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Paramedic Protocols Flashcards

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1
Q

3 Indications for Intubation

A
  1. Cardiac or respiratory arrest
  2. GCS < 8 w/o gag reflex
  3. GCS < 8 respirations < 8/min.
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2
Q

ET tube placement checklist

A
  1. Breath sounds
  2. No gastric sounds
  3. End tidal CO2
  4. Chest rise and good compliance
  5. Positive fogging.
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3
Q

ET tube medications

A
  1. Naloxone
  2. Atropine
  3. Midazolam
  4. Epinephrine
    a. adult- 2 mg (1:1000) q 3-5 in a code.
    b. ped- .1 mg/kg (1:1000) flush w/2ml NS
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4
Q

6 Indications for O2

A
  1. AMS
  2. Respiratory distress
  3. Chest pain
  4. Shock
  5. Abnormal heart rate
  6. Multiple system trauma
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5
Q

O2 delivery

A
  1. Low flow 6L NC
  2. High flow 15L NRB
  3. COPD start at 2L NC. Titrate to effect.
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6
Q

BVM

A
  1. Not breathing
  2. Breathing is too shallow
  3. GCS < 8.
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7
Q

IV

A
  1. Pt. may deteriorate
  2. Saline lock for meds per protocol
  3. EJ if essential and poor access
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8
Q

I/O

A
  1. Critically ill
  2. IV is essential
  3. One attempt, OR
  4. No immediately apparent vein!!!
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9
Q

IV fluid dosage

A
  1. In traumatic arrest or who require fluid replacement:
    a. 2L, or
    b. Systolic BP>100
  2. Fluid challenge: 500ml. Lungs/ BP.
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10
Q

Spinal Immobilization: 7 indications

A
  1. Posterior midline spinal pain or tenderness w/ trauma
  2. Blunt trauma: trauma score <14
  3. Distracting injuries.
  4. Severe head or facial trauma
  5. Extremity numbness/ weakness w/ trauma
  6. LOC secondary to trauma
  7. AMS
    a. no history
    b. found in setting of trauma
    c. Near drowning w/ possible diving injury.
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11
Q

Pacing Indications

A

HR < 60bpm who do not respond to medications with severe chest pain, severe shortness of breath, pulmonary edema, acutely AMS, or shock.

  1. Adult after 1mg atropine.
  2. Ped after O2, BVM, epi, atropine .02mg/kg
  3. Asystole < 10min electrocution
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12
Q

Pacing procedure

A
  1. Pads on chest and back
  2. Set TCP rate at 80 beats per min.
  3. Begin at 0mA, increase until capture. +10% at capture.
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13
Q

12 Lead Indications

A
  1. Coronary Ischemic chest discomfort
  2. Shortness of breath with pulmonary edema if acute onset
  3. Hypotension in presumable cardiogenic shock.
  4. ROSC.
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14
Q

CPAP Indications

A

Severe…

  1. SOB with wheezes
  2. SOB with pulmonary edema CHF.
  3. Allergic reactions with wheezes
  4. Must be conscious, breathing, able to follow commands
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15
Q

CPAP Contraindications

A
  1. Peds under 14.
  2. vomiting
  3. hypotensive. SBP<90
  4. Suspected pneumothorax
  5. Cannot obtain a good seal with mask.
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16
Q

Cardiac Arrest Medical

A
  1. Chest pain prior to arrest
  2. GI bleed or other blood loss
  3. Meds and allergies?
  4. Depression or hx of drug use
  5. Downtime prior to CPR
  6. Duration of CPR
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17
Q

Traumatic Arrest

A
  1. Defibrillate
  2. C-spine
  3. Airway
  4. Bilateral needle thoracostomy
  5. Transport
  6. IV large bore. 2. en route.
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18
Q

Dysrhythmia

A 
Stabilize PRIOR to transport.
Treat the patient, not the monitor
Print a strip
Breath sounds
Skin color temperature moisture
Hemodynamics
Dependent/ pulmonary edema
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19
Q

Symptomatic, according to ACLS

A
  1. Hypotension
  2. Acute AMS
  3. Signs of shock
  4. Ischemic chest discomfort
  5. Acute heart failure (pulmonary edema)
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20
Q

Myocardial Ischemia symptoms

A
  1. Sever chest pain
  2. Cold sweats
  3. Nausea
  4. Shortness of breath
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21
Q

Shock signs and symptoms

A
  1. low bp
  2. cold clammy skin
  3. weak pulse
  4. dizziness
  5. rapid shallow breathing
  6. AMS!!!
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22
Q

