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Paramedic > PGFD Medic Prep > Flashcards

PGFD Medic Prep Flashcards

PGFD Protocols and Gen Orders for Medics

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1
Q

Name the
Comprehensive STROKE (3)
and
Primary STROKE Centers (6)
in the area

A

Comprehensive STROKE:
Hopkins - Baltimore
Bayview - Baltimore
UM - Baltimore

Primary STROKE:
Anne Arundel Medical
Cap Regional
Doctors
Holy Cross
Howard General
Southern Maryland

TIA/Mild - Primary
FULL Deficit/Severe - Comprehensive

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2
Q

Name the (3) TRAUMA Centers in the area

Level 1

Level 2

And what is the difference?

A

Level 1 - Hopkins - Baltimore

Level 2 - Cap Region - Largo
** Suburban - Bethesda

Level 1 - more comprehensive, 24/7 surgeons, neurosurgeons, orthopedic

Level 2 - may not have same

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3
Q

When do you hyperventilate HEAD injury?
What is the target capno?

A

When there is signs of HERNIATION:
Posturing,
dilation of pupils,
vomiting,
hypertension,
bradycardia,
irreg respiration

ETCO2 Target: **35-40 mmHg

20 bpm for adults
30 bpm for peds
35 bpm for infant**

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4
Q

Treatment for Asthma / COPD -

Severe treatment -

And signs -

A

Albuterol 2.5mg Neb (can repeat once)
Atrovent 500 mcg

SEVERE - EPI 0.5mg IM (may repeat 3)
Dex 10mg IV
Terbutaline 0.25 mg IM (repeat once)

Consider CPAP 5cm or BVM

SIGNS - Hx, **SHARKFIN **Capno, and Wheezing

Contra - JVD, peripheral edema, rales (crackles)

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5
Q

What is the age MINIMUM for Lucas Machine

A

13 years old

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6
Q

What is the age of peds for TRAUMA and MEDICAL

What weight do you give adult dose?

A

TRAUMA is 15 years old

MEDICAL is 18 years old

Over 50kg (110lbs)

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7
Q

What HR is Brady?

When do you withhold Med?

A

Below 60 bpm - Brady

Withhold Atropine (1mg) with Complete Blocks (2nd Degree Type II, 3rd Degree)

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8
Q

When do you start CPR for Ped

A

HR below 60 bpm

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9
Q

What is the FORMULA for PED BP (lowest)

What is the minimum age for this formula

A

**70 + (2 x age) = **systolic BP

Greater than 1 year old

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10
Q

What do you give for each

Afib/Aflutter -

Wide QRS (stable)-

Torsades -

A

Afib/Aflutter - Cardizem 0.25mg/kg, 0.35mg/kg

Wide QRS - AMIO 150mg over 10 mins

Tosades - Mags Sulfate - 2g IV

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11
Q

When do you Sync Cardiovert
and how many Jules?

And how

A

when: Unstable SVT over 150bpm

Afib/Aflutter - 200j, 300, 360

SVT - - 100j, 200, 300, 360j

Use 12lead, and pads, push synch button

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12
Q

What is the general idea of WPW and LGL

A

They are** ACCESSORY PATHWAYS** from SA node to AV node

WPW has Delta Waves

LGL has short P-R interval, and narrow QRS

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13
Q

What is the Jules ( J ) for PED Tachy

What is the HR for PED Tachy

A

0.5j, 1j, 2j

HR -
**INFANT 220 BPM

PED 180 BPM**

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14
Q

What is the PED dose of ADENOSINE

A

0.1 mg/kg - Adenosine,
2nd Dose/ 3rd Dose** 0.2mg/kg**

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15
Q

What is the Ped Dose of Amio

A

Amiodarone -** 5 MG/KG**

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16
Q

What do you give for NA channel blocker (TCA)

Name one Na Drug and a TCA

A

GIVE Sodium BiCARB -** 1mEq/kg**

VerapaMIL or AmlodiPINE - na channel blocker

Amitriptyline - TCA

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17
Q

For a CODE, for refractory VF/VT after Amio, what do you give

A

Amio then…
Mag Sulfate 2g IV/IO

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18
Q

In a working CODE what are (4) Roles (JOBS)

