Protocols Flashcards
Asthma/COPD algorhythm
Duoneb x 2, albuteral repeat PRN
Solumedrol 125 SIVP
CPAP
Epi 1:1000 - 0.3mg x2 PRN (for asthma)
OLMC- epi drip or mag 2g over 10min
Cyanide algorythm (dose and administration)
O2
Unstable = cyanokit 5g IV over 15min
Draw blood before if possible
What intervention for pt w/ torsades
Mag sulfate 2g IV/IO
At what point during a cardiac arrest do you initiate a rhythm assessment w/ the monitor and shock?
Pt down >4 min or shitty CPR PTA = do 2min CPR first
Pt down < 4min or good CPR PTA = continue CPR and immediately analyze the rhythm
Your cardiac arrest pt is hypoglycemic. What do you do?
D10, 25g IV/IO. Repeat 3-5min if no effect
Your cardiac arrest pt is hyperkalemic. What do you do?
Calcium chloride 1g then Bicarb 8.4% at 100mEq
You suspect narcotic OD in your arrest pt. What do you do?
2mg narcan IV/IO. Repeat x1 in 3-5min if necessary
You suspect cyanide exposure in your cardiac arrest pt. What do you do?
5g Cyanokit IV/IO RIVP
In cardiac arrest, what types of pts should you suspect hyper K?
Renal failure/dialysis or diabetics, pts who take potassium supplements
Where do you take a ROSC pt?
Nearest PCI facility
What’s the ROSC protocol?
12-lead & BP
- fluid bolus if SBP <90 = 2000ml max. Reassess every 500cc
- Norepi drip 1-10mcg/min
- RONF = give versed 2.5mg IV/IO & fentanyl 50mcg (repeat x1 in 5min PRN)
Your ROSC pt has RONF and is fighting the tube. What do you do?
Versed 2.5mg IV + fentanyl 50mcg
Repeat x 1 after 5min if needed
OLMC if more required
What constitutes a STEMI alert?
ST elevation >1mm in 2+ continguous leads
Without getting into details, what constitutes a preACT STEMI?
You’re super sure its a stemi and the pt is in stable condition
Whats the nitro dose for ACS?
0.4mg SL every 3-5 until pain /angina goes away
Rx for stable, symptomatic bradycardia?
MOVAB
SBP < 90 = fluid bolus + atropine 0.5mg max 3mg
Rx for unstable bradycardia (AMS)
Pace (can give atropine while preparing pace but DONT delay)
Versed 2.5mg IV/IO or 5mg IN (repeat x1 in 3-5min)
OLMC for norepi drip (1-10mcg) or epi drip (2-5mcg)
When can/can’t you give atropine in a bradycardic pt?
Can = symptomatic w/ no signs MI
Can’t = evidence of AMI or ischemia
When do you get a 12-lead on cardiac emergencies
When they’re stable. Don’t delay Rx for unstable pts
Rx for stable wide tachyarrhythmia (regular, irregular, torsades)
Regular/irregular = amio infusion 150mg over 10min
Torsades = mag 2g over 10min
Rx for stable, narrow tachyarrhythmias (regular, regular w/ afib hx, irregular)
All = vagal & fluid challend
Regular = adenosin 6-12 RIVP
Irregular or afib hx = diltiazem 0.25mg/kg SIVP - max 20mg
Rx for unstable tachyarryhtmia (regular narrow/wide, irregular narrow/wide)
Regular narrow/wide = sync Cardio 100-120-150-170J
Irregular - narrow = sync Cardio 120j-150J-170j
Irregular wide/polymorphic = defib 150J
Cardiogenic shock Rx
MOVAB
- fluids for SBP <90
- norepi drip 1-10mcg/min
- closest PCI facility
CHF Rx/ pulmonary edema Rx
MOVAB
- Nitro every 3-5min based on BP (90-120-160 = 0.4-0.8-1.2)
- CPAP
What is “restart the heart” and when is it used?
