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PCP > Protocols > Flashcards

Protocols Flashcards

1
Q

What are the indications for the chest pain protocol?

A

Patients whose presentation is suggestive of cardiac chest pain, who have a history of heart disease, and who would normally take their prescribed Nitroglycerin for chest pain.

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2
Q

What are the contraindications for ASA?

A 
Gastrointestinal bleed or peptic ulcer
Allergy to ASA or already taken their recommended dose
Pediatric
Swallow ability
Asthma exacerbations
Pregnancy
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3
Q

What are the contraindications for Nitro?

A
  • If the patient has taken Viagra or Levitra in the last 24 hours, or Cialis in the last 48 hours
  • B.P. < 90 mmHg
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4
Q

Before initiating the chest pain protocol, what must you have done?

A
  • Performed a primary
  • Ruled in the CP is cardiac in nature
  • Administer 2 chewable 81 mg Aspirin PO
  • Investigated the pain complaint, including severity •Obtained a baseline set of vital signs
  • 0.4 mg Nitroglycerin SL q 3 min
  • Load and transport after the first Nitroglycerin
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5
Q

If chest pain is completely relieved, but returns, what do you do?

A
  • Re-initiate Nitroglycerin administration

* Continue with assessment, treatment and vital signs q 5 minutes.

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6
Q

If chest pain is not relieved or the BP is <90mmHg, what do you do?

A
  • Administer Entonox 5 minutes after last dose of Nitroglycerin.
  • Continue with assessment, treatment and vital signs q 5 minutes
  • After 30 minutes from first dose of Nitroglycerin, this protocol may be repeated after stopping Nitrous Oxide for 5 minutes
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7
Q

What is the indication for the nausea/vomiting protocol?

A

Patients experiencing the sensation of nausea or vomiting.

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8
Q

What must you do prior to initiating the N/V protocol?

A
  • Completed a primary survey
  • Obtained a baseline set of vital signs
  • Rule out any contraindications for the use of an anti-emetic
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9
Q

At what point do you administer Gravol during the N/V protocol?

A

Stable patients may be treated with Dimenhydrinate (Gravol) on scene.
Unstable patients will be treated enroute to hospital.

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10
Q

What is the dose of dimenhydrinate?

A

Dimenhydrinate:
25-50 mg IM/IV
12.5 mg in the frail elderly patient

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11
Q

What else do you need to do when administering dimenhydrinate?

A

Continue to manage and be aware of possible vomiting, position patient appropriately and have suction ready

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12
Q

What are the indications for the SOB protocol?

A

Chief complaint of shortness of breath in a patient with a history of asthma or chronic obstructive pulmonary disease (COPD).

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13
Q

What is the contraindication for the SOB protocol?

A

Allergy to Ventolin.

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14
Q

What must you have done prior to initiating the SOB protocol?

A
  • Performed a primary survey
  • Auscultated the chest
  • Transport
  • Obtained a chief complaint of shortness of breath
  • Obtained a history of asthma or COPD
  • Checked for drug allergies
  • Obtained a baseline set of vital signs including oximetry
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15
Q

In the SOB protocol, if the patient is ≥ 15kg, what is the drug and dose to administer?

A

Administer 5.0 mg Ventolin in 5.0 mL NS

Continue with assessment and treatment

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16
Q

In the SOB protocol, if the patient is < 15kg, what is the drug and dose to administer?

A

Administer 2.5 mg Ventolin 2.5 mL NS

Continue with assessment and treatment

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17
Q

If the patient has improved after the first dose of Ventolin in the SOB protocol, what is your next step?

A

If patient has a history of COPD, initiate low flow 02.

If patient has a history of Asthma, initiate high flow 02.

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18
Q

If the patient has not improved after the first dose of Ventolin in the SOB protocol, what is your next step?

A

Repeat dose of Ventolin

Consider assisting ineffective respirations

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19
Q

In the SOB protocol, what is the priority for these patients?

A

Rapid transport is a priority for these patients. Do not delay at the scene to initiate Ventolin.

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20
Q

Which patients get high flow O2?

A
  • Seriously ill patient
  • Short of Breath patient
  • Moderate to severely traumatized patient who may be bleeding
  • Patient who may be having internal bleeding
  • Smoke and carbon monoxide poisoning patient (maintain high oxygenation -NRB)
  • Patient with chest pains
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21
Q

Who should CPAP be considered for?

A

Patients who remain short of breath with low oxygen saturation despite administration of a bronchodilator, or in patients who present with other causes of shortness of breath (CHF, pulmonary edema, near drowning, pneumonia).

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22
Q

What are the indications for CPAP?

A 
Any patient ≥13 years of age in significant respiratory distress
•Awake and following commands
•Maintains a patent airway
•Exhibits all of the following:
RR > 24
SpO2< 94% (on O2)
Accessory muscle use
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23
Q

What are the contraindications for CPAP?

