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Region 10 HPH Medic SOPS 2024 > Region 10 HPH Medic SOPs > Flashcards

Region 10 HPH Medic SOPs Flashcards

1
Q

When calling a hospital, which type of calls do you notify as an ALERT?

A

Stemi, Trauma, Sepsis, Stroke

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2
Q

Medication Dosage and route for chest pain (ACS)

A

Aspirin 324 mg oral

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3
Q

Medication Dosage and route for chest pain (ACS), after aspirin

A

Nitroglycerin .4 mg Sublingual

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4
Q

Medication for pain management dose and route

A

Fentanyl 1 mcg/kg IVP/IN/IO/IM max dose 200 mcg

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5
Q

Nitro is contraindicated if there is elevation in which leads

A

II, III, AVF

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6
Q

For sedation, which medication and dose should you give to patients that need cardioversion or pacing?

A

Versed 2 mg IVP/IO

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7
Q

What is the treatment for someone who has A-Fib/A-Flutter and is unstable?

A

Synchronized Cardioversion (Zoll 120J, 150J, 200J)

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8
Q

What is the treatment for someone who has A-Fib/A-Flutter and is stable?

A

Verapamil 5 mg IVP slowly over 5 minutes

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9
Q

Medication for unstable bradycardia dose and route

A

Atropine 1 mg IVP/IO rapid, repeat every 3 mins max of 3 mg

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10
Q

If atropine does not work for unstable bradycardia, what do you do next?

A

Transcutaneous pacing

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11
Q

When pacing, if patient continues to deteriorate and MAP <65, contact medical control for which medication?

A

Push dose epinephrine 50 mcg IVP/IO, repeat in 5 min, max of 100mcg

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12
Q

Which heart blocks (2) should you not administer atropine and skip right to pacing?

A

2nd degree Type 2 or 3rd degree

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13
Q

What do you give for unstable cardiogenic shock?

A

Normal saline 500 mL increments, titrate to MAP > 65

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14
Q

If patient continues to deteriorate in cardiogenic shock, which medication can you call medical control for?

A

Push dose epinephrine 50 mcg IVP/IO repeat in 5 min, max 100mcg

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15
Q

Treatment for unstable SVT

A

Versed 2 mg IVP/IO
Synchronized Cardioversion (Zoll 70J, 120J, 150J, 200J)

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16
Q

Treatment for stable SVT

A

Adenosine 6 mg IVP RAPID followed by 20 ml flush of normal saline, if no response in 2 min, Adenosine 12 mg RAPID followed by 20 ml flush of normal saline.

If no response after 2 mins then Verapamil 5 mg IVP slowly over 5 min, may repeat in 15 mins, max of 10 mg

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17
Q

Treatment for Unstable V-tach with a pulse (wide complex tachycardia)

A

Synchronized Cardioversion (Zoll 120J, 150J, 200J)
If patient does not convert and first cardioversion,
Amiodarone 150 mg diluted in 100 mL D5W IVPb over 10 mins, may repeat, max dose 300 mg
Fentanyl 1 mcg/kg IVP/IN/IO/IM

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18
Q

Treatment for Stable V-tach with a pulse (wide complex tachycardia)

A

Amiodarone 150 mg diluted in 100 mL D5W IVPb over 10 mins, may repeat, max dose 300 mg

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19
Q

If rhythm appears to be Torsade’s de Pointes, which medication do you need to contact medical control for?

A

Magnesium Sulfate 2g diluted in 100 mL D5W IVPB over 5 mins
(Not to be given to renal failure or dialysis patients)

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20
Q

Treatment for asystole

A

Epinephrine 1 mg/10mL IVP/IO repeat every 3-5mins
Normal saline 500 mL increments
If patient is on dialysis: Sodium Bicarbonate 50 mEq IVP/IO

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21
Q

Treatment for V-Fib/pulseless V-Tach

A

Epinephrine 1 mg/10mL IVP/IO repeat every 3-5mins
Normal saline 500 mL increments
Analyze heart rhythm and defibrillate appropriately starting at 120J, 150J, 200J for Zoll
Amiodarone 300 mg IVP/IO
If patient is on dialysis: Sodium Bicarbonate 50 mEq IVP/IO
Amiodarone 150 mg IVP/IO

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22
Q

Criteria for termination of resuscitative efforts

A

Perform at least 20 minutes of ALS care
Reaffirm the following
Nontraumatic arrest
Normothermic
>18 years old
Unwitnessed arrest by EMS provider
No respirations, pulse, heart sounds
Asystole or PEA <60bpm
EtCO2 < 20 mmHgW

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23
Q

What needs to be documented when terminating resuscitative efforts?

A

Time of withdrawal of efforts and physician’s name

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24
Q

When do we withhold resuscitative efforts?