Peds = ABCDE w/in 5 min
Arrive, bag, CPR, drill, epi
What 4 pieces of info must you learn if suspecting stroke (NOT VS)
- time of onset/discovery
- time of last known normal
- SS present upon awakening?
- Name & phone of witness
What constitutes a stroke alert?
Positive stroke exam AND <24hrs last known normal
What constitutes a “complex” stroke?
Bleeding, blood thinner, brain issues, head trauma, head spine sugerry or stroke < 3mo, Fasted score 4+
When to take a stroke pt to primary vs comprehensive center?
Comprehensive = complex stroke or time 3.5hours +
Primary or closest = not complex and <3.5hrs
Rx for hypoglycemia? What number is hypo? Can you repeat med dosages
<60 mg/dL or symptomatic
- Oral glucose 15mg OR
- D10w (25g or 250ml)
- 1mg Glucagon last resort
Repeat x1 after 5-10min if needed
Rx for hyperglycemia? What number is hyper?
Hyper > 300 mg/dL
- NS 500ml - repeat x1 if no pulm edema
Sepsis criteria
Suspected infection + 2 or more of the following (RASH)
- RR > 20 or ETCO2 30 or less
- Acute AMS or GCS <12
- SBP < 90 or cap refill >4s or mottled skin
- HR > 100
What Rx for sepsis
- MOVAB
- Fluids
- Sbp <90 after initial 1000mL bolus = vasopressor (norepi 1mcg/min via 18g or bigger or IO)
- titrate norepit by 1mcg/min every min until SBP >90 or max 10mcg/min
How much fluid for sepsis adults?
Initial bolus 1000ml
If no pulm edema, Continue 500ml doses until hosp or max dose 20ml/kg
How do you give nor epi for sepsis? What size IV?
Via 18g at AC or IO
- start 1mcg/min and titrate by 1mcg every min until SBP >90 or max 10mcg rate
Rx and dose for anaphylaxis
- 0.3mg epi (1:1000) - repeat x1 in 3-5min
- Fluids (500ml increments until max 2000mL)
- benadryl 50mg IV/IO/IM
- steroids 125mg
- albuterol for wheezing
- 12-lead after every epi
OLMC (epi drip or more epi)
What epi drip for anaphylaxis? OLMC?
1-4mcg/min. Yes OLMC
Your sepsis pt has HR around 180 (SVT) what would you do?
Don’t treat the tachycardia. (No adenosine or cardizem)
What Rx for nausea vomiting
Zofran 4mg (IV or tab), repeat x1
Fluids 500ml
When can you give pain meds for abdominal pain?
Only acute onset pain
What BP do you want to maintain on a trauma with major head injury? What about a general multisystem trauma?
Head = SBP > or = 110
Multisystem = > or = 90
When do you needle decompress a trauma arrest?
Whenever there’s evidence of chest trauma
What Rx for trauma arrest?
ABC
- needle decompress PRN
- Fluids
- ALCS
How much fluids for a trauma arrest adult? Kid? 14-15?
Adults = 2000ml
14-15 = 1500ml
13 or < = handtevy
Lighting Rx
C-spine and CPR PRN
- cardiac arrest = trauma arrest rx
- no arrest = MOVAB & treat SS
Stingray sting Rx
Hot pack or hot water. Don’t remove the barb
Jellyfish Rx
Rubbing alcohol & rinse w/ NS
Snakebite Rx
Remove constricting things
- mark a circle
Insect sting
Credit card (no tweezers)
Cold pack
When to give fentanyl
Pain 7+
When can you give oral glucose to a diabetic?
If conscious and can protect airway
Your pt was driving prior to a seizure. Who must you call? Why?
PD. They need to be cleared before driving again
What assessment/VS must you always monitor when giving versed?
ETCO2 and SPO2
When you get ROSC, what must you do first
Radio rosc
Where do rosc pts go
Closest PCI
