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ROPE March 2022 > ROPE Preambles > Flashcards

ROPE Preambles Flashcards

1
Q

Do not initiate resuscitation in the following situations
prior to contacting Medical Control:

A

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

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2
Q

DNAR Documentation Requirements

A

Medical history
Medications
Last time patient was spoken to
Trauma or deformity
Unusual findings/circumstances
Position found
Skin temperature
Pupils
Names of significant bystander

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3
Q

Non Traumatic Termination of Resuscitation Criteria

A

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

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4
Q

If Medical Control does not grant Termination after two requests

A

transport to the closest appropriate ED

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5
Q

First step to take in an unconscious PT with upper airway obstruction:

A

Reposition airway (head tilt,
chin lift, jaw thrust)

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6
Q

What should be done in the conscious PT with evidence of severe upper airway obstruction?

A

Give continuous abdominal thrusts
until FB is expelled or patient
becomes unconscious
(give chest thrusts if unable
to encircle patient s abdomen)

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7
Q

What should be done in the conscious PT with mild/moderate upper airway obstruction (still moving air)?

A

Encourage forceful coughing
Observe for decompensation
Do not interfere with patient s
spontaneous coughing

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8
Q

When can a FBAO be removed with a finger?

A

Only when visualized directly

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9
Q

What SpO2 percentage should be maintained in the basic medical PT?

A

Maintain SpO2 >93%

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10
Q

What devices are used to assist with positive pressure ventilation?

A

Non-invasive positive pressure ventilation (CPAP, BPAP)
or
Bag-valve mask (BVM) with OPA/NPA as tolerated

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11
Q

What is the maximum number of reattempts for intubation?

A

2 attempts for medical, 1 attempt for trauma

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12
Q

What metric is used for counting an intubation attempt?

A

ETT passing the teeth

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13
Q

What mnemonic is used for assessing tube placement?

A

DOPES

Displacement of ETT

Obstruction (e.g. mucus
plug, kinked tube)

Pneumothorax, PNA,
pulmonary edema, PE

Equipment failure

Stacked breaths (e.g.
asthma, hyperventilation)

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14
Q

What medications can be used in post intubation sedation?

A

(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)

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15
Q

What are the signs of respiratory distress?

A

SpO 2 <90%
Nasal flaring
Unable to speak sentences
Supraclavicular/intercostal/
subcostal retractions
Absence of wheezing with
obvious SOB
Apprehension,
combativeness, anxiety
Cyanosis
Lethargy

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16
Q

What are some pulmonary and non-pulmonary causes of respiratory distress?

A

pulmonary embolism, pneumothorax, pulmonary edema ( cardiac asthma ), MI, pneumonia, sepsis, metabolic acidosis (DKA, AKA), anxiety

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17
Q

What physiological factor always indicated anaphylaxis after an exposure to a known allergen?

A

Hypotension

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18
Q

What generally differentiates an allergic reaction from anaphylaxis?

A

In an allergic reaction symptoms involve only one organ
system; generally considered a mild or moderate reaction

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19
Q

When recognized as an anaphylactic reaction, what is our first line treatment?

A

Epinephrine 1mg/ml (1:1000)
0.3mg – 0.5mg IM
(Thigh is preferred site)
May repeat x 1 after 5 min

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20
Q

When recognized as an allergic reaction, what is our first line treatment?

A

Diphenhydramine
50 mg IV/IM

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21
Q

What is the fastest IM site for Epinephrine administration?

A

The thigh is the fastest IM site – use either the vastus lateralus or the rectus femoris muscle

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22
Q

PTs on beta-blockers may experience what type of event in response to epinephrine administration?

A

Paradoxical. ie: bradycardia

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23
Q

What is the first line treatment for wheezing/bronchospasm?

A

Give high-flow oxygen & dual therapy via nebulizer:
Albuterol Sulfate 5mg
Ipratropium Bromide 500mcg (i.e. 0.5mg)

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24
Q

What capnography waveform is indicative of bronchospasm?

A

Waveform with “shark-fin” appearance.

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25
Q

What are the general signs of shock in the medical patient?

A

Altered mental status
Delayed/flash capillary refill
Weak or decreased pulses
Tachycardia
Elevated RR
Hypoxemia
Hypotension for age
Decreased urine output

26
Q

What are some commons causes of hypovolemic shock?

A

Hemorrhage – trauma or
medical (ex. GI bleed)
Vomiting/Diarrhea
Burns

27
Q

What are some common causes of cardiogenic shock?

A

Heart Failure
Arrhythmias
Cardiomyopathy
Valvular Disease

28
Q

What are some common causes of obstructive shock?

A

Tension pneumothorax
Hemopneumothorax
Massive PE
Cardiac tamponade
often have a narrow
pulse pressure
Pulse Pressure = SBP – DBP

29
Q

What are some common causes of distributive shock?

A

Septicemia
look for source & fever
*may have a low EtCO 2 *
Anaphylaxis
often warm/flush skin
Neurogenic
usually h/o trauma
often bradycardic

30
Q

What is the formula to determine mean arterial pressure?

A

MAP = (SBP + (2 x DBP)) / 3

31
Q

What is the formula to measure shock index?

A

SI = HR/SBP
(SI > 1 is poor)

32
Q

What is the first line treatment for Anaphylactic Shock?

A

Crystalloid Fluid Bolus 1L-2L

33
Q

What is the first line treatment for Septic Shock?

A

Crystalloid Fluid Bolus 1L-2L

34
Q

What is the first line treatment for Hypovolemic Shock?

