Mid Term REVIEW Flashcards
What is required for US to wear during any medication administration??
gloves!!
if NEB, mask too!
What are the SIX rights of drug administration??
RIGHT pt
RIGHT drug
RIGHT dose
RIGHT route
RIGHT time
RIGHT documentation
What considered hypotensive in the ALS?
<90mmHg SBP
What is considered NORMOtensive in the ALS?
> =100mmHg SBP
What are indications of the IV therapy directive?
Actual or potential need for IV meds or fluid therapy
What are conditions for IV cannulation?
> = 2 yrs old!
What are the conditions 0.9% NaCI fluid bolus?
> = 2 years old
SBP- hypotensive
What are contraindications for IV cannulation?
suspected # proximal to the access site !!!
What are contraindications for a fluid bolus?
Fluid overload
What is the TKVO rate for aged >= 2y/o - <12 y/o?
15ml/hr
What is the TKVO rate for aged >12 y/o?
30-60ml/hr
What is the mandatory patch point?
patch to BHP for authorization to administer 0.9% NaCl fluid bolus to hypotensive pts >=2y/o to <12y/o with suspected DKA (diabetic ketoacidosis)
What is the treatment for a fluid bolus in a >=2y/o - <12 y/o ???
20ml/kg
reassess every 100ml
max vol. 2,000ml
What is the treatment for a fluid bolus in a >=12 y/o ???
20ml/kg
reassess every 250ml
max vol. 2,000ml
The maxiumum volume of NaCl is LOWER for pts in ______ & ______ !!!
cardiogenic shock
ROSC
What is a PCP IV assist???
authorizes a PCP to cannulate a peripheral IV at the request and under direct supervision of an ACP!!
unable to deliver medications or fluid therapy
Which sets should be considered for IV access in patients <12 years old ??
micro-drips and or volume control admin sets
What kind of patients could IV bolus be considered for where it does NOT delay transport!!??
pts that do not meet the trauma TOR criteria
Is the fluid rate for IV cannulation ALWAYS 20ml/kg???
NO!!
What is consider TKVO rate?
15ml/hr - >=2y/o to <12years old
30-60ml/hr - >=12 years old
What are macro drip sets??
10, 15, 20 ggts/min
bigger drips!!
What is a MICRO set?
60 gtts/min, more, smaller drops per minute
What are crystalloid solutions?
SALT and sugars in water contains no proteins
remains in the intravascular space for only a short amount of time before diffusing across the capillary walls into the tissue
When do you change an IV bag?
150ml left
What is a colloid solution?
large molecules contains PROTEINS, do not pass through the capillary membrane as readily as crystalloids
What IV lines are PCPs allowed to MONITOR?
- IV TKVO:
<12 y/o w/ a flow rate of 15mL/hr
>= 12 y/o w/ a flow rate of 30-60mL/hr
–> of ANY isotonic crystalloid solution
- IV - fluid replacement:
a) A MAX flow rate infused of up to 2mL/kg/Hr to a max of 200ml/hr
b) thiamine, multivitamins preparations
c) drugs within qualifications
d) potassium chloride for pts OVER or EQUAL to 18y/o to a max of 10mEq in a 250mL bag!!
Use of ESCORTS: When do paramedics need one????
a) blood (or blood product) administration
b) Potassium chloride for people UNDER 18 y/o
c) administering MEDICATION (unless within our qualifications
d) electronic monitoring or uses pressurized IV fluid infuser, pump or central venous line!!!
e) for ANYONE under 2!!!!
What is the difference between a PCP IV autonomous? and PCP IV assist??
Autonomous- Able to practice IV cannulation on OWN!!
Assist- Under direct supervisor and authorization of ACP!!
What are JOULE settings for defibrillation of someone >= 24hrs - <8years!!??
initial dose- 2J/kg
subsequent dose- 4J/kg
interval- 2 mins
What are the ZOLL joule settings for anyone EQUAL OR OVER to 8 years old??
120J, 150J, 200J
What are the LIFEPAK joule settings for anyone EQUAL OR OVER to 8 years old??
200J, 300J, 360J
Medical Cardiac Arrest:
In the following settings, consider very early transport after a MIN of ONE analysis (or shock if required) once egress plan is organized:
- Pregnancy >=20 weeks gestation
- Hypothermia
- Non Opioid OVERDOSE
- AIRWAY obstruction
- Other known reversible cause of the arrest not addressed
Medical Cardiac Arrest:
If a pt is in refractory (persistent) VF or pulseless VT what do we do?
transport pt after THREE consecutive shocks!!
Medical Cardiac Arrest:
What are conditions for CPR?
altered LOA
performed in 2 mins intervals
Medical Cardiac Arrest:
Conditions for manual defib?