A

Risk to health and safety of personnel
Resources are inadequate to treat all patients
Valid POLST or DNR
Irreversible death such as:
Rigor mortis without profound hypothermia
Profound dependent lividity
Decapitation
Transection
Incineration
Decomposition
Injuries incompatible with life
Mummification or putrefaction

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25
Q

Treatment and dose for Asthma/COPD with wheezing

A

Albuterol 2.5 mg/Ipratropium Bromide .5mg
If severe, magnesium sulfate 2g diluted in 100 mL D5W IVPB over 15 minutes (not for renal failure or dialysis patients)
If patient continues to deteriorate contact medical control for
Epinephrine 1mg/mL: .3mg IM anterolateral thigh

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26
Q

Treatment for unstable acute heart failure(pulmonary edema)
SBP < 100

A

Normal saline in 500 mL increments, titrate to MAP > 65
If condition worsens, contact medical control for
Push dose epinephrine 50 mcg IVP/IO repeat in 5 min, max 100mcg

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27
Q

Treatment for unstable heart failure (pulmonary edema)
SBP > 160

A

Nitroglycerin 1.2 mg Sublingual initial dose, may repeat .4 mg SL every 5 mins
CPAP 5 cm PEEP, may increase to map of 10 cm PEEP

28
Q

Treatment for stable heart failure (pulmonary edema)

A

CPAP 5 cm PEEP, may increase to map of 10 cm PEEP

29
Q

If during CPAP, patient deteriorates, what do you do?

A

Remove CPAP and consider advanced airway placement

30
Q

Who is the coolest and best looking guy on Deerfield?

A

94

31
Q

What medication and dose do you use for Drug assisted intubation?

A

Ketamine 2 mg/kj IVP/IO slowly over 1 min, max of 300mg

32
Q

What medication and dose do you use for post intubation sedation?

A

.5mk/kg IVP/IO slowly over 1 min, may repeat every 5 min, no max dose

33
Q

What medications and dosages do you give for Anaphylactic shock?

A

.3 mg Epinephrine 1mg/1mL IM
Diphenhydramine 50 mg IVP/IO slowly over 2 mins or IM
Normal saline 500 mL increments
Albuterol 2.5 mg/Ipratropium bromide .5 mg may repeat x1
Albuterol 2.5 mg may repeat every 5 mins no max
If condition continues to deteriorate contact medical control for
Push dose Epinephrine 50 mcg IVP/IO, may repeat in 5 mins max of 100 mcg

34
Q

What medications and dosages do you give for a stable allergic reaction with airway involvement?

A

.3 mg Epinephrine 1mg/1mL IM
Diphenhydramine 50 mg IVP/IO slowly over 2 mins or IM
Albuterol 2.5 mg/Ipratropium bromide .5 mg may repeat x1
Albuterol 2.5 mg may repeat every 5 mins no max

35
Q

What medications and dosages do you give for a stable allergic reaction WITHOUT airway involvement?

A

Diphenhydramine 25 mg IVP slowly over 2 mins or IM

36
Q

What medication and dosages do we give for Hypoglycemia

A

Oral glucose gel 15 grams if patient is able to tolerate
Dextrose 10% 25 gram/250 mL IVP, may repeat to a max of 50 grams
If no IV, glucagon 1 mg IM/IN

37
Q

What medication do we give for nausea/vomiting?

A

Ondansetron(Zofran) 4mg IVP over 30 seconds
or 4 mg oral, may repeat in 10 mins, max of 8mg

38
Q

What medications and dosages do we give for a Beta Blocker overdose?

A

Normal saline 500 mL increments
Atropine 1 mg IVP/IO rapid, may repeat every 5 minutes, max of 3 mg
Glucagon 1 mg IVP/IO repeat in 5 mins, max of 2 mg
If widened QRS consider sodium bicarbonate 50 mEq IV/IO
Consider pacing

39
Q

What medications and dosages do we give for a Calcium Channel Blocker overdose?

A

Normal saline 500 mL increments
If patient deteriorates consider 1 mg IVP/IO, rapid, may repeat every 5 mins, max of 3 mg
Consider pacing

40
Q

What medication and dose do we give for an Overdose?

A

Narcan 2 mg IN/IM/IV/IO, repeat every 3 mins, max of 10 mg

41
Q

What medication do we give to someone with SEVERE agitation, aggression or violent behavior?

A

Last resort
<65 years old Ketamine 4 mg/kg IM, may repeat in 5 min 2 mg/kg, max of 500mg
>65 years old Midazolam 10 mg IM or 2 mg IVP/IO/IN may repeat every 2 mins, max of 10mg

42
Q

What medication do we give for seizures?

