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MCEMS Protocols > Protocols > Flashcards

Protocols Flashcards

1
Q

Pt has RUQ pain. What DIFF Dx?

A

Gallbladder, liver, pancreas

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2
Q

LUQ pain. What diff dx

A

Spleen, pancreas, stomach

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3
Q

RLQ PAIN = what issues

A

Appendicitis, kidney stone, PID, ovaries/cyst

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4
Q

LLQ pain = what issues

A

Diverticulitis, kidney stone, cyst/ovary

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5
Q

Per shock protocol, what MAP to maintain

A

55-65 mmHg

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6
Q

Abdominal pn rx

A

Position of comfort, maintain CO.

Pt is NPO

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7
Q

AMS rx

A

rule out SNOT & treat accordingly

sugar, seizure, stroke, narc, oxygen, trauma, toxicity/drugs

MOVAB

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8
Q

What’s hypoglycemia criteria

A

<60 mg/dL

Or <80mg/dL in known diabetic

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9
Q

Hypoglycemia rx

A

Oral, D10, D50, or glucagon

Reassess per 10min

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10
Q

When shouldn’t you give oral glucose to a hypoglycemic pt?

A

Can’t protect airway (rapid LOC decomp or no gag reflex

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11
Q

Opioid OD rx

A

Narcan IN IM IV IO until adequat ventilations (NOT loc)

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12
Q

Psych disorders have often cause AMS. True or false

A

FALSE. Suspect medical involvement if so

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13
Q

Non-organic coma rx

A

Inhalants/smelling salts for adult >16

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14
Q

GCS less than 8….

A

Intubate

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15
Q

Anaphylaxis rx

A

Mild (skin) = Benadryl & dexamethasone

Moderate (dyspnea & bad hives) = Epi IM 1:1000, Albuterol, and mild rx

Severe (shock) = all the above plus fluids and push dose epi (instead of IM)

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16
Q

What happens when giving Epi to pt on beta blockers?

A

Can cause severe HTN and brain bleed DT unopposed alpha1 receptors

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17
Q

Pt is on beta blockers and having a severe allergic reaction. And Epi doesn’t help. What now?

A

OLMC
Glucagon + cyrstalloid

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18
Q

When to tube a burned airway

A

High Resp distress
Stridor
New onset hoarse
Blister burns of oropharynx

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19
Q

Are 1st degree burns included in TBSA

A

No

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20
Q

Which pts go to a burn center? What tbsa?

A

> 10% tbsa

Or… chemical, critical spots, airway, electrical,

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21
Q

What can you use to cover burns

A

Blanket, Saran wrap, sheets

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22
Q

What carbon monoxide level = hi flo O2

A

> 15%

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23
Q

Max time to cool a burn pt

A

5 min

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24
Q

Pt has chemical burn. What Rx?

A

Call hazmat
PPE
Dry = brush
Wet = flush

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25
Q

Can you use neutralizers on chemical burns?

A

No

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26
Q

2 things to ask during electrical burn?

A

Arc flash or contact

What voltage?

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27
Q

What drugs for cyanide poisoning?

A

Cyanokit (Hydroxocobalamin)

Sodium Thiosulfate (if Cyanokit no available)

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28
Q

Baby vs adult rule of nines

A

Baby head = 18%

Baby legs = 13.5%

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29
Q

Max interruptions in CPR

A

<10s

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30
Q

Ventilation rate for cardiac arrest

A

8-10 bpm

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31
Q

Where to place defib pads?

A

Anterior - Posterior first (heart pad in front)

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32
Q

What to do after 3 defibrillations

A

Double sequential external defib

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33
Q

Preferred placement of an IO in a cardiac arrest?

A

Proximal humerus

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34
Q

Where to take all arrest patients?

A

Nearest PCI

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35
Q

When must you call OLMC to terminate CPR?

A

Pt has organized rhythm & ETCO2 >10 with waveform without CPR.

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36
Q

When to give sodium bicarb during an arrest?

A

Early if tricyclic antidepressant OD or hyper K

Prolonged arrest

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37
Q

When to OG tube during an arrest?

A

If tube is placed

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38
Q

Do we pre-charge defib prior to checking a pulse?

A

Yes

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39
Q

What Joules to defib pulseless V-fib or V-tach

A

360J

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40
Q

When to give epi during a v-fib/v-tach arrest?

A

After the 2nd shock

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41
Q

When to give Amio 300mg during a VF or VT arrest?

