Protocols Flashcards
What are the indications for the chest pain protocol?
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.
What are the contraindications for ASA?
Gastrointestinal bleed or peptic ulcer Allergy to ASA or already taken their recommended dose Pediatric Swallow ability Asthma exacerbations Pregnancy
What are the contraindications for Nitro?
- If the patient has taken Viagra or Levitra in the last 24 hours, or Cialis in the last 48 hours
- B.P. < 90 mmHg
Before initiating the chest pain protocol, what must you have done?
- 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
If chest pain is completely relieved, but returns, what do you do?
- Re-initiate Nitroglycerin administration
* Continue with assessment, treatment and vital signs q 5 minutes.
If chest pain is not relieved or the BP is <90mmHg, what do you do?
- 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
What is the indication for the nausea/vomiting protocol?
Patients experiencing the sensation of nausea or vomiting.
What must you do prior to initiating the N/V protocol?
- Completed a primary survey
- Obtained a baseline set of vital signs
- Rule out any contraindications for the use of an anti-emetic
At what point do you administer Gravol during the N/V protocol?
Stable patients may be treated with Dimenhydrinate (Gravol) on scene.
Unstable patients will be treated enroute to hospital.
What is the dose of dimenhydrinate?
Dimenhydrinate:
25-50 mg IM/IV
12.5 mg in the frail elderly patient
What else do you need to do when administering dimenhydrinate?
Continue to manage and be aware of possible vomiting, position patient appropriately and have suction ready
What are the indications for the SOB protocol?
Chief complaint of shortness of breath in a patient with a history of asthma or chronic obstructive pulmonary disease (COPD).
What is the contraindication for the SOB protocol?
Allergy to Ventolin.
What must you have done prior to initiating the SOB protocol?
- 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
In the SOB protocol, if the patient is ≥ 15kg, what is the drug and dose to administer?
Administer 5.0 mg Ventolin in 5.0 mL NS
Continue with assessment and treatment
In the SOB protocol, if the patient is < 15kg, what is the drug and dose to administer?
Administer 2.5 mg Ventolin 2.5 mL NS
Continue with assessment and treatment
If the patient has improved after the first dose of Ventolin in the SOB protocol, what is your next step?
If patient has a history of COPD, initiate low flow 02.
If patient has a history of Asthma, initiate high flow 02.
If the patient has not improved after the first dose of Ventolin in the SOB protocol, what is your next step?
Repeat dose of Ventolin
Consider assisting ineffective respirations
In the SOB protocol, what is the priority for these patients?
Rapid transport is a priority for these patients. Do not delay at the scene to initiate Ventolin.
Which patients get high flow O2?
- 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
Who should CPAP be considered for?
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).
What are the indications for CPAP?
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
What are the contraindications for CPAP?
- Decreased LOC
- Respiratory arrest – Hypoventilation
- Vomiting –Risk of aspiration
- Unable to fit mask
- Traumatic cause of SOB
- Pneumothorax
- SBP < 90 mmHg
What are the steps to using CPAP?
- Start at 5L/min with CPAP valve @ 5 cm/H2O
- Obtain facial seal
- Once manual seal obtained, increase CPAP valve to 5 cm/H2O
- Reassess patient and vitals
- Repeat to max. CPAP of 10 cm/H2O
What is the indication for the Entonox protocol?
Pain
What are the contraindications for the Entonox protocol?
Decompression illness Inability to comply Ventilation Inhalation injury Nitro in the last 5 minutes Embolism or suspected pneumothorax
What are the cautions for the Entonox protocol?
COPD Facial injury Abdomen distension Depressant drugs Shock
What must you have done prior to initiating the Entonox protocol?
- 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)
What are the indications for the hypovolemia protocol?
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.
What are the contraindications for the hypovolemia protocol? Cautions?
No contraindications.
Caution: SOB
What must you have done prior to initiating the hypovolemia protocol?