Coronary Chest Discomfort

A
  1. O2, low flow
  2. Monitor
  3. ASA, 2x81
  4. NTG .4mg SL q 5” if cp continues. BP>100, no ED Rx
  5. IV
  6. Amio, 150mg/10” if runs of vtach, frequent couplets
  7. 12 Lead
  8. Stat transport
  9. Nitro paste 1” BP>100.
  10. Midazolam 4mg slow IVP if cocaine use.
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23
Q

SOB with wheezes. COPD/ asthma

A
  1. O2 low flow/ high flow
  2. Monitor
  3. Albuterol. Transport after first dose. 2.5mg
    If patient in sever distress:
  4. Epinephrine .01mg/kg 1:1000 IM.
    a. Not over 70
    b. Hx asthma & COPD
    c. No signs of MI, Hx of angina, MI, or CVA.
  5. TRANSPORT
  6. CPAP.
  7. IV if needed.
  8. MgSO4 2g in 250ml/ 2”
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24
Q

SOB with pulmonary edema

A
  1. Sit them up!!! Legs lower than heart.
  2. O2 low/high
  3. Monitor
  4. NTG
    a. .4mg BP > 100
    b. .8mg BP > 120
    c. .12mg BP > 200
  5. Transport
  6. 12 Lead
  7. CPAP
  8. Nitro paste. BP>100 1”. BP>120 2”.
  9. IV
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25
Q

Respiratory distress assessment

A
  1. Mental status
  2. Breath sounds
  3. Peripheral edema
  4. cyanosis
  5. ins/exp ratio
  6. accessory muscle use
  7. retractions
  8. neck vein distension
  9. tracheal position
  10. chest diameter
  11. diaphoresis
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26
Q

Respiratory distress mgmt

A
  1. BVM?
  2. Monitor for ALL patients
  3. Ins difficulty/ stridor= upper airway
  4. Exp. difficulty/ wheezes, rales lower airway
  5. Fever?
  6. Lower airway, albuterol
  7. Use PASTMED.
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27
Q

PASTMED

A 
PROGRESSION
ASSOCIATED CHEST PAIN
SPUTUM
TIREDNESS/ TIME
MEDICATIONS
EXERTION
DIAGNOSIS OF LAST SIMILAR EPISODE
28
Q

Partial Airway obstruction

A
  1. Calm patient. DNE
  2. O2 lowflow
  3. Suction secretions
  4. Monitor
  5. Transport in position of comfort
  6. IV lock.
  7. Contact hospital
29
Q

Complete airway obstruction: Conscious pt.

A
  1. Defined: Awake, cyanotic, unable to speak
  2. Speak! Cough!
  3. Abdominal thrusts
  4. Speak! Cough!
  5. Transport code 3.
30
Q

Complete airway obstruction: Unconscious pt.

A
  1. Open airway. Ventilate
  2. Clear mouth. Visible? Finger sweep
  3. Ventilations
  4. Chest compressions
  5. Repeat. Visualize
  6. Transtracheal Jet Insufflation for complete obstruction.
  7. Stat transport
31
Q

AMS/ stroke/ syncope

A
  1. AMS, high flow O2, syncope, low flow
  2. Monitor
  3. Naloxone 2mg IN. 1mg IM. 1mg IV slow. RESP < 8!!!
  4. IV.
  5. BG, BEFAST stroke scale.
  6. Dextrose peds 1ml/kg D50. Infants 1ml/kg D25.
  7. Glucagon 1mg IN if BG<80, and no IV
  8. Transport.
32
Q

BEFAST

A
  1. Loss of balance?
  2. Blurry/ double vision?
  3. Smile. Stick out your tongue
  4. Hold out your hands supine for 10s.
  5. You can’t teach a dog old tricks
33
Q

Seizures

A
  1. C-Spine!!!
  2. O2. Low/High
  3. Monitor
  4. Midazolam 4mg IN (0.1 mg/kg).
  5. IV
  6. Accucheck.
  7. Dextrose. 25g if AMS > Time. BG
  8. Transport stat if unstable
  9. Passive cooling for febrile seizure.
34
Q

FACTS

A 
Focus generalized vs. local
Activity tonic-clonic vs. absence
Color pink, blue, ashen.  Hypoxia.
Time onset and duration
Supplemental Hx.  Med compliance.  Trauma, last seizure
35
Q

Ingestion Poisoning

A
  1. O2 low/ high
  2. Monitor
  3. IV lock
  4. Transport Stat if unstable
  5. Base
36
Q

Shock

A
  1. O2 high flow
  2. Monitor
  3. Transport. Therapy en route
  4. IV. 1 or 2. No pulm. ed., wide open BP<80. 80-100, 500ml challenge.
  5. 12 Lead
  6. Base. Profound shock? 1mg epi 1:10,000 in 250 bag, titrate to BP100. .5-1.5ml/min
  7. Hypovolemic? Cardiogenic? Obstructive? Distributive, sepsis, anaphylaxis?
37
Q

Wet lung sounds

A

Cardiac history, medications.

