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Protocol Knowledge Flashcards

1
Q

ACS Tx (Adult)

A

ASA 160 mg PO (not req if taken own as per dispatch)
NTG spray 0.4 mg SL (Q 5 min, SBP > 100)
NTG patch 0.2 mg/h (apply w/ 2nd spray, SBP > 100)
Fentanyl 25 mcg IV (Q 5 min, max 200 mcg, SBP > 100 , Sp02 > 95%)

Obtain a 12Lead within 10 min of Pt contact.

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2
Q

STEMI (Option 1)

A

(NOT A CANDIDATE)
Transport to SBGH ED.
Continue ACS Tx.

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3
Q

STEMI (Option 2)

A

(THROMBOLYTICS)
Req DCPO for TNK kit.
Tenecteplase IV (weight-base chart on kit/protocol)
Clopidogrel PO 300 mg (age <75) or 75 mg (age 75+)
Renal Failure - UF Heparin 60 U/kg IV (max 4000 U)
Good Renal - Enoxaparin 30 mg IV + 1 mg/kg SC (max 100 mg) (age <75) or 0.75 mg/kg SC (max 75 mg) (age 75+).

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4
Q

STEMI (Option 3)

A

(DIRECT FOR PCI)
Ticagrelor 180 mg PO.
UF Heparin 70 U/kg IV (max 10 000 U).

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5
Q

Analgesic for Transcutaneous Pacing

A

Tx for discomfort with following.
A: Fentanyl 25 mcg IV (Q 5 min X3, Q 10 min, no max) and/or Midazolam 1-2.5 mg IV (Q 5 min X3, Q 10 min, no max).
T: Fentanyl 0.5 mcg/kg IV (max 25 mcg) (Q 5 min X3, Q 10 min, no max) and/or Midazolam 0.05 mg/kg IV (max 1 mg) (Q 5 min X3, Q 10 min, no max)
P: &laquo_space;Fentanyl 0.5 mcg/kg IV (max 25 mcg) (Q 5 min X3, Q 10 min, no max) and/or Midazolam 0.05 mg/kg IV (max 1 mg) (Q 5 min X3, Q 10 min, no max)&raquo_space;.

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6
Q

Synchronized Cardioversion

A

PreTx for sedation (SBP > 90 and SpO2 > 95%)
A: Midazolam 1-2.5 mg IV.
T: Midazolam 0.05 mg/kg IV (max 2.5 mg).
P: No Tx.

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7
Q

Non-traumatic Shock

A

A: NS 250 mL IV (II/III/IV, PRN to max 2000 mL).
T: NS 10 mL/kg IV (II, over 20 min if DKA, PRN) 20 mL/kg IV (III/IV, PRN).
P: &laquo_space;NS 10 mL/kg IV (II, over 20 min if DKA, PRN) 20 mL/kg IV (III/IV, if class IV can use IO, PRN)&raquo_space;.

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8
Q

LVAD

A 
Do not cardiovert or pace.
Troubleshoot LVAD.
Auscultate LUQ for hum of working LVAD.
Do not place V5 and V6 to avoid 60 cycle interference.
Transport to SBGH.
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9
Q

Hypoglycemia

A

A: Glucose paste (no max) || D50W 50 mL IV (Q 10 min, 1X) || Glucagon 1 mg IM/SC.
T: Glucose paste (no max) || D50W 50 mL IV (Q 10 min, 1X) || Glucagon 1 mg IM/SC.
P: Glucose paste (no max) || &laquo_space;1-9 yo - D50W 1 mL/kg IV (1x dose), <1 yo - D25W 2 mL/kg IV (1x dose) || Glucagon 0.02 mg/kg IM/SC (max 1 mg)&raquo_space;
N: &laquo_space;<72h & <2.6 or >72h & <3.3- D10W 10 mL/kg IV || Glucagon 0.02 mg/kg IM/SC (max 1 mg)&raquo_space;

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10
Q

Chemical Restraint

A

Attempt de-escalation, attempt vitals w/ BGL.
If GCS <14, use Haloperidol only.
If Olanzapine given, use Midazolam only.
A: <50 kg - Haloperidol 5 mg IM + Midazolam 1 mg IM (Q 5 min max 1x || no max if narcotics)
>50 kg - Haloperidol 5 mg IM + Midazolam 2 mg IM (Q 5 min max 1x || no max if narcotics)
>60 yo - Haloperidol 2.5 mg IM + Midazolam 0.5 mg IM (Q 5 min max 1x || no max if narcotics)
T: 14-16 yo - Midazolam 0.05 mg/kg IM (max 2.5 mg, 1x dose)

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11
Q

Increased ICP

A

If advanced airway (ETT) is considered …
A: Lidocaine 1 mg/kg IV (max 100 mg) RR 20/min
T: Lidocaine 1 mg/kg IV (max 100 mg) RR 25/min
P: (1-9 yo) RR 25/min, (< 1 yo) RR 30/min
Once ETCO2 available target of 30-35.
Elevate head 30 degrees.

