Protocols 2021

Question 1

What do we report on a 12-lead?

Answer 1

LBBB, RBBB or poor quality EKG

Question 2

Where do we send the 12-lead?

Answer 2

receiving hospital

Question 3

Chest Pain

Systolic BP is 100 or greater

Answer 3

NTG, 0.4mg SL, SO, MR q3-5 min
Treat per pain management protocol

Question 4

Discomfort/pain of suspected cardiac origin with associated shock

Answer 4

250 mL fluid bolus IV/IO with no rales SO,
MR to maintain SBP >90 mmHg SO

Question 5

Discomfort/pain of suspected cardiac origin with associated shock:

If BP refractory to second fluid bolus?

Answer 5

Push-dose epinephrine 1:100,000 (0.01 mg/mL) 1 mL IV/IO BHO, MR q3 min, titrate to SBP mmHg BHO

Question 6

Push-dose epinephrine mixing instructions:

Answer 6

1. Remove 1 mL normal saline (NS) from the 10 mL NS syringe
2. Add 1 mL of epinephrine 1:10,000 (0.1 mg/mL) to 9 mL NS syringe

The mixture now has 10 mL of epinephrine at 0.01 mg/mL (10 mcg/mL) concentration.

Question 7

NTG is contraindicated in patients who have taken

Answer 7

erectile dysfunction medications such as sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil
(Levitra®) within 48 hours; and

pulmonary hypertension medications such as sildenafil (Revatio®) and epoprostenol sodium
(Flolan® and Veletri®)

Question 8

Use supplemental O2 to maintain saturation at?

Answer 8

94-98%

Question 9

Are we applying the pads and shocking V-fib or V-tach Pulseless now?

Answer 9

Yes; we are no longer waiting for two minutes to check and shock

Question 10

Team leader priorities? CPR

Answer 10

Monitor CPR quality, rate, depth, full chest recoil, and capnography value and waveform

Minimize interruption of compressions (<5 sec) during EKG rhythm checks

Charge monitor prior to rhythm checks. Do not interrupt CPR while charging.

Question 11

For EtCO2 ____ mmHg, may place ET/PAA without interrupting compressions

Answer 11

> 0

Question 12

If EtCO2 rises rapidly during CPR? Do what?

Answer 12

Pause CPR and check for pulse

Question 13

Unstable Bradycardia:

Answer 13

Obtain 12-lead EKG
Atropine 1 mg IV/IO SO, MR q3-5 min to max 3 mg SO
250 mL fluid bolus IV/IO SO, MR SO

Question 14

Unstable Bradycardia:

Rhythm unresponsive to atropine

Answer 14

Midazolam 1-5 mg IV/IO PRN pre-pacing SO

External cardiac pacing* SO

If capture occurs and Systolic BP is 100 or greater mmHg, treat per Pain Management Protocol (S-141)

Question 15

Unstable Bradycardia

Rhythm unresponsive to atropine

Answer 15

If SBP <90 mmHg after atropine or initiation of pacing

250 mL fluid bolus IV/IO SO, MR x1 SO

Push-dose epinephrine 1:100,000 (0.01 mg/mL) 1 mL IV/IO BHO. MR q3 min, titrate to SBP
mmHg BHO.

Question 16

What determines unstable for cardiac rhythms?

There is no more narrow vs wide for bradycardia.

Answer 16

SBP <90 HHmg and exhibiting signs or symptoms of inadequate perfusion, e.g.,
Altered mental status (decreased LOC, confusion, agitation)
Pallor
Diaphoresis
Significant chest pain of suspected cardiac origin
Severe dyspnea

Question 17

External cardiac pacing:

What rate do you begin at?

Dial up until capture occurs?

Increase by a small amount?

Answer 17

Begin at rate 60/min

Dial up until capture occurs, usually between 50 and 100 mA

Increase by a small amount, usually about 10%, for ongoing pacing

Question 18

SVT - Stable (symptomatic)

Answer 18

Obtain 12-lead EKG

If SBP <90 mmHg and rales not present, 250 mL fluid bolus IV/IO SO, MR SO, VSM SO

Adenosine 6 mg rapid IV/IO followed by 20 mL NS rapid IV/IO SO

Adenosine 12 mg rapid IV/IO followed by 20 mL NS rapid IV/IO SO, MR x1 SO

Question 19

SVT (Unstable)

Answer 19

Unstable‡ (or refractory to treatment)
Consider midazolam 1-5 mg IV/IO pre-cardioversion SO
Synchronized cardioversion at manufacturer’s recommended energy dose SO, MR x2 SO, MR BHO

After successful cardioversion

Check BP. If SBP <90mmHG and rales not present, 250 mL fluid bolus IV/IO SO, MR SO.

Obtain 12-lead EKG

Question 20

What does waveform look like in hyperventilation?

Answer 20

Becomes closer together and the level begins to decrease.

Question 21

What does waveform look like in hypoventilation?

Answer 21

Waveform looks normal in shape, but it increases.

Question 22

What does “shark fin” pattern normally indicate on ETCO2?

Answer 22

Some type of bronchoconstriction (asthma, COPD, or an airway obstruction)

• typically elevated ETCO2

Question 23

What does loss of waveform indicate in an intubated patient?

Answer 23

The tube might be dislodged

Question 24

What does ETCO2 measure?

Answer 24

Cardiac output

Question 25

What is necessary to generate a waveform in cardiac arrest patients?

Answer 25

CPR

Question 26

What tool can be used to determine good CPR?

Answer 26

ETCO2 waveform

Question 27

Someone that has been in cardiac arrest for a period of time may not have high ETCO2 or a good waveform. What might they have to prevent pulling a tube?

Answer 27

If they have a small but distinct square wave form

Question 28

What can be the first sign of ROSC?

Answer 28

ETCO2 (rapid increase of ETCO2)

—Stop CPR and check for a pulse

Question 29

“KING” Airway

Size use

Answer 29

Size 3 (yellow) is for patients 4-5 feet tall

Size 4 (red) is for patients 5-6 feet tall

Size 5 (purple) for patients >6 feet tall

Question 30

How far do you advance the KING airway?

Answer 30

Until the base of the ventilation port is at the teeth or gums

Question 31

KING Airway

Inflate a size 3 with how much air?

Answer 31

50ml

Question 32

KING Airway

Inflate a size 4 with how much air?

Answer 32

70ml

Question 33

KING Airway

Inflate a size 5 with how much air?

Answer 33

80ml

Question 34

If ventilation becomes hard with a KING airway, what can you do to make it easier?

Answer 34

Gently withdraw the tube until ventilation becomes easy

Question 35

LEAD-SD

Answer 35

Lung sounds
ETCO2
Abdominal sounds
Depth
Size
Document presence of EtCO2 waveform and EtCO2 numeric value at Transfer of Care

Question 36

When do we reconfirm SD-LEAD?

Answer 36

After we move the patient and after turn over.

Question 37

What’s the max gastric tube size we can place?

Answer 37

18 max French gastric tube