ROPE Preambles Flashcards
Do not initiate resuscitation in the following situations
prior to contacting Medical Control:
Obvious signs of death
o Body decomposition
o Lividity
o Rigor mortis
o Fetal maceration
Presence of legal documents stating resuscitation should be withheld
o POLST (Physician Orders for Life Sustaining Treatment)
o MOLST (Medical Orders for Life Sustaining Treatment)
o Advanced Directive, Living Will, DNR
Guidance from a healthcare proxy or power of attorney to withhold
resuscitation in the absence of formal written directions
Patient s personal physician is present at the scene and decides that
resuscitation is not to be initiated
DNAR Documentation Requirements
Medical history
Medications
Last time patient was spoken to
Trauma or deformity
Unusual findings/circumstances
Position found
Skin temperature
Pupils
Names of significant bystander
Non Traumatic Termination of Resuscitation Criteria
18 years of age or older
Pulseless and apneic prior to EMS arrival
> 30 min of chest compressions with interruptions only for rhythm checks
2
> 30 min resuscitation by an ALS provider following appropriate pulseless cardiac guidelineNo suspicion of hypothermia
Persistent asystole, agonal rhythm, or PEA < 40bpm without an identifiable reversible cause
No ROSC at any time during resuscitation
ETT or supraglottic airway in place with proper documentation of capnography (qualitative or quantitative)
Patent IV / IO line
Verification of proper BLS and ALS treatments by an on-duty paramedic and/or online medical director
All EMS personnel involved in the patient s care agree that discontinuation of resuscitation is appropriate
Patient s immediate family members on scene have been informed of the rational for termination
A safe environment for EMS/first responders
Law Enforcement/Coroner on scene or already notified
If Medical Control does not grant Termination after two requests
transport to the closest appropriate ED
First step to take in an unconscious PT with upper airway obstruction:
Reposition airway (head tilt,
chin lift, jaw thrust)
What should be done in the conscious PT with evidence of severe upper airway obstruction?
Give continuous abdominal thrusts
until FB is expelled or patient
becomes unconscious
(give chest thrusts if unable
to encircle patient s abdomen)
What should be done in the conscious PT with mild/moderate upper airway obstruction (still moving air)?
Encourage forceful coughing
Observe for decompensation
Do not interfere with patient s
spontaneous coughing
When can a FBAO be removed with a finger?
Only when visualized directly
What SpO2 percentage should be maintained in the basic medical PT?
Maintain SpO2 >93%
What devices are used to assist with positive pressure ventilation?
Non-invasive positive pressure ventilation (CPAP, BPAP)
or
Bag-valve mask (BVM) with OPA/NPA as tolerated
What is the maximum number of reattempts for intubation?
2 attempts for medical, 1 attempt for trauma
What metric is used for counting an intubation attempt?
ETT passing the teeth
What mnemonic is used for assessing tube placement?
DOPES
Displacement of ETT
Obstruction (e.g. mucus
plug, kinked tube)
Pneumothorax, PNA,
pulmonary edema, PE
Equipment failure
Stacked breaths (e.g.
asthma, hyperventilation)
What medications can be used in post intubation sedation?
(1) Fentanyl 25-50mcg IV/IO q 2 min prn (max 200mcg)
+/ –
Midazolam 5mg IV/IO/IM q2min prn (max 20mg) or
Lorazepam 2–4mg IV/IO/IM q2min prn (max 10 mg) or
Diazepam 5mg IV/IO or 10mg IM q2min prn (max 10 mg)
or
(2) Ketamine 2mg/kg IV/IO or 4mg/kg IM (may repeat x 1 prn)
What are the signs of respiratory distress?
SpO 2 <90%
Nasal flaring
Unable to speak sentences
Supraclavicular/intercostal/
subcostal retractions
Absence of wheezing with
obvious SOB
Apprehension,
combativeness, anxiety
Cyanosis
Lethargy
What are some pulmonary and non-pulmonary causes of respiratory distress?
pulmonary embolism, pneumothorax, pulmonary edema ( cardiac asthma ), MI, pneumonia, sepsis, metabolic acidosis (DKA, AKA), anxiety
What physiological factor always indicated anaphylaxis after an exposure to a known allergen?
Hypotension
What generally differentiates an allergic reaction from anaphylaxis?
In an allergic reaction symptoms involve only one organ
system; generally considered a mild or moderate reaction
When recognized as an anaphylactic reaction, what is our first line treatment?
Epinephrine 1mg/ml (1:1000)
0.3mg – 0.5mg IM
(Thigh is preferred site)
May repeat x 1 after 5 min
When recognized as an allergic reaction, what is our first line treatment?
Diphenhydramine
50 mg IV/IM
What is the fastest IM site for Epinephrine administration?
The thigh is the fastest IM site – use either the vastus lateralus or the rectus femoris muscle
PTs on beta-blockers may experience what type of event in response to epinephrine administration?
Paradoxical. ie: bradycardia
What is the first line treatment for wheezing/bronchospasm?
Give high-flow oxygen & dual therapy via nebulizer:
Albuterol Sulfate 5mg
Ipratropium Bromide 500mcg (i.e. 0.5mg)
What capnography waveform is indicative of bronchospasm?
Waveform with “shark-fin” appearance.