A

After 3rd shock

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42
Q

VF/VT drug sequence

A

Epi 1mg - Amio 300mg - Epi 1mg - Amio 150mg - Epi 1mg - Esmolol 500mcg/kg - Epi 1mg - Esmolol 500mcg/kg - Epi 1 mg - Lidocaine 1mg/kg - Epi - Lidocaine 1mg/kg

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43
Q

Who gets double sequential defib?

A

> 12 years

> 40kg

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44
Q

You get ROSC without shocking or giving an antidysrhythmic. What drugs to give?

A

NO antidysrhythmics

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45
Q

You get ROSC after shocking but didn’t give any antidysrhythmics. What drugs now?

A

Lidocaine

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46
Q

You get ROSC and the last antidysrhythmic you gave was amio. What drugs now?

A

Amio

47
Q

You get ROSC and the last antidysrhythmic was Esmolol. What drugs now?

A

Esmolol drip

48
Q

You get ROSC and gave mag sulfate for torsades during the arrest. What drugs now?

A

If mag worked = give more mag

Mag no worked = lidocaine

49
Q

How to confirm Asystole

A

2 leads
Increase GAIN to rule out fine v-fib

50
Q

Asystole/PEA protocol

A

CPR
Epi per 3-5min

51
Q

What are the H’s

A

Hermes the Ox drove to Cali to play Volleyball

HypoThermia
Hypoxia
Hydrogen Ion (acidosis)
Hyper/hypokalemia
Hypovolemia

52
Q

What are the T’s

A

Thrombo the lesbian raises tension and trauma when she tox about her tampons

Thrombosis (PE or MI)
Tension pneumo
Trauma
Toxicity
Tamponade

53
Q

When can you terminate a persistent Asystole arrest?

A

X3 epi given
Confirmed asystole in x6 limb leads (with full gain)

54
Q

How to transport a pregnant >22wk arrest?

A

Displace uterus w/ 2 hands
Tilt backboard 30 degrees to the left

55
Q

How does a preggo airway differ during intubations

A

It’s more difficult
Size 1-2 sizes down

56
Q

When to transport a pregnant arrest >22wks

A

ASAP regardless of ROSC

57
Q

Where to take a pregnant arrest >22 wks

A

No ROSC = Closest facility (w/ or w/o OB)

ROSC = closest OB or NICU

58
Q

Preferred antiarrhythmic for preggo arrests

A

Lidocaine > amio

59
Q

You suspect PE in an arrest pt. How does this change you treatments?

A

Load and go ASAP

60
Q

You suspect cardiac tamponade in an arrest pt. How does this change your interventions?

A

Load and go ASAP

61
Q

What signs = unstable for cardiac dysrhythmias

A

Chest pain, hypotensive, altered, pulmonary edema, shock signs

62
Q

Tachycardia Rx

A

MOVAB

Stable vs unstable?

63
Q

Stable narrow (regular) tachycardia Rx

A

Valsalva

Adenosine (6-12-12)

64
Q

Stable narrow irregular tachycardia Rx

A

Monitor

OLMC if you want

65
Q

Stable, wide irregular tachycardia Rx

A

Torsades = mag sulfate

Anything else = monitor

66
Q

Stable, wide, regular tachycardia Rx

A

Maybe adenosine

Amio drip x2

67
Q

Unstable tachycardia Rx

A

Cardiovert 360J x2

Consider versed or etomidate sedation

No = amio SIVP

No = cardiovert 360 J

No = OLMC & rapid transport

68
Q

Unstable wide, irregular tachycardia Rx

A

Defib 360 J

69
Q

When should you half the adenosine dosage?

A

Heart transplant

Carbamazepine (tegretol) & dipyridamole

Using a central line

70
Q

Why is adenosine bad for WPW?

A

Can trigger a-fib RVR

71
Q

How can adenosine risk asthma pts?

A

Can cause reactive airway response

72
Q

Unstable bradycardia Rx

A

Atropine vs pace (depends on rhythm type)

No = Epi infusion or norepi infusion

73
Q

When to pace vs atropine an unstable bradycardia

A

2nd degree type II or 3rd degree, or heart transplant = pace

1st deg or 2nd deg type I = atropine

74
Q

Good troubleshoot for not getting capture for pacing?

A

Reposition pads

75
Q

Why won’t atropine work on heart transplants?

A

They lack vagal innervation

76
Q

PVC Rx

A

Only if suspecting ischemia

Lidocaine

77
Q

When treating PVCS with lidocaine, when would you need OLMC?

