Protocols - Medical

Question 1

Symptoms of Mild Agitation

Answer 1

Agitated, but cooperative and making rationale decisions. No immediate concern for patient or clinician saFETY

Question 2

Symptoms of Moderate Agitation

Answer 2

Patient is irrational and exhibiting behavior that puts themselves or clinicians at risk

Question 3

Symptoms of Severe Agitation

Answer 3

Patient is physically violent and presents an immediate and imminent threat to themselves or others

Question 4

Treatment for Adult Moderate Agitation:

Answer 4

• Medical Delirium (Infection) or Psychiatric Emergency (Schizophrenia/off medication) - Droperidol 2.5mg IM (1.25mg IM 69 yoa or greater)
• Drug/Alcohol, Head Injury or an Unknown reason - **Midazolam 5mg IM/IV (2.5mg for patient’s 69 yoa or greater) **

Question 5

Treatment for Adult Severe Agitation:

Answer 5

1. Midazolam 5mg IM/IV OR
2. Ketamine 1mg/kg IV/IO (max 100mg) or 4 mg/kg IM (max 400mg) if there is immediate and imminent danger to patient or EMS

Question 6

Treatment for Pediatric Moderate Agitation:

Answer 6

• < 5 yoa: No medications
• 5-12 yoa: Consult for midazolam
• 13-18 yoa:** Droperidol 2.5mg IM** or consult for **Midazolam 0.1 mg/kg IV or 0.2 mg/kg IM/IN (max 5mg) **

Question 7

Treatment for Pediatric Severe Agitation:

Answer 7

• < 5 yoa: No medications
• 5-12 yoa: Consult for Midazolam or Ketamine
• 13-18 yoa: **Ketamine 1 mg/kg IV/IO (max 100 mg) or 4 mg/kg IM (max 400 mg) ** or **Midazolam 0.1 mg/kg IV or 0.2 mg/kg IM/IN (max 5mg) ***

Question 8

Allergic Reaction Mild Symptoms

Answer 8

Localized swelling and itching at the site

Question 9

Allergic Reaction Moderate Symptoms

Answer 9

Hives OR Mild Wheezing

Question 10

Allergis Reaction Severe Symptoms

Answer 10

Acute onset of severe illness after exposure to a knonw allergen with two of the following:
* Hive or acute swelling of the mucosa
* Respiratory compromise
* Hypotension
* GI symptoms

Question 11

Adult Mild Allergic Reaction Treatment:

Answer 11

Dipenhydramine 25mg SLOW IV or IM
OR
Epinephrine 0.5mg IM if patient has a hx of a life threatening allergic reaction

Question 12

Adult Moderate Allergic Reaction Treatment:

Answer 12

Epinephrine 0.5mg IM q 5 mins for a total of 3 doses
Dipenhydramine 50mg SLOW IVP or IM
Albuterol 2.5mg and Ipatropium 500mcg nebulizer

Question 13

Pediatric Mild Allergic Reaction Treatment:

Answer 13

Dipenhydramine 1mg/kg SLOW IV or IM (max 25mg)
OR
Epinephrine <5yoa 0.15mg IM in lateral thigh
>5yoa 0.5mg IM in lateral thigh

Question 14

Pediatric Moderate Allergic Reaction Treatment:

Answer 14

Epinephrine <5yoa 0.15mg IM in lateral thigh
>Greater than 5yoa 0.5mg IM in lateral thigh
>Dipenhydramine 1mg/kg SLOW IV or IM (max 50mg)
>Albuterol/Atrovent
><1 yoa Albuterol 1.25 mg
>1-2yoa Albuterol 1.25mg and Atrovent 250mcg
>2 yoa + Albuterol 2.5mg and Atrovent 500mcg

Question 15

Adult Severe Allergic Reaction (Anaphylaxis) treatment:

Answer 15

Epi 0.5mg IM q 5mins (max 3 doses)
Epi Infusion (extremis with severe hypotension or impending respiratory failure)
* 1mg Epi in 100ml bag (60 gtts) 1ml/min up to 2ml/min
Albuterol 2.5mg and Ipatropium 500mcg nebulizer
Dipenhydramine 50mg SLOW IVP or IM
Bolus 20ml/kg for hypotension
Dexamethasone 10mg IV/IO

Question 16

Pediatric Severe Allergic Reaction (Anaphylaxis) Treatment:

Answer 16

Epinephrine <5yoa 0.15mg IM in lateral thigh
>Greater than 5yoa 0.5mg IM in lateral thigh q 5mins (max 3 doses)
>Dipenhydramine 1mg/kg SLOW IV or IM (max 50mg)
>Albuterol/Atrovent
><1 yoa Albuterol 1.25 mg
>1-2yoa Albuterol 1.25mg and Atrovent 250mcg
>2 yoa + Albuterol 2.5mg and Atrovent 500mcg
>Bolus 20ml/kg
>Dexamethasone 0.5 mg/kg (Max 10mg)

Question 17

Adult Hypoglycemia Treatment:

Answer 17

Less than 70mg/dl
**Dextrose **10% in 50ml (5 gram) boluses 1 min apart OR 25grams of 50% IVP until glucose above 90mg/dl or change in altered mental status
Glucagon (Unable to establish IV access) 1mg Im

Question 18

<28 days old Hypoglycemia Treatment:

Answer 18

Less than 40 mg/dl
Dextrose 10% 2ml/kg

Question 19

28 days until 18th birthday Hypoglycemia Treatment:

Answer 19

Less than 70 mg/dl
**Dextrose **10% 2-4 ml/kg (Max 25 grams)
Glucagon (Unable to establish IV access)
28 days - 4 yoa 0.5 mg IM
5-18 yoa 1 mg IM