- Completed a primary survey
- Loaded and begin transport
- Obtained a baseline set of vital signs
- Auscultate chest (Base of the lungs)
If the SBP is ≥ 90mmHg in the hypovolemia protocol, what is your next step?
Administer IV NS at maintenance rate
Continue with assessment and treatment
If the SBP is < 90mmHg in the hypovolemia protocol, what is your next step?
Administer 500 mL NS bolus
Continue with assessment and treatment
What are the indications for the TXA protocol?
- 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
What must you have done prior to initiating the TXA protocol?
- Completed a primary survey
- Loaded and begin transport
- Obtained a baseline set of vital signs
- Initiated the Hypovolemia protocol
What are the doses for TXA? (piggyback and IV push)
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)
What are the indications for the anaphylaxis protocol?
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
What are the contraindications for the anaphylaxis protocol?
Diphenhydramine is contraindicated in patients with a known allergy to Diphenhydramine
Tablets are contraindicated in unconscious patients.
What must you have done prior to initiating the anaphylaxis protocol?
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
What is the anaphylaxis protocol treatment for patients > 12 years of age?
- 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
What is the anaphylaxis protocol treatment for patients 6-11 years of age?
- Administer 0.01 mg/kg Epinephrine 1:1000 IM33(to maximum 0.5 mg).
- Administer 25 mg Diphenhydramine PO (2 chewable tablets)
- Transport
What is the anaphylaxis protocol treatment for patients 2-5 years of age?
- Administer 0.01 mg/kg Epinephrine 1:1000 IM33(to maximum 0.5 mg).
- Administer 12.5 mg Diphenhydramine PO (1 tablet crushed)
- Transport
What are the indications for the NYD protocol?
Decreased/Altered LOC, Not yet diagnosed
What are the contraindications for the NYD protocol?
Naloxone Hydrochloride is contraindicated in patients with a known Naloxone allergy
Glucagon is contraindicated in patients with a known Glucagon allergy.
What must you have done prior to initiating the NYD protocol?
- 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
What are the steps for the NYD protocol IF there is no IV access and the BGL is > 4.0mmol?
Possible narcotic overdose:
administer 0.8mg Naloxone IM
Repeat if necessary
Initiate transport
What are the steps for the NYD protocol IF there is no IV access and the BGL is ≤ 4.0mmol?
Administer oral glucose Glucagon IM: 1mg ≥ 20kg .5 mg < 20kg Initiate transport
What are the steps for the NYD protocol if there is IV access, BGL > 4.0mmol, and SBP < 90mmHg?
IV NS 500ml bolus
Initiate transport
What are the steps for the NYD protocol if there is IV access, BGL ≤ 4.0mmol, and SBP ≥ 90mmHg?
Piggyback D10W 100ml bolus
Repeat if necessary
Initiate transport
What are the steps for the NYD protocol if there is IV access, BGL ≥ 4.0mmol, and SBP ≥ 90mmHg?
Possible narcotic overdose:
administer 0.4mg Naloxone IV push
repeat if necessary
initiate transport
What are the indications for the Naloxone protocol?
- Decreased LOC in a patient with a history that suggests narcotic overdose
- Difficulty in maintaining the patient’s airway
- Respiratory rate <10 per minute
What are the contraindications for the Naloxone protocol?
Naloxone Hydrochloride is contraindicated in patients with a known Naloxone allergy
What do you need to have prior to initiating the Naloxone protocol?
- 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
What is the treatment for the Naloxone protocol?
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
What are the indications for the diabetic protocol?
Known diabetic patients with decreased LOC whose history suggests hyperglycemia or hypoglycemia.
What must you have done prior to initiating the diabetic protocol?
- 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
If you are doing the diabetic protocol and your patient’s BGL is > 4.0mmol, what are your next steps?
- Initiate transport
- Administer IV NS at maintenance rate
- Continue with assessment and treatment
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?
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
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?
administer oral glucose
administer Glucagon IM:
•1.0 mg ≥ 20 kg
•0.5 mg < 20 kg
Initiate transport
Continue with assessments and treatments