Consider pulmonary edema with cardiogenic shock

38
Q

Dry lungs and JVD

A 
Consider PE
1.  females on bc
2.  immobility
3.  recent surgery
Consider TP:  Thoracentesis
1.  absent lung sounds on one side
2.  recent trauma
3.  hypotensive
4.  tracheal deviation
Pericardial Tamponade:  Treat with fluids
1.  recent trauma
2.  muffled heart tones
3.  recent MI.
39
Q

Dry lung, no JVD

A
  1. Hypovolemia
    a. vomiting and diarrhea, fever, GI bleeding, dehydration, trauma
  2. Septic shock
    a. warm skin, no pallor, flushed
    b. fever
    c. recent infectious illness
  3. Anaphylactic shock
    a. wheezes
    b. hives
    c. red skin
    d. exposure to allergen, history.
40
Q

Allergic reactions and Anaphylactic Shock: Mild

A
  1. No O2, Remove allergen
  2. Benadryl 50mg IM, 1mg/kg ped
  3. Transport
41
Q

Allergic reaction and Anaphylactic Shock: Severe

A

Unstable: hypotension, severe respiratory depression, wheezing, oral swelling, AMS, chest tightness

  1. Remove allergen
  2. Monitor
  3. Epinephrine .4mg 1:1,000 IM mrq 15”.
    a. ped dose: .01mg/kg 1:1,000 IM max .4ml.
  4. IV
    a. BP< 80, wide open
    b. BP 80-100, fluid challenge 500ml.
    c. BP>100, saline lock.
  5. Epinephrine
    a. BP<80 with signs and symptoms of shock, .1mg (1ml) 1:10,000 IVP very slow push
    b. peds .025ml/kg of 1:10,000 very slow IV push to max 1.0ml.
  6. Transport
  7. Nebulized epinephrine 2.5mg/3ml. mr 2.
  8. CPAP
  9. Benadryl 50mg IVP, IM. Peds: 1mg/kg slow IVP, IM.
42
Q

Profound shock Epinephrine

A

1mg 1:10,000 in 250ml, .5-1.5ml/min. 100 Systolic.

43
Q

Trauma

A
  1. Airway/ C-spine
  2. Control bleeding. Moist dressing for evisceration.
  3. Isolated extremity injury: Fentanyl 25mcg-100mcg IVIMIN q 5’’, Bp>100.
  4. Transport
  5. Advanced airway
  6. O2. Low if stable. High if unstable.
  7. IV. Lock. Y tubing.
    a. BP100 TKO.
    d. peds: 20ml/kg. if BP<80 with signs of shock.
  8. Monitor if indicated.
44
Q

On scene trauma treatment

A
  1. BLS airway
  2. Occlude sucking chest wounds, eviscerations
  3. C-Spine
  4. Bleeding control
45
Q

En route trauma treatment

A
  1. ALS airway
  2. IV
  3. Repeated neuro assessment: pupils, loc, respirations, motor response.
46
Q

MIVT

A

Mechanism
Injuries
Vital Signs
Treatment

47
Q

Burns

A
  1. O2 low/high
  2. Monitor
  3. Transport
  4. IV. LR 150ml/hr. Defer for Trn15% Dry sterile dressing. NO facial dressing
  5. FENTANYL for severe pain, no AMS, SBP>100. 25-100 q5”. Peds: 1mcg/kg/dose
48
Q

Burn History

A 
Thermal, chemical, electrical, radiation
enclosed space
blast
trauma
duration of exposure
time of occurrence
type of chemical
voltage, if electrical
LOC
49
Q

Burn airway assessment

A
  1. Oral or nasal burns
  2. Nasal hairs burnt
  3. Blisters or soot in mouth
  4. Soot in sputum?
50
Q