> =24 hours
Vtach (pulseless) or Vfib
Medical Cardiac Arrest:
Conditions for EPI?
> =24hours
Altered LOA
Anaphylaxis is suspected as causative event!!
Medical Cardiac Arrest:
Conditions of Medical TOR?
> = 16 years old
Other:
- arrest NOT witnessed by paramedics
AND
- NO ROSC 20 mins into resus
AND
- NO DEFIB delivered
Medical Cardiac Arrest:
What are CONTRAINDICATIONS for CPR?
- OBVI dead as per BLS PCS
- DNR!
Medical Cardiac Arrest:
What are contraindications for MANUAL DEFIB?
not a shockable rhythm!!
- NOT pulseless vtach or vfib
Medical Cardiac Arrest:
What are contraindications for MEDICAL TOR?
known reversible cause of arrest
pregnant >20 weeks
suspected hypothermia
airway obstruction
non-opioid drug OD
Medical Cardiac Arrest:
What are contraindications for EPI?
ax or sensitivity
What is the CPR rate for adults, children and infants??
Adult- 30:2
Children- 15:2
Infant- 15:2
Is there a limit of how many shocks we are able to deliver as PCP’s??
NO. Unlimited.
If I have an 7y/o pt, how many J should I defibrillate him with? (FIRST shock) !!
(age x2 ) + 10
= 24kg
2J/KG
48 J!!! for first shock
After 20 MINS of resuscitation on scene what do you do? (NO ROSC)
Patch for a medical TOR if they qualify-
if they DON’T then transport to nearest hospital continuing
What are signs of ROSC?
Sudden increase in ETCO2
Spontaneous respirations
Palpable pulses
Change in colour
Spontaneous movement
If you obtain a ROSC what are some things you need to do?
Do a complete assessment of C-A-B
12 lead ECG
Full set of vitals
Continually reassess and treat findings
What is the four steps after obtaining ROSC we need to do? (hint- ABCD)
A— advanced AIRWAY if needed
B— BREATHING!!!provide optimal ventilation and use waveform capnography; target Etco2 of 35 to 40 mm Hg and optimal oxygenation with a target O2 saturation of 94% to 98%.
C— CIRCULATION!!provide optimal perfusion with a target systolic blood pressure of greater than 90 mm Hg; treat hypotension with IV crystalloids as needed; Do a 12-lead ECG and look for signs of ST elevation. Findings should be communicated to the receiving facility.
D— consider raising the head of the bed by 30 degrees.
What do you do if the pt re arrests en route to the hospital??
- RESUME CPR IMMEDIATELY
- pull over
- immediately interpret rhythm
- treat accordingly (shock or no shock)
- continue to transport to the ER
- keep running the arrest en route!!
- can defibrillate while transporting:)) but should be pulled over
What are the SEVEN things that apply as life saving measures when talking about a DNR?
- chest compressions
- defibrillation
- artificial ventilation
- insertion of OPA, NPA or SGA
- endotracheal intubation
- transcutaneous pacing
- advanced resus drugs
If someone has a DNR what is our treatment for them as they die?
any action or service that is provided for a therapeutic, preventative, palliative, diagnostic, cosmetic or other health related purpose and includes a course of treatment or plan a treatment
What makes a VALID DNR??
Pre-printed serial number, that has been completed i FULL with the follow info:
- Patients NAME printed
- A check box that identifies:
1. A current treatment plan exists that reflects the
pt’s expressed wish to not include CPR in treatment
2. The physicians opinion that CPR will NOT
benefit the pt and NOT part of the plan
- SIGNATURE and name printed from Medical Doctor (M.D), Registered Nurse Practitioner (R.N.P), or RNP (extended class)
- The DATE!!!!!!!!
A VALID DNR confirmation form may be fully completed original, or a copy of fully completed original, T or F?
TRUEEEE :))
When inserting an SGA what happens to compressions and ventilation??
They become ASYNCHRONOUS
What is the ventilation rate on its own?
1 breath every 6 secs
What happens to compressions when an SGA has been inserted??
go for 2 mins straight!! no stopping for breaths
What are the two SGAs we use?
I-gel and king LTs
What are INDICATIONS for using an SGA’s?
need for ventilatory assistance or airway control
AND
other airway management is ineffective
what are CONDITIONS for SGAs?
absent gag reflex!
What are the contraindications to SGAs?
airway obstructed by a foreign object
know esophageal disease (varices)
trauma to the oropharynx
caustic ingestion
What is the MAX amount of attempts we have on each pt to insert an SGA?
2
What are the primary methods of confirmation of SGA placement according to the ALS PCS?
ETCO2 (waveform capnography)
What are the secondary methods of confirmation of SGA placement according to the ALS PCS?