A
  • Role 1 - Start COMPRESSIONS 100-120, BVM till pads are on
  • Role 2 - Attach PADS and VENTILATION 2 Breathes

- (my role) ROLE 3 - Establish I/O, Admin MEDS, iGEL, MONITOR

  • Role 4 (Officer) - Time Keeper, Talk to Family

(Every one else **put on the lucas **and gets swapped in every 2 mins)

19
Q

For PED CODE, what is the JULES

What is the EPI and AMIO DOSE

A

Defib 2, 4, 6, 8, 10 (code)

Epi 0.1mg

Amio 5mg/kg

20
Q

For ROSC what do you do next

A

Finish 2 mins of CPR

**Obtain a 12 Lead and check pulse
**
If VF/VT was present give Amio drip if now SVT

21
Q

What are the EXCEPTIONS for Termination

A

Hypothermia, submersion, Pregnant

22
Q

For TERMINATION, what is the CAPNO

A

Less than 15mmHg

23
Q

What are the parameters to give Nitro

A

Bp greater than 90 sys
HR 60-150bpm
IV established
12 Lead has been performed first (within 10 mins)
ED drugs and Meds for Pulmonary Artery Hypertension (Adcirca, Revatio) within 48hrs

Stop if BP drops more than 20 mmHg

24
Q

What are the parameters for STEMI

A
  • St elevation of 1 mm (atleast) in two or more anatomically contiguous leads

Or

- St Depression (1mm) in V1-V3

25
Q

For STEMI before giving NITRO

A

Check for Inferior involvement ( II, III, and avF)

Then to V4r if needed. If ST elevation then withhold Nitro.

26
Q

How do you Identify a LBBB on a 12 lead

A

QRS is wider than **120ms (more than 3 blocks) **

Broad, Slurred R wave in Lead I, Val, V5 and V6
Deep S wave in v1, v2

Find direction in V1 (confirm with slurred S) negative in V1

27
Q

When do you get Posterior pic of Heart

A

ST depression in V1-V3 posterior

May indicate anterior ischemia

28
Q

Signs to Confirm CHF

Treatment Protocol for CHF

A

Rales, Wheezing, Hypoxia
Peripheral Edema

Hypertension -** SBP OVER 150**

JVD
Hx of CHF or MI
Dyspnea
O2 LESS THAN** 94% **on Oxygen

Assess Capno and waveform **(no sharkfin) **

Treatment - 12lead, IV, capo, Oxygen,
NITRO 0.4, (up to 1.2) CPAP, Nitro paste (1 inch)

29
Q

Define RVR

A

RVR happens to people with A-FIB

When HR is greater than 100 BPM

its serious because it can cause
BLOOD CLOTS

30
Q

What are the PED DOSES of
(10 drugs)

AMIO

EPI CROUP

ADENOSINE

BENADRYL

NEB - ALBUTEROL and ATROVENT

DEXAMETHOSONE

D10

MIDAZOLAM

A

AMIO - 5 MG/KG (pulse over 20 mins in 100mL, pulseless - may repeat twice up to 15mg/kg)

EPI ASTHMA/ALLEGIC -
less than **5y/o **- 0.15 MG IM Thigh

**EPI **CROUP - **2.5 ML **via neb, can repeat once
severe croup - 0.01 mg/kg IM max 0.5mg IM

ADENOSINE - 0.1 MG/KG then 0.2 MG/KG
(2nd and 3rd dose)

BENADRYL - over 6mos - 1mg/kg SLOW IV/IM

NEB -** ALBUTEROL** less than 2y/o - 1.25MG ATROVENT - 1-2y/o 250 mcg
(no atrovent less than 1)

DEXAMETHASONE - 0.5 MG/KG by mouth (preferred) max 10mg

**D10 **- 28 days - bgl LESS THAN 40 - 2 ML/KG
28 - 4 y/o - bgl less 70 - 4 ML/KG **
(or 0.5 MG of Glucagon)
5y/o - 18 y/o - less 70 - 4 ML/KG **

