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Loudoun Protocols > Protocols Quiz > Flashcards

Protocols Quiz Flashcards

1
Q

Allergic Reactions
You patient presents with the following

Altered Mental Status

Hypotension (Adult SBP < 90 mmHg)

How would you classify this reaction?

A

Severe

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2
Q

Ventricular Tachycardia (with pulses)

You have determined that your patient is unstable. You have elected to administer escalating synchronized cardioversion. Your second shock will be at how many joules?

A

200 J

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3
Q

Supraventricular Tachycardia

You have correctly administered Adenosine ___ mg fast IV immediately followed by a 10 to 20 ml bolus. If the SVT rhythm does not convert in 1 min, administer Adenosine __ mg FAST IV.

A

6mg
12mg

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4
Q

Allergic Reactions

You patient presents with the following

Itching

Hives

Localized swelling

How would you classify this reaction?

A

mild

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5
Q

Ventricular Tachycardia (with pulses)

You have determined that your patient is stable. You have elected to give ______ with a dose of 5mg/kg up to ___mg in ____ mL Normal Saline over ____ minutes.

A

amiodarone
150
250
10

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6
Q

Ventricular Tachycardia (with pulses)

When administering Amiodarone (Cordarone®) for adults: mix___ mg in ____ ml NaCl to run wide open using __gtts/ml) drip set over ___ min. Consult medical control for pediatric administration.

A

150
250
60gtts
10

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7
Q

Asthma/COPD

You have called for and received orders to administer Magnesium Sulfate to your asthmatic patient. What is the dose and how is it administered?

A

2g
In 250NS
over 20 min

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8
Q

Asthma/COPD

CPAP, Epinephrine, and Magnesium may be utilized simultaneously and be requested sooner for critical patients.

For COPD or Asthma consider use of CPAP at __cmH2O.

A

5 cmH2O

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9
Q

Ventricular Tachycardia (with pulses)

You have determined that your patient is unstable. You have elected to administer escalating synchronized cardioversion. Do you have to contact medical control?

A

No

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10
Q

Pediatric Respiratory Distress

Your patient is exhibiting signs of focal/asymmetric wheezing. This may be seen in:

A

pneumonia or foreign body aspiration.

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11
Q

V-Fib or Pulseless Ventricular Tachycardia

You have correctly elected to defibrillate your patient. Shock at _J/kg up to ___joules an immediately resume ___min. of CPR. Establish IV/IO of Normal Saline and initiate ___ml/kg up to 1000 ml bolus.

A

2
200,
2,
20

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12
Q

Allergic Reactions

You patient presents with the following

Swelling of face, lips, tongue

Difficulty breathing

Wheezing and or stridor

Tachycardia

How would you classify this reaction?

A

Moderate

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13
Q

Behavioral Emergencies

Do not restrain a patient in the _____position.

A

prone

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14
Q

Morphine Sulfate may be given:

A

IM, IV

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15
Q

Supraventricular Tachycardia

Your patient is unstable. (“Pre-arrest” with Decreased level of consciousness or hypotension/poor perfusion.) You have elected to synchronized cardiovert your patient. Prior to delivering the electrical therapy you must….

A

Consult Med Control

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16
Q

V-Fib or Pulseless Ventricular Tachycardia

Performance Indicator

You should administer shock for VF/Pulseless VT within how many seconds of initial rhythm acquisition?

A

60 seconds

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17
Q

Behavioral Emergencies

If the Adult patient is still violent and presents an ongoing hazard to themselves or others after being restrained, administer Midazolam (Versed®) ___mg IM or IN or ___mg IV. Alternative Haloperidol (Haldol®) _____ mg IM. Can you administer these medications on standing orders?

A

5
2.5
5
No

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18
Q

Burns

Pain management: Establish SpO2 and ETC O2 monitoring. Fentanyl (Sublimaze®) __mcg/kg up to ____mcg IV / IN / IM OR Morphine __mg/kg up to ___mg IV / IM

(may repeat Fentanyl or Morphine twice if needed)

A

2mcg/kg, 200
0.2mg/kg 10

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19
Q

V-Fib or Pulseless Ventricular Tachycardia

You believe your patient to be in refractory V-Tach and have a high index of suspicion that the rhythm is Torsades de Pointes, administer ______ with a dose of 25mg/kg up to ___ gram IV push on standing orders.

A

Mag
1 g

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20
Q

V-Fib or Pulseless Ventricular Tachycardia

You have defibrillated your patient at 200, 300, and 360 joules.

Your patient is in refractory Ventricular Tachycardia, what drug will you administer next?