A

BP < 90
HR < 50

Sinus arrest periods
2nd or 3rd degree block

78
Q

What do ECGs look like with Hyper K?

A

Peak T
Lower/no P wave
Wide QRS

79
Q

What can cause hyper K?

A

Rhabdo

Renal failure\

Crush injury

80
Q

Wide Complex dysrhythmia w/ suspected hyper K Rx

A

Pulse = calcium gluconate, hi dose albuterol, sodium bicarb

No pulse = calcium gluconate & bicarb

81
Q

ACS Rx

A

MOVAB (O2 > 95%)

Nitro (AFTER IV if 1st time)

ASA

Pain meds

82
Q

When should you give Fentanyl to an ACS pt?

A

After x3 nitro with no pain relief and BP > 100 SBP

83
Q

STEMI criteria

A

1mm elevation in 2 contiguous LIMB leads

2mm elevation in 2 contiguous CHEST leads

84
Q

STEMI Rx

A

Activate alert

Defib pads on Pt

ACS protocol

85
Q

What are STEMI mimics

A

LBBB or RBBB
LVH
SVT
Pacer
pericarditis
Early repol
Digitalis

86
Q

Crush injury

A

Treat Hyper K if present

Give 1-2L isotonic prior to extrication

Maintain fluid infusion

87
Q

What BGL = hypoglycemia? Hyperglycemia?

A

Hypo =<60 or <80 (known diabetic)

Hyper = >300 or high

88
Q

Hypoglycemia Rx

A

Oral (if conscious with gag), D50, or D10

Recheck 10min

Glucagon if no access

89
Q

Hyperglycemia Rx

A

MOVAB + Etco2

500-1000ml fluids

Monitor for DKA or HNC

90
Q

What ETCO2 correlates with DKA or HNC?

A

< 25 mmHg

91
Q

Should you tube a pt in DKA or HNC

A

Try to avoid if possible

92
Q

Epistaxis Rx

A

Lean forward w/ nose plugs

Still bleed = blow nose to expel clots & oxymetazoline hydrochloride x 2 nose sprays

93
Q

Pt has nosebleed but is on NC oxygen normally

A

Put it in their mouth

94
Q

Eye emergency Rx

A

30 degree angle

Chemical burn = Irrigate from center eye

Trauma = eye shield & cover other eye

95
Q

Foreign body in superficial eye Rx

A

Proparacaine

Consider fluid irrigation

NO wiping.

96
Q

Hyperthermia Rx

A

Strip & evaporation/convection cooling

MOVAB

Chilled NS

97
Q

Hypothermia Rx

A

Strip wet clothes & heater w/ blankets

OLMC for arrested pts

98
Q

Should you CPR or pace a hypothermica brady pt?

A

No

99
Q

How does hypothermia affect meds on pts

A

Meds might not work until adequate circulation restored.

100
Q

What pts need full immobilization/restriction?

A

MOI w/ potential spinal injury and ANY of the following:

AMS
Intoxication
Distracting injury
Neuro deficit
Spine pain/deficit
Distracting situation (language, emotion..)

101
Q

When can you remove spinal immobilization stuff? What alternative?

A

Increases pain or neuro deficit = position of comfort/position found

102
Q

How to spinal immobilize a pregnant pt? What term of gestation is most risk for hypotension?

A

Backboard elevate 6in on right side

103
Q

What amputation pt’s become trauma systems?

A

Proximal to wrist or ankle

104
Q

Amputation Rx. What to do with severed limbs?

A

Cover end w/ wet sterile gauze + dry gauze

Bleeding control

Limb in plastic bag or wrap & ice water. Transport first if delayed extrication

105
Q

Partial amputation Rx

A

Splint in anatomical position

106
Q

You feel no distal pulse on a fracture/dislocation. What Rx?

A

Axial traction until PMS. Then splint

107
Q

Open Fracture Rx

A

Wet then dry dressing.

Splint position found unless PMS compromised

108
Q

Nausea vomiting Rx

A

Fluids
Alcohol inhalation
Zofran
Prochloperazine ( if zofran not able)
Benadryl (if both aren’t able or extrapyramidal reaction

109
Q

What must you do when giving zofran?

A

Cardiac monitor

110
Q

What position to transport any 3rd trimester momma

A

Left side with pillow under hip

Backboard = elevate right side board 6 inches)

111
Q

When should you give oxytocin to a mom?

A

If mom confirms single pregnancy by prenatal ultrasound

112
Q

What med to give moms if shock is present

A

TXA

113
Q

When

A

MCEMS Protocols (5 decks)

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