MIDAZOLAM - **0.1 MG/kg **in 2mg inc SLOW
or **1mL **IN per nare

31
Q

What are the doses of EPI for PED CARDIAC ARREST

A

28 days - 0.05mg **
29 days - 11mos - 0.1mg **
1 - 4 y/o -0.15mg **
5 -12 - 0.3 mg **
13 - 18 (under 50kg) - 0.5mg
13 - 18 (over 50 kg) - 1.0mg (adult dose)

32
Q

What is the treatment for 7 y/o with Severe Croup

(3 steps)

A
  • 0.01 mg/kg of Epi IM (max 0.5 mg IM)
  • Dexamethasone IV 0.5 mg/kg IV (10)
  • 2.5 mL Epi NEB Nebulized
33
Q

Pediatric Doses apply to patients weighing less than

A

50kg

34
Q

Infant is how old
Child is how old
Adult/Adolescent is how old
How old is a newborn

A

infant - less than 1 year
child - less than 12
adult medical - 13 or greater
newborn - less than 1 hour after birth

35
Q

What are unstable hr for sync cardiovert for

adult
child
infant

A

adult - over 150
child - over 180
infant - over 220

36
Q

Wide QRS (aflutter/afib) what med do you give , alert and oriented with cp and sob
bp within normal limits

A

give Cardizem

but wide QRS not afib, give Amio 150mg

37
Q

What is the joules settings for defibrillator 5 y/o in v-fib weighing 55lbs

A

50, 100, 150, 200, 250

38
Q

EMS may terminate resuscitation for asystole if

A

if AED advised no shockable rhythm prior to ALS arrival

39
Q

For a 5 y/o weighing 50 lbs in vfib with CPR in progress what dosages of drugs and volume and syringe will you need and joules

A

epi - o.o1 mg/kg IV IO 3mL syringe q 3-5 mins

Amio 5mg/kg IV/IO repeat up to 2 times max 300 mg

LR 20mL/kg bolus

Joules 2-4j/ kg

40
Q

What is the ALS algorithm
for Pulseless VFIB (and VTACH)

A

SHOCK IMMEDIATELY

Epi every 3-5 mins (1mg)

CPR, Ventilate

Shockable 200, 300, 360

Amio 1st dose 300
Amio 2nd dose 150

shock, cpr, shock, cpr/epi, shock, amio

41
Q

What is the treatment for PED Seizures

A

Seizure lasting more than 10 mins

check BGL

Assist patient with prescribed benzodiazepine

Establish IV/IO or give IM (active)

Midazolam IM 0.2mg/kg IM max 5mg IM prefered

IV 0.1 mg/kg in 2mg increments slow IVP max 5mg

use 3 way stop cock with 1mL syringe

42
Q

Patient is in the middle of being treated for MI and becomes a VFIB arrest how do you manage this patient?

A

Need to Shock IMMED
Attach **PADS and DEFIB at 200 J then give roles

  • Role 1 - Start COMPRESSIONS 100-120, BVM
  • Role 2 - VENTILATION** 2 Breathes

- (my role) ROLE 3 - Establish I/O, Admin MEDS, iGEL with CAPNO, MONITOR

  • Role 4 (Officer) - Time Keeper, Talk to Family

(Every one else **put on the lucas **and gets swapped in every 2 mins)

NOTE: don’t forget to charge during CPR 1min 45 seconds

charge every 1:45 secs
pulse check every 2 mins
epi or amino every 5 mins

capno range 10-20 (low too fast, high too slow)

42
Q

What is the protocol for CP

A

do 12 lead EKG (looking for INF STEMI) v4r , ASAP and allergies and ASA

establish IV access

give Nitro 0.4mg SL may repeat 2 more times

if sys is over 90 and hr 60-150bpm

INF - II, III, avF - right ventricular involvement

43
Q
A

Paramedic (24 decks)

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