ROSC + IV and Fluid Therapy Medical Directive - AUXILIARY Flashcards
ROSC
What are the INDICATIONS for the Return of Spontaneous Circulation?
Patient with return of spontaneous circulation (ROSC) after the resuscitation was initiated
ROSC
What are the CONDITIONS for 0.9% NaCl Fluid Bolus?
What are the CONTRAINDICATIONS for?
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
ROSC
What % do you titrate O2 at?
What should you avoid doing AND what is your target ETCO2?
94%-98%
Hyperventilation AND and ETCO2 of 30-40mmHg
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?
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
ROSC
Consider what about 12 lead ECG acquisition and interpretation?
Consider a STEMI
Consider doing manual interpretation
If inferior STEMI then do Lead V4R
ROSC
What would indicate a ROSC regarding capnography?
Show me no ROSC vs a potential ROSC (in capnography)
An abrupt increase in PETCO2
ROSC - capnography
What are you considering when there’s a SUDDEN LOSS OF WAVEFORM?
What are you considering when there’s a decreasing ETCO2?
ET tube disconnected, dislodged, kinked, or obstructed
Loss of circulatory funtion
ET tube cuff leak
ET tube in hypopharynx
Partial obstruction
ROSC - clinical considerations
Do I complete a 12-lead acquisition before I initiate transport?
Can all PCPs give IV bolus for ROSC?
Consider initiating transport in parallel with the above treatment
IV fluid bolus applies only to PCPs authorized for PCP Autonomous IV
ROSC - Capnography
What should you CONSIDER about CPR?
What should you CONSIDER about BVM ing?
What should you CONSIDER about ETCO2 in CPR?
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.
ROSC - Capnography
What should you do to change a decreasing/worsening waveform?
Change hand positions or compressor
Check the placement of the SGA/ETT
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
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
ROSC - fluid therapy
What’s the target SBP when adminitering a fluid bolus?
≥ 90 mmHg
Intravenous and Fluid Therapy Medical Directive- Auxiliary
What does a PCP have to be to provide the treatment in this directive?
authorized for PCP autonomus IV
Intravenous and Fluid Therapy Medical Directive- Auxiliary
What are the INDICATIONS?
Actual or potential need for intravenous medication
OR
Fluid therapy
If they meet either the stroke protocol
OR
the STEMI bypass protocol
Intravenous and Fluid Therapy Medical Directive- Auxiliary
What are the CONDITIONS for IV Cannulation?
What are the CONTRAINDICATIONS for IV Cannulation?
≥ 2 years
Suspected fracture proximal to the access site ( the integrity of the associated vascular structures and may result in extravasation)
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?
≥ 2 years
AND
Hypotension
Fluid overload - eg. pulmonary edema
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?
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
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?
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
Intravenous and Fluid Therapy Medical Directive- Auxiliary
Mandatory Provincial Patch Point
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
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?
“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
Intravenous and Fluid Therapy Medical Directive- Auxiliary - clinical
What assessment should you consider doing frequently after administering a fluid bolus?
Chest assessments
Intravenous and Fluid Therapy Medical Directive- Auxiliary - clinical
What’s the formula for hypotension in pediatrics?
Up to what AGE is a pediatric?
SBP = (age x 2) + 70
10y/o
Intravenous and Fluid Therapy Medical Directive- Auxiliary - clinical
What should you obtain (2) before initiating a fluid bolus?
2 BP (1 being manual at least)
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?
Adults - 250ml
Child/Infant - 100ml
