 min, if no change 0.35 mg/kg (max 35 mg) IV/2 min, MC for more if Pt is on Beta blocker, metoprolol 5 mg/2 min IV for both doses instead

MC:
-Ami 150 mg/100 ml NS/10 min (10 ml/min or 3 drops/5 sec using a 10 drop set)

30
Q

Wide Complex Tachy

A
  • Stable: Ami 150 mg/100 ml NS/10 min (3 drops / 5 sec using 10 set)
  • Unstable: Consider sedation, synch. cardioversion starting at 100 J or biphasic equivalent, may repeat up to x3 times total

MC:

  • unsynch. cardioversion
  • Adenosine 6 or 12 mg IV
  • Lido 1.5 mg/kg IV
  • Ami if rhythm converted
  • Mag 2 g IV/10 min (stable) or /2 min (unstable)
31
Q

Trauma

A
  • Compensated: NS 1 L, then 500 ml/hr
  • Decompensated: NS 2 L, then 500 ml/hr

MC:
-Norepi 2-20 mcg/min after fluid bolus (for MAP > 65, SBP > 100)

STPP NYS Protocols (1 decks)

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