ETCO2 (the colour changing device, not waveform)
Auscultation
Chest rise
According the BLS deceased patient standard what defines a deceased patient???
- obvious dead
- medical certificate of death
- VSA with DNR confirmation form
- VSA with TOR from BHP
- VSA with withhold of resus from BHP
According the BLS deceased patient standard what does expected death mean?
imminently anticipated generally as a result of a progressive end stage terminal illness
According the BLS deceased patient standard what is consider OBVIOUSLY DEAD?
- decaptitation, transection, visible decomposition, putrefaction or
- absence of vital signs and
- grossly charred body
- gross rigor mortis
- dependent lividity
- an open head or torso wound with gross outpouring of cranial or visceral contents
According the BLS deceased patient standard, what is a palliative care team?
a team of people that care for a terminally ill patient
According the BLS deceased patient standard, what is an unexpected death?
was not imminently anticipated (trauma, environmental, accidental, apparently natural deaths that are sudden
According the BLS deceased patient standard, what should the medic do in cases of ALL death??
- confirm pt is actually dead
- ensure dignity and respect to pt
- consider supportive care for family
- notify police if suspected foul play
- follow all directions given by coroner
- if TOR happens enroute to hospital, notify CACC and continue enroute! (unless otherwise advised)
According the BLS deceased patient standard, who is allowed to stay with a deceased patient in an UNEXPECTED DEATH ?
paramedics
police
coroner or someone delegated by the coroner
we can leave as soon as documentation is complete if police take over scene!
Even if WE see the death as UNEXPECTED, it is always a coroners investigation, T or F??
FALSE GIRL.
although the death may be viewed as unexpected from the perspective of the person reporting the death, this does NOT necessarily imply that the death requires investigation by a coroner!
According the BLS deceased patient standard, in the case of an EXPECTED death…. what should the paramedic do?
ADVISE CACC
request a responsible person, if present ask them to notify the pts primary care practitioner or a member of their palliative care team, if not CACC will !!!
Only leave pt if you deem a responsible person present
CACC will notify PD or coroner if primary care practitioner or a member of their palliative care team is UNABLE to be there
What are conditions to get a MEDICAL TOR?
over or equal to 16 yrs of age
LOA - altered, obviously!!
Arrest NOT witnessed by medics
AND
No defibs given
AND
No ROSC after 20 mins of resus
What are contraindications of MEDICAL TORS?
hypothermia
known reversible cause not addressed
pregnant over 20 wks gestation
airway obstruction
non opioid OD ot toxicity
What are the conditions for a TRAUMA TOR?
> = 16 years
LOA- altered
HR- 0
RR- 0
no palpable pulses AND
no defibs given, asystole AND
no signs of life at ANY time OR
signs of life BUT transport time is >=30mins OR
PEA with transport time >= 30 mins!!!
What are contraindications of trauma TORS?
<16 years old
defibs given
ANY SIGNS OF LIFE
AND
PEA and closest ED is <30 mins
OR
head/neck/torso penetrating trauma and TRAUMA ED is <30 mins
What is the normal ETCO2 values?
35-45 mmHg
If the ETCO2 is less than 35 mmHg, how would the pt be presenting in terms of resps?
hyperventilation/ hypocapnia (low etco2)
If the ETCO2 is more than 45mmHg, how would the pt be presenting in terms of resps?
HYPOventilation/ hypercapnia (high ETCO2)
How does the waveform begin and end in terms of each BREATH?
begins with BEFORE EXHALATION
ends with INSPIRATION
What is PHASE 1 of the ETCO2 waveform? (A-B)
inspiratory baseline (low CO2 because it is inspired air!!)
What is phase 2 in the ETCO2 waveform? (B-C)
exhalation upstroke (dead space gas mixes with lung gas!!)
What is phase 3 of the ETCO2 waveform? (C-D)
continuation of exhalation (gas is all alveolar now, rich in CO2!!)
What value is D in the ETCO2 waveform???
the end tidal VALUE (peak concentration!!!!)
What is phase 4 of the ETCO2 waveform? (D-E)
start of a new inspiration!! back to phase 1
What happens to ETCO2 when performing CPR?
should be lower at about 10-15mmhg
What happens to the ETCO2 when you get a ROSC??
SPIKES UP high!!
What does bronchospasm waveform look like?
SHARK fin!!
If your pt ETCO2 is less than 10 mmhg during a cardiac arrest what should concern you?
that pt is probably not going to survive!!
You are doing great keep going!!!
You are so smart, killing it!!
What is the syringe formula??
Desired dose
——————– X vol. on HAND!!
dose on hand
What is the IV infusion formula??
VOL to be infused (mL)
————————— X drop factor!! (gtts/min)
time to be infused (mins)