A

Midazolam(Versed) 10 mg IM or 2 mg IVP/IO/IN

43
Q

What medications do we give for Sepsis?

A

Normal saline 500 mL increments, target 30 mL/kg
If condition continues to deteriorate,
Push dose Epinephrine 50 mcg IVP/IO repeat in 5 mins,
max of 100 mcg

44
Q

What scale do we use for strokes?

A

BEFAST
Balance
Eyes
Face
Arm
Speech
Time

45
Q

When would you consider a stroke to be a large vessel occlusion?

A

Dense profound deficit
-new sudden onset speech deficit
-sudden significant gait disturbance
-significant extremity weakness
Fixed eye gaze deviation
Hemineglect (ignoring on side of the body)

46
Q

Where do we take patients that are positive for a LVO(large vessel occlusion) screen?

A

Comprehensive Stroke Center (LGH or Evanston)

47
Q

What are our level 1 trauma centers that we transport to?

A

Condell, Evanston, LGH

48
Q

If transporting a traumatic arrest, where do we transport to?

A

Closest trauma center(HPH)

49
Q

When can we withhold resuscitation on a traumatic arrest?

A

Patients in asystole
Patient with an injury incompatible with life
-decapitation
-thoracic transection
-incineration

50
Q

What medication do we give for a traumatic arrest?

A

None

51
Q

What are some injuries that would be considered Category 1 and transport to a Level 1 trauma center?

A

Penetrating injuries to head, neck, torso or extremities proximal to elbow/knee
>1 proximal long bone fractures
Unstable pelvis
Chest wall instability or deformity
Crushed, degloved, mangled or pulseless extremity
Open or depressed skull fractures
Amputation proximal to wrist or ankle
Paralysis

52
Q

How do we treat a patient with a crush injury?

A

Coordinate extrication with treatment, administer fluids
Contact medical control for Sodium Bicarbonate 50 mEq IVP/IO
and/or Albuterol 2.5mg NEB, may repeat in 5 mins, max of 5 mg
Fentanyl 1mcg/kg IVP/IN/IO/IM max single dose 100mcg, may repeat in 10 mins. max dose of 200mcg

53
Q

What medication do we give for patients that have sustained some sort of trauma and are unstable? (SBP < 90 and HR > 120bpm)
(not an isolated head injury)

A

Transexamic Acid(TXA) 1g diluted in 100 mL D5W IVPB over 10 mins

54
Q

What is are the signs and symptoms of heat stroke?

A

Altered mental status. rectal temperature > 104F, sweating has stopped

55
Q

What is the treatment for a patient with EXERTIONAL heat stroke?

A

Cool on scene with a tank, or Tarp assisted cooling with oscillation (TACO method). Transport when altered mental status improves. Rectal temperatures only ;)
Stop immersive cooling if patient begins to shiver
Watch for Arrhythmias and brain injuries

56
Q

What is the treatment for a patient with heat stroke?

A

Establish IV and administer normal saline only if the patient is hypotensive
Initiate active rapid cooling
Stop active cooling if patient begins to shiver

57
Q

What questions should you ask a patient with signs of imminent birth?

A

Duration/frequency of contractions
Gravida (# of pregnancies)
Para (# of births)
Due date
Previous labor time

58
Q

What are signs of imminent birth?

A

Crowning
Bulging perineum
Involuntary pushing

59
Q

What are signs of complications during emergency childbirth?

A

Prolapsed cord
Profuse bleeding
Meconium staining

60
Q

What is a nuchal cord?

A

Umbilical cord is wrapped around the neonates neck

61
Q

How do you stimulate a neonate?

A

Drying, rubbing the back or flicking soles of the feet.
Do not shake the neonate

62
Q

When should you obtain an APGAR score?

A

1 minute and 5 minute mark, if APGAR score is < 7, repeat every 5 mins for 20 mins total

63
Q

What does APGAR stand for?

A

0 1 2
Appearance Blue/pale Blue hands/feet Pink
Pulse Absent <100 >100
Grimace Absent Grimace Crying/active withdrawal
Activity Absent Some movement Active motion
Respirations Absent Weak cry Strong cry

64
Q

What is a Glasgow coma scale?

A

EYE Verbal Motor
6 Obeys commands
5 Oriented Localizes pain
4 Spontaneous Confused Withdraws from pain
3 To voice Inappropriate Flexion to pain
2 To pain Incomprehensible Extension to pain
1 None None None

65
Q

What does MAP stand for and how do we calculate it?

A

Mean arterial pressure
MAP = (2 x DBP) + SBP BP: 120/80 (2 x 80) +120
———————– ——————
3 3
MAP = 93

Region 10 HPH Medic SOPS 2024 (1 decks)

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