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Protocols Flashcards

1
Q

Asthma/COPD algorhythm

A

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

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2
Q

Cyanide algorythm (dose and administration)

A

O2
Unstable = cyanokit 5g IV over 15min
Draw blood before if possible

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3
Q

What intervention for pt w/ torsades

A

Mag sulfate 2g IV/IO

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4
Q

At what point during a cardiac arrest do you initiate a rhythm assessment w/ the monitor and shock?

A

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

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5
Q

Your cardiac arrest pt is hypoglycemic. What do you do?

A

D10, 25g IV/IO. Repeat 3-5min if no effect

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6
Q

Your cardiac arrest pt is hyperkalemic. What do you do?

A

Calcium chloride 1g then Bicarb 8.4% at 100mEq

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7
Q

You suspect narcotic OD in your arrest pt. What do you do?

A

2mg narcan IV/IO. Repeat x1 in 3-5min if necessary

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8
Q

You suspect cyanide exposure in your cardiac arrest pt. What do you do?

A

5g Cyanokit IV/IO RIVP

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9
Q

In cardiac arrest, what types of pts should you suspect hyper K?

A

Renal failure/dialysis or diabetics, pts who take potassium supplements

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10
Q

Where do you take a ROSC pt?

A

Nearest PCI facility

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11
Q

What’s the ROSC protocol?

A

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)
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12
Q

Your ROSC pt has RONF and is fighting the tube. What do you do?

A

Versed 2.5mg IV + fentanyl 50mcg

Repeat x 1 after 5min if needed

OLMC if more required

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13
Q

What constitutes a STEMI alert?

A

ST elevation >1mm in 2+ continguous leads

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14
Q

Without getting into details, what constitutes a preACT STEMI?

A

You’re super sure its a stemi and the pt is in stable condition

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15
Q

Whats the nitro dose for ACS?

A

0.4mg SL every 3-5 until pain /angina goes away

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16
Q

Rx for stable, symptomatic bradycardia?

A

MOVAB

SBP < 90 = fluid bolus + atropine 0.5mg max 3mg

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17
Q

Rx for unstable bradycardia (AMS)

A

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)

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18
Q

When can/can’t you give atropine in a bradycardic pt?

A

Can = symptomatic w/ no signs MI

Can’t = evidence of AMI or ischemia

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19
Q

When do you get a 12-lead on cardiac emergencies

A

When they’re stable. Don’t delay Rx for unstable pts

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20
Q

Rx for stable wide tachyarrhythmia (regular, irregular, torsades)

A

Regular/irregular = amio infusion 150mg over 10min

Torsades = mag 2g over 10min

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21
Q

Rx for stable, narrow tachyarrhythmias (regular, regular w/ afib hx, irregular)

A

All = vagal & fluid challend

Regular = adenosin 6-12 RIVP

Irregular or afib hx = diltiazem 0.25mg/kg SIVP - max 20mg

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22
Q

Rx for unstable tachyarryhtmia (regular narrow/wide, irregular narrow/wide)

A

Regular narrow/wide = sync Cardio 100-120-150-170J

Irregular - narrow = sync Cardio 120j-150J-170j

Irregular wide/polymorphic = defib 150J

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23
Q

Cardiogenic shock Rx

A

MOVAB

  • fluids for SBP <90
  • norepi drip 1-10mcg/min
  • closest PCI facility
24
Q

CHF Rx/ pulmonary edema Rx

A

MOVAB

  • Nitro every 3-5min based on BP (90-120-160 = 0.4-0.8-1.2)
  • CPAP
25
Q

What is “restart the heart” and when is it used?

A

Peds = ABCDE w/in 5 min

Arrive, bag, CPR, drill, epi

26
Q

What 4 pieces of info must you learn if suspecting stroke (NOT VS)

A
  • time of onset/discovery
  • time of last known normal
  • SS present upon awakening?
  • Name & phone of witness
27
Q

What constitutes a stroke alert?

A

Positive stroke exam AND <24hrs last known normal

28
Q

What constitutes a “complex” stroke?

A

Bleeding, blood thinner, brain issues, head trauma, head spine sugerry or stroke < 3mo, Fasted score 4+

29
Q

When to take a stroke pt to primary vs comprehensive center?

A

Comprehensive = complex stroke or time 3.5hours +

Primary or closest = not complex and <3.5hrs

30
Q

Rx for hypoglycemia? What number is hypo? Can you repeat med dosages

A

<60 mg/dL or symptomatic

  • Oral glucose 15mg OR
  • D10w (25g or 250ml)
  • 1mg Glucagon last resort

Repeat x1 after 5-10min if needed

31
Q

Rx for hyperglycemia? What number is hyper?

A

Hyper > 300 mg/dL

  • NS 500ml - repeat x1 if no pulm edema
32
Q

Sepsis criteria

A

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
33
Q

What Rx for sepsis

A
  • 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
34
Q

How much fluid for sepsis adults?

A

Initial bolus 1000ml

If no pulm edema, Continue 500ml doses until hosp or max dose 20ml/kg

35
Q

How do you give nor epi for sepsis? What size IV?

A

Via 18g at AC or IO

  • start 1mcg/min and titrate by 1mcg every min until SBP >90 or max 10mcg rate
36
Q

Rx and dose for anaphylaxis

A
  • 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)

37
Q

What epi drip for anaphylaxis? OLMC?

A

1-4mcg/min. Yes OLMC

38
Q

Your sepsis pt has HR around 180 (SVT) what would you do?

A

Don’t treat the tachycardia. (No adenosine or cardizem)

39
Q

What Rx for nausea vomiting

A

Zofran 4mg (IV or tab), repeat x1

Fluids 500ml

40
Q

When can you give pain meds for abdominal pain?

A

Only acute onset pain

41
Q

What BP do you want to maintain on a trauma with major head injury? What about a general multisystem trauma?

A

Head = SBP > or = 110

Multisystem = > or = 90

42
Q

When do you needle decompress a trauma arrest?

A

Whenever there’s evidence of chest trauma

43
Q

What Rx for trauma arrest?

A

ABC

  • needle decompress PRN
  • Fluids
  • ALCS
44
Q

How much fluids for a trauma arrest adult? Kid? 14-15?

A

Adults = 2000ml

14-15 = 1500ml

13 or < = handtevy

45
Q

Lighting Rx

A

C-spine and CPR PRN

  • cardiac arrest = trauma arrest rx
  • no arrest = MOVAB & treat SS
46
Q

Stingray sting Rx

A

Hot pack or hot water. Don’t remove the barb

47
Q

Jellyfish Rx

A

Rubbing alcohol & rinse w/ NS

48
Q

Snakebite Rx

A

Remove constricting things

  • mark a circle
49
Q

Insect sting

A

Credit card (no tweezers)

Cold pack

50
Q

When to give fentanyl

A

Pain 7+

51
Q

When can you give oral glucose to a diabetic?

A

If conscious and can protect airway

52
Q

Your pt was driving prior to a seizure. Who must you call? Why?

A

PD. They need to be cleared before driving again

53
Q

What assessment/VS must you always monitor when giving versed?

A

ETCO2 and SPO2

54
Q

When you get ROSC, what must you do first

A

Radio rosc

55
Q

Where do rosc pts go

A

Closest PCI

als protocols (4 decks)

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