A

Crystalloid Fluid Bolus 1L-2L

35
Q

What is the first line treatment for Neurogenic Shock?

A

Crystalloid Fluid Bolus 1L-2L

36
Q

What is the first line treatment for Obstructive Shock?

A

High flow O2 via NRB
Evaluate lung sounds
Decompress tension
pneumothorax

37
Q

What is the first line treatment for Cardiogenic Shock?

A

Evaluate lung sounds
Crystalloid Fluid bolus:
250-500ml if lungs
sounds clear bilaterally

38
Q

What medications can be considered should fluid boluses not adequately correct the PT is shock?

A

Norepinephrine 2-12 mcg/min
or
Epinephrine 2-20 mcg/ming
or
Dopamine 5-20 mcg/kg/min
titrate to MAP
65mmHg

39
Q

What mnemonic is used in identifying potential causes for altered mental status?

A

Alcohol Drug Overdose
Epilepsy Seizure
Insulin Diabetic Emergency
Opiates Drug Overdose
Uremia N/A (dialysis needed)
Trauma Cardiac Arrest, Traumatic Shock, Head Injury
Temperature Hypo-/Hyperthermia
Infection Shock
Psychosis Behavioral Emergency, Excited Delirium
Stroke
Seizure

40
Q

When assessing an overdose/acute poisoning what details of the ingestion should be ask for?

A

Time of ingestion
Dose of ingestion
Quantity of Ingestion

41
Q

What are some signs of compromised respiratory function?

A

SpO2 < 94%,
drooling
shallow respirations
RR 10/min
rising etCO2 above
patient s baseline

42
Q

What medication option should we consider first with ETOH poisoning?

A

NS/LR fluid
bolus IV prn
(max 2L)

43
Q

What medication option should we consider first with dystonic reactions?

A

Diphenhydramine
25 – 50 mg IV/IO/IM

44
Q

What medication option should we consider first with Stimulants?

A

Benzodiazepines prn as per Agitated/
Combative or Excited Delirium guideline

45
Q

What medication option should we consider first with Carbon Monoxide?

A

O 2 @ 15 L/min via NRB
Measure CO, if able, as
per CO guideline

46
Q

What medication option should we consider first with ASA, TCA, Unknown Meds with widened QRS (>120ms)?

A

Sodium Bicarbonate
1-2mEq/kg IV/IO
repeat prn until QRS < 120ms

47
Q

What medication option should we consider first with CA2+ Channel Blocker?

A

Calcium Chloride
500-1000mg IV infusion
over 10-20 minutes

48
Q

What medication option should we consider first with SSRI, MAOI, Benzo, Barbituate, APAP, or Beta Blockers?

A

NS/LR fluid bolus IV prn (max 2L)
Contact Medical Control for additional orders

49
Q

What medication option should we consider first with opiate overdose?

A

Naloxone 2-4mg IN q2-3min prn
or
Naloxone 0.5-2mg IV/IM/IO
q2-3min prn

50
Q

What indicator should we use in selecting if additional doses of naloxone should be administered?

A

Administer Naloxone until mentation improves and adequate ventilation/oxygenation is confirmed by RR, SpO2, and EtCo2.

51
Q

What constitutes hypoglycemia as indicated by CBG?

A

CBG 60mg/dL

52
Q

What constitutes hyperglycemia as indicated by CBG?

A

CBG > 250mg/dL
and
signs of ketoacidosis

53
Q

Consider refusals after hypoglycemia
only if ALL of the following are true:

A

Repeat CBG > 80mg/dL
Patient returns to normal mental status
A clear cause of hypoglycemia has been
identified (e.g. missed a meal)
Patient has no other symptoms (e.g. chest
pain, SOB, intoxication, seizure)
Patient only takes metformin and/or insulin
Patient can promptly obtain and eat a meal
A reliable family member is present that
can reactivate 911 if needed

54
Q

Signs of Ketoacidosis

A

Ill appearance
Dyspnea
Deep rapid (Kussmaul) respirations
Tachycardia +/- weak pulses
Nausea or vomiting
Abdominal pain or cramping
Headache or double vision
Altered LOC
Fruity/acetone breath or odor
Muscle wasting or weight loss
Flushed/dry skin, skin tenting
Dry mucous membranes

55
Q

What are some of the EKG changes of hyperkalemia?

A

peaked T waves
long PR interval
widened QRS complex
loss of P wave
sine wave
asystole

56
Q

What are some causes of hyperglycemia?

A

Infection
Insufficient Insulin
Ischemia (i.e. acute MI)
It s new-onset diabetes

57
Q

What are the components of the Cincinnati Stroke Scale?

A

Facial Droop
Arm Drift
Speech Deficit

58
Q

What are the components of the VAN assessment?

A

Arm Weakness +
any one of the following:

Visual Disturbance: field cut,
double vision, new blindness

Aphasia: inability to speak or
understand

Neglect: forced gaze, ignoring
one side, unable to feel on
both sides at the same time

59
Q

How should PTs with an unclear time of stroke onset be treated?

A

Patients with an unclear time of onset, i.e. Wake-Up strokes, should be treated with the same urgency as those with a clear TSO.

60
Q

What are some signs of eclampsia?

A

SBP >160, DBP >110
Confusion
Pulmonary edema
RUQ or epigastric pain
Seizures

61
Q

How long into and after pregnancy should a PT be considered an obstetric PT when considering the use of MgSO4 for seizure activity?

A

> 20 weeks pregnant
(uterus appears above umbilicus)
or < 6 weeks postpartum

ROPE March 2022 (3 decks)

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