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Sara's - Medical Directives > ROSC + IV and Fluid Therapy Medical Directive - AUXILIARY > Flashcards

ROSC + IV and Fluid Therapy Medical Directive - AUXILIARY Flashcards

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USMLE® Step 1 flashcards
1
Q

ROSC

What are the INDICATIONS for the Return of Spontaneous Circulation?

A

Patient with return of spontaneous circulation (ROSC) after the resuscitation was initiated

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2
Q

ROSC

What are the CONDITIONS for 0.9% NaCl Fluid Bolus?

What are the CONTRAINDICATIONS for?

A

Pt has to be GREATER/EQUAL to 2y/o

Pt has to have HYPOtension

Pt’s chest auscultation is clear

Fluid overload i.e high BP, Edema, cramping, and SOB

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3
Q

ROSC

What % do you titrate O2 at?

What should you avoid doing AND what is your target ETCO2?

A

94%-98%

Hyperventilation AND and ETCO2 of 30-40mmHg

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4
Q

ROSC

What is the ROUTE and TREATMENT PLAN for 0.9% NaCl fluid
Bolus (if availableand authorized) for a patient ≥2 years to <12 years?

What is the ROUTE and TREATMENT PLAN for 0.9% NaCl fluid
Bolus (if availableand authorized) for a patient ≥ 12 years?

A

ROUTE = IV
Infusion - 10ml/kg

Infusion Interval - immediate

Reassess Every - 100ml

Max. Volume - 1,000ml

ROUTE = IV
Infusion - 10ml/kg

Infusion Interval - Immediate

Reassess Every - 250ml

Max. Volume - 1,000ml

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5
Q

ROSC

Consider what about 12 lead ECG acquisition and interpretation?

A

Consider a STEMI
Consider doing manual interpretation
If inferior STEMI then do Lead V4R

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6
Q

ROSC

What would indicate a ROSC regarding capnography?

Show me no ROSC vs a potential ROSC (in capnography)

A

An abrupt increase in PETCO2

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7
Q

ROSC - capnography

What are you considering when there’s a SUDDEN LOSS OF WAVEFORM?

What are you considering when there’s a decreasing ETCO2?

A

ET tube disconnected, dislodged, kinked, or obstructed

Loss of circulatory funtion

ET tube cuff leak

ET tube in hypopharynx

Partial obstruction

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8
Q

ROSC - clinical considerations

Do I complete a 12-lead acquisition before I initiate transport?

Can all PCPs give IV bolus for ROSC?

A

Consider initiating transport in parallel with the above treatment

IV fluid bolus applies only to PCPs authorized for PCP Autonomous IV

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9
Q

ROSC - Capnography

What should you CONSIDER about CPR?

What should you CONSIDER about BVM ing?

What should you CONSIDER about ETCO2 in CPR?

A

Keep with consistent comprssions and appropriate depth.

Ensure good placement/maks sealand allow for adequate exhalation stage

To aim for GREATER than 10mmHg during CPR.

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10
Q

ROSC - Capnography

What should you do to change a decreasing/worsening waveform?

A

Change hand positions or compressor

Check the placement of the SGA/ETT

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11
Q

ROSC

Should you discontinue the use of O2 if the pt’s SPO2 values are ideal but they remain unstable?

What do you NEVER do when vetilating the pt?

At what rate do you MAINTAIN VENTILATION and ETCO2 for an adult and for a child/infant

A

Fuck no

Hyperventilate

10 breaths/min so 1 breath every 6sec

20 breaths/min so a breath every 3sec

Both ETCO2 should be maintained around 30-40mmHg

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12
Q

ROSC - fluid therapy

What’s the target SBP when adminitering a fluid bolus?

A

≥ 90 mmHg

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13
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary

What does a PCP have to be to provide the treatment in this directive?

A

authorized for PCP autonomus IV

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14
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary

What are the INDICATIONS?

A

Actual or potential need for intravenous medication
OR
Fluid therapy

If they meet either the stroke protocol
OR
the STEMI bypass protocol

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15
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary

What are the CONDITIONS for IV Cannulation?

What are the CONTRAINDICATIONS for IV Cannulation?

A

≥ 2 years

Suspected fracture proximal to the access site ( the integrity of the associated vascular structures and may result in extravasation)

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16
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary

What are the CONDITIONS for 0.9% NaCl Fluid Bolus?

What are the CONTRAINDICATIONS for 0.9% NaCl Fluid Bolus?

A

≥ 2 years

AND

Hypotension

Fluid overload - eg. pulmonary edema

17
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary

What is the ROUTE and TREATMENT PLAN for 0.9% NaCl INFUSION for a pt ≥ 2 years to <12 years?

What is the ROUTE and TREATMENT PLAN for 0.9% NaCl infusion for a pt ≥12 years?

A

ROUTE = IV
Infusion - 15ml/hr

Infusion Interval - N/A

Reassess every - N/A

Max. volume - N/A

ROUTE = IV
Infusion - 30-60ml/hr

Infusion Interval - N/A

Reassess every - N/A

Max. volume - N/A

18
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary

What is the ROUTE and TREATMENT PLAN for 0.9% NaCl FLUID BOLUS for a pt ≥ 2 years to <12 years?

What is the ROUTE and TREATMENT PLAN for 0.9% NaCl FLUID BOLUS for a pt ≥12 years?

A

ROUTE = IV
Infusion - 20ml/kg

Infusion Interval - N/A

Reassess every - 100ml

Max. volume - 2,000ml

ROUTE = IV
Infusion - 20ml/kg

Infusion Interval - N/A

Reassess every - 250ml

Max. volume - 2,000ml

19
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary

Mandatory Provincial Patch Point

A

Patch to BHP for authorization to administer IV NaCl bolus to a patient ≥ 2 years to <12 years with suspected Diabetic Ketoacidosis (DKA)

it’s to help prevent cerebral edema

20
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary - clinical

What if you’re not Autonomous IV?

What can you do if there’s a VSA and the patient doen’t meet the TOR?

When should you use a macrodrip vs. a microdrip?

A

“PCP Assist IV” authorizes a PCP to cannulate a peripheral IV at the request and under the direct supervision of an ACP - they CANNOT administer the medication or fluid therapy though

Consider IV fluid bolus but DON”T delay transport or prioritize over rev

Microdrips and/or volume control administration sets should be considered when IV access is indicated for patients <12 years of age

21
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary - clinical

What assessment should you consider doing frequently after administering a fluid bolus?

A

Chest assessments

22
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary - clinical

What’s the formula for hypotension in pediatrics?

Up to what AGE is a pediatric?

A

SBP = (age x 2) + 70

10y/o

23
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary - clinical

What should you obtain (2) before initiating a fluid bolus?

A

2 BP (1 being manual at least)

24
Q

Intravenous and Fluid Therapy Medical Directive- Auxiliary - clinical

What minimum volume can you administer for a patient either ADULT or CHILD/INFANT even if they become normotensive?

A

Adults - 250ml

Child/Infant - 100ml

Sara's - Medical Directives (16 decks)

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