Scenerio Flashcards
Pain management: What do you do if the patient is hypotensive?
Administer fluid bolus
20cc/kg
Pain management: What do you do for moderate pain? Wong scale: 1-4
Acetaminophen 15mg/kg
Toradol: 15mg IM/IV
Pain management: What do you do for pain >7 on the wong scale?
Morphine: .1mg/kg IV/IO -Max dose of 10mg -May repeat one time; total max 20mg Fentanyl: 1mcg/kg IV/IO -Max single dose of 100mcg -Max total 200mcg
Pain management: What should you consider after giving Morphine or fentanyl?
If pt begins feeling N/V
-Zofran
Pleural Decompression: When would you perform?
Suspected tension Pneumothorax
-H’s and T’s
Pleural Decompression: What is the procedure?
- Assemble equipment (14g at least 3” in length, antiseptic swab, dressing and tape)
- Identify landmarks (Insertion site is the mid-clavicular line at the second intercostal space just above the third rib
- Prep the area with swab
- Remove flash chamber cap from IV catheter
- Insert the catheter over the top of the rib until air rushes out. Advance catheter over the needle. Remove needle leaving catheter in place.
- Reassess breath sounds and patient’s condition (patient’s condition should improve
almost immediately). - Secure catheter with tape
Abdominal pain: What is the treatment
- If symptoms of shock, refer to shock protocol
- N/V?: Zofran 4mg IV (nothing by mouth)
- Pain: refer to pain protocol
- Position of comfort
Shock: What is the shock treatment?
- Primary assessment then…* POHT
1. If bleeding, control
2. Prompt transport
3. Obtain IV
4. NS fluid bolus (1 liter) - Fluid bolus contraindicated with pulmonary edema
- Fluid should be slowed to TKO when SBP is greater than 90mm/Hg
- Peds is 20mL/kg
5. Consider a second large bore IV en route
Shock: What is the dose for additional IV fluid bolus?
Adult: Max 2L
Ped: Max 40mL/kg
Anaphylaxis/Allergic rxn: What is the treatment if initial SBP >90?
Initial medical care
1. Facial swelling, wheezing, or tongue swelling?: Epi autoinjector .3mg IM
2. Benadryl: 50mg IV (slowly over 2 minutes)
3. Improved?
Yes: Transport
No: Duoneb tx
Anaphylaxis/Allergic rxn: What is the treatment if initial SBP <90?
- Initial medical care*
1. Maintain airway (if obstructed, attempt ET. If unsuccessful: Needle cric) - Oxygen 100%
2. IV NS wide open
3. Epi .3mg IM
4. Benadryl: 50mg IV (over 2 min)
5. If respiratory distress: Duo neb
Adrenal Crisis: What is the treatment?
Initial medical care
For patients with known history of adrenal insufficiency
Has signs and symptoms of Addison’s crisis?:
1. Fluid bolus NS
2. Methylpresnisolone 125mg IV
Behavioral emergencies: What can be used as sedation?
Versed 10mg IM
5mg IV
Adult acute asthma: What is the treatment?
Initial medical care
1. Duoneb
2. Methylprednisolone 125mg IV
severe
3. epi .3mg IM (impending respiratory failure)
4. Mag 2g in 100mL NS over 10 min
Adult COPD: What is the treatment?
Initial medical care
1. Duoneb
2. Methylprednisolone 125mg IV
severe
3. epi .3mg IM (impending respiratory failure)
4. Mag 2g in 100mL NS over 10 min
ALOC: What are you considering for ALOC?
BGL Opiate sepsis UTIs Head trauma Addison crisis
ALOC: Treatment
- Initial medical care*
1. No suspected trauma, place in recovery position
2. BGL (<60 Dextrose 25g IV)
Stroke: What is the treatment?
- Initial medical care*
1. Perform Cincinnati scale - Transport right away
2. Identify patients “last known normal”
3. Check blood glucose
4. IV
5. 12-lead if available
Seizure: What is the treatment for seizure?
Initial Medical care
Actively seizing:
1. Midazolam: 10mg IM or 5mg IV
2. BGL <60: dextrose 25g IV
Sepsis: What are the suspicion criteria for sepsis?
- Hyperthermia (>100.4)
- Hypothermia (<96.8)
- HR >90
- RR: <10 or >20
- SBP<90mmHg
Sepsis: What is the treatment for sepsis?
- Initial medical care*
1. Place patient supine
2. IV
3. Cardiac monitor
4. Measure BGL
5. Fluid bolus 20ml/kg
Cardiac chest pain: Treatment if SBP >110?
- initial medical care*
- O2 if low spo2
1. Aspirin
2. Nitro - Have IV in line (TKO) (if BP less than 100mmhg, fluid bolus, recheck after 250mL)
- ED meds contraindicated
- make sure 12-lead isnt inferior
3. Fentanyl or morphine
Pulmonary Edema/CHF: Treatment?
- Initial medical care*
1. Initiate O2
2. Position patient upright
3. Consider CPAP
4. Nitro (BP above 100. IV in) (ED contra)
5. If wheezing: Albuterol (or duoneb)
Pulmonary Edema/CHF: what are the signs for CHF?
- Respiratory noises: Rales
- Vitals: Increased BP (200/100)
- Positive JVD
- SOB
CPAP: What are the indications?
Severe respiratory distress not responding to initial treatment with:
- CHF/Pulmonary edema/ near drowing
- Asthma/COPD
CPAP: Contraindications?
- Respiratory/cardiac arrest
- BP <90mmHg
- Unresponsive to speech
- Inability to maintain patent airway
- Major trauma, pneumothorax, penetrating chest trauma.
- Vomiting or active GI bleeding with emesis.
- Unstable facial fractures.
CPAP: procedure?
- EXPLAIN THE PROCEDURE TO THE PATIENT.
- Apply CPAP/BiPAP per manufacturer’s recommendations.
- Place the patient on continuous pulse oximetry.
- Secure the mask with provided straps and tighten to obtain a good seal, check for air leaks
- Continue to coach the patient to keep the mask in place, readjust as needed.
- Advise medical control of CPAP/BiPAP use during radio report.
- If respiratory status deteriorates, remove the device and assist ventilations with a BVM/supplemental O2; place an appropriate airway control device.
- Place the patient on cardiac monitor and record rhythm and vital signs.
- Administer medications, per respiratory distress protocol, as indicated.
CPAP: CPAP removal.
- CPAP/BiPAP therapy needs to be continuous and should not be removed unless the patient cannot tolerate the mask or has marked deterioration including respiratory arrest, decreasing LOC or patient may vomit.
- Assist ventilations as necessary
Do not remove CPAP/BiPAP until hospital therapy is ready to be placed on the
patient