A

Amio

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21
Q

Pain and Nausea Management

If nauseated or vomiting:

Establish an IV of Normal Saline. If age 6 months or older, administer Ondansetron (Zofran®) ____mg/kg up to ____mg slow IV push or IM

A

0.15mg/kg
4mg

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22
Q

Midazolam (Versed®)

List the concentrations we carry for this medication

A

5mg/5ml and 10mg/2ml

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23
Q

Blood Glucose Emergencies

If hyperglycemia is suspected, with signs of dehydration, establish IV access and deliver a ___ml/kg up to____ ml

A

20ml
1,000

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24
Q

Pain and Nausea Management

For milder pain consider Acetaminophen (Tylenol®) _____mg/kg up to ____mg PO.

A

15
975

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25
Q

Environmental Emergencies

Your patient presents with severely elevated temperature and altered mental status. What is your diagnosis?

A

Heat Stroke

26
Q

Seizures

For an eclamptic patient, you have elected to administer _____Grams in _______ml over _______min of _________ ?

A

5
250
10
Mag
(need Med Control)

27
Q

Pain and Nausea Management

If patient is anxious/agitated: Consider administration of Midazolam (Versed®) 1-2 mg SLOW IV push or up to 5mg IN/IM. Do you have standing orders to administer an anxiolytic without calling OLMC?

A

NO

28
Q

Obstetrical / Childbirth

Pregnant patients with even minor blunt trauma (e.g. slow speed MVC) should be urgently evaluated by a physician especially after __weeks gestation.

A

20 weeks

29
Q

Environmental Emergencies

Your patient presents with dehydration, salt depletion, dizziness, fever, weakness ,headache, cramping, nausea and vomiting. Vital signs usually consist of tachycardia, mild hypotension and an elevated temperature. What is your diagnosis?

A

Heat exhaustion

30
Q

Blood Glucose Emergencies

A patient who appears intoxicated may be having a diabetic or other type of emergency and should be thoroughly assessed. After administration of glucose if the patient is fully alert and oriented and refuses transport, you should:

A

Contact OLMC and advise the patient to eat. Obtain a waiver from the patient.

31
Q

Obstetrical / Childbirth

Management of the newborn

Confirm that the baby is still breathing; if breathing is not present begin artificial ventilation with oxygen. If a pulse is not present or the pulse is less than __beats per minute, begin CPR.

A

60

32
Q

Obstetrical / Childbirth

In the setting of pregnancy, hypertension is defined as BP greater than ___ systolic or greater than ___ diastolic, or a relative increase of 20 systolic and 20 diastolic from the patient’s normal (pre-pregnancy) blood pressure.

A

140, 90

33
Q

Advanced Airway Management

If intubation attempts have been unsuccessful and unable to ventilate: Age ____and up only, perform surgical cricothyroidotomy. You must consult medical control.

A

10

34
Q

Blood Glucose Emergencies

If unable to establish IV access, administer Glucagon ____ mg/kg up to __mg IM.

A

0.025, 1mg

35
Q

Poisonings / Overdose

If tricyclic anti-depressant overdose

please give dose and drug you will administer in presence of wide complex Tachycardia and/or hypotension

A

1mEq/kg
50mEq
Sodium Bicarb

36
Q

Poisonings / Overdose

For patients with signs of an opiate overdose with respiratory depression, ANY LOCALLY AUTHORIZED PROVIDER may administer Naloxone (Narcan®) ___mg/kg up to __ mg intranasal (IN).

A

0.1mg 4mg

37
Q

Poisonings / Overdose

If beta blocker or calcium channel blocker overdose

If patient presents bradycardic and hypotensive administer ______ at ____mg/kg up to ___mg IV push. May repeat dose in 3-5minutes if no improvement.

A

Glucagon
0.1
2

38
Q

Seizures

For active generalized seizures, while closely monitoring for respiratory depression, administer:

A

Midazolam (Versed®) 0.1mg/kg up to 2.5 mg SLOW IV (over 2 minutes), titrating to termination of seizure activity.

OR
Midazolam (Versed®) 0.2mg/kg up to 5.0 mg IN/IM, titrating to termination of seizure activity. Be prepared to assist ventilations w/ BVM.

39
Q

Seizures

For active generalized seizures, the preferred route and dose are

A

Midazolam (Versed®) 0.2mg/kg up to 5.0 mg IN/IM, titrating to termination of seizure activity. Be prepared to assist ventilations w/ BVM.

