Set 3

Question 1

8031 Non-Traumatic Cardiac Arrest

Answer 1

Drug Therapy

Epinephrine IV/IO Dose:
1 mg (1:10,000) every 3-5 minutes

Amiodarone IV/IO Dose:
First dose: 300 mg bolus.
Second dose: 150 mg

Question 2

8062 Behavioral Crisis/Restraint

Answer 2

Midazolam:
a) Intravenous (IV) - 0.1 mg/Kg (max dose 6 mg) slow IV push in 2 mg increments titrate to the reduction in agitation.

b) Intranasal (IN) – 0.1 mg/Kg (max dose 6 mg) one-half dose in each nares.

c) Intramuscular (IM) - 0.1 mg/Kg (max dose 6 mg) in single IM injection (may be split into two sites if sufficient muscle mass is not present for a single injection).

Question 3

8063 Nausea and Vomiting

Answer 3

Ondansetron:
4 mg PO/SL/IM/IV/IO.
For IV or IO Ondansetron, administer slowly (over one (1) minute) to prevent syncope.
For persistent vomiting, may repeat x one (1) for max dose of eight (8) mg.
Withhold from first trimester (< 12 weeks) pregnant patients not already using Ondansetron.

Question 4

8065 Hemorrhage

Answer 4

Tranexamic Acid (TXA) IV/IO
Mix 1 g, TXA in 100mL D5W or NS and infuse over 10 min

Question 5

8066 Pain Management​​​

Answer 5

Acetaminophen For patients with mild to moderate pain):
- 1000 mg IV/IO infusion over 15 minutes.
- 1000 mg PO.
- Do not repeat.

Ketorolac (For patients with mild to moderate pain):
- 15 mg slow IV/IO push or 30 mg IM.
- Do not repeat.

Fentanyl Citrate (For patients with moderate to severe pain):
- 1 mcg/kg (maximum single dose 100 mcg) slow IV, IO, or IN every 5 minutes. Maximum cumulative dose of 3 mcg/kg (300 mcg) total.

Morphine Sulfate (if Fentanyl is unavailable):
- 0.1 mg/kg (maximum single dose 10 mg) slow IV, IO, or IN every 5 minutes. A maximum cumulative dose of 0.2 mg/kg (20 mg).

Ketamine (For patients with moderate to severe pain):
- Mix 0.3 mg/kg Ketamine (maximum single dose = 30 mg) in 50-100cc normal saline solution (NSS) or D5W and administer slow IV drip over ten (10) minutes.
- If pain remains at, or returns to, moderate or severe, you may administer a second dose of 0.3 mg/kg Ketamine (max dose=30 mg) in 50-100cc NSS or D5W and administer slow IV drip over ten (10) minutes.

Question 6

8067 Sepsis/Septic Shock

Answer 6

PRESSURE BAG ALL SALINE BOLUSES
- Administer a 500 ml bolus of Normal Saline to ALL patients regardless of Systolic Blood Pressure (SBP).
- If SBP remains < 90 mmHG, repeat 500 ml bolus of NS until SBP > 90 mmHG. Total amount of fluid not to exceed 2000 ml. Recheck vital signs and lung sounds
after every 500 ml bolus.
- Give boluses in rapid succession if SBP remains < 90 mmHG.

• Albuterol if wheezing and SOB per PD# 8026 – Respiratory Distress.

If SBP remains < 90 mmHg after four (4) fluid boluses:
- Push Dose Epinephrine 0.01 mg/ml (10mcg/ml).
DOSE: 0.5-2 ml (5-20mcg) every 2-5 minutes (5-20mcg) IV/IO Titrate to SBP > 90 mmHg
NOTE: Monitor SBP while administering/titrating.

Question 7

8069 Buprenorphine​

Answer 7

OPIOID WITHDRAWALS

Administer 16 mg buprenorphine SL

Administer Zofran 4mg PO/IV/IM

Reassess after 10 minutes

Administer an additional 8 mg buprenorphine SL

Total maximum dose 24 mg SL during encounter