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12
Q

Suspected Opiate Overdose

A

If alt LOC or RR < 8/min or less than age normal …
A: Naloxone 0.4 mg - 2 mg IM/IV PRN
T: Naloxone 0.4 mg - 2 mg IM/IV PRN
P: (<20 kg) Naloxone 1 mg IM PRN, (>=20 kg) Naloxone 2 mg IM PRN.

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13
Q

Tricyclic Overdose

A 
If TCA confirmed and QRS >0.12 sec ...
A:  Sodium Bicarb 100 mEq IV
T:  Sodium Bicarb 2 mEq/kg IV
P:  << 2 mEq/kg IV >>
If dysrhythmia continues treat as Wide Complex Tach
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14
Q

Amphetamine type Stim Toxicity

A

Confirm Amphetamine use in last 48 hours, has no acute medical complaint, and showing signs of hallucination or agitation …
A: Olanzapine 10 mg PO

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15
Q

Seizure

A

A: Midazolam 2.5 mg IV (Q 5 min, max 10 mg) || 0.2 mg/kg IM (max 10 mg, max 1x)
T: (>=20 kg) Midazolam 2.5 mg IV (Q 5 min, max 10 mg), (<20 kg) Midazolam 0.15 mg/kg IV (Q 5 min, max 10 mg) || (>40 kg) 0.2 mg/kg IM (max 10 mg, max 1x), (13-40 kg) 0.2 mg/kg IM (max 5 mg, max 1x)
P: &laquo_space;(>=20 kg) Midazolam 2.5 mg IV || 5 mg IN (Q 5 min, max 4X), (<20 kg) Midazolam 0.15 mg/kg IV || 0.3 mg/kg IN (Q 5 min, max 4X)&raquo_space;

A: treat BGL if <4 mmol/L
T: treat BGL if <3 mmol/L
P: (>72 days) treat if BGL <3mmol/L, (<72 days) treat if BGL <2.6 mmol/L

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16
Q

Postpartum Hemorrhage

A

A: Oxytocin 5 mg IM/IV. If significant hemorrhage: Oxytocin 10 mg in 1000 mL NS IV, run wide open
T: Oxytocin 5 mg IM/IV. If significant hemorrhage: Oxytocin 10 mg in 1000 mL NS IV, run wide open

17
Q

Epinephrine for Anaphylaxis

A

A: 0.3 mg (1:1000) IM (Q 10 min, max 1x)
T: 0.3 mg (1:1000) IM (Q 10 min, max 1x)
P: (5-9 yo) 0.3 mg (1:1000) IM (Q 10 min, max 1x), (1-4 yo) 0.2 mg (1:1000) IM (Q 10 min, max 1x), (0-1 yo) 0.1 mg (1:1000) IM (Q 10 min, max 1x)

If Pt deteriorating 10 min post 2nd dose:
A: 0.1 mg (1:10 000) IV (over 5 min)
T: 0.1 mg (1:10 000) IV (over 5 min)
P: &laquo_space;0.01 mg/kg (1:10 000) IV (over 5 min)&raquo_space;

18
Q

Diphenhydramine

A

A: 25 mg IV (Q 15 min max 1x).
T: 1 mg/kg IV (max 25 mg, Q 15 min max 1x)
P: &laquo_space;1 mg/kg IV (max 25 mg, Q 15 min max 1x)&raquo_space;

19
Q

Asthma/COPD

A

A: Salbutamol 2.5 mg NEB or 400 mcg MDI (Q 15 min max 3x, continuous if critical) || Combivent 1 amp NEB (Q 15 min max 3x, continuous if critical)
T: Salbutamol 2.5 mg NEB or 400 mcg MDI (Q 15 min max 3x, continuous if critical) || Combivent 1 amp NEB (Q 15 min max 3x, continuous if critical)
P: Salbutamol 2.5 mg NEB or 400 mcg MDI (Q 15 min max 3x, continuous if critical)

  • Combivent 1 amp = 0.5 mg Ipratroprium + 2.5 mg Salbutamol
  • Pt <1 yo requires Dx of asthma otherwise consider bronchiolitis
  • If critical and no response to prior Tx consider IM Epinepherine Tx as per Anaphylaxis. &laquo_space;MS/ACPP for Peds&raquo_space;
20
Q

Pumonary Edema (Cardiac Origin)

A

A: NTG spray 0.4 mg SL (Q 5 min if SBP >100). Furosemide 40 mg min IV (or daily dose max 160 mg) (single dose if SBP >100)
T: no protocol
P: no protocol

  • Apply NTG patch 0.2 mg/hr after first spray.
  • If brochospasm present, consider Salbutamol as per Asthma/COPD.
  • Consider CPAP if increased WOB or Sp02 <=92%.
21
Q

Sedation (Post Intubation)

A

A: Midazolam 2 mg IV (Q 5 min first 3x then Q 10 min, no max)
T: Midazolam 2 mg IV (Q 5 min first 3x then Q 10 min, no max)
P: no protocol

22
Q

Symptomatic Bradycardia

A

A: Atropine 0.5 mg IV (Q 3 min, max 0.04 mg/kg or 3 mg)

WEMS (4 decks)

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