40
Q

Pain and Nausea Management

If the patient is in consistent/severe pain and does not have a diminished level of consciousness, respiratory depression, hypotension, or suspected head injury: Establish EKG, SpO2 and ETCO2 monitoring as appropriate.

Administer Fentanyl (Sublimaze®) __mcg/kg up to _____micrograms SLOW IV (over 2 min.) or IN or IM. May repeat once if inadequate response.

A

1mcg/kg,
100

41
Q

Hypotensive Emergencies

Using the Pediatric Hypotension guidelines. Hypotension generally defined as:

A

70+ (2 x age in years)

42
Q

Supraventricular Tachycardia (SVT)

Greater than what heart rate is considered to be an elevated heart rate in an infant?

A

220

43
Q

Use of pulse oximetry (SpO2) can help guide use of supplemental oxygen in other patients. Patients shall receive supplemental oxygen to maintain an SpO2 of at least __% with attention to avoid over-oxygenation in patients with acute MI and Stroke.

A

94

44
Q

Asystole/Pulseless Electrical Activity

If hyperkalemia is suspected (renal failure, dialysis), consider on standing order Sodium Bicarbonate ___mEq/kg up to __ and/or Calcium Chloride ____ mg/kg up to ____gram.

A

1mEq,
50mEq
20mg,
1

45
Q

Supraventricular Tachycardia (SVT)

Greater than what heart rate is considered to be an elevated heart rate in a child?

A

180

46
Q

Termination of Resuscitation (TOR)

Situations where there is an arrest witnessed by EMS or an initial “shockable” rhythm that degenerates into asystole or PEA generally require a minimum of __ minutes of continuous pulselessness with a non-shockable rhythm to be considered for TOR.

A

25 min

47
Q

Stroke / TIA

Performance Indicators include:

Time of onset

Cincinnati Stroke Scale

Blood glucose documentation

Prompt transport with a goal of less than____minutes.

A

10 min

48
Q

In the following special situation, resuscitation efforts should generally be initiated and more prolonged efforts may be appropriate. Pregnant patients late term (beyond __ weeks pregnant with top of the uterus at or above the _____.

A

20 weeks, umbilicus

49
Q

Congestive Heart Failure

You have placed your patient on CPAP. If the patient improves but does not tolerate CPAP can you administer 2.5 mg of Midazolam on standing orders?

A

No

50
Q

Hypertensive Emergencies

You are unable to obtain IV access on your patient.

If SBP ≥220 and/or DBP ≥120, Administer which drug?

(Repeat dose if BP does not improve by 10% In 5 min.)

A

Nitro

51
Q

Stroke / TIA

Oxygen therapy only as needed to maintain O2 sats above ___%. Avoid hyper-oxygenation.

A

94%

52
Q

Congestive Heart Failure

If SBP > 100 mmHg administer Nitroglycerin 0.4 mg SL every 5 min. (discontinue use if SBP < 100 mmHg.)

Reassess, if no improvement after 3 Nitroglycerin with SBP > 140 mmHg administer Furosemide (Lasix®.) What is your dose?

A

40mg IV over 1 min

53
Q

Congestive Heart Failure

If SBP > 100 mmHg administer Nitroglycerin 0.4 mg SL every 5 min. (discontinue use if SBP < 100 mmHg.)

Reassess, if no improvement after 3 Nitroglycerin with SBP > 140 mmHg administer ___ mg of Furosemide (Lasix®) IV over 1 minute. If no improvement administer Morphine _mg IV over 2 minutes.

A

40mg
2mg

54
Q

Supraventricular Tachycardia (SVT)

Greater than what heart rate is considered to be an elevated heart rate in adults?

A

150

55
Q

Performance Indicators

A 12 lead ECG should be acquired on all patients that present with cardiac symptoms. Acquisition and transmission should occur within __ minutes for STEMI patients.

A

10min

56
Q

CPAP is contraindicated if SBP < __ mmHg.

A

90

57
Q

Supraventricular Tachycardia (SVT)

Consider treating atrial fibrillation in symptomatic patients even if degree of HR elevation is modest. What range would be considered a modest elevation

A

110, 140

58
Q

Your patient is experiencing chest pain. You have obtained a 12 lead and administered ASA. There is difficulty establishing an IV. Can the 1st dose of Nitroglycerin be given if SBP is 100 mmHg or greater?

A

Yes

59
Q

Hypertensive Emergencies

Defined as SBP > ___ and/or DBP > ___

A

220, 120

60
Q

Bradycardia

The patient has clinical findings consistent with symptomatic bradycardia.

Which drug is administered to improve the heart rate?

A

Atropine

Loudoun Protocols (3 decks)

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