A
  • Decreased LOC
  • Respiratory arrest – Hypoventilation
  • Vomiting –Risk of aspiration
  • Unable to fit mask
  • Traumatic cause of SOB
  • Pneumothorax
  • SBP < 90 mmHg
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24
Q

What are the steps to using CPAP?

A
  1. Start at 5L/min with CPAP valve @ 5 cm/H2O
  2. Obtain facial seal
  3. Once manual seal obtained, increase CPAP valve to 5 cm/H2O
  4. Reassess patient and vitals
  5. Repeat to max. CPAP of 10 cm/H2O
25
Q

What is the indication for the Entonox protocol?

A

Pain

26
Q

What are the contraindications for the Entonox protocol?

A 
Decompression illness
Inability to comply
Ventilation
Inhalation injury
Nitro in the last 5 minutes
Embolism or suspected pneumothorax
27
Q

What are the cautions for the Entonox protocol?

A 
COPD
Facial injury
Abdomen distension
Depressant drugs
Shock
28
Q

What must you have done prior to initiating the Entonox protocol?

A
  • Completed a primary survey
  • Investigated the pain complaint, including severity
  • Obtained a baseline set of vital signs, including oxygen saturation
  • Conducted a history and physical examination sufficient to rule out the contraindications for use of Entonox
  • Invert cylinder 3 X
  • (If in the ambulance) Turn on vehicle ventilation system (intake and output)
29
Q

What are the indications for the hypovolemia protocol?

A 
Patients with all of the following:
•Hypovolemia
•Systolic BP < 90 mmHg*
•Other clinical signs of shock
•Patients with burns > 20% BSA (second-and third-degree)

*The Hypovolemia protocol may be used for patients with BP > 90 mm Hg if shock is anticipated because of the mechanism of injury, the nature and extent of the injuries or the patient’s condition.

30
Q

What are the contraindications for the hypovolemia protocol? Cautions?

A

No contraindications.

Caution: SOB

31
Q

What must you have done prior to initiating the hypovolemia protocol?

A
  • Completed a primary survey
  • Loaded and begin transport
  • Obtained a baseline set of vital signs
  • Auscultate chest (Base of the lungs)
32
Q

If the SBP is ≥ 90mmHg in the hypovolemia protocol, what is your next step?

A

Administer IV NS at maintenance rate

Continue with assessment and treatment

33
Q

If the SBP is < 90mmHg in the hypovolemia protocol, what is your next step?

A

Administer 500 mL NS bolus

Continue with assessment and treatment

34
Q

What are the indications for the TXA protocol?

A
  • Trauma with signs of shock/hypoperfusion in association with injury suggestive of occult or ongoing bleeding
  • ≥12 years
  • Systolic pressure < 90 mmHg
  • Heart rate > 110 beats per/minute
  • Within 3 hours from time of injury and on route to receiving hospital
35
Q

What must you have done prior to initiating the TXA protocol?

A
  • Completed a primary survey
  • Loaded and begin transport
  • Obtained a baseline set of vital signs
  • Initiated the Hypovolemia protocol
36
Q

What are the doses for TXA? (piggyback and IV push)

A

Piggyback 1 gram (1000 mg) infused in 50 mL bag of NS and deliver at a rate of 60 gtts/min

Deliver 1 gram (1000mg) in 10 mL NS slow IV push administered over 10 min (1mL/min)

37
Q

What are the indications for the anaphylaxis protocol?

A

Patient with suspected anaphylaxis, including all of the following:
Signs of anaphylaxis
History of an allergy
Exposure to an allergen
Unstable: decreased LOC, or hypotension (BP < 90 mmHg), or respiratory distress

38
Q

What are the contraindications for the anaphylaxis protocol?

A

Diphenhydramine is contraindicated in patients with a known allergy to Diphenhydramine
Tablets are contraindicated in unconscious patients.

39
Q

What must you have done prior to initiating the anaphylaxis protocol?

A

Completed a primary survey
Obtained a history sufficient to establish a history of an allergy
Obtained signs and symptoms of an allergic reaction or anaphylaxis
Obtained a baseline set of vital signs

40
Q

What is the anaphylaxis protocol treatment for patients > 12 years of age?

A
  • Administer 0.01 mg/kg Epinephrine 1:1000 IM33(to maximum 0.5 mg).
  • Administer 25-50 mg Diphenhydramine PO (2-4 chewable tablets)
  • Transport
  • Initiate IV NS
  • Reassess vital signs
41
Q

What is the anaphylaxis protocol treatment for patients 6-11 years of age?

A
  • Administer 0.01 mg/kg Epinephrine 1:1000 IM33(to maximum 0.5 mg).
  • Administer 25 mg Diphenhydramine PO (2 chewable tablets)
  • Transport
42
Q

What is the anaphylaxis protocol treatment for patients 2-5 years of age?