Near Drowning

A
  1. O2 low flow high flow
  2. Remove wet clothing. Dry blankets
  3. C-Spine
  4. Monitor
  5. Transport
  6. IV, Lock.
  7. Asst: lung sounds, LOC, C-spine.
  8. Drugs, EtOH.
51
Q

Snakebite

A
  1. ABCs, Airway, O2 low/high, Transport
  2. Remove jewelry!
  3. Elastic bandage.
  4. Immobilize extremity BELOW LEVEL OF HEART!!!!
  5. IV LR TKO.
  6. NO ICE.
52
Q

Behavioral Health Emergency

A
  1. Scene safety
  2. Restraints
  3. Transport
53
Q

Phenothiazine OD

A

Reglan/metoclopramide, Phenergan/promethazine, Thorazine, Compazine
Benadryl 50mg. ped: 1mg/kg.

54
Q

Vag bleed

A
  1. O2 low flow/ symptomatic. High flow/ unstable.
  2. Transport. Vitals en route
  3. IV: 80 wide open. 80-100 challenge. 100. TKO.
  4. Left side
  5. Tissue remains
55
Q

Childbirth

A
  1. O2 low, stable. High if complications
  2. IV.
  3. Transport
  4. BASE
  5. Suction nose, then mouth. Warm. Dry. Stimulate. O2
    Crowning: Deliver
    Prolapsed cord, breech: Transport.
56
Q

Breech

A

Lights and sirens.

1. Reach in. Make a V. Mom in shock position

57
Q

Prolapsed cord

A 
Mom in shock position.
1.  O2 high flow.
2.  Protect cord.  
3.  Cover exposed cord with saline soaked gauze
TRANSPORT lights and sirens.
58
Q

Pediatric Respiratory Distress

  1. Epiglottitis
  2. Asthma
  3. Bronchiolitis
  4. Croup
A
  1. Lung sounds
  2. O2 100% NRB.
  3. Position of comfort
  4. Albuterol under 14 yrs. 10mg/2ml. mr 2x. Transport immediately after first treatment.
  5. 0.3mg 1:10,000 in 3ml nebulized epinephrine for croup ONLY
  6. Transport
  7. Severe distress: epi 1:1,000 IM .01mg.kg.
59
Q

Pediatric Shock

A
  1. O2 high flow
  2. Transport
  3. IV/IO. 2 large gauge. Unconscious? I/O!!!
  4. Fluids: 20ml/kg. mr 2x.
    Intubate if needed.
60
Q

Pediatric Shock Symptoms

A

Weak and thready tachycardic pulse
changes in mental status including lethargy, irritability, or confusion
cold clammy, cyanotic skin. Mottled.
Poor capillary refill.
HYPOTENSION IS A LATE SIGN!!!!!!!!!!!!!!!!!!!!!!!!

61
Q

Causes of shock

A

hypovolemia from
trauma, vomiting, diarrhea, and DKA.
sepsis, cardiogenic, neurogenic as in OD and IC hemorrhage.
anaphylaxis: bee sting. peanuts. penicillin.

62
Q

Adult Bradycardia HR< 50, HASIA

A 
O2 high flow.  
Atropine 0.5mg.  Fluid challenge. 
Stat Transport.
Atropine .5mg
TCP
63
Q

Pediatric Bradycardia

HR<80 infant

A 
100% O2.NRB.
CPR if child is unconscious
IV/IO
TRANSPORT
Epinephrine.01mg/kg 1:10,000 
Atropine .02mg/kg, max .5.  
Fluid challenge 20ml/kg
64
Q

Pedi Tachy w/pulses

A 
All get ABC, High flow O2, IV/IO access.
HASIA:
QRS < .08
ST---> T. F. 
SVT----> U. M.F.C. .5J/KG T.
VT---> U.  M.F.C. 1J/KG. T. A. 5mg/kg
Base:  Vagals/ adensosine. .1mg/kg, .2mg/kg.
65
Q

Ring Down

A 
Unit ID.
Name
ETA
Age, Sex, Weight
CC, STAT/Non-STAT/Medical or Trauma/Code Blue
Big Six? BB, R, AL, CM, O2, Resp
Trauma
GCS
Mechanism and Trauma Score
V/S
66
Q

Needle Thoracostomy

A

S/S:

  1. Severe respdep.
  2. Lateralizing exam.
  3. Hemodynamic compromise
67
Q

3 indications for ET tube

A
  1. Cardiac or Respiratory Arrest

2. GCS <8 unable to protect airway

Paramedic (2 decks)

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