A
  • Administer 0.01 mg/kg Epinephrine 1:1000 IM33(to maximum 0.5 mg).
  • Administer 12.5 mg Diphenhydramine PO (1 tablet crushed)
  • Transport
43
Q

What are the indications for the NYD protocol?

A

Decreased/Altered LOC, Not yet diagnosed

44
Q

What are the contraindications for the NYD protocol?

A

Naloxone Hydrochloride is contraindicated in patients with a known Naloxone allergy
Glucagon is contraindicated in patients with a known Glucagon allergy.

45
Q

What must you have done prior to initiating the NYD protocol?

A
  • Completed a primary survey
  • Obtained a history sufficient to rule out contraindications for this protocol
  • Obtained a baseline set of vital signs
  • Obtain Blood Glucose reading and GCS
46
Q

What are the steps for the NYD protocol IF there is no IV access and the BGL is > 4.0mmol?

A

Possible narcotic overdose:
administer 0.8mg Naloxone IM
Repeat if necessary
Initiate transport

47
Q

What are the steps for the NYD protocol IF there is no IV access and the BGL is ≤ 4.0mmol?

A 
Administer oral glucose
Glucagon IM:
1mg ≥ 20kg
.5 mg < 20kg
Initiate transport
48
Q

What are the steps for the NYD protocol if there is IV access, BGL > 4.0mmol, and SBP < 90mmHg?

A

IV NS 500ml bolus

Initiate transport

49
Q

What are the steps for the NYD protocol if there is IV access, BGL ≤ 4.0mmol, and SBP ≥ 90mmHg?

A

Piggyback D10W 100ml bolus
Repeat if necessary
Initiate transport

50
Q

What are the steps for the NYD protocol if there is IV access, BGL ≥ 4.0mmol, and SBP ≥ 90mmHg?

A

Possible narcotic overdose:
administer 0.4mg Naloxone IV push
repeat if necessary
initiate transport

51
Q

What are the indications for the Naloxone protocol?

A
  • Decreased LOC in a patient with a history that suggests narcotic overdose
  • Difficulty in maintaining the patient’s airway
  • Respiratory rate <10 per minute
52
Q

What are the contraindications for the Naloxone protocol?

A

Naloxone Hydrochloride is contraindicated in patients with a known Naloxone allergy

53
Q

What do you need to have prior to initiating the Naloxone protocol?

A
  • Primary airway management is paramount by ensuring the patient’s airway is protected, open and clear.
  • Ensure the patient is well oxygenated and/or ventilated with a BVM
  • Primary survey
  • A history sufficient to suggest narcotic overdose as the cause of unconsciousness
  • A history sufficient to rule out contraindications for the suspected narcotic overdose protocol
  • A baseline set of vitals
54
Q

What is the treatment for the Naloxone protocol?

A

Administer 0.4 mg Naloxone Hydrochloride IM
•Load and transport
If no improvement:
•Administer 0.4 mg Naloxone Hydrochloride IM
If no improvement:
•Administer 0.8 mg Naloxone Hydrochloride IM
If no improvement:
•Administer 2.0mg Naloxone Hydrochloride IM
Also consider assessing blood glucose level:
If blood glucose ≤ 4mmol/L, consider diabetic protocol

55
Q

What are the indications for the diabetic protocol?

A

Known diabetic patients with decreased LOC whose history suggests hyperglycemia or hypoglycemia.

56
Q

What must you have done prior to initiating the diabetic protocol?

A
  • Request equipment be prepared for rapid transport
  • A primary survey
  • A history of diabetes
  • A baseline set of vital signs
  • Signs and symptoms sufficient to suggest hypoglycemia or hyperglycemia
57
Q

If you are doing the diabetic protocol and your patient’s BGL is > 4.0mmol, what are your next steps?

A
  • Initiate transport
  • Administer IV NS at maintenance rate
  • Continue with assessment and treatment
58
Q

If you are doing the diabetic protocol and your patient’s BGL is < 4.0mmol and you DO have IV access, what are your next steps?

A

Administer IV D10W 100ml bolus
Initiate transport
Reassess LOC

If improvement:
•D10W maintenance rate 100ml/hr
•continue with assessments and treatments

If no improvement:
•D10W second bolus 100ml
•maintain IV D10W at maintenance rate 100ml/hr
•repeat BGL
•continue with assessments and treatment
59
Q

If you are doing the diabetic protocol and your patient’s BGL is < 4.0mmol and you DON’T have IV access, what are your next steps?

A

administer oral glucose
administer Glucagon IM:
•1.0 mg ≥ 20 kg
•0.5 mg < 20 kg

Initiate transport
Continue with assessments and treatments

PCP (10 decks)

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